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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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83% of Physicians Are Resistant to Use EHRs for Clinical Communications

83% of Physicians Are Resistant to Use EHRs for Clinical Communications | EHR and Health IT Consulting | Scoop.it

83 percent of physicians expressed frustration using EHRs to support clinical communications due to poor EHR interoperability, limited EHR messaging capabilities and poor usability that makes it difficult to find relevant clinical data, according to a recent study by Spyglass Consulting Group. The report entitled Point of Care Communications for Physicians 2014 based on 100 doctors working in hospital‐based and ambulatory environments nationwide reveals physicians are universally (96 percent) using smartphones as their primary device to support clinical communications.
Physicians Face Obstacles to Support Collaborative Care

Despite the universal smartphone adoption, the report finds 70 percent of physicians believe hospital IT organizations are making inadequate investments to address physician mobile computing and communication requirements at point of care due to limited planned investments, poor mobile EHR tools, and inadequate mobile user support. Majority of physicians interviewed report that they lacked the financial incentives, tools, and processes to support collaborative team‐based care. According to the Ponemon Institute, inefficient communications during critical clinical workflows costs the average U.S. hospital approximately $1.75 million annually.
Former CMIO Shares His Experiences

Steven Davidson, MD, MBA former CMIO at Maimonides Medical Center, Brooklyn, NY whose last project at Maimonides improving physician communication comments, “As we were developing our plans for improving communication among clinicians, we discovered that few hospitals were investing in communication‐driven workflow support, perhaps because meaningful use and HIPAA are consuming all the resources. Still, it seems many IT leaders hope the EHR‐‐a tool poorly suited to the task‐‐will suffice. In reality, overwhelmed nurses and doctors struggle accomplishing necessary communication through the EHR; instead implementing workarounds on their own devices.”

Next Generation Communications

The report states that hospital IT has an imperative need to evaluate mobile devices and unified communications solutions to support collaborative team-based care and address regulatory requirements introduced by the Affordable Care Act including readmissions penalties, patient centered care models, and pay for performance. Spyglass notes that the next generation communications solutions must be secure, easy-to-use, and tightly integrated with the EHR to provide adequate clinical context to successfully close the communications loop with colleagues and team members.

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Functional Limitation Reporting in Your EMR

Functional Limitation Reporting in Your EMR | EHR and Health IT Consulting | Scoop.it
There are a lot of myths, misconceptions and fears about functional limitation reporting. The bottom line is that clinicians who see Medicare patients after July 1, 2015 must use functional limitation codes on their documentation for the initial evaluation, at least once every 10 visits, and at the time of discharge or they won’t get paid.

All practitioners need is an EMR system that prompts them to select one of the functional limitation measures and the goal codes at the appropriate time. It’s then a simple matter of sending the claim to the clearinghouse and on to Medicare for approval and payment. Functional limitation reporting is essentially a goal-oriented process.

 Clinical Judgment

The judgment of the physical therapist is critical in meeting functional limitation reporting requirements. Therapists will need to document the patient’s condition at the initial visit, the selected treatment plan, severity of the client’s limitation and the expected outcome when therapy is completed.

In Touch EMR™ provides clinicians with prompts for all the information, G-codes and modifiers needed and at the appropriate times to remain within compliance. The data automatically goes into the patient file for transmission.

Supporting Evidence

Documentation to support every decision, measure taken and treatment is critical. Therapists must maintain a record of the patient’s level of function upon their initial visit using their best clinical judgment, combined with the information obtained from the patient.

Listen closely to what the client says and observe their range of movement to accurately select the level of severity under which they’re functioning. Meticulous records are necessary to document the condition of the patient at each treatment session and when the patient is discharged from further therapy. The process begins again if further treatment is required.

The EMR clinicians choose should have the ability to prompt them at the three major checkpoints of functional limitation reporting – initial evaluation, the 10th visit, and at discharge. In Touch EMR™ provides practitioners with that functionality, making it easy to remain in compliance and get paid.


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Direct Reimbursement Solutions's curator insight, June 29, 2015 1:22 PM

Make sure your biller knows the ins and outs of FLR!

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Survey: Physicians See Benefits, Drawbacks in EHR System Switches

Survey: Physicians See Benefits, Drawbacks in EHR System Switches | EHR and Health IT Consulting | Scoop.it

Changing electronic health record systems could improve EHR functionality and help physicians meet meaningful use requirements, but physicians might be unhappy with the switch, according to a survey published in the journal Family Practice Management, FierceEMR reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Durben Hirsch, FierceEMR, 1/20).

For the survey, researchers polled 305 family physicians who had switched EHR systems in 2010 or later. The survey was conducted between July 2014 and September 2014 (Edsall/Adler, Family Practice Management, January/February 2015).

Survey Findings

The survey found that the most common reasons for changing EHR systems were:

  • Needing additional functionality;
  • Wanting to meet meaningful use requirements;
  • Desire to increase usability; and
  • Requiring improved training and support.

Researchers also found that 59% of respondents agreed or strongly agreed that their new system had better functionality, and 57% said that the change helped them to meet meaningful use requirements.

