EHR and Health IT Consulting
36.3K views | +2 today
Follow
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
Your new post is loading...
Your new post is loading...
Scoop.it!

HITECH Helped Promote EHR Use, but Usability Issues Remain

HITECH Helped Promote EHR Use, but Usability Issues Remain | EHR and Health IT Consulting | Scoop.it

While the recent push to adopt health IT systems has helped to improve care and reduce costs, issues with usability and interoperability require further federal attention, according to a study published in the Journal of the American Medical Informatics Association, FierceHealthIT reports.

Study Details

For the study, University of Edinburgh researchers interviewed 47 U.S.-based health IT stakeholders. The researchers sought to determine whether health IT has helped to achieve the Institute for Healthcare Improvement's "triple aim," for health care. The triple aim includes:

  • Enhancing population health;
  • Improving patient care; and
  • Reducing health care costs.

The stakeholders interviewed included:

  • Government employees;
  • Health IT experts;
  • Health policy experts;
  • Patient advocates;
  • Payers;
  • Providers; and
  • Vendors.
Study Findings

The researchers found "a widely shared belief" that the HITECH Act spurred the adoption of a digital infrastructure that is being used to improve the quality of care while reducing costs.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

However, there was concern among physicians regarding the usability of:

  • Electronic health records; and
  • Computerized decision-support systems.

Physicians said the systems were immature technologies that had been written based on old code designed for hospital billing. In addition, physicians said they considered currently used EHR technology to be inadequate in:

  • Supporting multidisciplinary teamwork; and
  • Incorporating quality measurement into care delivery.

Both physicians and vendors said meaningful use requirements present a distraction from more development and clinical priorities.

In addition, many respondents reported that it is important to move toward value-based care driven by data and high levels of care, and away from fee-for service payment models.

Policy Recommendations

During the interviews, many respondents suggested that CMS and the Office of the National Coordinator for Health IT require vendors to open their application program interfaces and encourage collaboration with:

  • Small vendors; and
  • The medical informatics community.

The two areas that were considered the biggest policy issues were:

  • Further financial reform; and
  • Interoperability.


more...
No comment yet.
Scoop.it!

HITECH and Meaningful Use at a Crossroads

HITECH and Meaningful Use at a Crossroads | EHR and Health IT Consulting | Scoop.it

It is hard to believe that the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed into law five years ago, in 2009, and at the end of the year, the massive legislation was shaped into a program that has profoundly altered the informatics world, not to mention all of healthcare. Like most large undertakings, especially when infused with politics, the results have been mixed. Clearly the goals of EHR adoption have been substantial in hospitals and by physicians, even if the resulting systems have not achieved the ideals we held out for them. Perhaps as much depending on your political views as much as your informatics views, the glass is either partially empty or partially full.


On the positive side, a large proportion of US physicians [1] and nearly all US hospitals [2] now use an electronic health record. While many have argued that there should have been a much greater focus from the start on data interoperability, we are seeing progress with the rapid coalescence behind the FHIR, ReST, and OAuth2 standards in the Argonaut Project of HL7.


On the negative side, the systems we have implemented have been driven by meaningful use criteria. While no one would argue against these criteria generally (e.g., problem lists, electronic prescribing, etc.), many have argued that healthcare organizations have had to devote too much effort to meeting the criteria rather than innovating and leading with the beneficial aspects of technology. By the same token, the focus of vendors has had to be on certification to insure their customers can meet the meaningful use criteria with their products. On top of this is the toxic political environment in the US, with one’s views’ on HITECH and the Affordable Care Act being a sort of political Rorschach Test, making it even more difficult to have a meaningful conversation.


I tend to be glass-half-full kind of person, although I certainly acknowledge the limitations of the situation we are in now. It is easy to find critics of the current situation, but I tend to prefer to read and converse with those who present a balanced view that recognizes the problems in paper-based healthcare that led us to adopt the (still not achieved) promise of information technology (IT)-enabled healthcare. I give a special call-out to my colleagues Bob Wachter [3] and Jacob Reider [4] for their recent writings, and the former for his book that was just released [5], which I am enjoying but admittedly not done reading yet.


The real question is how we can get from here to where we want to be. This is especially so with the release of the Notice of Proposed Rule Making (NPRM) for Meaningful Use Stage 3 as well as the legislation to solve the Sustainable Growth Rate (SGR) problem (the “doc fix”) of Medicare, which contains a proposal to roll the Meaningful Use Program into a more coalesced approach to incentives for quality in the Medicare Program.


My own view is that we should be focusing on data standards and interoperability, aiming to allow innovation to flourish on top of it. We also need to be open and critical of current failings, but also willing to move beyond negativity and linking the current situation to politics and/or greed. Not that both of these are not present, but that we need to come together as a community so those negative attributes are held in check by the greater community working toward more positive goals.


more...
No comment yet.
Scoop.it!

HITECH Stage 3 Security Rules

HITECH Stage 3 Security Rules | EHR and Health IT Consulting | Scoop.it

Some security experts are concerned that narrower risk assessment requirements in a proposed rule for Stage 3 of the HITECH Act "meaningful use" electronic health records incentive program could confuse healthcare organizations about the importance of conducting a broader risk assessment as required under HIPAA.

On March 20, the Department of Health and Human Services' Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking for Stage 3 of the Medicare and Medicaid EHR incentive program, and HHS' Office of the National Coordinator for Health IT issued the notice of proposed rulemaking for EHR software that qualifies for the incentive program: 2015 Edition Health Information Technology Certification Criteria.


