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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
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How EHR Data Exchange Drives Healthcare Reform, Improvement

How EHR Data Exchange Drives Healthcare Reform, Improvement | EHR and Health IT Consulting | Scoop.it

Increased EHR data exchange is beginning to play an important role in reforming the healthcare industry and enhancing the quality of care. Essentially, EHR data exchange is being used to transform the efficiency of care, engage patients, support population health management, and boost healthcare quality.

The Office of the National Coordinator for Health Information Technology (ONC) explains that the benefits of exchanging EHR information include reducing test redundancy and improving efficiency by ensuring all healthcare professionals handling a patient’s care have access to the same data. Additionally, EHR systems provide a more streamlined approach to administrative tasks and in doing so the costs associated with these aspects of care are reduced.

Through patient portals and the curtailing of redundant paperwork due to the growth of health information exchange (HIE), patient engagement is also increased. In fact, the Centers for Medicare & Medicaid Services (CMS) has elevated the importance of patient engagement by incorporating patient-centered conditions into Stage 2 Meaningful Use requirements.

For example, the EHR Incentive Programs calls for patients to be able to access their health information and communicate with their healthcare professionals electronically. Many patients have already received follow-up or preventive care reminders and used a patient portal to access their medical data such lab test results and current medication lists. Privacy and security of these messaging services are also of the utmost importance to the healthcare field, as it is a major part of Stage 2 Meaningful Use requirements.

As part of its Health IT Success Stories series, ONC discussed the patient engagement initiatives at Helping Hands Pediatrics, Inc., a small clinic located in Sharon, Penn. Using this practice’s assessment tools, patients with asthma are able to contemplate how the condition influences their day-to-day life.

“Through the integration of assessment tools, the children in our practice really get a chance to think about their disease and how it affects their daily life. This sense of ownership in their disease management was well worth the effort,” Office Manager Angie Chlpka told ONC representatives.

Along with increasing patient engagement, EHR data exchange improves population health management by allowing physicians to coordinate with public health officials and improve community health initiatives.

EHR systems can improve public health reporting by offering an efficient data collection process with the ability to share information across various healthcare facilities. For example, immunization registries and electronic laboratory reporting provide a streamlined system in which physicians can send population health data to public health officials.

This type of information exchange could play a large role in studying, preventing, and managing disease. For instance, clinicians should be able to receive alerts on major public health concerns in the near future. EHR technology also offers a way to improve communication and collaboration between public health officials and physicians.

One of the most important roles EHR systems play in healthcare reform is in quality improvements. EHR technology is poised to reduce medical errors and drug prescription mistakes. On the whole, this should lead to better patient health outcomes and improved safety.

Accurate and error-free EHR data is tied directly to quality improvements in the healthcare industry. Poor or insufficient data, on the other hand, will reduce patient safety and undermine the effectiveness of HIE, according to the American Health Information Management Association (AHIMA).

Enhanced decision-making and quality care delivery is directly linked to complete and accurate EHR data. In order to ensure data quality is first-rate, AHIMA advises medical organizations to focus on data capture and improving clinical documentation practices. Also, incorporating uniform data models will better establish the reliability of the information stored in EHR systems.

Whether it’s patient engagement and greater healthcare efficiency or better population health management capabilities and quality improvements, the collection and sharing of EHR data plays a large role in the ongoing healthcare reform across the nation.


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Stage 3 Meaningful Use proposals at White House for final review

Stage 3 Meaningful Use proposals at White House for final review | EHR and Health IT Consulting | Scoop.it

Why do these things always seem to happen late on Friday afternoons? At least this time it’s not right before a holiday. Actually, with a bit more inspection, I see that it did happen right before a holiday.

HIMSS is reporting today that the White House’s Office of Management and Budget is “in its final stages of review” of the proposed rules for Stage 3 of the Meaningful Use EHR incentive program. OMB always goes over proposed and final regulations to measure the fiscal — and, presumably, political — impact before allowing executive-branch agencies to make public releases.

A peek at OMB’s reginfo.gov site indicates that the MU Stage 3 proposal from CMS and related ONC plan for certification of EHRs are indeed at OMB for final review.

“We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients. Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements,” CMS states in a rule summary on the OMB site.

A placeholder date (“02/00/2015 “) on the same page suggests that the proposal will be published in February. However, a placeholder date on the page for the forthcoming ONC certification standards indicates that the plan was supposed to come out in November.

And the date the two notices appeared on the reginfo.gov? Dec. 31, when pretty much everyone was already checked out for the extended New Year’s weekend.

Stage 3 is scheduled to start no earlier than Oct. 1, 2016, for hospitals and Jan. 1, 2017, for individual providers.


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IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?



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FDA Expands EHR Data Analytics with Active Surveillance System

FDA Expands EHR Data Analytics with Active Surveillance System | EHR and Health IT Consulting | Scoop.it

The Food and Drug Administration’s Sentinel Initiative, one of the first active surveillance infrastructures focused on identifying patient safety issues related to pharmaceuticals and other medical products, will expand past its pilot phase this year, announced Janet Woodcock, MD, Director of the Center for Drug Evaluation and Research in a blog post.  As a planned continuation of the Mini-Sentinel project, the full-scale system will allow the FDA to leverage advanced EHR data analytics by scanning millions of files for adverse events linked to drugs that fall under the Administration’s purview.

“Over the past five years, the Mini-Sentinel pilot program has established secure access to the electronic healthcare data of more than 178 million patients across the country, enabling researchers to evaluate a great deal of valuable safety information,” Woodcock writes. “While protecting the identity of individual patients we can get valuable information from Mini-Sentinel that helps us better understand potential safety issues, and share with you information on how to use medicines safely. We have used Mini-Sentinel to explore many safety issues, helping FDA enhance our safety surveillance capabilities, and giving us valuable input in decision-making on drugs and vaccines.”

The Sentinel Initiative differs from previous drug safety monitoring efforts in that it allows FDA researchers to actively dive into EHR data and insurance claims to analyze potential adverse events and establish links to specific pharmaceutical products.  This allows the FDA to work more quickly to identify problems than if they continued to rely on voluntary reporting alone.  Mini-Sentinel has previously confirmed the safety of two vaccines intended to protect infants against rotavirus after the voluntary recall of a third product that raised the risk of intussusception in patients who received the immunization.

The expansion of the project will build upon successful use cases from Mini-Sentinel, Woodcock says.  The FDA will refine its EHR data analytics methodologies as it continues to grow into what the Administration hopes will be a national resource at the center of an industry-wide collaboration between researchers, pharmaceutical developers, and other healthcare stakeholders.

The success of this vision relies on cooperation from academic and research partners, all of whom will need to further develop industry data standards for the system to function effectively.  “This work will allow computer systems to better ‘talk’ to each other and, ultimately will lead to better treatment decisions as clinicians will have a more complete picture of their patients’ medical histories, including visits with other providers,” Woodcock wrote in a previous blog post touting the success of the pilot system.  “Defining standards for capturing data from clinical trials, and using standard terms for items such as ‘adverse events’ or ‘treatments’ will allow researchers to combine data from different clinical studies to learn more.”

“From the outset, the goals of the Sentinel Initiative have been large and of ground-breaking scale,” she concludes. “We knew it would be years in the making, but Mini-Sentinel’s successful completion marks important progress. We look forward to continuing and expanding our active surveillance capabilities as we now transition to the full-scale Sentinel program.”


