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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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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HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model

HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model | EHR and Health IT Consulting | Scoop.it

EMRAM is an eight-step process that allows healthcare provider organizations to analyze their level of EMR adoption, chart accomplishments, and benchmark progress against other healthcare organizations across the country. Each of the stages is measured by cumulative capabilities and all capabilities within each stage must be reached before progressing.

“We’re happy to be able to confirm eClinicalWorks as an EMRAM Certified Educator,” said Blain Newton, COO, HIMSS Analytics. “EMRAM allows organizations to align IT initiatives and overall business strategy, which is essential to shaping future direction and moving the industry forward.”

Vendors achieving HIMSS Analytics Certified Educator status must pass an annual certification exam and commit to an annual educator program. This ensures they stay current with trends within the model and are equipped with the necessary knowledge to help their clients advance through the various stages.


“A major goal is having our customers utilizing the EMR the most beneficial way possible for both providers and patients,” said Girish Navani, CEO and co-founder of eClinicalWorks. “This certification will benefit organizations looking to analyze their adoption of EMR technology. We welcome being part of the program.”


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HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News

HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

It's more of a requisite first step than milestone, but the Department of Health and Human Services sent the proposed rule for meaningful use Stage 3 to the Office of Management and Budget.

There’s precious little detail in these submissions, but HHS foreshadowed the major problems it intends to address with this next, and perhaps final, stage of the federal EHR Incentive Program.

"Stage 3 will focus on improving health care outcomes and further advance interoperability," according to OMB’s website. "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."

The Office of the National Coordinator for Health IT also submitted a rule to OMB proposing a new 2015 Edition Base EHR definition, as well as modifications to the ONC Health IT Certification Program, "to make it more broadly applicable to other types of health IT health care settings and programs," another OMB web page states.

ONC’s proposed rule would establish capabilities and criteria, and specify standards and implementation specifications that EHR makers must meet, to "at a minimum support the achievement of meaningful use" for customers including eligible hospitals and eligible providers looking to attest and receive incentives.

OMB ranks both proposed rules as “major” but the in the form’s legal deadline field the status is none.

Stage 3 is expected to begin in 2017.


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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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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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101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85 | EHR and Health IT Consulting | Scoop.it

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

85. Test, retest, and test the network and wireless
Far too many EHR implementations fail because of basic technology issues. Of course, the blame usually gets placed squarely on the head of the EHR company. However, in many of the cases, the EHR company has no control over the issues you have. Your local wireless and network is one place where you can doom an EHR installation and the EHR company can do nothing about it. If you want to have a great EHR installation make sure you have a great network and/or wireless infrastructure set up and tested.

84. Have ONE number to call
This recommendation applies more to large EMR installations than it does to small ones. The basic suggestion is not to give one phone number for EMR issues (ie. I can’t login) and another for technology related issues (ie. my PC crashed). The problem with multiple lines is that people don’t generally know the difference between an EMR issue and a PC issue. At the end of the day, they’re likely to consider almost everything an EMR issue. So, they’re going to call the same number anyway. You might as well just have one number that knows how to triage the issue well and direct them to the right support resource.

83. Remember who the support team’s customers are
Another recommendation for hospital EHR support. It is a great idea to remember that the support team’s customers are the clinicians that are calling for help. Prepare them for the calls they’re going to get. While clinicians are highly educated, that doesn’t guarantee that their education included even basic computer skills. You’ll be surprised how many of the issues have to do with basic computer skills as much as any EMR specific support.

82. Have a communication strategy for when things go wrong
Things are bound to go wrong. So, be ready to communicate those issues. Don’t sweep the issues under the rug either. Communicate more than is necessary. It won’t hurt as much to over communicate as it will to not communicate something important.

81. Make all of your planning very public within your organization
The fastest way to get buy in for an EHR project is to involve your organization in the planning process. Yes, that means that you’re going to hear some harsh feedback from people about what you’ve planned. Be grateful that you’re hearing the feedback during the planning stage when you can work to do something about it. That’s much better than being half way through the project and hearing the harsh criticism of your project.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

85. Test, retest, and test the network and wireless
Far too many EHR implementations fail because of basic technology issues. Of course, the blame usually gets placed squarely on the head of the EHR company. However, in many of the cases, the EHR company has no control over the issues you have. Your local wireless and network is one place where you can doom an EHR installation and the EHR company can do nothing about it. If you want to have a great EHR installation make sure you have a great network and/or wireless infrastructure set up and tested.

