Tuesday 31 January 2023
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Hot Topics for Healthcare Finance Execs for HFMA ANI

Duplicate Medical Records; The Unintended Consequence of Implementing EMRs

Healthcare Finance Exec Hot Topics for HFMA ANI

The Velocity Interoperability Blog and Velocity Interoperability Podcast are sponsored by Velocity Health Informatics. Velocity provides both data quality and data integration as a service offerings to ensure that healthcare providers access the correct patient record with the right data for each patient they serve.  See the introductory blog post. Visit Velocity on the Web and follow them on Twitter, LinkedIN and Facebook!

Hot Topics for Healthcare Finance Execs for HFMA ANI

TODAYS GUEST Lorraine Fernandes, Principal, Fernandes Healthcare Insights

We asked Lorraine to join us again today because many Finance Executives will be preparing to attend Healthcare Financial Management Association (HFMA) Annual National Institute (ANI) Conference 2017 on June 25 in Orlando and we wanted Lorraine to help us frame some of the key issues for Healthcare Finance Executives.

Specifically, we discuss the following with Lorraine:

  1. Lorraine, we’ve talked quite a bit about patient engagement on our show, but most of the conversations have been around clinical engagement. How do you see the increased level of consumerism impacting patients and their families?
  2. Many providers are convinced that value base care really is right around the corner, yet there are many more that are not really doing anything to prepare. How should providers/ACOs be preparing for value-based care, especially with respect to patient engagement?
  3. Are you hearing about any good examples of efforts by providers to increase patient financial examples? If, so will you share a couple?
  4.  MACRA/MIPS/etc – how should providers be reacting to all the current legislation?
  5. What other key issues are top-of-mind for healthcare finance executives as we near the ANI conference?
  6. Are their any emerging issues that may be too new to be addressed at ANI?
  7. Last time we chatted quite a bit about the challenge of patient matching and identification yet my understanding is that providers are slow to adopt solutions to first clean their data and then to ensure that they can clearly identify each patient. Why do you believe providers are not aggressively pursuing these solutions?

About Lorraine Fernandes

Lorraine Fernandes is an international and domestic thought leader, accomplished author and respected public speaker on topics related to technology’s role in healthcare transformation. Lorraine is President-Elect for the International Federation of Health Information Management Associations (IFHIMA) and serves as editor for the IFHIMA Global News. Lorraine is recipient of the American Health Information Management Association (AHIMA) 2013 Pioneer Award and 1998 Discovery Award and California Health Information Association (CHIA) 2002 Distinguished Member Award.

She has published numerous articles and blogs, and presented domestically and internationally on using information technology for the improvement of individual and population health, and creating a single view of citizen records for health and social services. Connect with Lorraine on LinkedIN!

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The Velocity Interoperability Blog and Velocity Interoperability Podcast are sponsored by Velocity Health Informatics. Velocity provides both data quality and data integration as a service offerings to ensure that healthcare providers access the correct patient record with the right data for each patient they serve.  Visit Velocity on the Web and follow them on Twitter, LinkedIN and Facebook!


Joe Lavelle 01:06 Welcome to the Velocity Interoperability Podcast brought to us by the gurus at Velocity, I am your host, Joe Lavelle and I am really looking forward to another thought provoking discussion where we further investigate data quality, interoperability and medical record remediation.

We’re going to get right to it today. Today we’re joined by Lorraine Fernandes, Principal of Fernandes Healthcare Insights. Lorraine, welcome back to the show!

Lorraine Fernandes 01:31 Well, thank you Joe. I appreciate the invitation.

Joe Lavelle 01:34 Could you take the next couple of minutes Lorraine and just remind the audience about you and your background?

Lorraine Fernandes 01:41 I’m happy to do that. So, I’m Lorraine Fernandes, Principal and Founder of Fernandes Healthcare Insights. I’ve spent my entire health information career as a practitioner and a sales and marketing role and in industry leadership role, and a lot of years in international as well as domestic really helping clients and my colleagues out there understand the importance of data and how it’s used and how it is so mission critical today compared to the beginning of my career almost 40 years ago.