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Why Should Your Practice Have a Cloud-Based EHR? - HITECH AnswersHITECH Answers

Why Should Your Practice Have a Cloud-Based EHR? - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

If you’re still debating whether to go with a web-based EHR or a server-based EHR, you should know why a growing number of practices are choosing to go with a cloud EMR.

How does a web-based EMR differ from the older technology of a client server-based EHR system?

A cloud EMR is different (and better, in our opinion) due to the following factors:

Your software is always up to date
With a web-based EMR, the software is always up to date, usually at no additional charge. No more expensive upgrades causing delays; just open the SaaS-based software and you have the latest version.

Rest easy on HIPAA data requirements
Data security is much easier to manage with a web-based system. Cloud EHR vendors can provide much more security for your data than you can internally with office servers. As reported by the Business Insurance site, “Data breaches seem to be everywhere these days except the one place everyone fears—the cloud.” That could be because cloud EMRs offer financial-level security for your data.

Accessibility—work from anywhere
One of the things many users love about the cloud is the ability to work from anywhere—whether it’s e-prescribing from a smartphone or checking a patient record from the beach while on vacation. We don’t recommend you work on your vacation, but we understand the realities of medical practice.

Cloud-based EHR systems allow continued functioning during and immediately after disasters
Hospitals and physicians discovered the benefits of cloud-based data first after Hurricane Katrina and again after Super Storm Sandy; with a web-based system, you can practice (and bill) from anywhere.

Reduced expense for both software and hardware
A cloud-based system is more cost-effective, particularly for small to medium sized practices, since there are no large hardware expenditures and the software expense is a consistent, low subscription rate. You won’t have to plan for large hardware and software expenditures.

Better IT support
Damn it, Jim, you’re a doctor—not an IT person. And you will probably not be able to hire IT support of the same caliber as the staff of a web-based EHR vendor. Why not make use of their resources and eliminate your headaches?

You can use a cloud-based EHR on a mobile device such as an iPad or other tablet
A survey of physicians by web-based EHR review group Software Advice showed that 39% of physicians want to use their EHR on a tablet such as iPad, and in another survey, a majority of patient respondents indicated that they find use of an EHR on a tablet in the exam room to be “not at all bothersome.”

Satisfaction levels are higher among mobile EHR users
A recent survey by tablet-based EHR review group Software Advice found that providers using a mobile EHR expressed twice the satisfaction levels of those using EHRs via non-mobile systems. And as mentioned above, an effective mobile EHR needs to be cloud-based.

It’s particularly important to note that cloud-based systems are nearly always more secure than any system you could set up in your office. For most practices, data security and HIPAA best practices are not their area of expertise—excellent patient care is. But for cloud EMR systems, those areas are key to our success. We are better at it because we must be in order to continue in business. And as mentioned above, the proof is in the lack of data breaches among cloud-based companies.

One proof of the idea that a cloud-based EHR is the best choice is the fact that most EHRs that were originally server-based have since developed cloud-based offerings as well. If server-based technology is state of the art, why are those vendors switching platforms?


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2015 Hospital Healthcare IT Predictions | Hospital EMR and EHR

2015 Hospital Healthcare IT Predictions | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

At the start of 2015, I thought I’d put down some predictions on what will happen in the world of healthcare IT and EHR. These won’t be crazy predictions, since I don’t think anything crazy is going to happen in healthcare in 2015. We’ll see some clarity with a few programs and we’ll some some incremental change in things that matter to hospitals.

ICD-10 – I predict that ICD-10 will again be delayed with the next SGR fix. I don’t have any inside information on this. I just still believe that nothing’s different in 2015 that wasn’t true in 2014 (maybe AHIMA’s lobbying harder for no delay). I think another delay will put all of ICD-10 in question. Let’s hope whatever the decision is on ICD-10, it happens sooner than later. The ICD-10 uncertainty is worse than either outcome.

Meaningful Use – MU stage 2 will change from 365 days to 90 days. It will probably take until summer for it to actually happen which will put more people in a lurch since they’ll have even less time to plan for the 90 days than if they just made the change now. MU stage 2 numbers will be seen as great by those who love meaningful use and terrible by those who think it’s far reaching. The switch to 90 days means enough hospitals will hop on board that meaningful use will continue forward until it runs out of money.

EHR Penalties – Doctors will be blind sided by all the penalties that are coming with meaningful use, PQRS, and value based reimnbursement, even though it’s been very clear that these penalties are coming. Doctors will pan it off on “I can’t keep up with all the complex legislation.” and “I knew the penalties were coming, but I din’t think they’d be that big.” Watch for some movement to try and get some relief from these penalties for doctors. However, it won’t be enough for the doctors who want to start a perpetual SGR fix like delay of the EHR penalties. Many practices will have to shut down because of poor business management.

Direct to Consumer Medicine – Doctors will start to move towards a number of direct to consumer medicine options such as telemedicine and concierge medicine. These doctors will love their new found freedom from insurance reimbursement and the ongoing hamster on a treadmill churn of patients through their office. How far this will go, I’m not sure, but it will create a gap between these doctors who love this “new” form of medicine and those who feel their stuck on the treadmill.

Interoperability – 2015 still won’t see widespread healthcare interoperability, but it will help to lay a clear framework of where healthcare interoperability needs to go. A couple large EHR vendors will embrace this framework as an attempt to differentiate themselves from their competitors.

There you go. A few 2015 predictions. What do you think of these predictions? Any others you’d like to make? I feel like my predictions feel a little bit dire. A few show signs of promise, but I think that 2015 will largely be a transitory period as we try to figure out how to get the most value out of EHR.

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How Innovative EHR Use Supports Care Quality Improvements | EHRintelligence.com

How Innovative EHR Use Supports Care Quality Improvements | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Care quality improvements through innovative EHR use are front and center at University of Missouri (MU) Health Care. Over the past few years, the organization has climbed the rankings awarded by the University HealthSystem Consortium (UHC) and now is one of a dozen academic medical centers to receive a Quality Leadership Award in 2014.

According to the head of the organization, MU Health Care owes much of its progress to its work through Tiger Institute for Health Innovation, a private/public partnership between the University of Missouri and Cerner Corporation.

“So much of the EMR is documentation, patient safety, etc., so our ranking and technology use are closely related and correlated,” MU Health Care CEO & COO Mitch Wasden, EdD, tells EHRIntelligence.com. “Three years ago we were 56 out of 141 academic medical centers, last year we were 27th, and this year were 9th.”

Several years ago, MU Health Care took a risk, albeit a calculated one (given the nature of the Tiger Institute), in choosing to outsource their health IT services to Cerner, but it has quickly paid dividends.

“As a vendor, they know the development pipeline — they know what products they’re making that are going to dovetail nicely with other products — so when we talk about what we want to do strategically with IT, they know exactly what the timelines are and how it can happen,” Wasden explains. “In my prior life, I have been in organizations that had their own IT shops. I also have been in organizations that did outsource IT and it was a disaster.”

A major benefit of the partnership is the ability of MU Health Care to shift its workload from supporting EHR and health IT systems to developing innovative ideas for improving the use of these technologies.