However, just 43% of respondents indicated they were happy with the switch to a different EHR system. Respondents who were part of the decision to change EHR systems were happier with the change than those who were not part of the decision-making process.

Overall, 81% said the time investment in changing EHR systems was challenging, with issues such as:

  • Productivity loss;
  • Data loss; and
  • Data migration problems.
Comments

Researchers said that physicians need to carry out a careful evaluation of their current EHR system prior to making a change. They also said that making alterations in physician workflow could result in better outcomes.

They noted that switching EHR systems might be necessary to improve functionality or achieve meaningful use but added that "if you just want to change because you don't like using your current EHR or consider it a drag on your productivity, the grass may not be greener on the other side"


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Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com

Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10.  More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together.  But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process.  Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.

“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions.  The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.

Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them.  Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues.  They will address issues as they occur and learn as they go after implementation.  They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.

“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”

“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.”  Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.

“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.

“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.

Will EHR vendors and billing partners pick up the slack?  Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education.  The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists.  One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.

The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are.  CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing.  ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed.  Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so.  “Articles on ICD-10 are fear-based,” said a participant.  “I try not to go there.”

So where will they go?  To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions.  It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs.  ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.

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Bright Futures VisitPlanner iPhone and iPad medical app review

Bright Futures VisitPlanner iPhone and iPad medical app review | EHR and Health IT Consulting | Scoop.it

“Bright Futures” is a national children’s health promotion initiative that has been adopted by the American Academy of Pediatrics for well-child care and is used in most pediatric practices.

These guidelines include recommendations in 26 categories covering 32 recommended well-child visits from newborns to 21 year-olds, and keeping track of recommendations at each visit is a challenge. Making these recommendations more accessible is the challenge the Bright Futures VisitPlanner app from the AAP attempts to address.

The home screen opens to the “Doctor’s Dashboard,” which may be a bit off-putting to non-physician primary care providers.


Users can choose “visits” or “patients.” Choosing visits brings up the “Visit Plan Builder,” where users can select one of the 32 recommended visits or create their own custom visit. The planner can be connected to a specific child or used generically. Users can input recommended immunizations scheduled (if connected to a specific patient) or view generic schedules under the “immunizations” tab. Under the “Anticipatory Guidance” tab, users can input some or all specific recommended anticipatory guidance questions for the patient’s age.


Users can also input, under the “notes” tab, information on guidance given, immunizations, and patient info. Selecting “patients” enables users to add new patients with demographic data, photos, records of illnesses, and birth information. The records of illnesses do not come pre-programmed with any list of conditions or ICD-9 codes, so requires all free text. Also, the birth information is limited to time and anthropometric data, without fields for newborn screens (e.g., the congenital heart screen, hearing screen, metabolic screens) or even free text information. Once the build is complete, users can view the “visit plan” which includes recommended screening and physical exam maneuvers under the “perform” tab, immunizations, the selected anticipatory guidance questions, and any inputted notes. Once the visit is selected, users have to return to the visit screen to edit the visit, while users in the “in visit” mode can check off immunizations or anticipatory guidance questions as completed. The header is helpfully different — blue in the “visit plan builder” mode and green in the “in visit” mode.


The visit summaries can be emailed or AirPrinted once completed, with the app warning about the data security of email — although there is no mention of data security elsewhere on the app.


The app also includes PDFs of the “Bright Future” Previsit questionnaires and parent handouts for each recommended well-child visit, although they are only in English and not available in Spanish. Starting in adolescence with the 11 year-old visit, the app includes separate parent and patient handouts. There is a section for “Tools and Resources”, which has useful information, although mostly via embedded web links to the AAP’s Bright Futures website.


There are also BSA and BMI calculators, a PDF of the summary “Bright Futures” schedule, and a useful PDF on “Coding for Pediatric Preventive Care”. None of the PDFs can be opened in any other PDF app. Lastly, the app includes a section on “Doctor’s Contacts” where users can input other providers and their contact information and link those providers to specific patients.


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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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Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com

Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Developments during the last week of January will have a serious effect on the progress of meaningful use, interoperability, and health reform in the coming year.

Perhaps the most important development for health IT was a reduction in meaningful use reporting requirements in 2015. After months of feedback criticizing the meaningful use requiring for reporting in 2015, the Centers for Medicare & Medicaid Services (CMS) finally decided to opt for a 90-day reporting period rather than one requiring a full year’s worth of EHR data.

In a CMS blog post, Patrick Conway, MD, the Deputy Administrator for Innovation & Quality and CMO, highlighted three meaningful use requirements the federal agency is considering for an upcoming proposed rule.

The first would require eligible hospitals like eligible professionals to report based on the calendar year, which would give these organizations time to implement 2014 Edition certified EHR technology (CEHRT). The second would change “other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” Lastly and most importantly, CMS is considering reducing the meaningful use reporting requirement from 365 days to 90 days.

As Conway noted, this proposed rule is separate from the one for Stage 3 Meaningful Use expected next month. However, the spirit of the two proposals is to reduce burdens on providers while promoting expanded use of CEHRT.

