EHR and Health IT Consulting
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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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Is Your EHR On The Right Track ?

Is Your EHR On The Right Track ? | EHR and Health IT Consulting | Scoop.it

Medical Records Briefing (MRB) is conducting its benchmarking survey on electronic health record implementation, and we would appreciate your input. Please take a few moments to complete this survey.

 

To show our thanks, we will select one respondent at random to win a complimentary HCPro webcast of his or her choice. To enter to win, please include your contact information at the end of the survey once you have answered the questions.

 

Entering your contact information will also enable us to email you the results of the survey along with commentary from industry experts. The results will also be featured in the October 2015 issue of MRB. The link below will take you to the survey’s website; simply click on the link to answer the survey questions online.

 

If the click-through does not work, please copy and paste the URL below into the address bar of your browser.

Technical Dr. Inc.'s insight:

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inquiry@technicaldr.com or 877-910-0004
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Solo Practitioners Exempt from EHR Implementation in Minnesota

Solo Practitioners Exempt from EHR Implementation in Minnesota | EHR and Health IT Consulting | Scoop.it

One of the key issues that some healthcare providers have found with the Medicare and Medicaid EHR Incentive Programs is the mere financial impact of EHR implementation. In Minnesota, small medical practices – particularly solo practitioners – will no longer have to invest in costly EHR implementation plans due to a bill that was passed by Minnesota lawmakers in both the House and Senate.


Under the Minnesota Department of Human Services policy omnibus bill, there are various healthcare reform objectives including exempting solo practitioners and cash providers from having to invest in health IT systems and EHR implementation.


While this may benefit these providers financially and allow them to run their practice without monetary disadvantages, paper-based patient records could potentially lead to safety issues and additional medical errors that impact population health outcomes across underserved regions within the state.


Nonetheless, Minnesota seems to be the only state in the nation where an EHR mandate required all healthcare providers and hospitals to install and implement EHR systems by January 1 of this year.

The bill’s amendment on EHR implementation is now in place and providers will have to comply with it starting in January 2015, according to a press release from the Citizen’s Council for Health Freedom (CCHF), a Minnesota-based organization aimed at protecting patient privacy and rights.


CCHF feels the EHR mandate that required all providers to participate in EHR implementation was too costly and had patient privacy implications the organization does not support. Essentially, Minessota was the only state that did not have an opt-out option. Other providers across the country could take the payment penalty hit from the Centers for Medicare & Medicaid Services (CMS) instead of being required to adopt certified EHR technology.


In particular, providers in Minnesota were required to implement an interoperable EHR system that was connected to a state government-approved Health Information Organization, which is a costly endeavor.

“We’re pleased that lawmakers have included this important amendment in Rep. Tara Mack’s bill that will allow small clinics and practices to continue to serve patients in Minnesota,” stated CCHF president and co-founder Twila Brase. “Many small clinics and practices cannot afford the cost of the EHR system, and many practices do not want to make their patients’ data accessible online.”

“This amended bill will allow small clinics to thrive in smaller communities,” Brase continued. “And it will allow single doctor’s offices to keep their doors open, rather than be forced to join a big practice.


Patients would be able to search for practitioners who hold their medical data truly confidential and for doctors that look them in the eye rather than turning their back on them and typing into a computer. Minnesota is the only state that, until now, did not allow healthcare providers to opt out of expensive, intrusive online-accessible EHRs. The federal HITECH Act mandates EHRs, but allows any provider to opt out. This amendment begins to give Minnesota the level of freedom and privacy available to doctors and patients in the rest of the nation.”


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Did Meaningful Use Requirements Propel Hospital EHR Adoption?

Did Meaningful Use Requirements Propel Hospital EHR Adoption? | EHR and Health IT Consulting | Scoop.it

Ever since 2009 when the Health Information Technology for Economic and Clinical Health (HITECH) Act became law, the majority of healthcare providers began adopting EHR systems and other health IT tools in order to meet the meaningful use requirements under the Medicare and Medicaid EHR Incentives Programs and avoid the financial penalties set for 2015 and the following years.

The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) supported EHR adoption among hospitals and physician practices through a variety of resources and advisories. Recently, ONC released a data brief that outlines the high EHR adoption rates among hospitals and other providers.


The brief outlines the trends in the adoption of EHR technology between the years 2008 to 2014. ONC also tracked the implementation of certified EHR systems that meet meaningful use requirements as well as general health IT systems.


