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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Why Our Independent Practice May Be at Its End

Why Our Independent Practice May Be at Its End | EHR and Health IT Consulting | Scoop.it

We are many things: husband and wife, doctor and administrator, and parents. When you first meet us we appear pretty vanilla, but in fact, in our lives, when we come upon two metaphorical roads diverged in a wood, we often choose the one less traveled by. This month, on September 9, we celebrated 15 years of marriage and took time to reflect on our path so far and where we think we're going next.


Here are a few unusual choices we've made along our path so far. We met on Match.com in 1999 when very few people did that. We got engaged only six months after meeting and married nine months after that. Uncle Sam paid for Terence's medical school education which meant we spent the first six years of his career — and our marriage — as an active-duty military couple. The Air Force took us away from our home state of Massachusetts; we lived three years in Dayton, Ohio, and the next three in Albuquerque, New Mexico. In 2006, we opened our solo pediatric micro-practice even though everyone, including our accountant at the time, told us it couldn't be done. And in 2008, we met a beautiful four-and-half-year-old little boy whom we adopted a year later.


From 2006 to 2014, our micro-practice model worked well for us. We enjoyed an average income for primary-care pediatricians in our area all while maintaining work-life balance and giving patients long appointments that run on time. We also continually received high marks on patient satisfaction surveys and performed very well on the quality measures set by our independent physician association (IPA). And, because we were small and flexible, it was easy for us to adapt to changes, like integrating behavior health, into our model. It's not that small practice ownership has even been simple, but until recently we could make it work.


Our model in 2015, though, has stopped working as well. Understanding why our revenue is down, over 20 percent, is pretty easy and almost all due to the consolidation of insurance companies. To be clear, our problems are not at all uncommon; we see many primary-care peers, in all sorts of different practice models, suffering for the same reason. We are losing confidence that any independent practice model has the power to survive against the oligopoly of powerful insurance payers.


The pressure to abandon independence, and along with it the many benefits to ourselves and our patients, is increasing exponentially. The day is drawing near when we must choose between the road everyone else is taking —namely to abandon independence — or find a more creative road less traveled. For now, we appear to be on a single-lane, one-way highway to selling out without an off ramp to stay independent in sight.

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Is your EHR hurting your nurses?

Is your EHR hurting your nurses? | EHR and Health IT Consulting | Scoop.it

Healthcare organizations continue to face unprecedented change. Electronic health records are altering nearly every aspect of the caregiver-patient relationship – not to mention changing caregivers’ workflows with omnipresent tablets, handhelds, wall mounts and mobile carts. Today, nurses are on the front lines of this transformation. During a typical shift, they spend 35 percent of their time on documentation, or 3.5 hours of their workday entering information at a computer. Despite this, a recent survey from HIMSS Analytics found that 71 percent of nurses would not consider going back to paper-based medical records. What’s more, nurse respondents agree that EHR benefits are good for patient safety: 72 percent believe they improve patient safety and avoid medication errors and 73 percent admit they enable collaboration with other clinicians inside their organizations.


Underscoring every EHR implementation is the goal of doing business more efficiently, and the HIMSS Analytics findings demonstrate nurses’ integral role in helping hospitals achieve this. It is of equal importance that administrators understand the complete picture surrounding the complex systems nurses have to master. If the necessary equipment doesn’t fit within their workflow or is uncomfortable to work on, not only will EHR systems never reach their full potential, but they stand to cause physical strain to caregivers. This limits their ability to execute their jobs and can ultimately impact the quality of care patients receive. In order for organizations to maximize their system implementations and investments, they must evaluate their caregivers’ new workflows and embrace supportive design and devices that improves comfort while also allowing them to deliver a similar or improved level of patient care.


Importance of ergonomics


A recent Ergotron report, “How Digital Healthcare Helps and Hurts Nurses,” surveyed 250 full-time US nurses and found that 49 percent report feeling some level of discomfort while inputting charting data into a computer workstation. One of the most important factors to consider when integrating technology into nursing workflow is the ergonomics of the equipment. Ergonomics refers to the application of scientific knowledge to a workplace to improve the well-being and efficiency of workers. Access to ergonomic equipment in the workplace increases workers’ efficiency and productivity, while helping to reduce fatigue, exertion and musculoskeletal disorders – all side effects nurses can experience during a long work shifts.  Multiple studies have found that a sound ergonomics program helps reduce the number of workplace injuries and absenteeism, and can contribute to overall employee wellness.


Though technology has brought many wonderful innovations to the healthcare system, it also has the potential to introduce improper ergonomics into many clinical settings. Before EHRs, nurses could work on their charting while seated at a nursing station, giving them a break from their active work day. Now, nurses often stand with a computer on wheels when documenting. If the device does not offer standard ergonomic features – such as broad height-adjustment capabilities to adapt a unit to the correct height of the caregiver or negative tilt keyboards – repeated usage over time will add to the nurse’s physical strain.


What’s more, while nurse pain has been well documented, what’s often not addressed is how this physical discomfort directly affects their patient care, or patient experience. Ergotron’s survey revealed that nurses admit to being less friendly or engaging with patients (22 percent), modifying or limiting their patient interaction on the job if their body is hurting (22 percent) or needing to ask for more assistance from other staff (14 percent).


