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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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EHR Interoperability Stalled Due to Information Blocking

EHR Interoperability Stalled Due to Information Blocking | EHR and Health IT Consulting | Scoop.it

When it comes to the practice of medicine and drug discovery, the federal government plays a role in supporting these sectors and developing legislation that opens up avenues for healthcare professionals and scientific researchers. The House Committee on Energy and Commerce has gone forward with creating legislation called 21st Century Cures that delves directly into stimulating the discovery and development of new treatments and medications for patients across the nation. The legislation also impacts the expansion of EHR interoperability.

While the intentions of the 21st Century Cures legislation is beneficial for drug discovery, the American Hospital Association (AHA) finds that the enforcement strategies under the proposed rules could have negative consequences for providers, particularly in its aim to expand EHR interoperability.

AHA Executive Vice President Rick Pollack stated in a letter to the House Committee on Energy and Commerce that, which the organization appreciates the inclusion of EHR interoperability expansion, the “enforcement mechanisms” could lead to issues for healthcare providers such as putting together an ecosystem in which doctors may be significantly penalized for minor errors.

AHA does support health information exchange and EHR interoperability in pursuit of improving patient outcomes and incorporating new models of care. Nonetheless, AHA finds some issues with the enforcement related to vendors participating in information blocking problematic.

“The bill includes a number of enforcement mechanisms against those who engage in information blocking,” wrote AHA Executive Vice President Rick Pollack in the letter. “On the provider side, we believe that the use of Medicare fraud and abuse mechanisms, such as investigations by the Office of the Inspector General, imposition of civil monetary penalties or exclusion from the Medicare program, is unnecessary and inappropriate to address the concerns that the legislation seeks to remedy. We recommend that you use the existing structures of the meaningful use program to promote information sharing.”

On behalf of AHA, Pollack mentions that the organization appreciates the committee’s aim to ensure EHR vendors are responsible for creating interoperable health IT products. However, Pollack also stated that the committee should instruct the Federal Trade Commission to analyze any anti-competitive behavior among EHR vendors. In particular, Pollack finds the decertification of EHR systems among vendors that participated in information blocking objectionable, as it would affect healthcare providers and disrupt patient care.

“The language also includes decertification as a sanction for vendors that engage in information blocking. Decertification would be disruptive to hospitals and physicians that have invested in and deployed an EHR that is later decertified,” Pollack explained. “However, the inclusion of provider protections against meaningful use penalties if their EHR is decertified makes it more reasonable.”

The protections against payment penalties under the Medicare and Medicaid EHR Incentive Programs would last for more than one year, which would give providers ample time to find a new vendor, develop a suitable contract, install another EHR system, and attest to relevant meaningful use requirements.

Additionally, AHA would like the definition of information blocking to become narrower in order to avoid charges of fraud to be dealt due to standard business practices. Essentially, AHA would like to reduce some of the punitive approaches the committee set forth and develop more positive approaches to expanding health information exchange.


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Apple's health tech takes early lead among top hospitals

Apple's health tech takes early lead among top hospitals | EHR and Health IT Consulting | Scoop.it

Apple Inc's (AAPL.O) healthcare technology is spreading quickly among major U.S. hospitals, showing early promise as a way for doctors to monitor patients remotely and lower costs.

Fourteen of 23 top hospitals contacted by Reuters said they have rolled out a pilot program of Apple's HealthKit service - which acts as a repository for patient-generated health information like blood pressure, weight or heart rate - or are in talks to do so.

The pilots aim to help physicians monitor patients with such chronic conditions as diabetes and hypertension. Apple rivals Google Inc (GOOGL.O) and Samsung Electronics (005930.KS), which have released similar services, are only just starting to reach out to hospitals and other medical partners.

Such systems hold the promise of allowing doctors to watch for early signs of trouble and intervene before a medical problem becomes acute. That could help hospitals avoid repeat admissions, for which they are penalized under new U.S. government guidelines, all at a relatively low cost.

The U.S. healthcare market is $3 trillion, and researcher IDC Health Insights predicts that 70 percent of healthcare organizations worldwide will invest by 2018 in technology including apps, wearables, remote monitoring and virtual care.

Those trying out Apple's service included at least eight of the 17 hospitals on one list ranking the best hospitals, the U.S. News & World Report's Honor Roll. Google and Samsung had started discussions with just a few of these hospitals.

Apple's HealthKit works by gathering data from sources such as glucose measurement tools, food and exercise-tracking apps and Wi-fi connected scales. The company's Apple Watch, due for release in April, promises to add to the range of possible data, which with patients' consent can be sent to an electronic medical record for doctors to view.

"TIMING RIGHT"

Ochsner Medical Center in New Orleans has been working with Apple and Epic Systems, Ochsner's medical records vendor, to roll out a pilot program for high-risk patients. The team is already tracking several hundred patients who are struggling to control their blood pressure. The devices measure blood pressure and other statistics and send it to Apple phones and tablets.

"If we had more data, like daily weights, we could give the patient a call before they need to be hospitalized," said Chief Clinical Transformation Officer Dr. Richard Milani.

Sumit Rana, chief technology officer at Epic Systems, said the timing was right for mobile health tech to take off.

"We didn't have smartphones ten years ago; or an explosion of new sensors and devices," Rana said.

Apple has said that over 600 developers are integrating HealthKit into their health and fitness apps.