“When you bring up ideas with Cerner, they’re thinking about the value to all their clients. They see it more as an opportunity, a living lab, they can glean ideas from. From an innovation standpoint, I have seen that the uptake on ideas is much quicker,” Wasden says.

As a result of this freedom to innovative, MU Health Care has created the Plan, Do, Study, Act (PDSA) Model that challenges members of the organization to come up with quality improvement initiatives as a means of addressing each of those categories that gained the recognition of the likes of UHC.

As Wasden reveals, each of the 5,500 employees at MU Health Care are required to participate in two quality improvement projects annually — a bottom-up approach. “Healthcare is changing so fast that we need people on the frontlines thinking about how to change workflows because senior management is not close enough to it. We’re not going to have all the answers,” he adds.

To support the program, MU Health Care set out to create a database uniquely designed to log and track the progress of these quality improvement projects over a period of three years. The first two years aimed to support the logging of these projects and their completion. The third year brought with it a dozen or more metrics for quantifying the effectiveness of all this work.

“We don’t want to just have activity; we want to have results. That’s our development plan so that we can start quantifying in total what the impact is,” Wasden maintains.

Next wave of care quality improvements

Moving forward, Wasden sees innovation focuses on three closely related areas all centered on patient engagement. For his part, Wasden has been an outspoken advocate of the patient portal as key player in aggregating patient health information. It is no surprise then that MU Health Care is putting all of its eggs in that basket.

“We have been pretty aggressive about patient portal. In the future it’s about migrating it to be more of a mobile platform. Today, we’re one of a few organizations where you can go on to hundreds of doctors’ schedules and book your appointment without any permission from the clinic,” Wasden reveals.

MU Health Care is preparing to expand those scheduling options to include electronic visits, either real-time videoconferencing with clinicians or asynchronous texting visits. Currently, the $40 service is in its pilot stage in three offices.

The next thing we’re going to allow you to do is book electronic visits — video or asynchronous texting visits — for $40. We’ve built it and are actually piloting it in three doctors’ offices.

Additionally, making the patient portal more robust will soon include giving patients access to registry data in order to view the status of their medical conditions. But the most significant addition to the patient portal is likely to be the use of a patient-facing dashboard for patients to see procedures based on their age, sex, and medical condition that they should complete in a given time period.

“In healthcare based on your age, sex, and medical condition, there are probably five or six things every year you should have done, but you’re just not tracking it,” Wasden explains. “We’re taking your age, sex, and medical condition and pushing to the portal the things you need to have done this year and click here to schedule. Now we’re showing to the patient the value of integrated medical care.”

Integration is the impetus behind the expansion of the patient portal at MU Health Care, a solution to fragmentation in care delivery. The organization is banking on getting patients signed up for and using the patient portal and aggregating disparate health data in one place. “When you look at this age of biometric data, we really think that your portal is going to become the aggregator,” says Wasden.


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Report: Epic, Cerner Leading “Next Wave” EMR Vendors

Report: Epic, Cerner Leading “Next Wave” EMR Vendors | EHR and Health IT Consulting | Scoop.it

Nearly half of large hospitals surveyed will be making a new electronic medical record (EMR) purchase by 2016, according to a recent report from the Orem, Utah-based KLAS research. Of those planning on making a change, Verona, Wisc.-based Epic and Kansas City-based Cerner are the leading contenders among EMR vendors.

KLAS interviewed 277 providers from large hospitals (200+ beds), which gave feedback on what vendors they are considering, why they are considering them, and what their timelines look like for making these purchases. The survey was good news for Epic and Cerner. Forty-six percent of those respondents who mentioned Epic and 23 percent who mentioned Cerner were leaning towards choosing them for their second EMR purchase. Next was McKesson and Meditech, with 19 percent each. At the low end of the totem poll was Siemens at 9 percent and Allscripts with 4 percent.

Furthermore, 79 percent who mentioned Allscripts said they were steering clear of the company and 82 percent said the same of Siemens. Siemens, McKesson, and Allscripts were the most likely EMR systems to be replaced by the providers. Not a single person with Epic plans on replacing that system.

“Where the last round of EMR purchases was fueled by meaningful use requirements and enticing reimbursements, this next round is being fueled by concerns about outdated technology and health system consolidation,” report author Colin Buckley. “This shift in focus will play a major factor in which EMRs are being considered.”

Integration is a huge reason why Epic and Cerner are doing well. KLAS says Epic is seen as safe due to “total integration” and reliable delivery. Cerner, too, is a market leader due to integration and expansive functionality. The only caveat to Cerner’s success is its revenue cycle stability. On the other end, Allscripts lack of integration has turned away buyers. Although, current customers are encouraged by the company’s change in management (Paul Black became CEO in late 2012) and acquisitions of Jardogs and dbMotion.


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Why most EHR’s will fail, is yours next? - referralMD

The main goals when it comes to the healthcare industry today, the care of the patient in the most efficient manner possible. Time is also a factor in both the care and efficiency.

The purpose of EHR – Electronic health records is to get the needed information quickly and make sure the patient is on the right path for his or her medical care. The other big concern is the safety of these records.

The traditional EHR has its challenges

In an article on Government Health IT (July 16, 2012), Craig Collins, wrote about the problems involving the management of health records in a traditional data-center. His concerns are listed below.

Forty percent of large patient health data breaches involve lost or stolen devices, according to the U.S. Department of Health and Human Services.
The actions of insiders – negligence or willful misconduct by employees and contractors – accounted for nearly three times as many patient record security breaches as external attacks, said a report last year by the Privacy Rights Clearinghouse.
Less than 2 percent of healthcare data breaches were from hacking. More than 10 percent were from insider theft or data lost or stolen when being physically transported somewhere else, according to a 2011 survey by the Identity Theft Resource Center.
Insider attacks are more costly than outsider attacks, both in dollars and damaged reputation, said a cyber-security survey by CSO magazine last year.

Robert Rowley, MD, also writing for the same site on (July 18, 2012) talks about how the EHR Market is being flooded with vendors.

As a result, large established EHR companies, some of whom have been around for 15 years or more, are experiencing competition from a wave of smaller start-ups – some successful, others not.
The beginning of the end – EHR failures

This scenario seems ripe for consolidation. Market forces, however, are rather Darwinian – novel approaches abound (“mutation”), but many will not achieve market penetration (“selection”). Failure of products, even well-designed ones, are part of the start-up experience – true in all market spaces, not just health care.

These companies are reaching out to two distinct categories of EHRs, ambulatory and the hospital. Dr. Rowley goes into detail in his July 15th article, Comprehensive EHR market analysis.

It is important for all medical practices on any level to do as much research as possible to make sure that their investment is a solid, well-chosen one. Attention to Security, by means of a Secure socket layer (SSL) and AES-256 bit encryption should be used. Accessibility, and integration with other networks is critical in our hi-tech world.

According to EHR Scope, in their article, “Is an EHR Usable” (May 25, 2012), there are three main components.

Effectiveness
Efficiency
User Satisfaction
Check out this article we wrote called “When was the last time you gave your practice a Checkup” and learn some ways to make your office more efficient

All of this helps to keep lost time under control. Lost time, lost reports mean lost money and that is not needed in today’s economy. Efficiency, effectiveness, action as well as follow through are the keys to keeping it all under control. Make sure you know how the system functions so you can recognize the benefits you will get through using an electronic health records system.