The results show that 76 percent of hospitals have a basic EHR system. This statistic has increased tremendously over the years, rising by 27 percent from 2013. Out of these reported hospitals, 97 percent have adopted certified EHR technology that meets meaningful use requirements under the EHR Incentive Programs.


Hospital EHR adoption varies significantly across states, ranging from 50 percent to 100 percent. Delaware, South Dakota, and Virginia have the highest rates of basic EHR adoption among hospitals. Kansas, West Virginia, and Hawaii were the three states with the lowest adoption rate of basic EHR systems.

State adoption of EHR systems has also risen significantly from 2008 to 2014, the ONC data brief shows. In 2008, only Connecticut and New Mexico had adoption rates of basic EHR systems above 20 percent.


By 2011, this statistic rose and 32 states had a hospital EHR adoption rate above 20 percent while seven states had a rate above 40 percent. By 2014, hospital EHR adoption rates were above 60 percent in 48 states and above 80 percent in 17 of those states. Clearly, these trends are rising significantly to meet meaningful use requirements and prevent the financial penalties under the EHR Incentive Programs.


The use of advanced functionalities within EHR systems is also increasing. For example, many more hospitals are using EHR technology that includes clinician notes. Additionally, 34.4 percent of hospitals have implemented comprehensive EHR systems in 2014.

Essentially, the adoption of EHR systems among acute care hospitals has quickly increased once the HITECH Act was passed in 2009 and providers began pursuing meaningful use requirements. State EHR adoption rates have also steadily increased among hospitals since the legislation was passed.


“A favorite question of mine, asked during the sessions and included in the report, is the following: ‘The real question is not what data we want to collect, but what problem are we trying to solve?’ I believe the real problem we are trying to solve is how to advance the public’s health wherever people live, work, learn or play, using information and data as a tool,” National Coordinator for Health IT Karen B. DeSalvo stated on the ONC website.


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The Evolution of Enterprise Databases and EHR Interoperability

The Evolution of Enterprise Databases and EHR Interoperability | EHR and Health IT Consulting | Scoop.it

There are many parallels between the enterprise database sector and EHRs. Can the evolution of this database industry guide progress in the EHR front? I think there are a number of similarities and solutions which can address the proposed problems facing EHRs and the global healthcare system.

Oracle, the first commercially available database system, has been in existence for more than 35 years.  As a company, Oracle has encountered numerous competitive, technologic and economic challenges forcing it to re-think, re-engineer and re-develop its platform while maintaining backward access to huge volumes of data for its customers.  Many enterprise database companies have since entered the marketplace, all bringing a unique and proprietary set of options, designs and performance.

Despite these differences, enterprise database systems, along with open source and the relatively new NoSQL databases are able to interoperate to meet the demands of customers who are dependent on reliable, scalable, high performing, usable and secure access to data.

Dr. Donald Voltz

Hospital EHRs are babies when compared to enterprise database systems, but they share a great deal of similarities and have become a central player in our healthcare system. Physicians, patients and other healthcare providers are becoming dependent on EHRs for the daily management of patients. Meanwhile, administrators, insurers and regulatory bodies have been developing policies, process and practices to using EHR data for population health, patient engagement and development of best practices at a systems level. 

With the development of large scale, high performance ways to store and access increasingly larger data sets, enterprise applications have evolved to utilize the changing functionality with a commensurate understanding of customer demands leading to increased database functionality.

A cycle of sorts advanced the capabilities and allowed for the migration of application-centric software applications which were slow to change due to interdependencies. Looming was the real possibility of losing business critical functionality during upgrades to software as a service models (Saas) allowing for better scalability, more frequent software updates and higher reliability with lower overall costs.

The history of enterprise databases, and that of other enterprise software, shared similar criticisms as technologic advances occurred. The integration of legacy systems with evolving technology presented the greatest barrier to adoption, even when validated claims of higher performance, increased functionality, and lower costs were realized. These same criticisms have been voiced for EHR technology and are not likely to quite any time soon. 

The problem of integrating new and old technology or bringing technology into an area traditionally administered by manual, static and labor intensive means, boils down to the misapplication and misunderstanding of prior solutions. In enterprise database applications and others, middleware integration architecture was introduced, but was slow to fix these challenges.

Middleware was dispelled and slow to be applied to the enterprise software problem, stemming from attempting to solve integration problems of evolving technology with middleware platforms built upon prior technology.  

