EHR and Health IT Consulting
39.2K views | +5 today
Follow
EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
Your new post is loading...
Your new post is loading...
Scoop.it!

A prescription for EHRs and patient engagement 

A prescription for EHRs and patient engagement  | EHR and Health IT Consulting | Scoop.it

Most physician practices and hospitals in the U.S. have installed electronic health records. In a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse.

 

“How do we make it easier for patients to request and manage their own data?” asks a report from the Office of the National Coordinator for Healthcare IT-Improving the Health Records Request Process for Patients – Highlights from User Experience Research.

 

The ONC has been responsible for implementing the HITECH Act’s provisions, ensuring that healthcare providers have met meaningful use criteria for implementing EHRs, and then receiving the financial incentives embedded in the Act for meeting those provisions.

 

Now that the majority of healthcare providers in the U.S. have indeed purchased and implemented EHRs, it remains for patients, health consumers, and caregivers to take advantage of them. In my post on the EHR Field of Dreams effect, I highlighted research from the U.S. General Accountability Office that explored the question of how the Department of Health and Human Services should assess the effectiveness of efforts to enhance patient access to EHRs.

 

The ONC team conducted in-depth interviews with 17 patients to understand their health IT personae and personal workflows for accessing their personal medical records. The research also considered medical record release forms and information for 50 large U.S. health systems and hospitals, and interviewed “insiders” – healthcare stakeholders inside and outside of ONC – to assess how patients request access to medical records data and look for solutions to improve that process.

 

Why is it so important for people to access their medical records? By doing so, patients and caregivers can better manage and control their health and well-being, ONC notes, by preventing repeat tests, managing clinical numbers (like blood pressure for heart or glucose for diabetes), and sharing decision-making with doctors and other clinicians – together, the process of patient and health engagement, which boosts health outcomes for individuals and populations.

 

The general process of a patient requesting their health data works like this, illustrated by the patient journey of Melissa and Ava Crawford, a mother and toddler daughter portrayed in the ONC report:

  • A patient/consumer makes an initial inquiry
  • The consumer requests the records, which can be done via a paper authorization form (that is then completed and either mailed or faxed to a provider) or sent online via the portal. Sometimes a consumer must write a letter to request the provider.
  • The consumer waits for a response, which ONC calls “a bit of a black hole for consumers.” This can be as long as 30 days under the HIPAA law.
  • The health system receives and verifies the request, then verifies the patient identify and address.
  • Health systems then fulfill the records request, often a printed copy of the medical record that can be faxed or mailed, PDF files, or a computer disk – CD.

 

ONC conducted research into the consumer journey through this process to identify opportunities to improve the patient experience of requesting and receiving personal health information.

 

Health Populi’s Hot Points: Most Americans see their doctors entering medical information electronically, and most people say accessing all kinds of medical information is important, the Kaiser Family Foundation learned in a health tracking poll conducted in August 2016. However, there are big gaps in the information available to U.S. patients online, such as prescription drug histories and lab results – two very popularly demanded information categories. And through the consumer-patient demand lens, 1 in 2 U.S. adults said they had no need to access their health information online, as the chart from the KFF poll attests.

 

How to bridge the chasm between self-health IT, providers, and patients? The most effective patient engagement technologies are biometric measurement devices like WiFi scales and glucometers, apps, texting, and wearables – with portals ranking last – according to physicians and clinical leaders polled in a New England Journal of Medicine (NEJM) survey published earlier this month.

 

The top benefit of engaging patients with these technologies is to support people in their efforts to be healthy and to provide input to providers on how patients are doing when not in the clinic, this research found.

 

My friend and collaborator Michael Millenson wrote in the BMJ in July about patient-centered care no longer being “enough.” In this era of technology-enabled healthcare, and rising consumerism among patients, three core principles must underpin the relationship between patient and provider:

  • Shared information
  • Shared engagement
  • Shared accountability.

 

Michael quotes Jay Katz from his book, The Silent World of Doctor and Patient, who talked 35 years ago about the concept of “caring custody.” Jay explained this as, “the idea of physicians’ Aesculapian authority over patients'” being replaced with “mutual trust.”

 

It is not enough to build and offer a technology “meant” for patients and people to use for their health and healthcare. Trust underpins all health engagement and must be designed and “baked” into the offering. Today, that trust is built as much on consumer retail experience (the last-best experience someone has had in their daily life, exemplified at this moment by Amazon) as in a new social health contract between providers and patients.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

The EHR and Rage Against the Machine

The EHR and Rage Against the Machine | EHR and Health IT Consulting | Scoop.it

The EHR is the latest focus of our rage against the machine. Case in point: Chrissy Farr’s poke at the EHR in today’s Fast Company. Red meat for angry old doctors.

 

What might be interesting is to take a bunch of millennial doctors and make them work for a month with clipboards, fax machines, mailed letters and emulsion films on view boxes? Then we could write a story about the joy and efficiency of manilla folder medicine.

 

I suspect it would put things in perspective.

We fancy ourselves as victims of our technology. But while EHRs have a long way to go, it’s a long way back to paper.

 

I was in an elevator at Texas Children’s Hospital this weekend where there were a number of people looking at their smartphones.  An older gentleman in the elevator remarked shaking his head, “I remember a time when people used to talk.”

 

Actually, no one talked in elevators.  We’ve always stood the same direction and stared at the numbers at the top of the door.

 

It’s easy to blame technology on our human shortcomings.  It’s been suggested that the adoption of EHR has us ignoring patients.  But in the old days, we scribbled on paper.  Irresponsible resident and medical student conduct with social media are blamed on the platform.  But trainees have always done and said stupid things.

Blame it our chauvinistic human bias:  “It’s not me, it’s the machine.”

 

While there are those of us who share a perverse relationship with our tools, it’s important to remember that the world wasn’t necessarily rainbows and unicorns before [insert technology of choice] appeared.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

EHR and the Failure to Communicate

EHR and the Failure to Communicate | EHR and Health IT Consulting | Scoop.it

Clinical workflow in my early career included the ritual of phone messages. Every day, at least once and usually in the afternoon, I would sit with my clinic nurse and a pile of manila folders to discuss phone calls. Details were discussed, recommendations were made, triage assessments were cosigned and I would hold the charts of those patients needing a callback. The ritual began with the daily call to action, “Let’s do calls.”

EHR and the disruption of the nurse-doctor interaction

About 15 years ago when our first EHR, Logician (evolved as Centricity), came along the process of handling calls changed. It was Texas Children’s first venture into EHR and with it we began the long calculation of how electronic records fit our clinical flow.

My nurse at the time was a pediatric nurse with years of experience. Seasoned and crusty, her capacity for laser-sharp phone triage was impeccable. She was a stickler for tight documentation.

 

As we grew comfortable with Logician, the ritual of call review evolved. While we began doing calls around the screen, my nurse began to insist that our daily rendezvous was no longer necessary. “It's’ all in the message. Just read the message, Dr V,” she would crow from her cramped desk. “And the documentation is better. Trust me.” Despite my insistence, she ultimately became an unwilling partner in a clinical dance for two.

 

Our digital phone messages involved a back and forth of queries and replies through the EHR. Documentation was tight. But something was missing.

Not all media are created equal

When it comes to communication not all media are created equal. The assumption on the part of my nurse was that communication through the EHR was the same independent of how it was transmitted. A message, in the end, was just a message.

As it turns out, there are different ways for patients and health professionals to exchange information with one another. All bring different affordances to a human encounter.

 

  • In person (mano y mano)
  • Asynchronous text (Epic MyChart, email)
  • Synchronous text (Live texting)
  • video stream (Skype)
  • audio transmission (phone)
  • And there are lots more.

 

All represent ways for us to exchange health information. As I have written, different problems call for different media depending on the type of problem at hand. Text works well for simple problems. But the text isn’t always enough. A video is an overkill for simple issues. And as inconvenient as it may be for both the patient and the doctor, sometimes a patient needs to be seen, heard or touched in person.

The EHR and the subtle dimensions of the human experience

So when my nurse stopped talking to me about my understanding of what was happening with my kids fell off significantly. The notes were impeccable and the transmission instant. But something was missing.

 

So what was missing from the EHR? As it turns out in human exchange there are subtle elements that get lost in the type. There are critical bits of information during a phone exchange that get picked up by an experienced pediatric nurse. Often there are subtle contextual elements of a social situation that are never properly documented. Some of these things can’t be documented.

 

Sometimes these details only come to my attention when face-to-face with my staff. And there are things that come from the gut that we don’t share in the record.

 

Paper charts didn’t solve this problem with the EHR. Written messages are exactly the same. They just forced us to sit at a table because there was no way to send a paper message across the office and easily back again.

 

Humans are messy. They rarely fit the constraints of the technology we create. The dimensions of the human experience are rarely felt through typewritten messages. Consequently, the accurate exchange of information and documentation of human interaction is potentially more challenging than we think.

 

Communication through and around the electronic health record is an inevitable part of medical practice. But we have a long way to go with regard to capturing the subtle elements of human engagement.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

The future of EHRs - and it's not even in the EHR 

The future of EHRs - and it's not even in the EHR  | EHR and Health IT Consulting | Scoop.it

Voice recognition and natural language processing will enable doctors and nurses to interact with electronic health record platforms in more comfortable ways.