When it comes to user satisfaction, does it fit your needs? Are you able to personalize settings in the system menus, in the screens and reports? When these are available “their comfort level improves.”

What can develop over time is a smoothly functioning network of physicians, specialists and outpatient testing. As everyone becomes more familiar with how efficient the system functions, it will build up a solid rapport among them. There will be more satisfied patients as well.
Concerns about the current system?

What are your main concerns? Do you have any questions to ask as you seek to move forward and upgrade your practice to electronic health records?
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CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com

CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

While this week marks the end of one and beginning of another year, those in the healthcare industry should take note of all that transpired in the previous year to avoid similar setbacks in 2015. This is especially true for matters scheduled to have been addressed over the last 12 months.

ICD-10 delays, meaningful use changes, health IT vendor competition, and EHR implementation gaffes. Based on the interest of our readers, those were the most popular topics of 2014 on EHRIntelligence.com.

ICD-10 transition delay one more year

More than any other topic on our news site, ICD-10 garners the greatest amount of our readership’s attention and given its high stakes, it makes sense. This past October was supposed to usher in a new era of clinical coding — the move from ICD-9 to ICD-10 — and put the United States on par with other leading nations in terms of healthcare documentation.

The Congressional debate over the sustainable growth rate (SGR), however, swiftly dashed those visions. Close to one week after expectations began to build that Congress would vote on an SGR patch that included a one-year ICD-10 compliance delay, the Senate voted in favor of the bill. While the rest of the nation took this as business as usual on the Hill, the healthcare industry scrambled to put new plans together for postponing their 2014 ICD-10 implementation activities.

What the delay meant to providers depended on where they practices. Larger healthcare organizations reported high levels of ICD-10 readiness while some smaller physician groups and practices were completely unsure where they stood. No matter their view of the most recent ICD-10 delay, most are committed to removing ICD-10 implementation pain points to be ICD-10 ready by Oct. 1, 2015.

The bending but not breaking of meaningful use

This past year began with eligible professionals and hospitals working to achieve Stage 2 Meaningful Use, but that is hard to do when certified EHR technology is unavailable.

Early hints of changes to meaningful use reporting in 2014 emerged as early as February when the Centers for Medicare & Medicaid Services (CMS) introduce a new meaningful use hardship exception dealing with a lack of available CEHRT.

In September, the federal agency finalized a rule intended to give providers greater flexibility in meeting meaningful use requirements in 2014 — known as the flexibility rule. However, this did not turn out to be CMS’s final move.

The flexibility rule was followed by the reopening of the meaningful use hardship exception application submission period for both EPs and EHs and the extension of the 2014 meaningful use attestation period for EHs and critical access hospitals through the end of the year.

Despite their intentions, neither has put to rest repeated calls for 2015 meaningful use reporting requirement changes by industry stakeholders.

Heading to a showdown

Prognosticators in health information technology (IT) have foreseen consolidation in the marketplace over the next few years. But it is unlikely that they saw things playing out as they did in 2014.

Cerner’s acquisition of Siemens Health Siemens over the summer is an example of how quickly and dramatically the market can change. Most viewed the maneuver as a power play by the Kansas City-based health IT company to contend with Epic Systems and its market share among health systems and hospitals.

While the growth of both Cerner and Epic continues to loom large over the industry, they still have to contend with numerous other players in the ambulatory care space, especially given Epic’s recent loss to athenahealth as the top overall software vendor over the past year.

Expect more to come.

Squeaky wheel gets the grease

When EHR implementations go well, those involved in the process are more than willing to share details of their experiences. When they don’t, it is like pulling teeth.

Poorly managed EHR implementations can prove costly. The University of Arizona Health Network saw red of a different variety as a result of its Epic EHR adoption. Whidbey General Hospital felt the financial effects of a software glitch in its MEDITECH EHR that crippled its billing system and left it short on cash. Meanwhile, a Cerner EHR implementation gone awry led to the dismissal of Athens Regional Medical Center’s CEO.

If 2014 was a busy year, then 2015 is only likely to be busier. Stay with us as we continue our coverage of meaningful use, EHR and ICD-10 implementation, and anything else health IT-related that comes our way.



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Given access, some patients would hide EHR data, Regenstrief shows | Healthcare IT News

Given access, some patients would hide EHR data, Regenstrief shows | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

A recent study led by the Regenstrief Institute raises interesting questions about patient health data: who controls it, who sees it in the electronic health record and how it should be shared across the care continuum.

Billed as the "first real-world trial" exploring patient-controlled access to EHRs, the Regenstrief research, done in partnership with Indiana University School of Medicine and Eskenazi Health, showed that nearly half of those who participated withheld clinically sensitive information from some or all of their care providers.

"We learned that patients have widely different opinions of what kinds of their healthcare data they would like visible to different members of their healthcare team and others, such as health services researchers, who might have access to information in their electronic medical record," said Regenstrief President and CEO William Tierney, MD, principal investigator of the project, in a statement.

During the six-month trial, 105 patients in an Eskenazi primary care clinic were given the opportunity to indicate preferences for which clinicians could access sensitive data in the EHR – information on sexually transmitted diseases, substance abuse or mental health, for instance – and choose what the clinicians could see.

Regenstrief informatics developers then created a system where those preferences guided what data doctors, nurses and other clinicians could see.

Patients were able to hide some or all of their data from some or all providers but, importantly, those providers could override their preferences and view any hidden data if they felt the patient's healthcare required it.

When providers hit this "break the glass" button, the program recorded the time, the patient whose electronic chart was being viewed and the data displayed.

Forty-nine percent of the 105 patients who participated elected to withhold information contained in their medical record from some or all of their healthcare providers.

While patients were in favor of such control, their providers had mixed reactions. Some just wanted to make sure patients were aware that hiding information could adversely affect their care; others "strongly objected" to not being able to see all of the information in their patients' records, not wanting to be responsible for bad or unsafe care, according to researchers.

"Fair Information Practice Principles – federal guidelines focusing on privacy issues – dictate that patients should control all access to information in their medical records; but hiding information from doctors could have dangerous repercussions," said Tierney in a statement.

"Yet without having control over who sees sensitive information in their electronic charts, patients may not be willing to tell such things to their doctors and nurses," he added. "So there is a tension between patients who should have control over their health information and doctors who may not serve them well, and may actually harm them, if important information is hidden."

This study, was supported in part by a $1.6 million grant from the Office of the National Coordinator for Health IT to the Indiana Health Information Technology Corp.

"To the best of our knowledge, a trial like ours has never been attempted before, and we believe it presents an opportunity to shape national policy based on evidence," said Tierney.



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CMS Provides Details about ICD-10 End-to-End Testing Weeks | EHRintelligence.com

CMS Provides Details about ICD-10 End-to-End Testing Weeks | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

With the deadline for physicians, providers, suppliers, clearinghouses, and billing agencies to apply to take part in the next wave of ICD-10 end-to-end testing, the Centers for Medicare & Medicaid Services (CMS) is providing a closer look at these ICD-10 preparation activities.

The application deadline for volunteer testers to participate in ICD-10 end-to-end testing between April 26 and May 1 is scheduled for January 9. Those who are already slated to participate in ICD-10 end-to-end testing next month do not need to re-apply.

“Approximately 850 volunteer submitters will be selected to participate in the April end-to-end testing,” the federal agency announced earlier this week. “This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers.”