EHR interoperability in the early state of implementation and development does not have the legacy middleware problem since nothing existed before. In light of health information exchanges, proposals to develop data sharing standards, little has been presented on the middleware as a viable solution to the interoperability problem in healthcare. Although early in the implementation of EHR’s, they have made a large splash in healthcare and will be required to quickly scale to the available technology, including mobile.  Medicine is many years behind other fields in the deployment of enterprise software solutions to meet the needs of hospitals and patients. 

Oracle recently announced the release of a node.js database driver. This is yet another example of how large, proprietary enterprise software understands the need to implement middleware access so other innovative and motivated companies can develop new solutions to business, personal and social needs.

As we look forward, patient engagement with their health data, insurance, medical decisions and access to healthcare providers will necessitate additional development onto existing and emerging technologies.  If healthcare follows the trends of other enterprise software, and there is no reason to suggest it will not, middleware has been the only architectural pattern to solve the integration problem in a cost effective way while supporting scaling, security and reliability of critical business operations.



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4 Stumbling Blocks to Avoid in System Implementation

4 Stumbling Blocks to Avoid in System Implementation | EHR and Health IT Consulting | Scoop.it

Every organization, at one time or another, goes through some type of system upgrade or implementation. Common practice is to develop a very detailed project plan. These documents are laid out to ensure that all tasks are performed and that all deadlines are met. Meetings are scheduled, milestones are agreed upon, and staff are informed of what to expect. Unfortunately what may look like a well thought out plan on paper may not address the day-to-day issues that can often disrupt a thoughtful plan.


So how do you prevent this kind of interruption? It is good practice to think about possible stumbling blocks that can cause employee angst, reworking of project plans, and/or potential deadline delays. Take a look at the following potential road blocks and how to prevent them.


Potential stumbling blocks:


  • Calendar disruptors – Consider outside elements that may cause changes to the calendar. For example, are there holidays which need to be taken into account during the timeline development? A long three day weekend, like Memorial Day, typically means a reduced staff for testing and training. In the northeast, is it wise to plan for a winter go-live? In Florida, which of the months could impact a successful project during hurricane season? Weather conditions can have the potential to wreak havoc on a well thought out project plan.
  • Business office constraints – Take a look at potential business office constraints. If the expectation is to have business office staff training during month end close it is unlikely that those training sessions will be well attended. Are there any other upgrades or implementations that may be going on at the same time? If so, there may be a limited resource pool to pull from. Keep in mind that employees may already be concerned if they are currently spread too thin.
  • Training and testing limitations – Depending on the size of the office that is scheduled to attend training or provide testing assistance take all schedules and workloads into consideration. If it is a small office, where each provider has a heavy schedule, how likely will it be that staff can attend training classes or testing assistance while ensuring that patient care is not being compromised? Look at additional resources or supplemental staff to fill in so staff can leave the office and attend training sessions.
  • Inadequate go-live support – Another component worthy of evaluation and consideration is go-live support. Most organizations incorporate a “help line” to aid the staff after a go-live. But what happens to that large practice that has a long line of patients, phones ringing, providers requiring attention, and employee anxiety? There needs to be a plan in place to circle back with those practices and make sure they are getting the necessary support.


To ensure your system implementation goes smoothly, consider the following steps:


  • Develop a well thought out project plan.
  • Make sure the objectives are clear.
  • Coordinate training schedule with business office needs.
  • Allocate resources and back-up plans early in the planning process.
  • Provide consistent and clear communication.


It is important to understand that little changes may impact well intentioned go-live of a system implementation. A well thought out project plan that accounts for these stumbling blocks and has contingencies built in will help to ensure a successful go-live. You can then focus on ensuring employee and patient satisfaction, which helps everyone in the long run.

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Do Health IT Systems Need Greater Interoperability?

Do Health IT Systems Need Greater Interoperability? | EHR and Health IT Consulting | Scoop.it

The medical sector is aimed at reaching the triple aim of healthcare by incorporating health IT systems and EHR technology. The triple aim focuses on improving patient care, lowering medical costs, and boosting population health outcomes.


In a Health Affairs Blog, National Coordinator for Health IT Karen B. DeSalvo discusses the landscape of information technology in the medical space.  DeSalvo emphasizes the need for interoperability among health IT systems and mentioned how the Office of the National Coordinator for Health IT (ONC) is developing new implementation standards. Additionally, the need for privacy and security of patient data is also asserted by DeSalvo.


The sharing of patient data through health IT systems has been a major focus for the healthcare industry over the last year. To improve EHR interoperability, ONC has listened to the health IT community to develop a roadmap for establishing strategies and opportunities to move the country toward greater health data exchange.