 

Along with a fistful of cutting-edge technologies, an interesting trend has begun to emerge that may help predict a direction forward for the way users interface with electronic health records.

Hint: It’s not in the EHR. Instead, emerging technologies such as ambient listening, voice assistants and natural language processing will provide a subtle buffer between EHR data and users. Clinicians will be able to access and contribute to data within electronic health records software or cloud services, in fact, without having to touch the EHR itself.

 

Let’s take a look at how this could play out.

EHRs today

As they have evolved, EHRs have also become more complicated and “busy.”  They require significant investment in training, both prior to adoption and ongoing as new features are released. 

Telling a primary care group back in 2000 that 6-8 hours of classroom training was required for every physician would have been the ultimate non-starter. Today, this is the norm and accepted as reasonable and it also holds true for the analysts who configure and support these systems of record.

 

Documentation requirements continue to increase, too. The push to document in a codified way has become more important in order to inform not only electronic decision support but also to support population health management initiatives and advanced data analytics. Plus, medical knowledge is eclipsing providers’ capabilities to internalize it and incorporate it into their practice.

So what does this point to?

Voice recognition, NLP and remote scribes

Providers have already begun to adopt technologies such as voice recognition and natural language processing that allow them to distance themselves from the complexities of the EHR.

Since a clinician is technically in the record while dictating via voice recognition, he or she is interacting with the system with a software buffer that the typist does not have.

 

A more pronounced example is the scribe. Far from a new idea, the scribe allows the provider to see the patient and remain fully focused on the task at hand while someone else does the documentation on their behalf.  While this comes with a certain level of awkwardness for the patient, it has been widely adopted in some clinical settings.

 

Natural language processing has been discussed in concept and used in pockets for many years. While loaded with potential and extremely appealing, it has yet to take off as a full-fledged documentation solution.

 

More innovative alternatives are also being explored. Remote scribes allow the transcriptionist to listen to the visit in real time and document as the provider speaks their way through the examination.  his may be implemented as an audio-only solution or with audio and video through the use of a tablet or some other video-enabled device in the exam room. Ambient devices are also being investigated as alternatives — pairing voice recognition with a mostly hands-free documentation experience minus the scribe. Google Glass is another interesting alternative. In this concept, the provider is not only dictating as they examine the patient but also visualizing elements of the record as they go without having to refer to a computer or tablet.

Tech challenges and costs

These novel technologies are not without challenges.  For the remote scribe model to be successful – especially in the case of audio-only – providers need to run through their visits in a common way for the process to be accurate and efficient. The scribe also must document the right information in the right place in the record. If they are merely typing a free text note – the value of the data is lost. Decision support is one of the most compelling reasons to use an EHR. How can the provider receive this guidance if they are not interacting directly with the system? A hybrid solution could solve for this – with the provider manually performing order entry and prescribing tasks. Alternatively, technology developers may come up with an innovative solution to address the requirement in the future.

 

Patient perception is also a concern. As with the traditional human scribe, patients may react negatively to the notion of a virtual third party participating in their visit. How can the patient be sure that only the identified third party is listening/watching? How can they be assured that the visit is not being recorded or shared? What type of consent is required and what details need to be shared with the patient in order for them to be aware of the process? What if the patient declines to participate in this type of visit?

 

Security, of course, will be paramount both for the patient and the hospital.  We all hear of major security breaches on a weekly basis. Executives and (increasingly) patients will need guarantees that these solutions are secure and insulated from the risks that come with the possibility of a data breach.

 

Traditionally the solutions that allow providers to document patient care without interacting with the record have been utilized mainly in the ambulatory, urgent care, and emergency department settings. Is there an option that would work for inpatient providers? Is there an option that would be suitable for nursing documentation? It may very well be that the answer is “no” and that these caregivers will continue to document directly in the record (either manually or with traditional voice recognition) for the foreseeable future.

Back to the future

There is, of course, a financial component to all this as well. Scribes and the more advanced technologies described are not inexpensive.  It will be up to technology developers and service providers to clearly articulate the return on investment.  It is noteworthy that some of that ROI will be difficult to quantify in terms of dollars or efficiency as it relates to provider happiness.

Even with all of these questions, it is clear that the trend of providers moving further away from direct interaction with the EHR is real and likely to continue. 

 

Ideally, EHR developers and regulatory agencies will see this as a challenge to simplify their products and documentation requirements. It’s possible that this is the push the industry needs to rethink usability and truly develop intuitive systems that are easy to learn and easy to use. This will require not only creativity and skill but also a willingness to rethink many of the constructs the industry has operated under for the last decade-plus.

 

It is more likely that the burgeoning trend will continue to progress and we will find ourselves in a “Back to Future” scenario where providers use the medical record to access information but harness various forms of new age dictation to keep it updated.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

5 Steps to EHR Data Conversion

5 Steps to EHR Data Conversion | EHR and Health IT Consulting | Scoop.it

EHR data conversion is the process of moving patient data from legacy EHR system to a new EHR system. While automated EHR data conversion seems like a complex affair, it doesn’t have to be. When an experienced vendor partners with strong internal leadership, the data conversion will follow a proven, 5-step process, and the data will undergo a failsafe ETL.

Why Change EHR?

Healthcare providers are expected to document patient encounters. Traditionally, this documentation has been completed on paper and stored in file cabinets. However, the last decade has seen significant growth in provider adoption of Electronic Health Records (EHRs). The combination of government incentives, advances in technology, and improved outcomes and operations have fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. EHRs improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

While EHR adoption has increased, so too has the need to change systems while maintaining the access to and integrity of patient health information. Healthcare administrators point to provider dissatisfaction and mergers and acquisitions as the primary contributors for changing EHR providers within their organization. In preparing for the implementation of a new EHR, healthcare organizations have been grappling with how to handle the data in the legacy systems.

What is EHR Data Conversion?

In response to this challenge, many healthcare organizations are turning to automated EHR data conversion to maintain data integrity. An automated ETL (Extract, Transform, Load) process avoids risks related to data manipulation, because not a single patient record is touched.

 

In an automated conversion, source values are extracted from both the legacy (source) system and new (target) system to create a conversion map. That map is entered into a conversion utility software. Data from the legacy system is run through the conversion utility and transformed to meet the needs of the new system. While it is being transformed, the conversion utility is monitoring for errors and estimated completion. After the data has met the standards, it is then loaded into the new system.

The process of an automated EHR data conversion may seem like a complicated and difficult undertaking. It doesn’t have to be when it is handled by an experienced vendor working with strong internal leadershipundergoing a recognized data conversion process.

5 Steps to EHR Data Conversion

1. Discovery

During the discovery phase of the process, the healthcare organization team will play a large role. An EHR vendor will ask internal IT staff to extract all data from the current system. Working together with an internal designated leader, IT staff, and Physicians Advisory Committee (PAC), the data conversion vendor will work to identify how much data is available, what data needs to be converted, and the accuracy of the legacy data.

2. Scope Definition

The scope definition phase of the process is the point at which both parties come to an agreement on which portions of the data need to be converted, the method of the conversion, and the prioritization of the data. During this time, the two teams should schedule time to review the records, format them to meet the new formatting requirements, and set the processes to updated record fields not available in the conversion.

3. Testing

Once the scope has been fully defined, and the formatting requirements are completely understood, the primary responsibility of the conversion then shifts to the vendor. Based on the input gathered during the scope definition step, the data architects working for the vendor will map the data fields and formatting from the old system to equivalent data fields and formatting in the new systems. After the map has been created, the data architects upload the test conversion data to a testing site.

4. Validation

This step is a shared responsibility between the healthcare organization and EHR data conversion vendor. Once the data has been loaded to the test site, the data architects validate the data. Then the healthcare organization leaders review the content, validate the records, and sign off on the final data set. This step may require several cycles. However, it is imperative for the success of the conversion.

5. Migration

Once the data has been validated, the vendor will executive the final migration. While the data is migrating, the vendor’s conversion utility should be monitoring total errors, parsing errors, mapping misses, percent complete, date/time to finish, and success rate. When all the data is converted and migrated to the new system, the healthcare organization will go live!

Throughout the EHR data conversion process, healthcare organizations are tasked with making important, and often tough, decisions about how to handle data, the methods of conversion, and data prioritization. It is important that healthcare organizations plan ahead, schedule the necessary time, and work closely with EHR data conversion vendors who are well versed in the each step of the process.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration | EHR and Health IT Consulting | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

 

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

 

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS? Learn how Pivot Point can help with your value-based strategy.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

Health IoT creates huge opportunities for public health and software companies 

Health IoT creates huge opportunities for public health and software companies  | EHR and Health IT Consulting | Scoop.it

It was evident from this year’s Consumer Electronics Show (CES) earlier this month that there’s a great deal of interest in the Internet of Things (IoT) in general and for Health IoT in particular. Given that interest I thought I would reach out to a couple of experts to help explore the IoT landscape. Murali Kurukunda is Director of IT and Lead Architect at Medecision and Dr. Peter L. Levin, is CEO at Amida, director of ConversaHealth, and a father of the BlueButton initiative (which he helped launch as CTO of VA). Murali and Peter (along with Medecision and Amida) are right in the middle of intersection of data, interoperability, hardware, software and services for IoT in healthcare; they were kind enough to share with me what they’re seeing as the major opportunities in the space.