After April’s testing week, physicians, providers, suppliers, clearinghouses, and billing agencies will have one final end-to-end testing week to be a part of between July 20 and 24.

In a list of frequently asked questions (FAQs) released alongside this call for ICD-10 end-to-end testing volunteer applications, CMS details components of the testing activities ranging from differences between types of testing as well as the data used during the testing process.  Here’s a sampling:

How is ICD-10 end-to-end testing different from acknowledgement testing?

The goal of acknowledgement testing is for testers to submit claims with ICD-10 codes to the Medicare Fee-For-Service claims systems and receive acknowledgements to confirm that their claims were accepted or rejected.

End-to-end testing takes that a step further, processing claims through all Medicare system edits to produce and return an accurate Electronic Remittance Advice (ERA). While acknowledgement testing is open to all electronic submitters, end-to-end testing is limited to a smaller sample of submitters who volunteer and are selected for testing.

Is it safe to submit test claims with Protected Health Information (PHI)?

The test claims you submit are accepted into the system using the same secure method used for production claims on a daily basis. They will be processed by the same MACs who process production claims, and all the same security protocols will be followed. Therefore, using real data for this test does not cause any additional risk of release of PHI.

Last month, American Health Information Management Association (AHIMA) and eHealth Initiative found that some healthcare providers still lacked ICD-10 testing plans as well as assessments of the impact ICD-10 implementation would have on their facilities. According to their findings, ten percent of organizations did not have a plan in place for conducting end-to-end testing, with 17% having no clear understanding of when their organization will be ready to begin ICD-10 testing processes.

The AHIMA-eHealth Initiative survey gives credence to claims from Workgroup for Electronic Data Interchange (WEDI) that the most recent ICD-10 delay will cause many providers to postpone their ICD-10 testing activities until 2015 with potentially costly effects.

“Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production. We urge the industry to accelerate implementation efforts in order to avoid disruption on Oct. 1, 2015,” WEDI Chairman and ICD-10 Workgroup Co-chair, said in September.

Physicians, providers, suppliers, clearinghouses, and billing agencies applying to be part of April’s testing week will receive word from their Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractors in late January.



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Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR

Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

I think we could broaden the question even more and ask if any EHR vendor has really fostered healthcare innovation. I’m sorry to say that I can’t think of any real major innovation from any of the top hospital EHR companies. They all seem very incremental in their process and focused on replicating previous processes in the digital world.

Considering the balance sheets of these companies, that seems to have been a really smart business decision. However, I think it’s missing out on the real opportunity of what technology can do to help healthcare.

I’ve said before that I think that the current EHR crop was possibly the baseline that would be needed to really innovate healthcare. I hope that’s right. Although, I’m scared that these closed EHR systems are going to try and lock in the status quo as opposed to enabling the future healthcare innovation.

Of course, I’ll also round out this conversation with a mention of meaningful use. The past 3-5 years meaningful use has defined the development roadmap for EHR companies. Show me the last press release from an EHR company about some innovation they achieved. Unfortunately, I haven’t found any and that’s because all of the press releases have been about EHR certification and meaningful use. Meaningful use has sucked the innovation opportunity out of EHR software. We’ll see if that changes in a post-meaningful use era.



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Can True EHR Customization Help Physician Practices Survive?

Can True EHR Customization Help Physician Practices Survive? | EHR and Health IT Consulting | Scoop.it
In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.

It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.

Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today’s world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.

This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from “corporatized” healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.

Capable and cost-effective?

So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government’s evolving mandates that regulate healthcare record-keeping.

In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.

And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way, and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence ‘Rusty’ Hofmann in The Huffington Post, describes it, EHRs are like Model T Ford: Any Color You Want As Long As It’s Black.” The majority of these solutions hitting the market today just don’t cut the mustard when it comes to really addressing the needs of our country’s doctors and healthcare practices.

Furthermore, while the creators of many of these packaged EHR solutions claim to be “customizable,” they are actually merely “configurable.” Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.

These solutions also require heavy reliance on a computer screen, which often hinders a doctor’s ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.

Diversity and true EHR customization rule

So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.

In short, it is crucial that developers of these software tools accommodate doctors’ needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.

This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.


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What Gets Measured Gets Managed - HITECH AnswersHITECH Answers

What Gets Measured Gets Managed - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I’ll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can’t deny that data doesn’t lie and when we measure data, we can manage it.

Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group’s practice manager was new to the organization and tasked with the responsibility of managing the eligible providers’ progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.

The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn’t sure if they could meet the patient engagement requirements and she didn’t know where they stood with the newly introduced objectives.

She asked for support through her network and found me.

Data > Information > Knowledge

I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)

 

I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).

They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.

We had 90 days to turn this around.

Team Work

Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.

Meaningful Use is a team sport, after all.

The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.

We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.

With each week’s reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.

Getting Creative with the Portal

In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.

Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and  gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.

They even told patients what to say:

Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]

This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.

The First Big Win

Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.

Their main focus on closing out the year was to keep up the good work.

Non-Percentage Based Objectives

Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.

Lessons Learned

1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.

2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.


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Physician Office EHR Adoption Increases, Meaningful Use Lags

Physician Office EHR Adoption Increases, Meaningful Use Lags | EHR and Health IT Consulting | Scoop.it
Physician offices continue to adopt EHR technology so why is meaningful use participation being ignored by these eligible providers?

Physician office EHR adoption continued its upward swing between 2013 and 2014, but less than half of physicians in a recent survey report plans to attest for Stage 2 Meaningful Use.

The last bit of news comes from a survey of nearly 2000 members of SERMO, the online social network for physicians. Frank Irving of Medical Practice Insider reports that 55 percent of respondents will not demonstrate Stage 2 Meaningful Use in 2015, 994 of 1816 to participants.

Eligible professionals have until the end of next month — February 28 — to attest for meaningful use in 2014. According to the Centers for Medicare & Medicaid Services (CMS), more than 257,000 EPs are receiving 2015 Medicare payment adjustments for failing to demonstrate meaningful use as part of the Medicare EHR Incentive Program prior to 2014. That number is less close to 60,000 EPs who successfully filed for a meaningful use hardship exception during one of the two application periods in 2014. Those failing to demonstrate meaningful use in 2014 will be subject to Medicare payment adjustments in 2016.

It is unclear whether respondents to the SERMO survey are referencing their 2014 meaningful use reporting as the attestation period runs through the end of February 2015 or if they have chosen one of several options in a meaningful use flexibility rule or received a meaningful use hardship exception. That 55 percent could therefore prove misleading.

Continued growth of physician office EHR use

Whatever the reasons behind these responses from SERMO members, physician office EHR adoption is on the rise. An ongoing study by SK&A indicates a ten-percent increase in physician office adoption of EHR technology between 2013 and 2014. What’s more, it provides a breakdown of the top-five EHR vendors nationally and regionally.

At the national level, Epic Systems controls 30 percent of the market followed by eClinicialWorks (22%), Allscripts (19%), Practice Fusion (16%), and NextGen Healthcare (13%).

A closer look by region shows a close competition between Epic Systems and eClinicalWorks for EHR selection by physician offices.