84. Have ONE number to call
This recommendation applies more to large EMR installations than it does to small ones. The basic suggestion is not to give one phone number for EMR issues (ie. I can’t login) and another for technology related issues (ie. my PC crashed). The problem with multiple lines is that people don’t generally know the difference between an EMR issue and a PC issue. At the end of the day, they’re likely to consider almost everything an EMR issue. So, they’re going to call the same number anyway. You might as well just have one number that knows how to triage the issue well and direct them to the right support resource.

83. Remember who the support team’s customers are
Another recommendation for hospital EHR support. It is a great idea to remember that the support team’s customers are the clinicians that are calling for help. Prepare them for the calls they’re going to get. While clinicians are highly educated, that doesn’t guarantee that their education included even basic computer skills. You’ll be surprised how many of the issues have to do with basic computer skills as much as any EMR specific support.

82. Have a communication strategy for when things go wrong
Things are bound to go wrong. So, be ready to communicate those issues. Don’t sweep the issues under the rug either. Communicate more than is necessary. It won’t hurt as much to over communicate as it will to not communicate something important.

81. Make all of your planning very public within your organization
The fastest way to get buy in for an EHR project is to involve your organization in the planning process. Yes, that means that you’re going to hear some harsh feedback from people about what you’ve planned. Be grateful that you’re hearing the feedback during the planning stage when you can work to do something about it. That’s much better than being half way through the project and hearing the harsh criticism of your project.


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What are the Benefits of EHR

What are the Benefits of EHR | EHR and Health IT Consulting | Scoop.it

Electronic Health Records (EHR) is one such constituent of information technology in the healthcare sector that has been researched extensively in the recent times post the Health Information Technology for Economic and Clinical Health (HITECH) Act.

With an ability to streamline medical records and initiate integrated healthcare, EHRs can transform the way in which care is given. With an increased access to patient’s medical history, EHR is the future of healthcare. Once implemented the benefits of EHR outweigh the cost incurred in its application.

When completely functional to the extent that the information present can be exchanged with doctors, there are innumerable benefits of EHR which include.
  • EHR Can store comprehensive health information from lab results to radiology tests, medicines, and even allergies.
  • EHR not only stores information but also computes it with the inclusion of Electronic clinical decision support alerts, which aid in monitoring drug interaction checks and thereby reduces medication errors and improves the overall quality of healthcare.
  • EHR with their enhanced ability to store and analyse data prompt healthcare providers with preventive measures for the patient at the point of care thus enhancing clinical decision making.
  • Through EHR The health history can be shared with other health care providers in nursing homes, hospitals, across state and even across country at any given time.
  • Electronic Health Records (EHR) can be accessed on any gadgets such as laptops, tablets, phones.
  • It improves the efficiency of the care givers who can quickly refer to the health history of the patients via EHR and track the treatment progress with greater ease.
  • It enables quick access to the medical records of the patient.
  • It aids in lowering the health cost by preventing redundant medical tests.
  • EHR reduces paperwork and saves time and space required to store or search for any medical history.
  • It improves clinical decision making by integrating patient information from various sources and making it available to the physicians thus encouraging integrated healthcare.
  • It ensures safety of the patient and promotes productivity of the health care staff by reducing medical errors that arise due to missing information, a common occurrence with manual charts.
  • EHR encourages proper documentation with legal and accurate billing.
  • It promotes e prescribing thereby reducing any reading errors by the pharmacist and in turn ensures patients safety.

Therefore in a nutshell Electronic Health records (EHR) with its many benefits are definitely the future of healthcare. It is convenient, reliable and also saves cost in the long run. An exhaustive use of this system will certainly improve the quality of health care eventually.


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Lesa Moore's curator insight, January 3, 2015 11:36 AM

I bought a online service for my family and parents to use/share between us so we can help each other at any time if there is an emergency.

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Study: EHR Modification Can Help Meet Quality and Safety Goals - iHealthBeat

Study: EHR Modification Can Help Meet Quality and Safety Goals - iHealthBeat | EHR and Health IT Consulting | Scoop.it

The ability to easily modify electronic health record systems can help providers meet safety and quality goals, according to a study published in Electronic Data Methods, Politico's "Morning eHealth" reports (Gold, "Morning eHealth," Politico, 12/23).

Study Details

For the study, researchers at Baylor Scott & White Health investigated an integrated care health system's use of EHRs to implement procedures to prevent and mitigate intensive care unit patients from developing delirium. Providers commonly use an evidence-based practice called daily awakening and breathing trials, formal delirium screening, and early mobility -- or ABCDE bundle -- to prevent delirium in ICU patients (Collinsworth et al., EDM, 12/18).