 

Here’s what they think, in their own words:

 

Connecting smart biological sensors to the internet is not a new idea. There are already dozens of products in the market that continuously monitor blood glucose and heart function, for example, and enable secure remote management for clinicians and caretakers. The safety of life implications are enormous, and the commercial opportunities untold. Some analysts predict a $100 billion-plus market for the healthcare segment of the “internet of things” (IoT).


What is new and emerging is the physical scale of the devices on the one hand, and the need to aggregate, reconcile, and consolidate those data streams for downstream clinical care services. Advances in semiconductor device manufacturing will relentlessly drive down the price and the size of these electro-physiological sensors, literally to nanometer scale, which will ultimately be able to do more than detect, they will be able to intervene. At the same time, our ability to make sense of the torrents of information is catching up to our ability to create them.

We believe that these are tremendous opportunities for public health and software companies like ours. It is why we are investing so much of our own resources to promote the open design, secure exchange, and value-added analysis of health data systems. Perhaps the largest inhibitor to a promising future of longer, healthier, less expensive life are the software merchants and device manufacturers who still and astonishingly insist on keeping data closed, isolated, and trapped in proprietary systems. We believe this is about to change too.

 

The interoperability troubles with electronic medical records are legion, and we won’t waste our page space or your attention lamenting the deeply ignorant and the nearly criminal. The immortal words of Forest Gump’s assessment about doing dumb things finds purchase here.

 

What we can do, however, is find clever ways leverage of IoT as yet-another, and maybe decisive, fulcrum of connected care. For what is today true in isolation – progressive plans, concerned parents, engaged patients – will soon-enough be more the ubiquitous standard of coordinated care; that coordination will reach deeply into pocketbooks as well as bodies.

We know that there are legitimate concerns about individual privacy and device safety, and that some people would literally rather die than compromise on either. We respect that, even as we actively promote more automation and digital services in health care.

 

Some of us believe that the existential benefits of independence and longevity outweigh the potential risks of intrusion and malfunction, some of us don’t. The point is that everyone should have the choice, and that no one should be coerced or manipulated into choosing one side of the argument. Fear mongering (about privacy) and fabrication (about intrusion) are forms of manipulation. In the case of health care they cost lives and money.

 

Let’s, instead, imagine a world of seamless, secure, and reliable health data interoperability. Let’s find a better way to safely liberate data at its source – labs, pharmacies, hospital and clinics, insurance claims, as well as implantable and wearable devices – pass it through hygienically sealed pipes, and receive it in places where it does the most good. That may be during a clinical care or remote telemedical encounter (to give you the best possible advice based on evidence and your personal health history), it may be when you pick up your medicines (to check for interactions with other medicines), or it may be to help your insurance company help you (because they have always had a bird’s eye view of your services, and they can’t kick you out for pre-existing conditions anymore).

 

Because of changes in the law, it may be with a loved one or trusted caretaker. It may be you.

 

The data could be as simple as a reminder message about an upcoming appointment, a warning message that a clinical value seems out of range, or an answer to a securely-texted question to your doctor. We have imagined that future and it is, as Ray Kurzweil likes to say, near.

 

There are two challenges, and they are slowly receding.

 

The first is that the data holders are still reluctant to share, even though it isn’t “their” data.  This will become less of a problem, as forward-looking providers like VA and DoD have shown, as well as payers like CMS, Aetna, and HCSC among many others have demonstrated.  All are outspoken supporters of the Blue Button program, now in its fifth year, and still growing.

 

The second falls squarely on our shoulders:  we need to make the user experience attractive, convenient, and useful.  The health IT community has made terrific strides recently – we-two have worked on the InCircle and a soon-to-be announced medication management app, for example –  and there are many companies that target data-driven patient-provider interactions, including AmericanWell and ConversaHealth.

 

The beautiful thing is that IoT fits so neatly into this conversation. The goal, of course, is to help us achieve our best-possible health. The best way to do this is with data. And the best data is coming at us in ever more granular packages, from patient-hosted sensors that monitor, detect, interact, and intervene. Weaving those into the tapestry of your personal health history is the next vanguard of coordinated and managed care.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

Electronic Health Record Solutions Don’t Make Errors, People Do It

Electronic Health Record Solutions Don’t Make Errors, People Do It | EHR and Health IT Consulting | Scoop.it

HealthITNews reports that the Centers for Disease Control and Prevention is expressing increased alarm about patient care errors that are being introduced as a result of poorly designed or poorly implemented electronic health record solutions. The US Food and Drug Administration has also be weighing in lately on whether Health IT solutions should be more tightly regulated.

 

Whether or not more regulatory oversight of Health IT is needed, I suspect many of us have experienced instances where health information about us is found to be in error. I recall when my mother was hospitalized for chest pain that doctors were treating her as though she had been a life-long smoker. In fact she had never, ever been a smoker. At some point in time, information about smoking history had been erroneously entered into the electronic record. Now, the doctors treating her for chest pain were making decisions about the likelihood of heart disease based in part on that information about smoking history. In my own medical records I have also found, and had to correct, occasional errors in medication history, allergies, and immunizations over the years.

 

Despite this, I would tend to put the blame not on the computer or the software. It is not generally these systems making the errors, but rather the people using them. Sometimes the wrong information has been entered into the system, as in the case of my mother. Sometimes, errors are made because the information being displayed is in the wrong chronological order or is buried in a user interface that is out of synch with real-world, clinical workflow. In both instances, the problem is with people—those who designed the software and those who use it, but not with the software itself or the machines running it. How can we improve on this situation? Here are four ideas:

 

 

Involve the Patient Right from the Start

 

In gathering the information that becomes the foundation of our medical records, we are putting too much burden on caregivers. How much of the complete medical history or SOAP note is information that comes directly from the patient? Chief complaint, history of present illness, past medical history, social, family and occupational history, medications, allergies, review of systems? All of this information is retrieved by “interviewing” the patient. Perhaps it would be more efficient and more accurate if the patient himself entered all that information into a kiosk, or some other kind of fully automated, information intake solution. Surely with today’s technology we could design systems that would do a more consistent and comprehensive patient interview and subsequent documentation of information without taking even a minute of clinical staff time. Patients could then review the information captured about them for accuracy before it was officially entered into their record. 

 

 

Ease the Documentation Burden on Clinicians 

 

We need to ease up on documentation requirements for clinical staff. The patient-centered machine capture solution mentioned above would help remove a lot of the documentation burden. The remaining documentation of the exam, differential diagnosis, and treatment plan could be better facilitated by free text, medical dictation solutions with natural language processing and coding technology on the back end. Nothing is more important that freeing our clinicians of the time currently being spent doing data entry.

 

 

Prohibit Templates, Cut and Paste

 

Templates simply don’t work because it is impossible to template the “patient story” and all of the other nuances of a good clinical exam. Likewise, cut and paste solutions are probably responsible for more medical misinformation and errors than anything else. EHRs should ban “cut and paste” capabilities altogether.

 

 

Share Information with Patients

 

At the end of the day, I believe all information in the medical record should be shared with the patient. The patient is an extra set of eyes, an extra check point if you will, against medical errors. Giving patients complete and full access to the information about them is not only a better way to engage patients in their care, but also a way to help make sure everyone is on the same page about their care. As eHealth advocates proclaim, “Nothing about me, without me!” I think this is sage advice for preventing misinformation and the introduction of errors in our medical records.

 

I would also be the first to admit that many, if not most of today’s electronic health record solutions are still too hard to use. They have been poorly designed in our attempt to replicate a clinical workflow previously based on paper records. As I have stated many times before, there is a unique opportunity to design solutions that really take full advantage of today’s technology

 

 

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

Techniques For Matching Patient Record Data Across Disparate EHRs & Other Systems 

Techniques For Matching Patient Record Data Across Disparate EHRs & Other Systems  | EHR and Health IT Consulting | Scoop.it

Some of the most frequent questions I receive these days surround data interoperability and integrating multiple health IT systems. One of the biggest problems in connectivity is matching patient record data and ensuring that the same patient data in different systems is linked properly. Given how many times this topic comes up, I reached out to Cameron Thompson, Acxiom Healthcare Group Managing Director. Acxiom has an interesting method of patient data matching, called persistent links, and when I saw what they were doing for matching consumer records in non-healthcare settings (e.g. marketing) I thought some of you might want to learn about it. Here’s what Cameron had to say about the various techniques for matching patient data:

 

The promise of secure and seamless exchange of patient healthcare information is powerful. As payers, providers, Health Information Exchanges (HIXs) and Accountable Care Organizations (ACOs) move rapidly toward the full deployment of electronic medical records, healthcare IT professionals are grappling with a fragmented network of systems and data silos. These disparate systems and databases often house redundant copies of patient medical data in multiple formats, which limits the ability to see a true 360-degree view of the patient. The benefits from connected patient data are many, including:

 

  • Reductions in inaccurate coverage determinations.
  • Intelligent information sharing for clinical decision making.
  • Honoring patient consents and preferences consistently and accurately.
  • Minimizing risks of data breach with a unique health identifier that allows the transfer of patient information but NOT personally identifiable information such as name and address.
  • Reduction in time and effort in administrative processes including billing or claims inaccuracies.
  • Avoiding costly duplication or unnecessary testing.

 

To reduce these inefficiencies and solve the underlying problem, the new healthcare ecosystem needs an accurate means of identifying and matching patient record data to the correct individual across internal and external healthcare systems, including collaborative care delivery models.