The former dominates the West, Midwest, and East regions of the United States. The latter holds sway in the South and New England regions. Here’s a region-by-region breakdown:

West
Epic (25%)
eCW (23%)
Practice Fusion (20%)
NextGen (17%)
Allscripts (15%)

Midwest
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

South
eCW (30%)
Allscripts (23%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

East
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

New England
eCW (31%)
Allscripts (24%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

Interestingly, where neither is first both companies drop to the third or fourth spots. Considering that both companies specialize in working with health systems and hospitals, their domination of various markets may indicate the ownership of physician practices and use of that health system’s or hospital’s EHR technology.

Despite the increased implementation and use of EHR technology by physician offices, their physicians have a ways to go in order to keep pace with the evolution of the EHR Incentive Programs.


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Developing a Specialty-Specific Action Plan for ICD-10

Developing a Specialty-Specific Action Plan for ICD-10 | EHR and Health IT Consulting | Scoop.it

As the calendar turns over to the beginning of a new year, the healthcare industry begins yet another countdown towards an autumn implementation date for ICD-10.  With just under ten months left until the most recent deadline of October 1, 2015 – and that date likely to stick thanks to Congressional support and a growing chorus of healthcare stakeholders endorsing the switch – healthcare providers may not have the luxury of banking on an additional delay.  Organizations can make the most of their remaining time by using CMS resources to develop a specialty-specific action plan that will carry them through their ICD-10 prep for the rest of the year.

The Centers for Medicare and Medicaid Services has provided a number of transition resources to providers who may not be sure what is required for the ICD-10 switch or how to achieve transition benchmarks.  Among these Road to 10 tools is an interactive timeline feature which allows providers to select their practice type, size, progress, and business partners to formulate a personalized plan.

The action plan tool provides common specialties with tailored information, including the clinical documentation changes necessary for the most common ICD-10 codes and sample clinical scenarios for practice.  For cardiologists, for example, the literature reminds practitioners that a myocardial infarction is only considered acute for a period of four weeks after the incident in ICD-10 compared to 8 weeks in ICD-9.  Orthopedists are prompted to remember the specificity requires to accurately code a bone fracture, including the type of fracture, localization, healing status, displacement, and complications, while obstetricians will need to distinguish between pre-existing conditions and pregnancy-related issues when documenting complications.

For the 27% of providers who have not planned to start their ICD-10 testing as of November, and especially the 30% who admitted that a lack of understanding had them stalled, the Road to 10 timeline provides detailed steps to achieve internal and external testing of systems.  From identifying sample cases for testing to coordinating with external business partners and fixing any problems that arise from the process, the resource allows providers to review checklists and suggestions that will set them on their way towards a successful testing period.

CMS suggests that healthcare providers have their internal testing already completed by this point in the process, and is currently seeking volunteers for their end-to-end testing week scheduled for the end of April.  According to the timeline, the external testing process is likely to extend through July as organizations coordinate with their payers and clearinghouses, but the number of providers that are significantly behind these recommended timeframes means that many in the healthcare industry are likely to experience a sharp crunch up against the October deadline.

Providers that are struggling with the sheer volume of tasks associated with the ICD-10 switch may benefit from using the Road to 10 toolset and exploring CMS resources on the transition to identify common pitfalls that may strike their specialty or size of practice.


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Time for Government to Step Out of the Way of EHR and Let the Market Takeover? | Hospital EMR and EHR

Time for Government to Step Out of the Way of EHR and Let the Market Takeover? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

The always interesting and insightful John Moore from Chilmark research has a post up that asks a very good question. The question is whether it’s time for the government to get out of the EHR regulation business and let the market forces back in so they can innovate. I love this section of the post which describes our current situation really well:

But as often happens with government initiatives, initial policy to foster adoption of a given technology can have unintended consequences no matter how well meaning the original intent may be.

During my stint at MIT my research focus was diffusion of technology into regulated markets. At the time I was looking at the environmental market and what both the Clean Air Act and Clean Water Act did to foster technology adoption. What my research found was that the policies instituted by these Acts led to rapid adoption of technology to meet specific guidelines and subsequently contributed to a cleaner environment. However, these policies also led to a complete stalling of innovation as the policies were too prescriptive. Innovation did not return to these markets until policies had changed allowing market forces to dictate compliance. In the case of the Clean Air Act, it was the creation of a market for trading of COx, SOx and NOx emissions.

We are beginning to see something similar play-out in the HIT market. Stage one got the adoption ball rolling for EHRs. Again, this is a great victory for federal policy and public health. But we are now at a point where federal policy needs to take a back seat to market forces. The market itself will separate the winners from the losers.

His points highlight another reason why I think that ONC should blow up meaningful use. In my plan, I basically see it as the government getting out of the EHR business. I do disagree with John Moore’s comments that the government should step away from interoperability. If they do, we just won’t have interoperability. I guess he’d make the argument that value based reimbursement will force it, but not in the same way that the rest of the EHR incentive money could force the issue.

I have learned that to really get out of this game or even do what I describe will take an act of congress. HHS can’t do this without their help. Although, they could get pretty close. Plus, maybe they could exert their influence to get congress to act, but I won’t be holding my breathe on that one.


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Addressing Health Data Sharing Risks

Addressing Health Data Sharing Risks | EHR and Health IT Consulting | Scoop.it

As healthcare organizations step up their efforts this year to exchange more patient data with others to help improve care, it's urgent that they address the "significant risks" involved, says Erik Devine, chief security officer at 370-bed Riverside Medical Center in Kankakee, Ill.

The Office of the National Coordinator for Health IT, the unit of the Department of Health and Human Services that oversees policy and standards for the HITECH Act electronic health record financial incentive program, later this month expects to release a final draft of a "10-year roadmap" that includes an emphasis on the interoperability of EHR systems, paving the way for nationwide secure health data exchange. This comes as Congress is demanding more scrutiny of EHRs that "block" interoperable health information exchange, impeding efforts to improve access to data to boost care quality.


An important question that healthcare organizations need to ask as health information exchange gains momentum, Devine says in an interview with Information Security Media Group, is "Are we prepared to manage all the information that's flowing in and out of the system?"

To help defend against the increased risk of breaches during health information exchange, Devine says it's vital that healthcare providers use "very strong encryption methods for data in transit and at rest."

Plus, data needs to be inaccessible to anyone who doesn't need to access it "at every level, from the provider, to the healthcare information exchange steward, to the data that's sitting on the servers in the data center at your hospital. That is key for HIE to be successful," Devine stresses.

Healthcare organizations need to step up their defenses as they ramp up information exchange locally, regionally and nationally because "it's not going to be rocket science for [bad actors] to take this data," Devine says. "They're going to find vulnerabilities in these systems, they are going to find vulnerabilities in process or workflow, including a simple social engineering attack."

In the interview, Devine also discusses:

  • Advanced persistent threats facing healthcare, as well as the threats posed by employees and business associates;
  • The challenges involved with securing applications;
  • Riverside's top information security priorities and projects for 2015;
  • How his new position teaching computer science at a local university will potentially help him tap new talent and ideas for his organization.


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EHRs: It's time to start from scratch

EHRs: It's time to start from scratch | EHR and Health IT Consulting | Scoop.it

A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing.


They have multitudes of unnecessary meaningful use buttons that must be clicked because the government says so. They have data formats that are incompatible with other EHR systems. Doctors fumble around trying to enter orders using electronic physician order entry (POE). There is terrible user support. And so on. At the end of the day there is decreased productivity, doctors are unhappy, and patients are unhappy. Big brother in the form of the hospital and the state have more big data to look at, but certainly there doesn’t seem to be many benefits to patient care. The major benefit is to the companies that make these proprietary closed-source EHR systems. They get obscenely rich.