Most recently, the Office of the National Coordinator for Health Information Technology provided its earliest plans for enabling nationwide interoperability. The first draft version of the interoperability is the first iteration of the federal agency’s long-term plans for enabling a health IT ecosystem and infrastructure with the ability to exchange patient health data efficiently and securely.

“To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.

The lengthy draft comprises both long- and near-term goals for promoting standards-based exchange among healthcare organizations and providers. The document is current open to public comment through the beginning of April.

At a higher level, the Department of Health & Human Services (HHS) laid out its plans for shifting healthcare dramatically from volume- to value-based care. Secretary Sylvia M. Burwell has committed Medicare to making half of the program’s reimbursements based on value by 2018. Over the next two years, the department is aiming to shift 30 percent of fee-for-service payments into quality-based reimbursement paid through accountable care organizations (ACOs) or bundled payments.

The challenge for the department and the Medicare program is significant considering that accountable care comprises an estimated 20 percent of total Medicare payments. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement,” Burwell said.

While all these changes took place within HHS, President Barack Obama and members of Congress began revealing their plans for supporting personalized medicine. The President’s Precision Medicine Initiative is already on the table and offers $215 million to support the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and ONC. Meanwhile, the House Committee on Energy & Commerce is moving forward with the discussion phase of its 21st Century Cures initiative which aims at speeding along patient-centered regulation and supporting medical researchers, clinical data sharing, clinical research, and product regulation.

All in all, the last week of the first month of 2015 may go down in history at a pivotal moment in the real transformation of healthcare in the United States.


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Questions to Ask Before Choosing an EHR

Like many managers or owners of a thriving medical practice, you have heard about the benefits of using electronic health records software and are interested in implementing an EHR in your organization. You can assume that many, if not all, of your nearby competitors are using EHR, and the more effective they are in using this software, the better they will be able to attract and keep patients.

Transitioning from the old methods of paper-based systems to the latest advances in medical software is bound to raise some questions among you and your staff. Therefore, it’s a good idea to do some research first before making the commitment and selecting your EHR. With that in mind, here are some questions to ask as you prepare to make your choice.

Is the Software Vendor Knowledgeable and Reliable?

It’s much better to go with a software vendor that has sufficient experience, knowledge, and a proven track record in developing mission-critical software like EHR. Find a firm that has been around for a while and that has excellent reviews from your peers, as well as your competitors.

A software developer for medical organizations must have a staff that keeps up with the changing nature of healthcare delivery, adjustments in industry standards, and governmental rules. This ensures that you will always have access to software this is compliant with the entities you do business with.

What Kind of Training is Available?

After assessing the skill level and knowledge of your medical organization, you will have a better idea of how much training you need. Make sure that your software provider will give your team the training and help it needs to quickly get up to speed with using EHR software.

How Does the Software Company Handle Upgrades?

Upgrades are a fact of life in any computer system. You’ll want to ask your vendor how it approaches upgrades. There will be upgrades to improve the quality of the software, to be sure, but there will also be required updates, such as the ones EHR software developers must finalize to meet the U.S. government’s required change from ICD-9 to version 10 of the International Classification of Diseases.

Does the Software Vendor Provide Good Customer Service?

The last thing you want when dealing with unfamiliar software is to contend with unanswered questions on how to use it. Check the level of customer service from your prospective provider. Otherwise, your staff may experience unexpected and unnecessary downtime, hampering office productivity and lowering your organization’s financial success.

Making the decision to move from a paper-based system for managing your medical organization will make a significant impact on your staff’s daily activities. Now that you know you want to implement an EHR, it’s crucial to resolve any unanswered questions before making your software selection.

Key Takeaway:

  • Medical practice owners and managers who are aware of electronic health record software will want to ask some questions before choosing their EHR.
  • Don’t rush into buying EHR software that you are unfamiliar with. Make sure you understand how it will integrate with your organization.
  • Check what kind of training your software provider offers to ensure your staff can quickly get up to speed with the EHR system.
  • Verify the skill level and knowledge of your software company to make sure it will be capable of handling upgrades, especially those mandated by governmental regulations.
  • Does the EHR vendor provide the type of customer service that you deem appropriate? You will want to go with a firm that has excellent communication skills and will respond in a timely manner.


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Docs urge big changes to health records program

Docs urge big changes to health records program | EHR and Health IT Consulting | Scoop.it

A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.

Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.


"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.

"Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers’ needs, patient safety, and product innovation," the letter stated.

The coalition called on regulators to decouple the certification of electronic health records from Meaningful Use, which imposes a timetable for EHR adoption and a series of penalties and incentives based on doctors' compliance.

The groups also asked the Office of the National Coordinator to reconsider alternative software testing methods and to incorporate stakeholder feedback on a variety of technical matters related to Meaningful Use.

The healthcare world has been struggling with the migration to digital records, arguing that the Meaningful Use standards are hampering their ability to deliver good care.

Advocates for Meaningful Use argue it is helping speed the transition to EHRs, which will ultimately boost care and prevent deadly medical errors.

The program has undergone several delays as doctors and hospitals fail to attest to its various stages.


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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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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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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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