 

Multiple systems across the healthcare enterprise produce duplicate patient records that are not easily recognizable as matches. Recognizing that Mary Jane Smith at 123 Elm Road in the 2009 clinical laboratory system is also Mary Collins of 78 Oak Street in the 2011 patient registration system is a challenge for any organization. Identifying a solid method for distinguishing patient information across multiple data systems and combining the data accurately will be pivotal to the effective adoption of Electronic Health Records (EHRs) and successful implementation of Health Information Exchange (HIE).

 

As organizations take on this challenge, several methods have been identified and considered to recognize an individual. Three leading methods can to be explored to achieve your business goals of continuity and cost reduction. These are:

 

1. Algorithm or String-Based Matching

 

An organization can develop an algorithm with string-based matching using identifiers in the existing data to uniquely identify individuals. The benefits of string-based matching include:

  • Recognizable practice – This is a well-known practice and resources capable of creating these programs are plentiful.
  • Options for processing – Algorithms can be created internally and run without sending data outside the organization or an external organization can be identified to conduct the match on the organization’s behalf.

Some of the challenges with this strategy include:

  • Inherent challenges in string-based matching – String-based matching relies on consistencies in reported names and addresses, which tend to change often.
  • Ensuring the accuracy of the data used in the algorithm – Manually entered names and addresses are often laden with inexactness. This makes string-based matching more difficult.
  • Absorbing the costs to develop and enable this identifier across systems – Costs would need to be incurred to develop, maintain and put the identifier into use across systems.

 

2. State-Issued Number

An organization can use another state-Issued number such as a state of issuance and birth certificate number. Benefits of this method include:

 

  • Development cost savings – using existing assigned identifiers would save costs on development of a new identifier.
  • Availability – an organization could select an identifier that is already available in many systems.

Some challenges with this strategy include:

  • Inconsistent data fields and record lengths – if state issued numbers are of different lengths this could create difficulty for the programmer creating the data field.
  • Protecting personal information from fraudsters – using a state-issued number could raise concern over identity theft with the proliferation of stolen Social Security numbers. Whether real or perceived, this information being made available opens the door for fraudsters to invade an individual’s privacy.

 

3. Persistent Links

Healthcare organizations should consider the use of highly accurate match technology that delivers knowledge-based persistent linking. This match technology delivers a set of persistent links a company uses to recognize their patients across a fragmented network of systems and data silos. Persistent Link match technology is regarded as the most precise match technology available to accurately resolve patient identity (such as AbiliTec, the linking technology offered by my company, Acxiom). The link provides a consistent, client-specific ID, across data variations, and it can be applied at all touch points and databases within an organization.

 

The use of persistent links, created from knowledge-based match technology, can provide:

 

  • More accurate patient recognition and identity resolution.
  • Greater control and governance around the patient data because each healthcare entity receives a dedicated set of encoded links, specific to their enterprise. This facilitates link transactions, minimizing the amount of personal identifiable information exchanged, aligning with the need for HIPAA compliance. Further, when multiple entities interact (e.g. an Accountable Care Organization between provider and payer) a unique link reconciliation can be processed by the provider in batch or real time.
  • A minimized amount of personal information that a healthcare entity needs to store as they use encoded links to integrate data and recognize patients.
  • Eliminate an upfront investment to develop and maintain identifiers. The first two options I mentioned – algorithms/string-based matching and state-issued numbers – require healthcare entities to develop and maintain the identifiers.
  • · Creation of a refresh cadence based on specific business needs, say monthly or quarterly, reducing non-matching exposure to the cadence latency.

 

There are also some challenges related to using persistent links:

  • Persistent link application and maintenance will be more costly and an organization needs to be willing to look at the investment in higher quality.
  • The healthcare organization needs to be willing and able to transmit records with personally identifiable information in a privacy compliant manner, such as encryption.

 

As healthcare organizations move forward by adopting technology to improve patient experience they will find that the accuracy of the data will drive their success. Organizations should consider each of these methods for recognizing patients, each have their benefits and select the method that best meets specific organizations needs.

 

 

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

Who Owns The Data In Your EHR ?

Who Owns The Data In Your EHR ? | EHR and Health IT Consulting | Scoop.it

The concept of healthcare and EHR data ownership carries many implications for patients, providers, and medical practices. While experts agree that EHR vendors do not own the data, this has not prevented vendors from winning court disputes that resulted in serious financial losses for medical providers.

 

These considerations make the discussion of data ownership critical for any physician or medical practice that utilizes electronic health records.

 

Defining Data and Data Ownership

 

Healthcare data comes from a variety of sources. One is the patient themselves, who individually provide data to platforms such as patient portals. Another is the physician or healthcare team in the form of examination findings and clinical observations. Results from laboratory studies or radiology, along with data from other external healthcare providers or practices, also contribute to EHRs.

 

The number of parties who lay claim to healthcare data makes grappling with EHR data ownership even more complicated. Patients, providers, vendors, and the medical practice itself all have aninvestment in healthcare data, and there is often uncertainty over EHR data ownership. Amazingly both of these groups report that 20% simply don’t know who owns the data.

 

Establishing Data Ownership

 

The best method of minimizing disputes over EHR data ownership is prevention. Measures such as establishing data ownership early, defining terms, and enforcing guidelines are critical to minimizing trouble down the road. With EHR vendors, defining conditions of data exportation in the event the practice wishes to end a business relationship is critical.

 

For all parties, the concept of access must also be clearly defined. Terms include practice or provider access to data from the vendor’s servers, as well as patient access to healthcare data via portals or other mechanisms. The most common source of disputes is when a party wishes to leave the relationship; either the practice decides to select a different EHR vendor, or a patient wishes to port their data to a new provider.

 

Vendor Red Flags

 

For a medical practice, establishing terms of EHR data ownership must begin at the time of vendor selection. Identifying warning signs during this process can help providers avoid much larger issues in the future.

 

When choosing an EHR, keep an eye out for red flags such as unstructured data formatting (i.e. PDF instead of CCDA), an inability to meet the National Coordinator for Health Information Technology’s certification requirements,or restrictive contracts thatdemand exorbitant financial charges to port data in the event of a vendor switch.

 

Establishingproductive EHR data ownership for a healthcare organization takes careful planning.

 

The ZH Healthcare HITaaS (Health IT as a Service) architecture is designed with the needs of medical professionals and their patients in mind, meaning, among other things, that you own your data, and have complete administrative control.

 

 

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

The Critical Importance of Comprehensive EHR Survey Data 

The Critical Importance of Comprehensive EHR Survey Data  | EHR and Health IT Consulting | Scoop.it

In order to respond to the question of survey populations, I would like to provide a summary of the survey oversight and governance process as well as a more detailed explanation of the methodology that American EHR uses to conduct EHR surveys.

 

  • American EHR Partners is a vendor neutral eHealth data organization that has been collecting information around EHR systems for over 5 years. Over 5,800 verified clinicians surveys have been completed since the launch of the site in 2010. All of the data collected is free for physicians and professional associations. American EHR Partners does not endorse any products or services. The program provides ratings on certified EHR systems. Ratings are based primarily on surveys of physicians conducted through their professional societies. Ratings are displayed on all EHR vendors regardless of their participation in the program.

 

  • Ratings are only displayed once a minimum number ‘n’ of survey responses have been received; the current minimum value is ten ratings. The rating scores are aggregated from the relevant questions asked on the physician user surveys, and these questions are available to the public. The ‘n’ is presented for all product ratings to assist the user when interpreting the rating data.

 

  • From time-to-time, American EHR Partners develops reports based upon the data collected.

 

  • American EHR Partners has a stringent governance process. Four advisory groups have been established to provide feedback on the American EHR Partners program. These are: Physician Advisory, Professional Society Advisory, EHR Vendors Advisory and a Healthcare Stakeholder advisory that includes national organizations not represented in the first three advisory groups.

 

  • All professional society participants, automatically have a seat on the society advisory group. The purpose of this advisory board is to guide American EHR from a specialty and subspecialty perspective and to provide guidance on education, collaborative initiatives and future development in relation to specialty and subspecialty physician groups.

 

Survey sample selection

 

When conducting a survey in conjunction with a professional society partner, for example the Physician Use of EHR Systems report, a randomized sample of members from each participating organization are surveyed. As the professional society partners are regularly surveying their members on a variety of topics, and in order to prevent over-surveying, each provides a random sample of members with active email addresses in order to conduct the American EHR survey. Each survey group receives an initial invitation to complete the survey as well as 1-2 reminders. Because the sample is selected randomly from the member database, we expect that some individuals will not be using EHRs. These individuals are excluded in the survey registration process. While it is desirable to be able to survey an entire professional organization’s membership, this is not possible due to the number of additional surveys that each organization conducts of their members as well as the issue of survey fatigue.

 

Prior to collection of data for the Physician Use of EHR Systems  report, an extensive review process was undertaken to update the American EHR survey in conjunction with the American Medical Association, American College of Physicians and the American Academy of Family Physicians. In particular, American EHR worked with AMA Market Research staff to formulate new questions designed to examine the economic impact of EHR use and the role of scribes. In order to keep the overall length of the survey at its current level, AMA and American  EHR agreed to eliminate questions that were not effective and/or addressed in other parts of the American EHR  survey.