Specifically, researchers aimed to identify best practices by designing a tab in the EHR system's patient viewer, allowing providers to track the progress of tasks within the ABCDE bundle and view the processes' effects.

Study Findings

Overall, researchers found that EHR customization was complex and time-consuming. Specifically, they said certain steps were necessary to customize EHR systems, including:

  • Allocating sufficient time for such a project, which took longer than researchers expected;
  • Gaining buy-in from senior leadership to secure resources to modify EHR systems;
  • Involving the different team players in EHR design;
  • Training clinical staff on proper EHR use and its importance; and
  • Understanding varying workflows in a multidisciplinary care team (Hall, FierceEMR, 12/22).

The researchers noted that while the study mainly focused on mitigating and preventing delirium, their research processes and takeaways "are generalizable to other health care settings and conditions." Moreover, they said that "the creation of learning health systems is contingent on an ability to modify EHRs to meet emerging care delivery and quality improvement needs" (EDM, 12/18).


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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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Craig Allen Keefner's curator insight, December 29, 2014 12:28 PM

The cost of going enterprise versus dealing with multiple vendors and the integrations (and the blame game) wins out.

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EHR/EMR Workflow System Usability–Roots in Aviation Human Factors

EHR/EMR Workflow System Usability–Roots in Aviation Human Factors | EHR and Health IT Consulting | Scoop.it

You may have noticed aviation-inspired terms, illustrations, and ideas on the High-Usability EncounterPRO EMR Workflow System:

  • A pilot helped to design EncounterPRO’s user interface (UI).
  • EMR UI design is mimicking evolution from traditional cockpits to today’s glass cockpits.
  • The phrase EMR “rollout” derives historically from “rolling out” a new aircraft from its hanger for its first public viewing.
  • EncounterPRO’s Office View is like a radar view from an aircraft control tower, from where staff can see where everyone is and how long they’ve been waiting.
  • The illustration at the top of each fat footer sitemap is an aviation concourse.
  • Aviation human factors is an important subdiscipline within Industrial Engineering (which has many other useful applications within pediatric and primary care “production systems”).
  • Then, of course, there is that cool helmet with an EncounterPRO screen projected on its wrap-around visor.

What if I told you that EHR/EMR workflow systems:

  • Reduce workload and difficulty of carrying out the phases of a patient encounter.
  • Relieve physicians of having to perform repetitive sequences that are unrewarding and for which human beings in their inconsistency can be at their best or their worst.
  • Endow physicians with the gratifying part of their jobs: decision making.

It would be true, but I would be paraphrasing page 176 of the Handbook of Aviation Human Factors in which it says that designers of cockpit automation hope to:

  • Reduce workload and difficulty of carrying out the phases of the flight.
  • Relieve pilots of having to perform repetitive sequences that are unrewarding and for which human beings in their inconsistency can be at their best or their worst.
  • Endow pilots with the gratifying part of their jobs: decision making.

I’ve seen many EMRs over the years, some designed by physicians, some designed by programmers, and many  designed by both. However, a physician, a programmer, *and* a pilot designed EncounterPRO—and it shows.

Aviation human factors techniques and ideas about individual and team performance have been used to improve patient safety (for example), but less so for sheer high-performance effective and efficient EMR data and order entry.  Since World War II, the aviation industry has spent millions (perhaps billions) of dollars on aviation human factors research on the design of high-usability, high-performance robust avionics and cockpit management systems. Many aspects of traditional EMR design contradict  this accumulated knowledge and experience.

As a result, an EMR Workflow System looks and works differently from any other EMR of which I am aware. While I wouldn’t want to fly a plane using EncounterPRO as cockpit management software, of the hundreds of EMRs out there it would the most suited to the task. In fact, after one presentation, representatives from an aviation software company approached us to ask if we would consider adapting EncounterPRO to serve as a cockpit management program. Given EncounterPRO’s roots we were flattered and intrigued, even if we eventually decided to continue to concentrate solely on ambulatory EMR workflow automation.

My own MS in Industrial Engineering at the University of Illinois, Champaign-Urbana involved a year in both the aviation human factors and health systems engineering programs. (This was by accident. There was a research assistantship available to work on an aviation human factors research project.) Aviation and aerospace medicine intrigued me for a while, but I decided that health care workflow was an even more target rich environment. Ironically, several years later I wrote natural language processing grammars for the Pilot’s Associate project (where I faced the truth of a popular linguistic proverb: All grammars leak.)