Many of the hospitals told Reuters they were eager to try pilots of the Google Fit service, since Google's Android software powers most smartphones. Google said it has several developer partners on board for Fit, which connects to apps and devices, but did not comment on its outreach to hospitals.

Samsung said it is working with Boston’s Massachusetts General Hospital to develop mobile health technology. The firm also has a relationship with the University of California's San Francisco Medical Center.

Apple's move into mobile health tech comes as the Affordable Care Act and other healthcare reform efforts aim to provide incentives for doctors to keep patients healthy. The aim is to move away from the "fee for service" model, which has tended to reward doctors for pricey procedures rather than for outcomes.

Still, hospitals must decide whether the difficulty of sorting through a deluge of patient-generated data of varying quality is worth the investment.

"This is a whole new data source that we don't understand the integrity of yet," said William Hanson, chief medical information officer at the University of Pennsylvania Health System.

FIRST STEPS

Apple has recruited informal industry advisors, including Rana and John Halamka, chief information officer of Beth Israel Deaconess Medical Center and Harvard Medical School, to discuss health data privacy and for introductions to the industry.

The company said it had an "incredible team" of experts in health and fitness and was talking to medical institutions, healthcare and industry experts on ways to deliver its services.

A few hospitals are also exploring how to manage the data that is flowing in from health and fitness-concerned patients, whom many in Silicon Valley refer to as the "worried well."

Beth Israel's Halamka said that many of the 250,000 patients in his system had data from sources such as Jawbone's Up activity tracker and wirelessly connected scales.

"Can I interface to every possible device that every patient uses? No. But Apple can,” he said.

Cedars-Sinai hospital in Los Angeles is developing visual dashboards to present patient-generated data to doctors in an easy-to-digest manner.

Experts say that there will eventually be a need for common standards to ensure that data can be gathered from both Apple's system and its competitors.

"How do we get Apple to work with Samsung? I think it will be a problem eventually," said Brian Carter, a director focused on personal and population health at Cerner, an electronic medical record vendor that is integrated with HealthKit.


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Important Features For Your Practice Computers

Important Features For Your Practice Computers | EHR and Health IT Consulting | Scoop.it

Medical computers are an essential element of the modern health care system. They help increase efficiency in every setting from the front office to exam rooms, surgery, and radiology departments. Choosing computers for your practice is an important task, so here are some features to look for:


Sanitation Promoting Features


A clean environment is indisputable in health care facilities, and a critical component of a medical grade computer is their ability to support one. Hygiene-promoting features on your practice computers should include the following:


  • Sealed enclosure resistant to liquid and can be cleaned with disinfectant.
  • Antimicrobial coating on keyboards and monitors or all-in-one computers.
  • Fanless design to reduce dirt accumulation in the system and dust from circulating.
  • Minimal crevices that are potential homes for bacteria.


Mobility and Accessibility


When medical computers are mobile and accessible, health care organizations can save time, money and improve patient care. Nurses and doctors can bring computers with them on patient rounds or during check-in. This accessibility in medical computers lets doctors and nurses focus on patients, not hardware, during appointments. Look for computers that fit into a variety of settings, whether they can be placed on wall mounts, medical carts or nursing stations. VESA mountable computers are the preferred industry standard. The medical computer supplier you choose should offer assistance in installing your computers where you need them. Also, check for an internal lithium battery that allows for mobility without interrupting data management.

Touchscreens are another significant option that lets caregivers focus on patients. When they are easy to use, caregivers can easily enter data and interact with the computer, while still giving attention to patients. Medical Computer touchscreens are also more hygienic since they can come with an antibacterial coating.


Administrative Tools


A high performing and efficient hospital or clinic has central coordination, and medical grade computers reinforce this. With medical grade computers, administrative staff can enter and edit a patient’s medical, insurance and billing information in a patient environment. Each computer on the network should have access to this information, with a setup that allows for HIPAA compliance. Elimination of redundant inputs, reduction of errors and the switch to electronic rather than paper billings all save costs.


Low-Cost Installation


While changing to a medical computer system or getting an overhaul of your current system will undoubtedly involve some expense, you can minimize it in a few ways. One is by choosing a system compatible with as much of your existing systems as possible. For example, inquire about the extent of inputs and outputs that would be necessary with a new system; you may be able to make use of parts of your current system and thus save trouble and money from redundant equipment purchases.


Another way to reduce the initial investment cost is to consider the time and resources required to get doctors and other employees able to operate the system. First, software should be easy to use. Look for medical grade computers that support your preferred software programs or that come with new software that is simple to learn. Insist on getting a free trial before committing to a purchase.

Second, be sure to train employees before your upgrade is complete. Extra time from tutorials is expensive to a hospital or clinic, so find out how long it typically takes for users to master the system. If possible, purchase your medical computers from a company that provides follow-up support..


Cloud-Based Systems


Your practice computers need to be compatible with the cloud. As recently explained on this site, 96 percent of health care organizations are using or considering the cloud. Those who do can hope for average cost savings of 20 percent each year.


Using the cloud has additional advantages over cost savings. It allows for unlimited storage and frequent backups. Also, storage on a remote server rather than a large server on site prevents the risk of losing data in case of a flood, fire, etc. Check for a computer with EN/UL 60601 medical certification with which protects against power surges, failures and improves on-site safety.


A quality medical grade computer has a number of important characteristics that allow for reduced costs and upgraded patient care. Keep a list of necessary features in mind when you shop for your new computer or system, and your health care organization may soon see benefits.


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