DeSalvo has participated in many listening sessions across the country and learned about certain issues that harm the interoperability of health IT systems and plague hospitals and providers. Rural communities in Alabama, for instance, do not have full broadband access while bordering state privacy laws in New Jersey block medical data exchange. The overall essence of DeSalvo’s discussion revolves around the importance of interoperability among health IT systems.


“I also listened to my own experiences — as a doctor, as a daughter, and as a consumer,” DeSalvo stated. “I thought of countless patients whom I have seen and those I continue to see when I am in clinic. Of visits where I did not have the information needed to make a decision that day, requiring patients to return and miss work, school, or other obligations. Of patients who want to engage and feel empowered but need not only data, but information, to help them level the playing field, to allow them to meaningfully engage.”


“Of being a caregiver for a mother dying of dementia and being frustrated at just how hard it was to get access to the information I needed to help her. And, as a public health advocate and official, needing information about my community to prioritize resources to help them address the broad determinants of health,” said DeSalvo.

Over the last six years since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, the healthcare industry has gone forward with meeting many of the goals ONC established such as widespread implementation of EHRs and health IT systems. More and more eligible providers began meeting meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs.


While these achievements are impressive, DeSalvo mentions the need to digitalize “the care experience across the entire care continuum” and gain “true interoperability.” ONC is currently working on a plan for both public and private sectors to gain interoperability. The next step for ONC and the healthcare industry is to go beyond meaningful use and EHR implementation in order to truly bring better health for patients across the country.


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Important Features For Your Practice Computers

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

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


Sanitation Promoting Features


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


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


Mobility and Accessibility


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

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


Administrative Tools


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


Low-Cost Installation


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


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

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


Cloud-Based Systems


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


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


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


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Deloitte Announces New Approach to EHR Implementation and Support

Deloitte Announces New Approach to EHR Implementation and Support | EHR and Health IT Consulting | Scoop.it

Today Deloitte announces Evergreen, a new approach to electronic health records implementation and maintenance designed to help reduce hospital system IT costs as health care moves to a value-based model more reliant on clinical and enterprise data.

Evergreen may help health systems save up to 30 percent on EHR operating costs by using a global staffing model and a standardized design that works to improve clinical optimization. Evergreen also leverages Deloitte’s acclaimed cyber risk services in providing advanced levels of data security and compliance.

In addition to supporting large providers and academic health centers, Evergreen may especially benefit mid-sized healthcare systems looking for more EHR innovation and efficiency as they move to a new environment marked by declining reimbursements and a focus on quality outcomes.


According to Mitch Morris, principal, Deloitte Consulting LLP, and Deloitte’s global healthcare leader, Evergreen’s potential savings will enable providers to put more capital back into caring for their communities. “Evergreen offers an innovative approach to achieving the expected benefits of clinical and revenue management systems in a post-reform world,” said Morris. “It can provide clinicians with the software applications they prefer while supporting the clinical and financial results that health systems are looking to achieve.”

Evergreen is modeled after Deloitte’s mature services approach developed for Catholic Health Initiatives’ Epic deployment, and it builds upon Deloitte’s extensive history in managing other application management services engagements. In addition to the core EHR benefits, Evergreen leverages Deloitte’s advanced analytics and reporting capabilities, which can improve clinical performance by gleaning insights from clinical and financial data.  It also wraps clinical transformation and workflow optimization into the approach.

“Evergreen draws upon Deloitte’s world-class capabilities in strategy, consulting and application management services,” said Tim Smith, principal, Deloitte Consulting LLP, and leader of Deloitte’s health care technology practice. “It brings the enterprise-wide view that organizations may need in retooling their cultures around a greater use of data.”

Catholic Health Initiatives is the first provider to implement the full Evergreen approach. The company said Evergreen is increasing its ability to capture, analyze and share information, which will help position the organization as a leader in the areas of evidence-based medicine and care coordination.

“Evergreen is part of our vision to become a forerunner as health care moves to a value-based model,” said Michael O’Rourke, chief information officer at CHI. “It will enhance our ability to deliver the right treatments to the right patients at the right time, with improved quality and reduced costs.”

Morris commented that there is “tremendous” market potential for Evergreen. “Health care is an industry looking for tools and direction on how to make the transition to population health,” he said.  “We anticipate that providers in the U.S. and abroad will be very receptive to an approach that makes EHRs more relevant to their missions.”


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