I had the enjoyable experience of hanging out with a sizable community of aviation human factors graduate students (both from IE and from other graduate departments such as psychology). That’s where I learned about the Fitts and Hicks laws that I discussed in the Cognitive Psychology of Pediatric EMR Usability and Workflow. I also bumped into an idea that has stuck with me since.

For each of the effects of the normal aging process–

  • vision decline,
  • hearing loss,
  • motor skill diminishment, and
  • cognitive decline

–there are a set of design principles and assistive technologies that address environmental challenges causing similar decreases in skilled performance.



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Why Don’t 35% of Patients Know that Patient Portals Exist? | EHRintelligence.com

Why Don’t 35% of Patients Know that Patient Portals Exist? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Patient portals are becoming important tools for engagement and population health, but patients are largely unaware of the technology.

While patients are generally enthusiastic about viewing their EHR data and engaging with their providers online, a concerning number of patients are unaware of the possibilities of using a patient portal, finds a new survey from Xerox.  Among the 64 percent of patients who are not portal users, 35 percent did not know a portal was available to them, and 31 percent stated that their providers had never mentioned the technology to them.  Despite the widespread lack of knowledge, 57 percent of non-users said they would be more engaged and more proactive in their own healthcare if they had access to their data online.

“With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals,” said Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox. “Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way.”

The survey indicates a generation gap when it comes to how patients use online tools.  While baby boomers are more likely to view patient portals as a utilitarian feature by making appointments online (70 percent), refilling prescriptions (58 percent), and communicating through emails with their physicians (60 percent), millennials view portals as an informational hub.  Younger patients want to see personalized information (44 percent), tailored care plans, details about related services from their providers (44 percent), and industry news that might relate to their issues and concerns (23 percent).

Perhaps surprisingly, baby boomers, aged 55 to 64, were among the most frequent users of patient portals.  Eighty-three percent of this age group indicated that they already do or would be very interested in communicating with their healthcare providers through a portal.  Millennials were more likely to want mobile access to online tools, with 43 percent stating their preference for smartphone and tablet interfaces.

Providers can help to shape patient engagement – and help themselves to meet the 5 percent patient engagement threshold included in Stage 2 meaningful use – by taking the time to educate patients about their options and opportunities.  Reinforcing the idea of signing up for a patient portal account at multiple points along the patients’ journey through the office, from check-in to follow-up, can help to secure a patient’s interest.  And physicians themselves should take the lead, St. Claire asserts.

“Physicians just aren’t having that dialogue,” she said to HealthITAnalytics.  “When we look at some of the best practices out there, we see that having that conversation multiple times along the patient’s path through the office is most effective.  And we think having that conversation directly with their physician is going to be most important.  People really want to hear it from their physician, because they’re that trusted source.  Even as medicine is changing, having that talk with the physician is probably going to have the most impact.”



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The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data. One way to bridge this gap is through standardized role-based education.

Conclusion
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort. Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT. As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.
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Fiona Ehret-Kayser's curator insight, December 23, 2014 3:28 PM

This is a really interesting take on the use of data in a patient's records. I wonder if ...?

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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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Lots of docs will be skipping Stage 2 meaningful use | Healthcare IT News

Lots of docs will be skipping Stage 2 meaningful use | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

A new survey of physicians by Healthcare IT News' sister site finds that 55 percent of them won't attest to Stage 2 meaningful use this year. It's "almost impossible" says one specialist polled by Medical Practice Insider.

"The following sentence is false 100 percent of the time: 'We completed meaningful use stages 1 and 2 and as a consequence the care we provide for our patients has improved,'" said another skeptical doc – one of nearly 2,000 polled by MPI in partnership with SERMO.

There are plenty of reasons that physicians find it preferable to forgo this next, much-harder stage of meaningful use. For many, it just doesn't make sense for their practice – or for their patients.

"It requires patients to have emails and engage my EHR," said a cardiologist. "Well, I have a lot of patients in their 80s and 90s, and they don’t have computers, let alone email."

"My patients are reluctant to use messaging and I personally do not like the interface for my portal," said a family practitioner.


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OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com

OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services is one step closer to issuing a notice of proposed rulemaking (NRPM) for the next stage of meaningful use requirements for the Medicare EHR Incentive Program.

The Office of Management and Budget (OMB) is currently reviewing the proposed rule for Stage 3 Meaningful Use that is expected to be published in February.

