Language Processing Algorithms Can Boost Orthopaedic Research
Manufacturing, farming, and shopping…These are just 3 diverse examples of how technology is advancing daily and automating tedious tasks, decreasing costs, and improving efficiencies. Orthopaedics and orthopaedic research are not being left behind in this progression. In the November 6, 2019 edition of JBJS, Wyles et al. evaluate the accuracy of natural language processing (NLP) tools in automating the extraction of orthopaedic data from electronic health records (EHRs) and registries. The findings suggest that NLP-generated algorithms can indeed reliably extract data without the labor-intensive and costly process of manual chart reviews.
First, using an open-source NLP “engine,” the researchers developed NLP algorithms focused on 3 elements of >1,500 total hip arthroplasty (THA) procedures captured in the Mayo Total Joint Registry: (1) operative approach, (2) fixation technique, and (3) bearing surface. They then applied the algorithm to operative notes from THAs performed at Mayo and to THA-specific EHR data from outside facilities to determine external validity.
Relative to the current “gold-standard” of manual chart reviews, the algorithm had an accuracy of 99.2% in identifying the operative approach, 90.7% in identifying the fixation technique, and 95.8% in identifying the bearing surface. The researchers found similar accuracy rates when they applied the algorithm to external operative notes.
The findings from this study strongly suggest that properly “trained” NLP algorithms may someday eliminate the need for manual data extraction. That, in turn, could substantially streamline future research, policy, and surveillance tasks within orthopaedics. As Gwo-Chin Lee, MD predicts in his Commentary on this study, “When perfected, NLP will become the gold standard in the initial data mining of patient records for research, billing, and quality-improvement initiatives.” Dr. Lee is quick to add, however, that “no machine learning can occur…without the integral and indispensable input of the human element.”
Orthopaedic surgeons are already using robots to assist them in performing total joint arthroplasties. Wyles et al. show how we can use technology to reliably expedite research on that same subject. I believe the future holds much promise for the use of ever-advancing technologies in orthopaedic surgery and research.
Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media
The Future of Private Practice Under Value-based Care
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
An increasingly frequent concern is that the Merit-based Incentive Payment System (MIPS) and value-based care in general could lead to the demise of private physician practices. With the prevalence of that concern comes pressure for private practices to join Accountable Care Organizations (ACOs), where groups of doctors and/or hospitals synergize to deliver coordinated care to Medicare patients. ACOs certainly have their benefits, but the risks of joining one need to be evaluated as well. An ACO may work for one orthopaedic practice but not for another. From my perspective, private practices, both small and large, will be able to thrive under MIPS. Here’s why:
- First, the final ruling from MACRA has given physicians the ability to report with the ‘pick your pace’ model. The slow, phased introduction for MIPS gives practices a window of time to get on track. 2017 is the transitional year, giving practices time to identify processes and an EHR system that best fit their needs.
- Second, CMS established flexible MIPS measurements based on practice size. (Small practices are typically considered to be those with ≤15 providers, and large practices have >15 providers.)
- Third, if you have the right support from your vendors—especially your EHR system vendor—you will have a built-in MIPS intelligence platform, composite scoring, and support and advisory services to help you along the way.
- Finally, the government has earmarked an extra $500 million for “exceptional performance” for each year of the first five years of MIPS. The right EHR system can direct and support you to achieve this exceptional-performance rating.
Ultimately, the decision to join an ACO or remain a private practice is a multifactorial one. You should consider the options available and how they will impact you, both in the short term and long term. Either way, value-based care is here to stay, and finding an EHR vendor with the best resources for your practice is a crucial component for success.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
Maximizing Specialized Health Registries Under MIPS
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
I want to expand on my previous posts (Tips to Excel Under MIPS and Why EHR Data & Analytics Matter) and focus on another differentiating factor when it comes to electronic health record (EHR) systems and your success with Medicare’s Merit-based Incentive Payment System (MIPS).
The ability to interact with specialized health registries is another functionality your EHR system should have. Active engagement with a clinical data registry falls under the Advancing Care Information (ACI) component of MIPS. In general, having EHR-enabled access to such specialized health registries can make MIPS compliance easier and help you earn bonus points, which translates into increased practice income.
Some examples of orthopaedic-specific registries could include the following:
- Medial Meniscus Tear, Acute Registry
- Plantar Fasciitis Registry
- Low Back Pain
- Herniated Disc, Cervical Registry
In addition to having the ability to interact with orthopaedic-specific registries in order to participate in ACI and improve your MIPS score, registry engagement through your EHR system will help to improve population health by collecting and reporting on data about musculoskeletal treatment effectiveness and disease trends. Public health reporting can be very complicated and time-consuming, but having an EHR system that automatically and seamlessly collects and transmits the data to the registry, without manual intervention, is a robust advantage.