But surely there can be benefits to EHR systems? What about the ease of access to the patient’s chart? No more waiting for the chart to come up from medical records. In fact, no more medical records department at all! Aren’t we saving health care dollars by cutting out those jobs, as well as medical transcriptionist jobs and unit secretary jobs. Surely paper charts were worse?

Doctors should not turn away from information technology. After all, we use all sorts of sophisticated computer technology every day, from the internals of the ultrasound machine to the software running an MRI scanner, to the recording system used in electrophysiology procedures. There is a role for technology in our record keeping as well.

The problems with current EHR systems are manifold. They are hack jobs, with nightmarish interfaces that obviously were never user tested. They are overly ambitious, trying to do all things and thus doing nothing well. They are ridiculous. I mean, having doctors enter orders directly into a computer — seriously? EHR companies have no incentive to improve their user interfaces, because government mandates require that they are used no matter how awful they are. Those who don’t adopt these systems are penalized by loss of Medicare dollars.

I think it is an interesting thought experiment to consider how EHR systems would have been designed if they had been allowed to evolve naturally, without the frenzied poorly thought out incentives that exist in the real world. Imagine a world where physicians, the primary users of these systems, drove development and adoption of these systems. Imagine that there were no mandates or penalties from the government to adopt these systems. If a system was developed that improved physician workflow, it would be adopted. Nothing that slowed productivity, as the current EHR systems do, would ever be bought by a practice if the physicians made the call. Imagine EHR companies visiting practices, analyzing workflows, seeing areas that could be improved by computers, and recognizing areas that wouldn’t, at least with current technology. Imagine EHR companies testing their user interfaces using doctors from a spectrum of computer experience, as major software companies like Apple and Google do. Imagine them competing with each other not on how many modules they can provide, but on how few keystrokes or mouse clicks their system used to do the same work as another system. Imagine no government mandates for meaningful use, no dummy buttons that say “click me” but otherwise do nothing.

Think about how you would design a system. Certainly it is useful to have old records available online and we would want to keep that. The problem is how to get them there. Having physicians enter data is probably the least efficient way. Dictation and handwriting are still the fastest data entry methods. If Dragon is good enough (I’m not convinced it is) use it, or keep your transcriptionists around. They are very nice people who need jobs anyway. If handwriting recognition is good enough (I don’t think it is yet) use that, otherwise just store the written notes as pictures and be satisfied. In the ideal world, rather than force physicians to become typists and data entry specialists, we would wait until computer artificial intelligence was developed enough to allow the physicians to continue to do things the old way, with the computer processing the doctors’ notes transparently. If the technology isn’t there yet, develop it, but don’t push it on us prematurely.

Medical records primarily should exist to document important information about patients. It should not be primarily a means to ensure maximum billing of patients. If we eliminate that aspect, EHRs become much simpler. I would envision a small tablet that the MD carries everywhere with him or her. Keep the old workflow. Pull up patient records on the tablet. Write notes on the tablet in handwriting or dictate into it. The tablet transcribes the input and files it appropriately.

Need to give patient orders? Select from some templates or write them in. If the software is not good enough to transcribe written orders on a tablet, hire some unit secretaries to do this like they used to. Let them learn the intricacies of computerized order entry, and let the doctor deal with the intricacies of making diagnoses, doing procedures, and looking patients in the eye and grasping their hands when they are ailing — things that doctors do best. Minimize the interactions with the computer and maximize the interactions with the patients.

A good EHR system can simplify drug reconciliation, pull in drug data from patient pharmacies, and automatically identify patients who are being “overprescribed” pain meds. The system can look up recent relevant medical articles, can show appropriate medical guidelines, and can provide sophisticated medical calculators. There are so many good things computers can do for medicine. They’ve gotten an awfully bad rap from the current iteration of EHR systems. I think the technology exists or can exist to do all these good things, but there is no incentive if we remain satisfied with the status quo. The current systems don’t do any of these things. They just get in the way.

If we lived in an ideal world it would be time to chuck the lot and start over.


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EHR Incentive Program Status Report October 2014 - HITECH AnswersHITECH Answers

EHR Incentive Program Status Report October 2014 - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

As of October 2014, more than 418,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  In May 2013, CMS announced that more than half of all eligible health care providers had been paid under the Medicare and Medicaid EHR Incentive Programs. In August of 2014, HHS reported more physicians and hospitals are using EHRs than before. And in December of 2014, an ONC data brief released stated financial incentives and ability to exchange clinical information found to be top reasons for EHR adoption.

The Centers for Medicare & Medicaid Services (CMS) has released the most recent numbers for the EHR Incentive programs. Here are some Program-to-date highlights from this latest CMS report – October.

  • Active registrations of those completed totaled 505,641 breaking down with 335,964 Medicare EPs, 164,912 Medicaid EPs, and 4,765 hospitals.
  • 50 States and 5 territories have open Medicaid registration. For links to states’ Medicaid EHR Incentive Program websites, see your State EHR Incentive Program Milestones and Web Resources guide.
  • A total of 418,752 unique providers have been paid with breakdown of 268,010 Medicare EPs, 132,412 Medicaid EPs, 4,695 eligible hospitals, and 13,635 Medicare Advantage Organizations for EPs.
  • 39,271 EPs have received a HPSA bonus payment for program years 2011 and 2012.
  • 3,514 hospitals have received payments under both Medicare and Medicaid (of those, 727 were CAHs).
  • A total of $25,774,554,152 has been paid out in the program to date.
  • Medicare EPs have been paid $6,525,991,926 with the majority of those, Doctors of Medicine or Osteopathy receiving $5,880,245,369.
  • Medicaid EPs have been paid $3,360,689,785 with the majority of those, Physicians receiving $2,358,438,340.
  • Eligible hospitals have been paid $15,481,118,733 with Medicare only $597,234,756, Medicaid only $366,549,394, and Medicare/Medicaid $14,517,334,584.
  • Medicare Advantage Organizations For Eligible Professionals have been paid $406,753,707.
  • Medicaid EHR Incentive payments began in January 2011 and Medicare EHR Incentive payments began in May 2011.
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EHR Requires You to Reconsider Your Workflow

EHR Requires You to Reconsider Your Workflow | EHR and Health IT Consulting | Scoop.it

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.


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Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR

Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.



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Debating Viability of Universal Electronic Health Record | EHRintelligence.com

Debating Viability of Universal Electronic Health Record | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
How possible or impossible is the idea of having a universal electronic health record in the US? Our readers highlight the health IT obstacles in the way.

In concept, a universal electronic health record would eliminate many of the obstacles in the patient’s path along the care continuum. Such an idea, however, is not reality.

In searching for a solution to fragmented healthcare, the authors of a recent Harvard Business Review article pointed to the lack of a universal EHR as one factor in the way of integrated healthcare in the United States.

“The lack of a single health record for each patient that clinicians from all specialties can access in both inpatient and outpatient settings is an obstacle to integrating care. In addition, patient privacy protections inhibit the sharing of health information, creating both perceived and real hurdles,” wrote Institute for Healthcare Improvement and Weill Cornell Medical College’s Kedar S. Mate, MD, and the Permanente Federation’s Amy L. Compton-Phillips, MD.