Few details about the requirements for Stage 3 appear in the rule submitted to the OMB by the Department of Health & Human Services as part of the Unified Agenda — that is, with the exception of the following:

In this proposed rule, CMS will implement Stage 3, another stage of the Medicare and Medicaid EHR Incentive Program as required by ARRA. We are proposing the Stage 3 criteria that EP’s, eligible hospitals, and CAHs 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.

The rule before the OMG also indicates that CMS will coordinate with the Office of the National Coordinator for Health Information Technology to ensure that EHR certification criteria and certified EHR technology will be in place when Stage 3 goes into effect no earlier than 2017.

During a Health IT Policy Committee meeting in March, the group voted to approve 19 objectives recommended by the Meaningful Use Workgroup. Those recommendations fall into four categories of care improvements:

Improving Quality of Care and Safety
1. Clinical decision support
2. Order tracking
3. Demographics/patient information
4. Care planning — advance directive
5. Electronic notes
6. Hospital labs
7. Unique device identifiers

Engaging Patients and Families in their Care
8. View, download, transmit
9. Patient generated health data
10. Secure messaging
11. Visit Summary/clinical summary
12. Patient education

Improving Care Coordination
13. Summary of care at transitions
14. Notifications
15. Medication reconciliation

Improving Population and Public Health
16. Immunization history
17. Registries
18. Electronic lab reporting
19. Syndromic surveillance

Before any of the proposed rule’s requirements for Stage 3 Meaningful Use are enacted, the NPRM must made available for public comment which has the potential to influence the requirements of the final rule. Given the resistance CMS has faced as a result of Stage 2 Meaningful Use, the federal agency is likely to receive requests for greater flexibility and timing from healthcare organizations and industry groups.


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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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Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com

Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
The adjustments involved in successful meaningful use attestation still get a thumbs-down from pessimistic physicians.

Physicians are still not sold on the idea of changing their daily workflows to meet the requirements of meaningful use, finds a new study in BMC Medical Informatics and Decision Making.  In a survey of 400 providers at 47 ambulatory practices, the researchers found a general unwillingness among all types of physicians to adapt to the needs of Stage 1 meaningful use (MU), and a general lack of confidence in their organization’s ability to rise to the challenges presented by EHR implementation.

The study cites the importance of effective change management strategies as a foundation for preparing healthcare providers for the impact of EHR implementation and meaningful use attestation.  “In busy practice settings, such change efforts are often difficult to implement effectively. In fact, experts have suggested that without sufficient readiness for change, change efforts are more likely to lead to unrealized benefits or fail altogether,” the authors write.  “With billions of dollars invested in MU and the countless hours spent by providers and clinical staff on MU implementation nationally, unrealized benefits from the program would carry significant financial and opportunity costs for health care systems.”

Resistance to the changes involved in meaningful use is nothing new in the healthcare industry.  The study adds to the anecdotal notion that physicians are particularly unwilling to embrace workflow changes due to new technologies and requirements.  While approximately 83% of nurses and advanced practice providers (APPs) indicated a willingness to change their workflow in response to meaningful use, just 57.9% of physicians reported the same.  Nearly 45% of nurses and APPs believed their organization would be able to address any problems that arose during meaningful use attestation, but only 28.4% of physicians were optimistic about overcoming issues.

Specialists were nearly three times more likely than primary care providers to believe that meaningful use would divert significant attention away from the practice of patient care.  Twelve percent of specialists thought their interactions will patients would suffer, compared to 4.4% of other providers.  However, specialists were no more likely than other providers to believe their organizations were unready to tackle meaningful use.

“These results suggest that leaders of health care organizations should pay attention to the perceptions that providers and clinical staff have about MU appropriateness and management support for MU,” the study concludes. “Change management efforts could focus on improving these perceptions if need be as it is feasible that doing so could improve willingness to change practices for MU.”

The authors suggest that organizational leaders invest in education for their staff about the benefits and opportunities involved in meaningful use.  Creating opportunities to provide guidance, demonstrations, and training for EHR proficiency and documentation measures required for attestation may help to ease trepidation among providers, while indicating a strong sense of support along with a clear implementation framework may help to make meaningful use attestation a more successful prospect.


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US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com

US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
A centralized EHR infrastructure is promoting care quality improvements in the US Immigration and Customs Enforcement department.

The US Immigration and Customs Enforcement (ICE) system is celebrating the completion its EHR infrastructure implementation, which transformed the agency’s paper-based healthcare system into a centralized, web-based system that allows health information exchange to improve care coordination while cutting costs.  For its quick and successful implementation, the team charged with developing the EHR infrastructure has received a 2014 Director’s Award for meritorious service for outstanding performance and inspiring accomplishments advancing the mission of ICE.