 

When the 155 question survey is conducted, all physicians are verified either directly in conjunction with their professional society through a verified sample, against the AMA Physician Masterfile or in limited situations through a manual process.

Due to the comprehensive nature of the EHR survey, the survey takes approximately 20 minutes to complete. However, the detailed nature of the data collected also provides key insights into the adoption and use of EHR systems by clinicians in varying practice sizes and by specialty.

 

We stand steadfastly behind the methodology, process, collection of data as well as the interpretation of the results as presented in our most recent report. In particular, we believe that the ability to survey physicians in conjunction with their professional organizations provides the most relevant and representative information on actual experiences in the use of EHRs.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

Why Your EHR Data Is In Migration Concerns ?

Why Your EHR Data Is In Migration Concerns ? | EHR and Health IT Consulting | Scoop.it

Migrating EHR data can look daunting. But there are many reasons a practice may wish to migrate its EHR data. But even after weighing costs and benefits of porting data elsewhere, some practices choose to avoid a potentially beneficial migration because of the complicated nature of the transition. However, there are many benefits that are well worth the effort of a successful migration of EHR data.

 

Why Do People Migrate Their EHR Data?

 

Some practices choose to migrate their data as a result of dissatisfaction with their EHR vendor. Others migrate because of a hospital acquisition, or to secure a vendor certified for Meaningful Use, or to move away from a vendor that could not certify.

 

And in the era of Big Data and analytics, it’s increasingly common to see EHR data migrations to vendors or analytics platforms with superior data management and analysis services.

 

A surge in EHR utilization has also heralded a rise in competition amongst EHR vendors. As of 2014, over 80% of office-based physicians had adopted EHRs. This rush in utilization has led to improved service offerings by vendors, spurring more movement of practice data.

 

The Cleanse: What Can You Clean Up in Your EHR

 

While data migration can be stressful for any practice or physician, the process also presents itself as an opportunity to clean up systems and organizedata. And practices don’t have to accomplish this all on their own. EHR vendors can assist with porting and cleaning up data, presenting a valuable benefit to migrating practices.

 

Thistype of project is especially helpful for the cleaning of legacy data, which is often essential to best practices (but frequently impossibly disorganized).

 

What if You Need to Convert Migrated Data?

 

If a data conversion is required, vendors can support this as well. Often, legacy data requires conversion when undergoing EHR data migration to a new system. Butin some cases, such data may not need to be immediately accessible. Experts recommend nonetheless that providers know how to access this information efficiently if the need arises.

 

Some firms may look to hire a data analyst who will have a better understanding what data you have to convert. These professionals advise that if not all your data is being converted; you need to know what is and where it’s going to be so you can get access to it.

 

Categorizing legacy data and conversions can be another great way to clean up databases, but it’s critical to generate backups and test the conversion with a small sample before full execution.

An EHR data migration is a greattime to establish a healthier vendor relationship, clean up data, and review policies for access, utility, and backups.

 

Access your Data

At ZH Healthcare, we believe that it should be easy to migrate your data and that you should always have access—no matter what. Explore our EHR, and especially OpenEMR, migration solutions like data conversion that puts the ownership and backups in the hands of medical providers and practices.

 

Our services are designed to make data transitions as simple and beneficial as possible for medical practices and professionals.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

Health Alerts App Brings Public Health Notifications to Your Mobile Device. 

Health Alerts App Brings Public Health Notifications to Your Mobile Device.  | EHR and Health IT Consulting | Scoop.it

I’m now excited to announce that AmericanEHR has recently released a mobile app called Health Alerts. The AmericanEHR Health Alerts app brings you timely information on outbreaks and incidents on public health emergency topics, including: diseases, infections, natural disasters, drug recalls, travel medicine, and more. This information is pulled directly from live feeds provided by the world’s most trusted sources for public health information, including:

 

  • Centers for Disease Control and Prevention (CDC)
  • World Health Organization (WHO)
  • US Food and Drug Administration (FDA)
  • International Society for Infectious Diseases (ISID)
  • US Department of Agriculture (USDA)
  • US Department of Health and Human Services (HHS)
  • International Society of Travel Medicine (ISTM)
  • European Centre for Disease Prevention and Control (ECDC)
  • Public Health Agency of Canada (PHAC)
  • And many more…

 

It is projected that a coordinated outbreak prevention strategy can help save tens of thousands of lives annually. The U.S. Centers for Disease Control and Prevention reported that by preventing infections from antibiotic-resistant germs through more efficient coordination among healthcare facilities and public health departments, as much as 80 percent of infections could be prevented in the next five years.

 

AmericanEHR’s Health Alerts app can not only slash the spread of these types of diseases and infections, but it provides clinicians, the public, health agencies and healthcare facilities with real time alerts and updates to stop outbreaks in their tracks. Being aware of the latest health bulletins and the symptoms to keep a watchful eye open for means lower healthcare costs, and faster, more accurate responses to health threats as they materialize.

 

The AmericanEHR Health Alerts app is free to use with an AmericanEHR account. The app is available for iOS (Apple) devices such as iPhone, iPad, and iPad Mini. It’s currently in limited release to select clinicians and patients as we gather feedback from the medical community.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

Getting the Most Out of Your EHR - Healthcare IT Consulting

Getting the Most Out of Your EHR - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.

 

8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and training can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.

 

EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.

 

EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.

 

Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

EHR and Challenges of the Modern Medical Note

EHR and Challenges of the Modern Medical Note | EHR and Health IT Consulting | Scoop.it

There was a time when documentation was an almost inconsequential process. After seeing a patient, the doctor would scratch a note, close the folder, and file it on a shelf until the next visit.

 

Things are different and the medical note has evolved. As it’s evolved, electronic health records (EHR) have brought efficiencies to the medical note while introducing new challenges. And like the cognitive biases that impact patient care, the problems inherent in documentation need attention.

 

Thinking about these challenges becomes important in documenting care and training the next generation of health professionals. Here are a few that I think about

Auto Documentation

One of the powers of the EHR is that it allows users to auto-populate the medical record with chunks of pre-fabricated text known as smart phrases. But these personally created building blocks of the medical note create the potential for one-clip-fits-all documentation. As I’ve said in the past, the smart phrase is not new technology.

 

I work to keep smart phrases out of my history of present illness and impression where individualized narratives show what’s unique about a case. Free text keeps me real.

Replicability

While smart phrases represent the dropping of self-created language, we have the ability to clip and paste information from other parts of the chart. This may include bits and pieces from notes penned by another medical professional.

 

While we all lift bits of language from places like CT and biopsy reports, issues arise when the origination of our language is that of another health professional. Epic now allows visualization of a phrase’s origin when not created by the author.

 

I’m careful about what I copy. I’m twice as careful with what I paste as a representation of my own thinking.

Size and absence of constraint

While smart phrases are limited only by our imagination, a digital note with no constraints predisposes to note bloat, one of the looming threats to modern medicine. Pre-digital notes were constrained by writer’s cramp.

 

I’ve laboured through notes where every single lab drawn on a complicated patient is dumped into the note. Pages and pages of marginally abnormal CBC and metabolic panels create a scenario where it’s difficult, if not impossible, to discern what data is relevant to the decisions made.

 

I try to consider the needs of the end user of the note. Of course, this is challenging when our opinion of what constitutes a ‘good note’ varies from that of the note read.

Ambiguity of purpose

This is the most remarkable phenomenon of the modern medical note. Medical notes have traditionally had pet purposes. Medical students learn early on that ‘the right way to write a note’ varies not only by speciality but by the whim of the individual physician responsible for the note. Physicians with firm views regarding what constitutes the purpose of a note may even morph their perspective depending upon the nature of an individual case.

So if you ask 3 physicians the purpose of a medical note and you’ll get 5 answers ranging from billing and quality documentation to legal coverage and professional communication. Over time the medical note has morphed into all of these things at once.

 

The problem with an ambiguity of purpose is how to manage the expectations of the end user. A physician who feels compelled to paste three months worth of blood results into the data portion of a note will be at odds with someone like myself who believes that a note serves to offer nothing other than concise support for what I’m thinking and planning.

 

As notes become more visible to more folks we can expect ambiguity of purpose to become more pronounced. Digital notes and their capacity for customization amplify this divergence of purpose.

Scaling visibility of the EHR

Once restricted to the shelves of offices in big buildings, medical documentation has traditionally been siloed. This was fine because notes existed for the doctors who occupied those individual offices.  The medical note is now enjoying new freedom in its electronic shape. More notes are more visible to more professionals. This is evident within consolidated health systems where networks of offices connect to big hospitals.

 

Beyond professionals, patients are watching and, in some cases, editing their own notes. OpenNotes is a related program based in Boston’s Beth Israel hospital. Regular patient review and revision represent a revolutionary move in medical documentation.

This scaling visibility of the modern note brings greater scrutiny for what we do or don’t do.

 

This idea of the medical note and its evolution gets little attention yet it represents the core medium of all documentation by medical professionals. It deserves more thorough attention and study.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

EHRs and the Problem of Efficiency

EHRs and the Problem of Efficiency | EHR and Health IT Consulting | Scoop.it

Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.

 

And when it comes to doctors and their EHRs, there’s a fine line between efficient and lazy.

 

Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.