Joe Lavelle 02:21 And an understatement to say the least and I look forward to really exploring that, but we asked Lorraine to join us today because many Healthcare Finance Executives are preparing to attend HFMA ANI Conference next week in Orlando and two weeks in Orlando starting on June 25th and we wanted Lorraine to help us frame some of the key issues for those Healthcare Finance Executives that will be departing shortly.

Lorraine, we’ve talked quite a bit about patient engagement on our show, but most of the conversations have been around clinical engagement. How do you see the increased level of consumerism impacting patients and their families?

Lorraine Fernandes 02:57 Well, I believe that the consumer consumerism patient oriented whatever you want to apply for terms there is equally important to the data quality and all of the other considerations we’re putting out there, because consumers, I happen to live in the state of California where consumers have had access to their health information for decades. In other states in our nation, in other countries around the world, consumers are just getting access to their data. So, the consumerism angle to all of these various methodologies that might be coming forward is really important, because we need to think about consumers are going to have access to their data, many of them for the first time, so we need to make sure that the organizations that are creating this clinical and financial data really have data that’s fit for purpose in a very different context.

Fit for purpose for the consumers, does the data really reflect the care? Does the data become available on a real time or near real time basis? And as you and I have talked about before Joe, does the data impact reflect the correct patient across all of their records about that patient or that consumer? So, all of these new priorities that an organization has really means the emphasis on accurate, timely, consistent clinical and financial data becomes even more important than it has been, because we no longer have data in silos, there are a lot of different parties who will be using this data for a variety of purposes. So, it is really important that you stay on top of your data for today and for tomorrow.

Joe Lavelle 05:01 Lorraine, the industry has been talking about the value-based care and I believed there are several places in the country where they are actually making progress, yet there are many more that are not and in those cases, in those places providers are I believe doing absolutely nothing. How should providers and the ACOs prepare for value-based care, especially with respect to patient engagement?

Lorraine Fernandes 05:25 So it scares me a lot Joe I have to say, to hear you say but I know it’s the truth. That there are organizations that are doing little or nothing to prepare for value-based care, and I think they’ve got to address and assess and apply governance to today’s data based upon their corporate culture, their corporate strategy, today’s data is driving tomorrow’s reimbursement. And when you think about the fact that today’s data is being used in developing the models, in applying predictive analytics, and all the other governance and quality and statistics that are being applied to this data, it means you can’t afford to do nothing today or you may have shuttered doors a year or two from now. So take action today, less you be sorry tomorrow.

Joe Lavelle 06:30 Lorraine, are you hearing about any good examples of efforts by providers to increase patient financial engagement? And if so, could you share a couple?

Lorraine Fernandes 06:41 I have to say I’m not hearing a whole lot, I do hear of more portals being used out there from both a provider’s perspective, getting the providers to look at their data, to engage in the value-based payment systems that are coming. I see more patient portals giving patients access to their own data on a timely basis, to do scheduling, to review data, but I don’t see the level of intensity that I might have anticipated, but knowing that many organizations are holding back, waiting to see what’s really going to happen which I believe is the wrong strategy, probably explains why we are not seeing as much activity in the marketplace as you and I might have anticipated, but it’s coming, I absolutely believe its coming.

Joe Lavelle 07:36 The alphabet soup of MU and ICD 10 has turned on MACRA and MIPS and we’ve got all this legislation, what should providers be doing to react to the current legislation, MACRA and MIPS?

Lorraine Fernandes 07:48 Well, I think first I think more broadly than MACRA and MIPS, because as we’ve mentioned we don’t know what tomorrow is going to bring for some of these models, but we are going to have value-based reimbursement in some form, we are going to have a more patient-centered, consumer-centered healthcare delivery system out there. So, I say it’s kind of make sure your data is fit for purpose in terms of quality and interoperability and meeting standards, because standards aren’t going to change that much, they are simply going to be strengthened and be I think a lot more dominant in driving data interoperability than what they are today. So, I don’t think you can ever go wrong with making sure you’re following standards, you’re auditing your quality of data to make sure it is standard-compliant. You’re making sure your data truly is fit for that consumer purpose, that value-based reimbursement, that predictive analytics, data exchange and data interoperability.