As with other governmental healthcare systems, the ICE Health Service Corps (IHSC) must track and coordinate care for persons that may travel between facilities or have a history of care at private providers.  IHSC, which operates under the Department of Homeland Security, provides care to around 15,000 ICE detainees at more than 20 facilities, the department’s website says.  Patients in the system also receive care from external providers when necessary, which requires the 900-strong IHSC staff to exchange health data electronically in order to ensure continuity.

“The very nature of detainee health care requires sending medical information across different locations,” said Capt. Deanna Gephart, deputy assistant director of Operations for IHSC in a press release.  “Now that we have the capability to share data electronically, the detainee health care system is much more efficient, which translates into increased quality health care provided to detainees.”

“I couldn’t be more proud of the effort of the team who dedicated their time and effort to modernizing this system,” added Jon Krohmer, assistant director of IHSC. “In less than 15 months, they successfully acquired, installed, configured, trained and deployed the system to all 22 IHSC-staffed facilities.  In the process, ICE has realized a $2 million annual cost avoidance.”

The EHR will allow ICE to better complete public records requests, including the release of data under the Freedom of Information Act, Congressional inquiries, and routine audits.  ICE also believes the new system will contribute to a reduction in the risk of medical errors, improved standardization of care, and the ability to better measure and achieve high performance on quality metrics.

Gephart previously noted that the department’s health information management system lacked sufficient interoperability “ICE has a frequent need to send medical information across different locations, which is cumbersome when each site has its own system,” she said in September.  In 2012, ICE completed 220,000 intake screenings and 104,000 physical exams while conducting more than 13,000 emergency room or off-site referrals, highlighting the need for robust care coordination throughout the busy system.

The successful EHR implementation comes amidst massive modernization efforts by the Department of Veterans Affairs and Department of Defense (DOD), both of which operate on an even larger scale.  Interoperability and care coordination cross multiple facilities are equally critical to these projects, and are some of the major criteria for the vendor selection process as the DOD seeks to leave its legacy systems behind in favor of a newly centralized infrastructure.


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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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11 indicators that you need a new EHR

11 indicators that you need a new EHR | EHR and Health IT Consulting | Scoop.it

Often so deeply immersed in looking for ways to make their practice more efficient, physicians sometimes fail to see the most obvious hurdle preventing this very process from occurring; their EHR. If your Electronic Health Record (EHR) solution is not up to the mark, you might be losing out on precious profits, and incurring costs that you can easily overcome.


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Scanning Medical Records and Keeping Your Practice Digital - HITECH AnswersHITECH Answers

Scanning Medical Records and Keeping Your Practice Digital - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

In my previous scanning post we discussed the important role scanning documents plays in a successful EHR implementation. Moving from paper to electronic medical records takes a plan to know what you want to migrate from your files to your computer. But what about after your implementation and now in your daily workflow? Does scanning have a new role? Practices and hospitals alike find that while going digital helps to lessen the paper flow it still doesn’t eliminate it. There will always be something that might be acquired on paper. And when that happens, it is important to scan the document and be sure it gets included in a patients record.

Having scanning stations that are available and easily accessible for use will help integrate scanning needs into your workflow. If the scanner is off in a workroom or administrative office, it is more likely the task will be overlooked or put off in a to-do pile. Consider more than one scanner depending on your physical layout and system workstations.  Here are some areas where you might continue to see documents for patients in paper form and should be included in a patient’s electronic record. Where is this paper being collected and how can it get scanned into your system most efficiently?

  • New patient admissions and history forms
  • Capture ID and insurance card images
  • Referrals sent from other physicians
  • Medical Orders
  • Patient submitted history records
  • Patient submitted lab or procedure results
  • Consent forms
  • Payer EOBs or denial and resubmit documentation

Practices should also remember their overall business and consider digitizing all areas not just patient records. Human Resources is a big paper department with employee records and files. There are a lot of forms that start on paper for the simple fact of collecting signatures. Are you still keeping all this information in file cabinets? Consider digital employee files and scan the documents for electronic retrieval and storage.

Is your practice still using paper log sheets for medication dispensing and inventory reconciliation? Are you still using a paper sign-in sheet for patients when they arrive? Are you still receiving paper faxes for business or patients? Evaluate all the paper processes and consider a solution to convert to electronic or continue and store by scanning the documents. Benefits to electronic documents range from ease of ability to retrieve and share to simply eliminating the physical storage needs of paper documents.