 

Four things I do to fight the downside of efficiency:

  1. Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I’ve typically crossed the line.
  2. Build narrative. My HPI and impressions represent an identifiable stream of thought. I don’t use smart phrases in my HPI or impression.
  3. Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
  4. Stay aware. All of this is a struggle for me. But my discussion and thinking around this make me aware of it. And that’s the first step to staying on top of it.

 

All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don’t be fooled. Take any doctor from the analogue age, give him two glasses of wine and he’ll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analogue pulldown.

 

Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

4 Key Considerations for Analysts When Implementing an EHR 

4 Key Considerations for Analysts When Implementing an EHR  | EHR and Health IT Consulting | Scoop.it

Implementing a new EHR system requires a great deal of collaboration between clinical and technical teams. Analyzing the legacy system and operational workflows, then successfully recreating—or better yet, improving—this experience in a new EHR takes finesse.

The foundation of every successful EHR and other large-scale implementation is a team of analysts who are knowledgeable, engaged and passionate about their work. From groundwork and discovery to build, acceptance testing and go-live support, analysts do it all. Here are four key considerations for analysts to keep in mind to help ensure their projects go well and they continue to thrive in their roles.

 

1 – Start with the end goal in mind.

When gathering requirements, project teams will often start by walking through every workflow in the legacy system with end users. This can be a long process and can lead to a lot of information gathering that is ultimately unnecessary. A better approach is to start at the end and work backwards. Ask users why they complete these workflows and what the expected outcome is. This will help get to the root of the requirements and allow analysts to immediately begin thinking in terms of the new EHR.

Here are several questions analysts can ask when gathering requirements:

  • What is the end goal or objective?
  • Why have you traditionally done it this way?
  • What would improve the process?
  • What is the clinical rationale for this workflow?

By starting at the end and asking users why they do what they do and what outcome they are hoping to achieve, analysts can more effectively and efficiently build a system that meets the needs of users.

 

2 – Be aware of the functional limitations of legacy systems.

A key point that is sometimes overlooked is that EHR workflows are often defined by—and limited by—the functionality of the EHR itself. Users will default to what they are familiar with, so if a certain workflow is used frequently in the legacy system, they will assume it is required in the new one. Some workflows may not be needed, however, because the new EHR is designed to achieve the objective in a different, more efficient way. If analysts do not understand this, they risk building in features that are counterproductive, or not needed at all in the new system.

For example, in her current workflow, a clinic manager needs to generate and print a report of all the assessments completed in the office each day. During requirements gathering, she may feel this is an important step to replicate in the new EHR. As it turns out, this workflow is a result of poor auditing functionality in the legacy system – to keep proper records, the clinic manager is required to generate and print these reports. Improved auditing functionality in the new EHR eliminates the need for the daily assessment report and makes this workflow unnecessary.

 

3 – Communication is key.

One of the most important things an analyst can do is to effectively translate the clinical and business needs of end users into technical requirements for the new EHR system. They must also communicate future-state workflows in a way end users can understand and relate to. Communicating effectively is vital to project success.

EHR transitions are often intimidating and frightening for users who have established a comfort level with the legacy system, and likely had little input in the decision to change platforms. Analysts can begin to alleviate concerns and increase user adoption by putting together a few “quick wins.” A quick win is when an analyst identifies a piece of functionality that is very important to users but is also easy to build and demonstrate in the new EHR. Quick wins communicate to users the team is not only listening to their needs but can also deliver solutions quickly and effectively. This also increases confidence, workgroup participation, and communication response time with users and stakeholders, all of which contribute to project success.

 

4 – Strike a balance between functionality and maintainability.

Enterprise EHR systems are complex and, depending on the size and diversity of the user base, may require a team of several hundred application analysts to maintain. In addition, it’s important to remember that every clinical user in a health system is depending on the EHR to complete their documentation and deliver the highest quality of care to patients. Because of this, it is important to strike a balance between functionality and maintainability.

 

If the project team attempts to build in every piece of functionality requested by end users, including things that are nice to have but not critical for the system to function, the EHR will become unwieldy and difficult to maintain. Future updates by the EHR vendor will likely break any customizations, cause unnecessary downtime, and push the volume of help desk requests beyond what the business can support.

In contrast, if the project team oversimplifies and standardizes too much, they risk building a system that does not meet the core requirements of end users. When users can’t leverage the system the way they need, they find “creative” approaches that don’t always work or simply don’t document everything needed. This can lead to a host of problems such as violating operational policy, regulatory reporting issues, loss of revenue due to incorrect documentation, HIPAA violations and, ultimately, lower quality of care for patients. A well-balanced system will keep the support team busy but not overwhelmed, include all required functionality as well as some quality of life features and allow clinicians to be at their best with patients.

In summary, by keeping workflow objectives in mind, understanding legacy system limitations, communicating effectively and balancing functionality and maintainability, analysts demonstrate the value of their critical role in EHR implementation success.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

Are Providers Satisfied With Their EHR?

Are Providers Satisfied With Their EHR? | EHR and Health IT Consulting | Scoop.it

Physicians are expected to document encounters with patients. This ensures there is a record of crucial information for decision-making and dispute. A decade ago, around 90% of physicians updated their patient records by hand. By the end of 2014, 83% of physicians had adopted EHR systems. The combination of government incentives, advances in technology, and improved outcomes and operations fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. Electronic Health Records (EHRs) improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

A national survey of providers highlights their perspective on the benefits of having EHR in their practice:

  • 94% of providers report that their EHR makes records readily available at point of care.
  • 88% of providers report that their EHR produces clinical benefits for the practice.
  • 75% of providers report that their EHR allows them to deliver better patient care.

As the adoption of EHR grew over the last 10 years, so too did the need to change EHR systems within health systems, hospitals, and private medical practices. Growth in M&A activity fueled many healthcare organizations to combine data through EHR data conversion. Provider dissatisfaction has played a key role in encouraging change in EHR systems, also increasing EHR data conversion activity.

A study completed by Health Affairs showed, by and large, providers recognize the important advances that EHRs enable. Fewer than 20% of all providers said they would return to paper records. That being said, providers also noted negative effects of current EHRs on their professional lives and on patient care.  While excited about the possibilities provided by EHRs, providers have ultimately found poor usability that does not match clinical workflows, time-consuming data entry, interference with patient interaction, and too many electronic messages and alerts.

According to a 2014 survey of physicians conducted by AmericanEHR Partners:

  • 54% indicated their EHR system increased their total operating costs.
  • 55% said is was difficult or very difficult to use their EHR to improve efficiency.
  • 72% said it was difficult or very difficult to use their EHR to decrease workload.
  • 43% said they had not yet overcome productivity challenges associated with their EHR implementation.

These concerns about EHR usability are in alignment with others, including the American Medical Informatics Association, researchers, and practicing physicians. Given the rate at which many healthcare organizations have adopted EHRs, these organizations find themselves unable to wait for the long-run fixes. Healthcare organizations are now looking to change EHR providers in order to fix many of the providers’ concerns.

As healthcare organizations begin the process of changing EHR providers, there is an increased need for solutions to provide access to and maintain the integrity of data stored in the legacy systems. When this need arises, healthcare organizations have the choice to archive the legacy data, run multiple systems simultaneously, or complete an EHR data conversion.

Given the complexity of the data and variety of potential solutions, one might suppose that handling legacy data would be a complex affair. In many ways, that is true. However, it doesn’t have to be. To learn more about the state of EHRs and potential solutions for maintaining access and integrity of legacy data.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

EHR Data Architect: A successful conversion and data integrity

EHR Data Architect: A successful conversion and data integrity | EHR and Health IT Consulting | Scoop.it

Over the last decade, adoption of EHR systems has increased dramatically among providers. While many healthcare providers have made the shift from paper to electronic health records, there has simultaneously been a growing need among healthcare organizations to change EHR providers. The two largest reasons for this change in systems are dissatisfaction and mergers and acquisitions.

When changing EHR systems, many healthcare organizations turn to experienced EHR Data Architects to help ensure the integrity of their patient data. For those EHR Data Architects, it is the process, not the EHR provider, that allows them to guarantee a successful conversion and data integrity. 

As is true with the initial adoption of electronic records, changing EHR providers is a very large project. As healthcare organizations work to convert legacy records and adopt new systems, patients continue to generate more data.

It can be quite challenging to determine the best method for maintaining and storing legacy date while also utilizing a new system. As a result, most healthcare organizations opt to incorporate legacy data into the new EHR system from day one. Out of the myriad of options available for guaranteeing data integrity, the best way to accomplish this is through an automated EHR data conversion.

What is EHR data conversion?

EHR data conversion utilizes a process known as ETL to move patient data from one EHR system to another. During an ETL conversion, patient data is EXTRACTED from the legacy system, TRANSFORMED to align with the map created for the new system, and LOADED into the new system. EHR data conversion can either be performed manually or through an automated process.

 

Manual data conversion carries a significant risk of data manipulation. As a result, many healthcare organizations choose automated EHR data conversion when working with large sets of data.

During an automated data conversion, not a single record is touched. Companies who specialize in healthcare data conversion utilize a failsafe ETL methodology specifically designed to mitigate clinical risk.

What are EHR Data Architects?

EHR Data Architects are the specialists who structure and run an automated data conversion. They are experts in extracting data out of any source system/database, using the necessary means specific to that system. EHR Data Architects have customized toolsets that allow them to transform the data to meet the specific needs of the target system.