So, I think to be a little more specific Joe, I’d say make sure you’ve got your house in order, we talked about data governance and information governance, but I think it’s easier for an organization to start with data governance, it’s not quite as big a cultural shift to make, you can get a lot more buy in from organizations, so think about data quality, think about your retention policies, think about how you manage the lifecycle of your data and other things like that that are components of a data governance strategy and then the execution.

Joe Lavelle 09:38 Well, you did it Lorraine. You’ve mentioned that word interoperability and so I have to get on the soapbox for a little bit. Last week I moved my mother from Melbourne Florida to Fairhope Alabama where I live. And in Melbourne for the last 5 years, we paid a registered nurse to go to medical visits with my mother to make sure that because she goes to so many different specialists and has so many chronic problems that care is coordinated.

Well, when we moved here I scheduled her first appointment on Monday for a new primary care doctor, and that nurse who we love and has done a great job provided all of my mom’s medical records to the new Doctor, who’s fabulous. However, this is the bad part of the interoperability story, out of all the records that were forwarded what got inputted into his medical record system of which he carried a laptop into his room and throughout the visit he was interacting with the medical record system, was 4 pages that were copies of her insurance card and her driver’s license, pictures and payment information.

There was no clinical information in the electronic medical record, which just drives me nuts because we’re out here, you and I are out here battling the battle, talking about interoperability every day, and the reality is we’re probably years away from having a generation, it’s probably not even your or my generation that when we move from one place to another our data is going to transfer seamlessly into a new medical record system. That just drives me nuts, I hate to get on my soapbox, but what’s your reaction to that reality of where we are today?

Lorraine Fernandes 11:27 So, I think my reaction Joe is your story and sadly it probably has repeated millions of times every year around the states, is that that right there shows you the need for interoperability, the need for data governance and many organizations are reluctant to either input this CCD or this CCR document or whatever else may come with the patient from another organization, because they don’t have adequate retention policies, they don’t understand how to manage the lifecycle of data particularly when it comes from a third party and some mistakenly believe that by incorporating data from another provider into their EMR they assume some liability for that.

So, all of that privacy, security, lifecycle data quality standards could be comprehensively addressed in a strong data governance, information governance approach that an organization really needs to take today since the silos of data have got to go and let’s hope Joe they are gone in our lifetime.

Joe Lavelle 12:47 And you know what? My mother had no idea what was going on behind the scenes with all that data, she was oblivious to it. But I can tell you 10 years from now when that’s me, I’m going to be irate that that’s happening to me.

Lorraine Fernandes 13:00 That’s right, because you and I are the educated consumers here.

Joe Lavelle 13:04 Exactly.

Lorraine Fernandes 13:06 Who are going to demand more, we’re going to demand it in real time, we’re going to read that data, ensure that it is our data and it really reflects the care that we’re given, and then our providers whether that’s the primary care physician, the nurse coordinator, the social worker, the physical therapists that they are taking advantage of that data, so that we have cost-effective timely comprehensive care. I’m waiting Joe, just like you.

Joe Lavelle 13:39 Me too with bated breath. Lorraine, what are some of the other key issues that are top-of-mind right now for healthcare finance executives?

Lorraine Fernandes 13:47 I think the others think beyond the consumerism and all of the aspects of that is when you think about new payment models and a lot more patient engagement, it’s the provider side of the house, the actual caregiver, the nurse, the social worker, the physical therapist, the pharmacist, the nurse practitioner is making sure that our data that reflects the care that is being given that that is attributable to the right caregiver, so let’s make sure we’re not only managing the clinical data from the care delivery, patient engagement, consumer engagement, but let’s make sure that we’ve got that data associated with the right provider at the right location for the right date obviously.