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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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Why bad EMRs are forced on physicians

Why bad EMRs are forced on physicians | EHR and Health IT Consulting | Scoop.it

I recently did a tally.  Since starting my locums adventure last year, and going to full-time locums in January, I’ve worked in a grand total of 11 emergency departments.  Let me qualify that for the occasional visitor to my blog.  I decided to do this for purposes of flexibility, finances and a much needed change of scenery.  Not because I’m a problem physician, or unable to do the work in a “real” job.  I say that to emphasize the fact that at 21 years into my career, I am a keen and qualified observer of life in emergency medicine; in fact, of life in medicine in general. It’s one of the things I write about most.  And I do so because there are so many regular physicians out there with grave concerns and real problems, for whom there is no voice at all.  I try to be that voice.


And one of the things the doctors are crying out over is electronic medical records, or EMR.  These are systems that hospitals impose upon physicians in order to capture extra federal dollars via meaningful use. Or in order to mine the data so that they can squeeze every more blood from the turnip of paying patients and insurers.  Or, they are used to track every motion, every action so that administrators can have sufficient flow charts, spread sheets and other data with which to send “bad boy” letters to clinicians reminding them to work faster or better.  (And which allow various mid-level managers something to do all day without having to actually care for patients or provide intrinsic value to the hospital.)

Mind you, EMRs were already on their way, but now the administrative pressure is high.  Sadly, the systems are very, very bad indeed.  It is said that use of an EMR, versus paper charts or dictation, typically reduces physician productivity by about 30% right out of the box.  It is also noted that now, young physicians in training spend more and more time at keyboards and less and less time looking at that pesky throwback to ancient times, the human patient.  (How dare they not be pixelated!)

The sound of medicine these days is the sound of the keyboard. It is so prevalent at times that it nearly causes me to have a headache and nausea.  Tap, tap, tap, day and night.  We dash to the patient and we come back and spend the lion’s share of our time using the one class of all our classes that mattered most; typing or keyboarding.

This is not because it generates a good chart.  In fact, most systems generate terrible charts.  Charts full of clipped sentences and check box histories and exams that read worse than the worst prose.  A patient encounter can generally be summarized in well composed paragraph.  It’s just harder to mine the data from said writing.  So modern EMR charts are inundated with time-stamps and worthless information, much of it put in the chart by nurses also forced to document everything from the patient’s pain scale to when they last fluffed his pillow or inquired as to his general state of happiness.  All too often, the reason for the visit is buried in nutritional assessments and statements about whether or not they feel safe at home, or the bed-rails are up.  (I have actually witnessed charts on patients with a laceration in which the laceration or its location were nowhere described.)

The whole thing is demoralizing.  It is my experience that physicians and nurses routinely stay an hour or two later than their shift time, just to complete charting that they couldn’t do while trying to see human beings in a timely and competent manner.  In the process, they develop repetitive stress injuries like carpal tunnel syndrome.  I have had right shoulder pain on several occasions after prolonged charting.  Of course, this extra time does not in any way result in extra hourly compensation. It is a requirement added on the already too many requirements of life in modern emergency departments, imposed by those whose jobs end at 3 or 5 and who do not spend their days logging in, logging out and trying to click all the right boxes while around them, people may well be dying.  But I digress.

Having used a number of EMR systems, I can say that some are horrendous.  These are the systems that require at least four to eight introductory hours of classroom time.  These are the systems that ultimately take users weeks to fully comprehend and employ.  These leave users frustrated and angry; sometimes tearful as they simply can’t be used in a manner commensurate with the pace of the actual medicine being practiced.

Why are cumbersome systems used?  Many reasons, no doubt.  Perhaps because the hospital or hospital system has been heavily courted by a large company that convinced them that it was an “industry standard,”  that “everyone who is anyone is using it.” Certainly not, in general, because the end-user (physicians and nurses) found it simple and effective; that metric seems almost laughable these days. Doctors and nurses are commoditized quantities who will do as they’re told or else.  Period.

The cumbersome systems are also, often, connected with the large corporations that run health care.  They own or are affiliated with EMRs and those systems, with their built in data capture and billing systems, are forced upon the system’s providers to maximize reimbursement. ( One more reason, in my estimation, that a simple laceration costs $1,000 in most emergency departments.)

I am not naming bad systems; not yet.  But I am going to name two systems that are excellent.  I am not an owner, shareholder or employee of either.  I simply want to illustrate the difference.  I have used systems that required an IT nurse educator to sit by my side for at least an entire 8 or 10 hour shift; and still I wasn’t clear.  And by way of disclaimer, I realize that even the systems I’m naming are businesses, dedicated to both documentation and generating revenue.