An EHR Data Architect has experience working with all genres of data. The process and tools allow for the Data Architect to perform an ETL for data from any system and to any system. They ARE NOT specific system experts, or specialists, in any specific system's operations, usability, or recommended workflows.

While they are not subject matter experts (SMEs) in any EHR system, they are in the process of data conversion. As a result, they are able to successfully convert data no matter what systems are being utilized.

It is important that your data conversion partner has developed a failsafe process for extracting, transforming, and loading data. A strong partner will have experience in many different EHR systems and potentially have extensive experience working with your EHR provider and system. However, experience working with your EHR provider is not enough.

Without a failsafe process and methodology, your patient data is still at risk. Furthermore, when the right process is in place, an EHR Data Architect can convert from any source system to any target system and ensure the integrity of your data.

To learn more about how you can adequate assess a potential EHR data conversion partner’s experience, download the EHR Data Conversion Guide and Workbook.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

more...
No comment yet.
Scoop.it!

Amazing Steps To Encrypt Your Patient Data

Amazing Steps To Encrypt Your Patient Data | EHR and Health IT Consulting | Scoop.it


Think your practice is too small for a data breach to occur? Think again. It’s vital to stay on the right side of HIPAA requirements for data security. This isn’t always easy and can cost a 
significant amount, but in general, locking down data is less expensive than damage control after a breach.

Breaches of patient information are on the rise—138% from 2012 to 2013, according to breach data reported to the Department of Health and Human Services (HHS). And no system is completely theft-proof. However, there are steps you can take to make your privacy harder to invade. That’s important because many data thieves are opportunists who will bypass difficult targets in search of easier quarry.

  1. Consider hiring a security expert and conducting a thorough vulnerability assessment. It isn’t cheap, but there are payoffs for practices that consider this an investment.
  2. Partner with strong IT vendors and services. Is your EHR as theft-proof as possible?
  3. Encrypt all transmission of electronic private health information, including texts and emails.
  4. The biggest threat to data security in your office could be your most loyal employees. Train your staff to be vigilant about email and web use, and develop a policy for BYOD (bring your own device). Many patients and employees now use their own mobile devices—everything from smart phones, laptops and tabletsto wearables—in the workplace. BYOD policies must ensure patient data remains secure.
  5. At the other end of the technology spectrum, paper-based data breaches still account for substantial amounts of data loss. In 2012, for example, there were 50 reports of data loss to HHS involving paper documents, representing information for 386,065 individuals. If your office still has file cabinets full of paper folders, consider scanning then shredding or removal to a secure storage site.
  6. Many small and midsized medical practices are weighing the pros and cons of purchasing cyber or data breach insurance to mitigate the financial risks of a breach. This might be a good option for your office.
  7. Lead by example. HHS offers CME-eligible online educational programs that can help physicians understand what’s required to comply with HIPAA privacy and security rules.

 

If a data breach does occur, inform those affected as soon as possible, and identify the information that has potentially been compromised. Keep in mind you won’t be able to do this if you don’t know what data resides in your practice or what systems are networked.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
CywareCo's curator insight, August 26, 2016 6:32 AM
Healthcare security can no longer be ignored. The details of your entire life in the hands of a hacker who is willing to sell it for money will lead to identity theft - https://cyware.com/journal/healthcare-security-ignored/
Scoop.it!

How Health IT Enables Safer Medical Travel & Tourism 

How Health IT Enables Safer Medical Travel & Tourism  | EHR and Health IT Consulting | Scoop.it

IT innovation, global medicine and frustrated medical patients drive the demand for medical travel. But telemedicine also improves patient care and the customer experience of medical travelers. Once again, we welcome medical IT entrepreneur, Agha Ahmed, Managing Partner of GHIMBA, as we explore how IT innovations help patients get high-quality healthcare outside of the USA.

 

How do IT innovations help provide services that medical travelers can benefit from?

 

IT helps deliver safe medical care and a pleasant trip to facilities overseas. For more than 20 years, IT innovations have improved patient care worldwide. Now, these innovations are helping medical travelers, too.

 

How so?

 

In telemedicine and m-health, telecommunications, mobile devices and information technologies provide clinical health care at a distance. (M-health is the practice of using mobile technology in healthcare.) There are three important devices and software capabilities that help deliver the promise of medical travel:

 

  • First, there are electronic media records. With an EMR system, it’s easy to gather patient clinical notes, diagnostic scans, medical administrator records, and discharge summaries in digital form. By automating and streamlining clinical workflow, IT cuts the time and effort needed to maintain information and create the data trail needed for medical audits and QA procedures.

 

  • Then, there are smartphones. Our familiar hand-held computers are becoming an important enabler in the cloud-based healthcare infrastructure. An EMR system deployed in the cloud can make a smartphone a virtual healthcare wallet. Patients can access their medical records from a smartphone and share the information with overseas healthcare providers.

 

  • Finally, data mining and analytics. Data mining and analytics technologies combine, prepare and search massive data stores gathered from many sources. Combined with analytics software, a cloud-based EMR system provides easy access to the knowledge and insight that overseas doctors can use to identify medical problems. And, patients can learn about cost-effective treatment for specific diseases and conditions without leaving home.

 

These innovations work with participants in the medical travel industry to deliver value to patients and business opportunities to entrepreneurs.

 

What’s the most important thing that IT provides patients and entrepreneurs?

 

Powerful data sharing and analysis, anywhere in the world. Cloud computing and modern IT devices make it easy to transfer, analyze and share massive amounts of medical data, quickly and safely. IT contributes medical services that patients and overseas healthcare providers can be confident in. There are three notable capabilities.

 

  • IT makes comprehensive medical information accessible. All patient-related data is stored in a single, authoritative source in a cloud computing center. Centralized data management makes it easier for qualified medical travel solution providers to identify gaps in information and synchronize the data and people involved at each step in patient care.

 

  • IT helps patients get the best care available. By hosting medical records, cloud computing centers become part of an ecosystem, which includes globally accredited hospitals and clinics. Healthcare providers anywhere in the world get easy access to medical information before patients arrive. Or, patients can use their smartphones to download information when they arrive. When highly qualified practitioners analyze and share medical information, patients benefit.

 

  • IT provides patients with a smoother, more pleasant trip. Internet data searches and medical travel solution facilitators reduce the time, effort and worry of finding, traveling to and engaging medical facilities overseas.

 

Cloud computing and other IT innovations can help make offshore treatment a safe, cost-effective alternatives to U.S. healthcare. These innovations can be used with medical travel facilitators and solution providers to deliver world-class medical services.

 

Where can we find out more about IT and medical travel?

 

Telemedicine is a major topic in an upcoming conference, the Medical Travel and Global Healthcare Business Summit in Tampa, Florida. If you’re wondering about medical travel business opportunities, you’ll want to check out the conference, which will be held on June 14th through 17th. The summit is designed for healthcare and wellness providers, IT services business leaders, and hospital and clinic administrators.

 

The conference discusses business and technical aspects of medical travel, including how IT, telemedicine and m-health support travel logistics and patient care. The emphasis is on finding and making the most of the many business opportunities available to entrepreneurs and healthcare industry professionals.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
Richard Stern's curator insight, July 8, 2016 9:15 AM

Safety and Health are priority issues when travelers have business travel needs on a regular basis. Technology innovations contribute to the likelihood of a better outcome. 

Scoop.it!

Should You Test Your EHR Data Backup and Restore Process?

Should You Test Your EHR Data Backup and Restore Process? | EHR and Health IT Consulting | Scoop.it

It’s common knowledge that backing up data for your medical practice is critical forprotecting against devastating losses of patient data in the event of a natural disaster, system glitch, or hardware failure. But practices should go further than simply backing their data up; testing these backup and restoration processes is just as important for ensuring data safety as the initial backup itself.

 

Why Backups are Important

 

For practices that utilize EHRs, having backups is critical for a number of reasons. While the first scenario that many imagine is a catastrophic loss of data resulting from a server malfunction or local event, this is not the only reason to have a data backup.

Experts recommend backups to protect againstsecurity breaches or viruses, to provide continuity of care across multiple providers or in the event of an outage, andthe protection ofvaluable assets for research and analytics.

Medical practices should establish scheduled, automatic backups as well as perform manual backups after making any system changes.

 

Your Backup is Only as Good as its Restore

 

When preparing an EHR data backup procedure, it’s important to remember that the value of your backup is congruous to the quality of the restore. A backup is no good if the restore is incompatible with current hardware or software, which is just one example of what can go wrong.

 

Particularly for practices using an EHR vendor, it’s essential to confirm compatibility of the restore with current systems. This restore must also be promptly accessible, and establishing synchronization with an EHR vendor is importantfor this timeliness. Checking post-restore integrity as a routine part of testing can ensure that once your restore is complete, your data will be accessible and useable.

 

How Will You Know if Your Backup is Good?

 

One of the most effective ways to know if your backup is good is to run a test. The test should exercise the system using common work processes that access multiple types of data.  The worst case is when a practice believes they have beensuccessfully backing up their data, only to find out that the backups are incomplete.

 

Other restore fail scenarios include practices that have discovered that theyhave only been backing up their software (URL: http://www.americanehr.com/blog/2011/12/data-backup-information-protection/), not their data. This kind of loss can be devastating for patients and providers alike, and regularly running tests can protect against these situations.