Finally, access to registry data will help your practice with the Improvement Activities component of MIPS, which, during the so-called transition year of 2017, is weighted at 15% of the total MIPS score.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
Why EHR Data & Analytics Matter to Orthopaedic Practices
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
Selecting and/or changing your electronic health record (EHR) system is an investment of time, money, and training. There should be a thorough vetting process in place so you can select the right technology for your practice. One of the many questions you should ask when evaluating an EHR for your practice is the system’s ability to capture and display data. Data capture and analysis are critical for many reasons, one of which is reporting for the Merit-Based Incentive Payment System (MIPS).
The Value of Structured/Discrete Data
You want an EHR system that can capture structured, actionable data and automate patient and regulatory compliance documentation in near real-time. It is crucial to focus specifically on what is known as “discrete” or “structured” data. The opposite of narrative data, discrete/structured data captures specifics from each patient encounter.
Structured data matters so much because it is mineable—that is, it can be uniquely identified retrospectively. Structured data is crucial for group analytics, research, and the imminent obligations, such as MIPS, that the government and payers are placing on orthopaedic groups.
To maximize financial success, your EHR system should automatically capture all the data you need at the point of care to build and report your composite MIPS score. Once you have this data, you need tools that can help you visualize and analyze it.
The Importance of Visible Analytics
Analytics tools in your EHR system should:
1) Comparatively benchmark your near real-time quality and cost data to those of your peers
2) Visibly illustrate financial information to improve your bottom line and operations.
It is essential for everyone at a practice to have access to this real-time comparative benchmarking of both quality and cost data to succeed under MIPS. The analytics tools should not only show individual clinician performance and practice performance, but also where you stand when compared to other orthopedic surgeons and practices.
Making your financials visible can aid in improving your bottom line and operations far beyond a MIPS score. Having peer-to-peer comparisons in real-time will give you the chance to make operational changes, if necessary, to improve your practice.
From patient check-in to discharge, your analytics tool should enable you to identify and track key clinical, financial and operational processes to uncover insights to help optimize your practice. For example, orthopaedists would undoubtedly benefit from analytics on the prescribing of high-risk medications such as narcotics, blood thinners, and NSAIDs. Ultimately, robust analytics capabilities can help you measure and enhance your performance by making high-quality medical decisions for your patients and keeping costs down.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
9 Tips to Excel with MIPS
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
MIPS—the Merit-based Incentive Payment System—is still a mystery to many orthopaedic surgeons. But it can have a big positive or negative impact on your practice.
MIPS is a federal improvement-incentive program consisting of Quality, Resource Use, Clinical Practice Improvement, and Advancing Care components. To demonstrate excellent performance (and reap the associated rewards), physicians can choose the activities and measures that are most meaningful for their practice. Weights are assigned to each category based on a 1 to 100 point scale. In 2017, the transition year, weights are as follows: Quality-60 percent, Cost-0 percent, Improvement Activities-15 percent and Advancing Care Information-25 percent.
I often hear a lot of grumbling from colleagues about their electronic health record (EHR) systems as one of the major causes of physician burnout. However, implementing the right technology will help you excel under this new reimbursement model.
Here are 9 MIPS tips related to EHRs:
- Choose the Quality benchmarks that best fit your practice. You need at least 20 eligible cases per Quality measure. Go to the CMS website and select benchmarks that have established measures.
- Report Quality for an entire year or over 90 days.
- Make sure your EHR has built-in dashboards that enable you to keep an eye on your composite score in near real-time, from day to day.
- Be sure that the EHR you select captures data being entered at the point of care and can enable this data to be used for multiple purposes.
- Get a head start on the Advancing Care component. Selecting an EHR vendor with successful Meaningful Use (MU) attestations is critical.
- Earn bonus points via specialty registries and Clinical Improvement Activities.
- Make sure your EHR allows you to compare your performance with that of your peers using analytical tools.
- When engaging in Clinical Improvement Activities, follow guidelines based on your specific practice size.
- Submit only the required number of Clinical Improvement Activities for the given measurement year, because the following year, you may need to pick a different activity.
With the shift to MIPS and value-based care, orthopaedic surgeons and their teams can thrive by adapting and utilizing technology that fits within their workflows and that helps them understand how they are performing in real time, both within their own practices and compared with their peers nationwide.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
Whither Meaningful Use?
Meaningful use (MU) Stage 2 and 3 requirements have been a bane of existence for many physician practices, so a collective sigh of relief was heard when acting CMS administrator Andy Slavitt hinted recently that a more streamlined approach to regulating health care IT is coming.