Having said that, I repeat that I have used systems that I understood and could use competently in 30 minutes.  Why aren’t these more popular?  Because if we want physicians to use EMR, and we want those physicians to do their jobs effectively and quickly, we need to simplify and streamline.

Which ones, you ask?  First of all, EPOWERdoc.  I have used this at two facilities and found it to be delightfully simple, with a very gentle learning curve.  I learned, and used it, within about 15 minutes.  The doctor leaving night shift showed it to me and I used it seamlessly for the next 12 hours and from then on at that, and another, facility.

Second, T system.  I have used paper T-sheets and they’re nice and simple.  Personally, given my bad penmanship, I prefer the electronic version.  When I first used it in June of this year, I was met by an IT educator as I walked into the shift.  In 20 minutes, I understood it and smiled as I enjoyed its intuitive design for the next 10 hours.

I suspect that if physicians had any control of this situation, the majority would use the simplest system possible. As it stands, however, we don’t.

Pity, because the demands on emergency departments grow more intense every day.  The stresses are high and the resources are stretched. The last thing anyone needs is a complicated, time-intensive, soul-sucking computer program.

What we need is simplicity and compassion for providers.

Is that too much to ask?



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EHR Data, Decision-Making Ultimately Lie in the Patient’s Hands | EHRintelligence.com

EHR Data, Decision-Making Ultimately Lie in the Patient’s Hands | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Patients should have the right to control their own healthcare and their own EHR data regardless of a provider’s opinions or disagreements, state David Blumenthal, MD, MPP and David Squires, MA in a commentary published in the Journal of General Internal Medicine.  Even though some patients withhold critical information from their physicians or refuse to comply with treatments, clinicians are nothing more than “guests” in a patient’s life and must act with respect and understanding, the authors say.

The question of whether patients should be able to control the information in their electronic health records (EHR) provokes strong opinions, says Blumenthal, a former National Coordinator for Health IT and current President of the Commonwealth Fund.  “Some argue that the information rightfully belongs to patients, and they should be able to decide what is recorded and who can access it. Some clinicians, however, argue that because they have a duty to provide their patients with the best possible care, doctors should have unfettered or nearly unfettered access to any information needed to meet that obligation.”

Blumenthal and Squires, a senior researcher at The Commonwealth Fund, come down on the side of the patient’s rights to make their own choices about the quantity and completeness of the data they share with their clinicians, as well as the access, use, and transmission of information stored in their EHRs.

As privacy and security concerns continue to affect the way patients view the use of EHRs, patients must be properly educated about data security, health information exchange, and the benefits of providing complete and accurate data to their physicians.  Providing this education is a “considerable challenge,” the authors note, as many patients do not understand the details of how data is exchanged between providers or even what privacy protections are built into HIPAA.

While patients may have the right to withhold information based on these concerns, incomplete or incorrect data can have significant impacts on a patient’s health and wellbeing in unanticipated ways.  “A patient’s decision to withhold data about a sensitive medication—such as a psychotropic or HIV-related drug—may have later consequences that neither patients nor clinicians could have anticipated,” Blumenthal and Squires write. “Beyond this, when evaluating a patient, experienced clinicians often rely on an array of data, including information not obviously related to the current problem, to raise and evaluate hypotheses about diagnosis and treatment.”

EHR developers are still working to refine and implement technologies that deal with patient consent for the sharing of specific pieces of information, such as HIV status, sexual orientation, or mental health diagnoses.  Even when these capacities are more mature, the authors point out, there will always be instances when clinicians feel they must override a patient’s wishes in order to provide proper care or protect other patients from communicable or infectious disease.

However, Squires and Blumenthal caution providers who wish to assert their unrestricted rights to a patient’s health information that “if patients do not trust the health system to protect them, their relationships with their clinicians will suffer, they will withhold information, and the value of the health information contained in the EHR will be undermined. In the long run, clinicians as well as patients will benefit from a health information system that patients feel they can depend on to protect their privacy.”

As EHR adoption reaches the majority of healthcare providers and the tension over issues of consent, data exchange, and data usage become more complex, these questions will continue to prompt discussion among healthcare professionals on both sides of the argument.  “Continued research on how to inform patients, support their choices, and understand the consequences for their care is essential,” the article concludes. “And while caution cannot be thrown to the wind, our prejudice should be to give patients a chance to express their views, and then abide by those as best we can.”



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