 

Scheduling Your Backups

 

Aside from testing the functionality of backups,strategically determining the times that these systems will run will prevent interference with staff or clinic activities. Frequency also depends on how much data the practice can afford to lose. If a backup runs weekly, this means that a worst-case scenario could result in the loss of six days’ worth of data.

 

Depending on practice volume, agenda, and other factors, setting goals and quantifiable standards for backups ensures alignment with best practices.

 

Conclusion

 

Protection against disaster-borne data loss, along with the convenience of external management,has led many practices to choose third parties or their EHR vendor to administrate backups.  Don’t rely on external entities to validate your backups.  Internally test and verify your systems restore process too.

 

At ZH Healthcare, our BlueEHS services offer complete peace of mind with multiple layers of protection, including automated backups and “snapshot” components which can be used to restore your systems quickly. In addition, we offer on-demand download access from the cloud, and in-house data storage. 

 

 

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

How To Measure What We Cannot See In Healthcare

How To Measure What We Cannot See In Healthcare | EHR and Health IT Consulting | Scoop.it

These days it seems that everyone in healthcare is buzzing about big data and analytics, and no wonder. Transforming, if not reimagining, healthcare is going to take everything we’ve got. Achieving the triple aim of higher quality, better access and lower cost of care cannot be done without being able to measure what we do. As the old adage says, “if you can’t measure it, you can’t improve it”. To that I might add, “if you can’t see it, you can’t improve it”.

 

Anyone who has walked the halls of a hospital or clinic knows there is no shortage of data. We just aren’t very good at knowing exactly how to get our arms around it. Data is only meaningful if it is organized in ways that we can truly comprehend what it is telling us. Today, the smart money is on technologies that help us visualize and therefore understand data without the need of a PhD in advanced analytics.

 

One such tool is something we call Power Map for Excel. This 3D visualization add-in is now a centerpiece (along with Power View, Power Query, and Power Pivot,) within the business intelligence capabilities ofMicrosoft Power BI in Excel.

 

Information workers with their data in Excel have realized the potential of Power Map to identify insights in geospatial and time-based data that traditional 2D charts cannot communicate. For instance, digital marketers can better target and time their campaigns while environmentally-conscious companies can fine-tune energy-saving programs across peak usage times. These are just a few of the examples of how location-based data is coming alive for customers using Power Map and distancing them from their competitors who are still staring blankly at a flat table, chart, or map.

 

Please take a look at the video below. Then ask yourself, what if instead of mapping U.S. Power Production we were looking at:

 

  • Syndromic surveillance of the geospatial distribution and severity of an infectious disease

 

  • A real-time map of a hospital system’s nosocomial infection rate

 

  • A representation of the incidence of chronic disease plotted against the geographic distribution of toxins in air, soil and water

 

  • A facilities, capabilities and occupancy map of a region’s readiness for accountable care
Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

American EHR Call For Submissions.

American EHR Call For Submissions. | EHR and Health IT Consulting | Scoop.it

Do you have a story to tell or experiences using health information technology? How would you like to share those experiences with American EHR’s 26,000+ members who represent all 52 states and territories and 152 medical specialties?

 

Whether positive or negative, shared experiences surrounding the usage of EHR’s or other technologies such as mobile apps or web-based tools are extremely valuable to clinicians, ancillary caregivers, and staff who work in clinical patient settings.

 

Whether you’re a primary care clinician, a practice administrator, or a technology expert, please take a few moments to share your experiences and insights.

 

What are we looking for?

 

500–700 word articles on topics such as the following:

  • Interopability
  • Connected Health
  • E-Prescribing
  • Data exchange (or the lack thereof)
  • Clinical decision support
  • Clinical mobile apps
  • Tips on time-saving
  • Areas in which technology use is challenging
  • Interacting with patients using portals or personal health records
  • MACRA and Meaningful Use

 

All submissions are reviewed by our editorial team prior to publication, and must be educational in nature. Open to clinicians, practice managers, consultants, CIO’s, or other health IT professionals.

 

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

What is Big Data for Healthcare IT?

What is Big Data for Healthcare IT? | EHR and Health IT Consulting | Scoop.it

Big data is a term commonly used by the press and analysts yet few people really understand what it means or how it might affect them. At it’s core, Big Data represents a very tangible pattern for IT workers and demands a plan of action. For those who understand it, the ability to create an actionable plan to use the knowledge tied up in the data can provide new opportunities and rewards.

 

Let’s first solidify our understanding of Big Data. Big Data is not about larger ones and zeros nor is it a tangible measurement of the overall size of data under your stewardship. Simply stated, one does not suddenly have “big data” when a database grows past a certain size. Big Data is a pattern in IT. The pattern captures the fact a lot of data collections that contain information related to an enterprise’s primary business are now accessible and actionable for that enterprise. The data is often distributed and in a variety of formats which makes it hard to curate or use, hence Big Data represents a problem as much as it does a situation. In many cases, just knowing that data even exists is a preliminary problem that many IT workers are finding hard to solve. The peripheral data is often available from governments, sensor readouts, in the public domain or simply made available from API’s into other organizations data. How do we know it is there, how can we get at it and how can we get the interesting parts out are all first class worries with respect to the big data problem.

To help illustrate the concepts involved in Big Data, we will use a hospital as an example. A hospital may need to plan for future capacity and needs to understand the aging patterns from demographics data that is available from a national census organization in the country they operate in. It also knows that supplementary data is available in terms of finding out how many people search for terms on search engines related to diseases and the percentage of the population that smokes, is not living healthy lifestyles and participates in certain activities.  This may have to be compared to current client lists and the ability to predict health outcomes for known patients of a specific hospital, augmented with the demographic data from the larger surrounding population.

 

The ability to plan for future capacity at a health institute may require that all of this data plus numerous other data repositories are searched for data to support or disprove the hypothesis that more people will require more healthcare from the hospital in ten years.

 

Another situation juxtaposed to illustrate other aspects to Big Data could be the situation whereby a single patient arrives at the hospital with an unknown disease or infection. Hospital workers may benefit from knowing the patients background yet may be unaware of where that data is. Such data may reside in that patients social media accounts such as FourSquare, a website that gamifies visits to businesses. The hospital IT workers in this scenario need to find a proverbial needle in a haystack. By searching across all known data sources, the IT workers might be able to scrape together a past history of the patient’s social media declarations which might provide valuable information about a person’s alcohol drinking patterns (scraped from FourSquare visits to licensed establishments), exercise data (from a site like socialcyclist.com) and data about their general lifestyle (stripped from Facebook, Twitter and other such sites). When this data is retrieved and combined with data from LinkedIn (data about the patients business life), a fairly accurate history can be established.

 

 By combining photos from Flickr and Facebook, Doctors could actually see the physical changes in the way a patient looks over time.

 

The last example illustrates that the Big Data pattern is not always about using large amounts of data. Sometimes it involves finding the smaller atoms of data from large data collections and finding intersections with other data. Together, these two hospital examples show how Big Data patterns can provide benefits to an enterprise and help them carry out their primary objectives.

 

To gain access to the data is one matter. Just knowing the data is available and how to get at it is a primary problem. Knowing how the data relates to other data and being able to tease out knowledge from each data repository is a secondary problem that many organizations are faced with.

 

Some of our staff members recently worked on a big data project for the United States Department of Energy related to Geothermal prospecting. The Big Data problem there involved finding areas that may be promising in terms of being able to support a commercially viable geothermal energy plant that must operate for ten or more years to provide a valid ROI for investors. Once the rough locations are listed, a huge amount of other data needs to be collected to help determine the viability of a location.

Some examples of the other questions that need to be answered with Big Data were:

 

  1. What is the permeability of the materials near the hot spot and what are the heat flow capabilities?
  2. How much water or other fluids are available on a year round basis to help collect thermal energy and turn it into kinetic energy?
  3. How close is the point of energy production to the energy consumption?
  4. Is the location accessible by current roads or other methods of transportation?
  5. How close is the location to transmission lines?
  6. Is the property currently under any moratoriums?
  7. Is the property parkland or other special use planning?
  8. Does the geothermal potential overlap with existing gas and oil claims or other mineral rights or leases?
  9. Etc…

 

All of this data is available, some of it in prime structured digital formats and some of it not even in digital format. An example of non-digital format might be a drill casing stored in a drawer in the basement of a University that represents the underground materials near the heat dome. By studying its’ structure, the rate of heat exchange through the material can provide clues about the potential rate of thermal energy available to the primary exchange core.

 

In order to keep track of all the data that exists and how to get at it, many IT shops are starting to use graphs and graph database technologies to represent the data. The graph databases might not store the actual data itself, but they may store the knowledge of what protocols and credentials to use to connect to the data, what format the data is in, where the data is located and how much data is available. Additionally, the power of a graph database is that the database structure is very good at tracking the relationships between clusters of data in the form of relationships that capture how the data is related to other data. This is a very important piece of the puzzle.

 

The conclusion of the introduction post to Big Data is that Big Data exists already. It is not something that will be created. The new Big Data IT movement is about implementing systems to track and understand what data exists, how it can be retrieved, how it can be ingested and used and how it related (semantically) to other data.

 

The real wins will be when systems can be built that can automatically find and use the data that is required for a specific endeavor in a real time manner. To be truly Big Data ready is going to require some planning and major architecture work in the next 3-5 years.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.