Suggesting that MU as we know it may end altogether sometime in 2016, Slavitt offered few specifics in a speech at the recent JP Morgan Healthcare Conference, saying only that details of the new plan will come out “over the next few months.”
Beth Israel Deaconess Medical Center CIO John Halamka, MD, a frequent blogger on the subject of meaningful use, has said more than once that Stages 2 and 3 tried to do too much too fast, while lauding the functional foundation established by Stage 1. Halamka noted that when MU requirements are heaped on other rules and regulations such as HIPAA, the ACA, ICD-10, and Medicare value-based payment systems, the entire game becomes too complicated and confusing for everyone, including government auditors.
On January 14, 2016, 31 healthcare organizations (including notables such as Geisinger, Intermountain, and Partners) sent a letter to HHS secretary Sylvia Burwell, urging her to “restructure the MU program to fit future care needs and focus on improving interoperability and usability” of EHRs.
Stay tuned…OrthoBuzz will keep you posted.
Is the Burgeoning Medical Scribe Industry a Good Thing?
Imagin
e conducting an in-depth physical exam and history-taking with a patient in your office, while someone stands silently and expressionlessly in the background taking notes on a laptop about the interaction. That’s essentially what medical scribes do, and their services are in increasingly high demand as doctors and hospitals try to meet meaningful use guidelines with often-unwieldy EHR systems.
Physicians remain responsible for the content of every patient’s medical record, which requires a review of the scribe’s notes, but the scribe industry promises to save physicians hours of work each day. Most scribes are medical students or pre-med undergrads hoping to embellish their medical school applications with in-the-trenches experience—and make a few extra bucks ($8 to $16 an hour). The American College of Medical Scribe Specialists estimates that the number of medical scribes in the U.S. will jump five-fold in the next five years, from 20,000 currently to 100,000 by 2020.
OrthoBuzz recently spoke with one middle-aged orthopaedist whose practice experimented with medical scribes but who felt uncomfortable having a stranger listening in on the patient-physician interaction. In a recent “viewpoint” piece in JAMA, George Gellert, MD, posed another reason why medical scribes might not be a good idea: they could impede the needed innovations in EHRs that will be driven primarily by direct physician engagement with the technology and feedback on it.
OrthoBuzz would like to know about your experiences with medical scribes. Please tell us what’s working and what’s not by clicking on the “leave a comment” button in the box to the left.
EHR is Top-of-Mind Tech for Orthopaedic Practice Management
In a recent survey by MedData Group, 65% of 254 physicians spanning all subspecialties and practice sizes said they expect electronic health records (EHRs) to have the greatest practice impact among all medical technologies in 2015. Among orthopaedists, 78% ranked EHRs as being the most influential practice technology. Diagnostic technologies ranked a distant second among physicians, but twice as many as last year considered this area of technology to be significant. The survey found that overall practice-management priorities in 2015 will focus on two areas: successful implementation of ICD-10 and better quality care for patients.
JBJS Reviews Ranks #1 with Mobile Devices
Kantar Media’s recent Mobile Device Usage Study evaluated 17 mobile apps. The study asked, orthopaedists which apps they used in the prior six months, time spent per usage, and how the apps they used performed on seven key performance metrics. JBJS Reviews (reviews.jbjs.org), an online review journal launched just one year ago, ranked first among orthopaedic app users in time spent as well as in the overall rating for the seven key performance indicators.
JBJS Reviews ranked #1 on delivering quality clinical content, keeping surgeons informed on the latest practices and procedures, and as being one of the top professional resources.
The survey also measured how physicians use tablets and smartphones. According to the study, physicians use smartphones primarily for managing contact information, texting colleagues, taking static images, maintaining their calendar and appointments, and emailing colleagues. The number-one for which doctors said they use tablets was viewing video, followed by receiving medical news.
The study also looked at the types of apps used on the two types of devices. The apps most frequently used on smartphones are for drug references. Tablet users use both medical journal apps and apps to access EHRs.
The JBJS Reviews App is available for iPhone, iPad, and Android devices.
Use of Google Glass with EHRs Expanding
Google Glass is expanding its medical applications far beyond capturing and transmitting videos of surgery. Google Glass is now entering and retrieving patient information into and from electronic health records. A pilot test of Google Glass and Augmedix taking place at Dignity Health’s Ventura Medical Clinic involves three family practices and over 2,700 patients. Physicians using Google Glass have reported a major drop in daily time spent entering info into the EHR from 33% to 9% and an increase in direct patient care time from 35% to 70%. Participating doctors put on Google Glass prior to meeting with the patient. During the visit, Augmedix software captures the audio and video through the device and enters it into the EHR system. The doctor can also ask questions to retrieve certain types of information such as lab-test results. (See related OrthoBuzz item from May 2, 2014.)
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