But it’s that provider side of the equation, because not only is the value-based care going to impact obviously all of the professionals who deliver care, it’s the organization also. So there are going to be two sides to this equation and a lot of risk that is going to be shared and a lot of people’s compensation, so let’s make sure we are taking care of the data all around the provider as well as the clinical data, that documents, the care that was delivered.

Joe Lavelle 15:12 You mentioned on our previous conversation about the challenges of patient matching and identification and yet providers are still slow to adopt any solution here and they are still kind of dragging their feet from my perspective. Why do you believe providers are not being more aggressive to pursue these kinds of solutions?

Lorraine Fernandes 15:34 I think it’s Joe they have so much on their plate and obviously we live in a period here in the middle of the decade and the specific year that we’re in that where do I start and data quality might seem a bit overwhelming, so I think it’s just so much facing them the very thin margins that providers work on the one, two, three I mean once in a while we read about somebody who functions on a 6 or a 7% margin, but that’s clearly not the norm.

So it is how do I spend my margin to deliver better care today and to prepare for tomorrow? And I think they do have to spend today, because of those spend margins, if you get it wrong, next year or the year after those margins will be none existent. And then what are you going to do, because you’ve not created the high data quality, the interoperability of data to support the future payment models and the consumer engagement.

Joe Lavelle 16:44 Right. Some people have told me it’s a shiny object syndrome, so getting clean data isn’t a shiny object, it’s doing the analytics. Well, you’ve articulated very well in this conversation, you’ve got to have data governance before you can do analytics. Well, your data, your analytics will be wrong if you have bad data. It’s just that simple.

Lorraine Fernandes 17:06 It is and when you think about, we read every day I’m sure, about artificial intelligence being applied to data, and the effective way that is in identifying insight, natural language processing, cognitive being applied and the list goes on and on. But it’s kind of scary to think of all the new technology that can be applied to data, but if we’re applying this to lousy data, well what does that say about the insight, we’re supposed to be deriving from this data, pretty scary.

Joe Lavelle 17:42 It is scary. Lorraine, we talked a little bit about the ANI conference, I know you attend conferences throughout the year. What advice do you have for attendees of a conference like ANI in order to get their maximum impact?

Lorraine Fernandes 17:57 I always go to a conference with a very short shopping list of three or four presentations I want to attend, or three or four vendors I want to make sure I talk with, and I’m always in listening mode. I go with one or two questions in mind, and then I go to learn and even if I’m talking with the vendors, I want to hear what they are saying, what their customers are saying, then I want to hear the speakers that comes from organizations that have either been successful or perhaps maybe even more importantly who tried and failed, because we are all going to have to try and fail more than ones chances are in this process, but let’s apply the learning’s from others, so that we can try and fail quickly and move on to success.

Joe Lavelle 18:47 Lorraine, It was so great to chat with you once again, thanks for stopping by and sharing your wisdom with us!

Lorraine Fernandes 18:53 Happy to join you Joe.

Joe Lavelle 18:54 All right, it’s our pleasure. Before we wrap this conversation, we want to thank the great folks at Velocity for sponsoring the show once again. Please go to to find out more about the innovative ways that they are solving the data quality and interoperability needs of their clients. And now on behalf of our guest, Lorraine Fernandes, I am Joe Lavelle and we’ll see you soon with another informative episode of the Velocity Interoperability Podcast. See you then.


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JOE LAVELLE is a Healthcare Management and Technology Consultant with a record of successfully meeting the business and technology challenges of diverse organizations including health plans, health delivery networks, and health care companies for 25 years. Joe worked his way up through Cap Gemini and Andersen Consulting to the partner/VP level of at First Consulting Group, Technology Solutions Group and Santa Rosa Consulting. After running his own company, Results First Consulting, for 12 years Joe Co-Founded intrepidNow with Todd Schnick to create incredible content to dramatically improve the sales and marketing efforts of their clients.