Patient-centered environment


The survey from HIMSS Analytics also revealed that nurses were less likely to think that EHRs help with efficiency and many responded that EHRs did not allow them to spend more time with patients. To create more patient-centered environments, healthcare facilities must find solutions in which nurses can use technology with ease.


Effectively integrating technology into all aspects of the healthcare environment to enhance the patient experience requires attention to positioning the patient, the caregiver and the technology, into a more favorable Triangle of Care alignment, or what Ergotron calls “Patientricity.” Creating a patient-centered environment that is inclusive of technology is only effective when the needs of the patient and medical staff alike are considered – whether documenting at the bedside or reviewing documentation at the nurses station.


When technology is integrated correctly into clinical workflow, it is beneficial to all involved. It promotes increased interaction, satisfaction, safety and efficiency to the patient-caregiver exchange. The patient not only receives the benefit of the face-to-face connection with the caregiver, but the technology becomes a partner in the exchange. When considering this workflow strategy, stakeholders should consider:


  • Avoid inappropriate or cumbersome placement of technology that impedes the efficiency of care, such as a computer mounted in a room but the caregivers back is to the patient.
  • Consider adjustable options that allow caregivers to sit or stand while accessing or inputting data to offer a new level of work flexibility.
  • Avoid skimping on key ergonomic considerations in terms of helping users achieve proper computing postures, and adjustability when manipulating the equipment.
  • Evaluate and better understand the human interaction that needs to take place within the digital workflow.
  • Understand space constraints to determine whether fixed, permanent and dedicated equipment is required, or whether a mobile solution best serves the care-giving requirements.


When nurses feel good, it improves their ability to deliver higher quality of care. Conversely, injuries and physical discomfort directly affect patient interaction. When asked what nurses would change in their work environment to support the prevention of discomfort, pain or injury to themselves and fellow nurses: 28 percent would add a dedicated ergonomics team to help ensure equipment is supportive to staff, and 28 percent would redesign the physical space in the patient rooms and units to better align with clinical workflow and patient needs.


Despite electronic devices being ubiquitous and important tools in health facilities, technology is not always properly integrated into the healthcare environment to help nurses or patients. There are many benefits to exploring ergonomics and patientricity. Besides the inherent productivity gains associated with an ergonomic investment, it also leads to more satisfied employees and patients, increased access to technology, long-term cost reductions and decreased injuries due to poor ergonomics. In order for nurses to take better care of patients, the healthcare system must first take care of its nurses.

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Laurie Bolick Wolf's curator insight, June 19, 2015 1:54 PM

With the increase use of computers, there has also been an increase in injuries from non-ergonomic work environments to do required charting.  While this is not something I had ever thought of, on reflection it is very true.  Rather than sitting comfortably at a desk with good body alignment, I often stand at a mobile station talking to patients that are behind me as I document.  I think developing a plan and team to improve the workspace to be more ergonomic would be very beneficial.

 

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July ICD-10 Testing Shows CMS Readiness for Implementation

July ICD-10 Testing Shows CMS Readiness for Implementation | EHR and Health IT Consulting | Scoop.it

In preparation for the October 1 ICD-10 implementation deadline, the Centers for Medicare & Medicaid Services (CMS) have completed their third Medicare fee-for-service end-to-end testing with great success, according to a recent CMS report. This is the third successful CMS ICD-10 testing to occur in 2015.

The testing week, which occurred between July 20 and 24, included healthcare providers, clearinghouses, and billing agencies. These entities utilized the help of Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) to file their claims. Participants from previous tests were invited to partake in the July tests, thus bringing a considerable amount of returners to this session.


The July test was a success, according to CMS, with an 87 percent acceptance rate of the 29,286 claims received. The rejection rate for ICD-10 errors was 1.8 percent, and the rejection rate for ICD-9 errors was 2.6 percent. However, majority of rejected claims were not ICD-10 related. Among others, these included invalid NPIs, claims outside of the covered date range, and invalid place of service. CMS confirms that many of these same errors occurred in previous test sessions.

Additionally, CMS states that many rejected claims may have been submitted with errors on purpose. This practice, referred to as “negative testing,” is intended to ensure that CMS’ rejection processes are functioning properly and will indeed reject a provider’s invalid claim.


CMS reports a larger cross-section of volunteers this test session, with about 1,200 organizations selected to participate in the test. There were 493 organizations returning for previous tests. Additionally, 1,400 National Provider Identifiers (NPIs) participated in the test, and approximately 12 percent of those were repeats from prior tests.


This test brought about similar results to previous tests performed in January and April. In January, CMS reported an 81 percent approval rating between January 26 and February 3. This test included 661 volunteers. Just like this most recent test, the January test boasts a high success rate, with a majority of rejected claims resulting from non-ICD-10 related errors.

Tests performed in April were likewise successful. With 875 participants, CMS reported an 88 percent acceptance rate, which is consistent with the July tests. The number of rejections due to ICD-10 and ICD-9 errors are also consistent with the July tests, with a majority of rejections being due to other provider-related issues.

As providers and payers alike continue to prepare for the impending October 1 ICD-10 deadline, these test results bring promise to CMS. Not only have CMS’ systems shown a proven capability for accuracy, but they have shown consistent accuracy, with only a seven percent difference between the best and worst test performances. Provided these positive results, CMS has shown that it is ready for this new coding system.

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