The following question about universal EHRs was put to our audience: How possible or impossible is the idea of having a universal electronic health record in the US?

Three of our readers offered their insight into answering that question and their feedback providers more detail about the factors contributing to fragmented health data, highlighting how health data and privacy make the concept of a universal EHR highly unlikely.

The first set of comments comes from the head of a health IT privacy and security consultancy who recalls the work of the Nationwide Health Information Network and its inability to resolve interoperability after ten years of work:

I don’t think we’ll see anything like a universal EHR for the US for some time if ever. You have a significant number of vendors out there who would oppose this and may even call it a monopoly unless it was run by the government. At this time I really don’t think an EHR run by the government would be very popular with the voters in this country.

What I would settle for is true interoperability which we are a ways from. About 10 years ago ONC sponsored the Health Information Security and Privacy Implementation Collaborative which lasted for about three years. That was at the same time a fair amount of money and effort was being spent on building NHIN. It’s 10 years later and we still haven’t seen much progress on that front.

These comments were echoed by another health IT privacy and security consultant who highlighted the potential of local health information exchanges to make up for the lack of a national HIE infrastructure:

NHIN was about the only program I’d get behind, but it languished due to bureaucratic obesity. Too many consultants hired solely to work that project. Regional HIEs connected together would work, but the privacy implications in our government today worry me. Lots.

The last set of reader comments placed the concept of a universal EHR in the context of federal and state health IT regulations and policies (i.e., the requirements on covered entities and business associates under HIPAA) that continue to place limits on HIE, intentionally and unintentionally. These comments come from a regional health IT director with experience working with state HIEs:

Unfortunately some providers still see information as patient ownership. But the consumer will go to the provider that takes their insurance. Sharing that information between providers isn’t just required under MU it’s the morally right thing. I’ve seen and helped build numerous regional HIE and the amount of resistance regarding what to share and how much to share drives me crazy.

As for privacy, it’s bad enough that the consumer doesn’t fully understand HIPAA but providers still struggle with interpretation of the regulations. That struggle will continue as long as the OCR and HHS struggle with the “gray areas” left to the interpretation of the CE and BA.

Improved technical security is just a small part of the solution. The key was, is and always will be the policies, procedures and administrative piece of HIPAA. I’d venture to say most breaches in the past and most to come will be the result of provider employees failing to follow their training or choosing to intentionally ignore the patient right to medical and financial privacy.

Integrated is the focus of most current attempts at healthcare reform, but up to this point regulation and infrastructure have yet been able to work well together. As the comments from our readers clearly suggest, the resolution to interoperability is unlikely to come from those incapable of seeing the barriers in its path.


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Lessons learned from an award-winning EHR system replacement | Healthcare IT News

Lessons learned from an award-winning EHR system replacement | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

In 2012, ARcare undertook a fast-paced transition to a next-generation electronic health record system. Less than two years later, ARcare was nationally recognized, receiving HIMSS Analytics' Stage 7 Ambulatory Award, the highest HIMSS honor for EHR adoption.


ARcare, a private, non-profit corporation providing primary care in rural Arkansas and Kentucky through a network of clinics, pharmacies and wellness centers, is the first Federally Qualified Health Center – and was one of only two ambulatory practices not connected with a hospital – to receive a Stage 7 ambulatory award.

On the way to a successful implementation, ARcare learned a great deal about the relationship between ongoing physician involvement and final clinical training – information that may help our peers who are moving forward with similarly ambitious systems replacements.

Managing change during the transition

ARcare’s system replacement involved moving from comparatively basic EHR use to a more comprehensive system with clinical event functionality that would enable us to better manage patient conditions across multiple care venues. A primary goal was to have the system drive orders and events rather than merely document clinical activity.

Migrating to next-generation technology across an enterprise requires significant IT resources, training, management support and workflow changes. Our strategy was to tie these elements together with a carefully constructed change-management plan, in which a highly experienced, multi-disciplinary team with C-level support facilitated all aspects of system adoption. The change-management team was tasked with creating a continuum of sustained change with a primary focus on improved patient care, stripping away governance of information silos. In this spirit of change management, each identified issue was relevant to the team – rather than individual roles – without regard to reporting structures.

The importance of keeping physicians in the change-management loop

Although ARcare achieved significant success in the arena of change management from an IT perspective, and within an aggressive timeframe, we also found in hindsight that keeping physicians in the loop throughout the transition can simplify clinical training during the final stages of implementation.

While ARcare actively sought input and buy-in from physicians on the front end of the transition, our sensitivity to the demands on physicians’ available time led us to remove most of them from the actual transition process, preserving involvement to a select few clinical staff members as physician representatives. While physicians remained involved to provide input to the new standardized workflows required by the new system, most of them had minimal exposure to the new system prior to clinical training.


The scheduled training sessions involved the clinical staff who were part of the change-management team performing training duty: nurse practitioners training other nurse practitioners and physicians training other physicians. We had anticipated this to be one of the easier tasks of implementation, and hadn’t fully accounted for the learning needs of clinical staff.

Although our physician leadership group requested they be the trainers, it soon became apparent that many healthcare professionals are simply uncomfortable voicing the need for additional help, especially to their peers. We also learned that having select clinical staff involved in the overall process didn’t necessarily translate directly to building teaching skills; the ability to understand complex technology and to teach its use are quite different. We decided to revisit training with the assistance of our own KMS – knowledge management systems – education team.

Getting clinical training back on track

Together with the KMS education team and led by four top instructors, we created a new, three-day program that integrated training for physicians, nurses and physician assistants.

Working in small groups, clinical staff participated in the training program, which was rolled out across facilities in series. Feedback gathered at the end of each training session helped to improve each subsequent session. Satisfaction increased quickly and steadily, and ARcare has continued to provide training updates on a regular basis to ensure continued optimal performance.

Well worth the effort

Five months after going live with our new system, ARcare became the first ambulatory practice that was not part of a hospital to achieve Stage 6 on the HIMSS Analytics EMR Adoption Model. One year later, we became the first FQHC to achieve the highest level of EHR usage, Stage 7.

The overall experience helped the organization recognize and develop an appreciation for the fact that change can and should be a positive experience. ARcare has developed a level of confidence across the organization where employees are less reluctant or fearful of change, and where learning from failure produced valuable outcome – not just in successful training, but in the successful adoption of a new Greenway Health EHR that brought with it substantial benefits, including:

  • Improved patient management with better information access for providers and clinical event management that drives events and orders, computerized provider order entry and closed-loop medication administration, and other advanced functions that improve patient care
  • The ability to exchange data directly with the state health department
  • Streamlined access to patient records across the network of primary care clinics, dental clinics, pharmacies and wellness centers

During the transition to the new system, ARcare successfully converted more than 17.2 million records, including clinical notes, images and test results. Now, when ARcare identifies and secures a new clinic site, the new site can be completely operational from an IT perspective in 30 days or less thanks to advanced system capabilities for scalability and extremely fast implementations. As of today, the system provides paperless charting and order entry for 37 ARcare clinics.

In all, it’s been a very satisfying transition in which the gains were well worth the pain – pain that can be avoided by following the lessons learned in ARcare’s approach and re-working of clinical training. In short: It’s all about identifying an effective training team.



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