The rules are slated to be published in the Federal Register on March 30, with HHS accepting public comment for 60 days. Regulators are expected to issue final rules after reviewing the comments, which could take months.

Under Stage 3 of the HITECH Act incentive program, eligible hospitals and healthcare professionals can qualify to receive additional incentives by "meaningfully" using certified EHR software to accomplish a list of objectives, including sending secure messages to patients and conducting a security risk assessment of EHR data.

Currently, depending upon when they began participating in the HITECH program, which launched in 2011, eligible hospitals and healthcare professionals are participating in Stage 1 or Stage 2 of program.

Under the HITECH Act, penalties for not using a certified EHR system will kick in beginning in January 2018. Hospitals and physicians participating in the Medicare program must meet a list of Stage 3 objectives and measurements to avoid reduced Medicare payments, a CMS spokesman explains. Those participating in Medicaid have through 2021 to qualify for financial incentives under the HITECH program, and are not subject to financial penalties for failing to meet the objectives.

Meaningful Use Proposals

One of the most significant proposed changes for Stage 3 requirements deals with risk assessments.

While healthcare providers are still expected to conduct broader HIPAA security risk analysis as part of their HIPAA compliance, the Stage 3 proposals state that healthcare providers must conduct annually an assessment that specifically looks at technical, administrative and physical risks and vulnerabilities to electronic protected health information created or maintained by the certified EHR technology.

The proposal addresses "the relationship" between this EHR-related measure and the HIPAA Security Rule risk assessments. "We explain that the requirement of this proposed measure is narrower than what is required to satisfy the security risk analysis requirement under [HIPAA]," the proposal says.

"The requirement of this proposed measure is limited to annually conducting or reviewing a security risk analysis to assess whether the technical, administrative and physical safeguards and risk management strategies are sufficient to reduce the potential risks and vulnerabilities to the confidentiality, availability and integrity of ePHI created by or maintained in [the certified EHR technology]," says the proposal.

"In contrast, the security risk analysis requirement under [HIPAA] must assess the potential risks and vulnerabilities to the confidentiality, availability, and integrity of all ePHI that an organization creates, receives, maintains or transmits. This includes ePHI in all forms of electronic media, such as hard drives, floppy disks, CDs, DVDs, smart cards or other storage devices, personal digital assistants, transmission media or portable electronic media."

Seeking Clarity

Security expert Tom Walsh, founder of consulting firm tw-Security, says the proposed rule offers some clarity of what's expected of healthcare providers.

"With the new MU Stage 3 there was clarification that this was the original intent" to assess the security risk of EHR data, he says.

However, the focus on the annual security risk analysis of EHR data may inadvertently water down the importance of conducting broader HIPAA risk analysis, he says.

"Some organizations, especially smaller organizations that do not have a dedicated information security professional on staff, think that the only risk analysis they need to conduct is just for the certified EHR," Walsh says. "The HIPAA Security Rule requires that all applications and systems that store or transmit ePHI need to have a risk analysis conducted."

John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, expressed disappointment with the risk assessment language in the proposed meaningful use rule. "The MU3 security requirements are less than HIPAA requirements in that they focus only on the EHR and not all information flows. Since security is an end-to-end process, it is not clear to me why the security focus of MU should be less than HIPAA."

Halamka suggests that "maybe a balanced approach is to require a HIPAA Security analysis - NIST 800-66 for example - once every three years, then ask for yearly progress on the plan, rather than yearly re-audits."

Secure Messaging

Another security issue spotlighted in the meaningful use requirements proposed for Stage 3 is secure messaging.

The proposal call for healthcare providers ramping up patient communication using secure messaging, especially after patients are discharged from a hospital or emergency room. For instance, the proposal says that providers should electronically send secure messages to more than 35 percent of all patients seen by a provider or discharged from a hospital during the EHR reporting period. The secure message should be sent "using the electronic messaging function of the certified EHR technology to the patient - or the patient's authorized representatives - or in response to a secure message sent by the patient or the patient's authorized representative."


more...
No comment yet.
Scoop.it!

Future of EHRs: Interoperability, Population Health, and the Cloud

Future of EHRs: Interoperability, Population Health, and the Cloud | EHR and Health IT Consulting | Scoop.it

Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers have been quickly implementing EHR systems and adopting health IT tools. The overall movement toward improved quality of care and greater access to healthcare information will likely stimulate the future of EHRs.


Before predictions regarding the future of EHRs and their designs can be considered, it is critical to examine the history and evolution of EHR technology over the last five decades. The American Medical Association Journal of Ethics discussed how the earliest developments in EHR design took place in the 1960s and 1970s.  Healthcare leaders began forming organizations as early as the 1980s to develop standards for the increased use of EHR systems across the sector.

The very first health IT platforms, developed by Lockheed in the mid-1960s, were called clinical information systems. This particular system has been modified over the years and is now part of Allscripts’ platforms.  The clinical information system was capable of having multiple users on at once due to its high processing speed. During the same period, the University of Utah developed the Health Evaluation through Logical Processing (HELP) system and later Massachusetts General Hospital created the Computer Stored Ambulatory Record (COSTAR).


The COSTAR platform was able to separate key healthcare processes into separate entities such as accounting or billing versus clinical information. The federal government adopted an EHR system in the 1970s through the Department of Veteran Affairs’ Computerized Patient Record System.


Over the last several decades, there have been even more developments in EHR design and implementation, especially since the federal government constructed meaningful use objectives under the EHR Incentive Programs. In 1991, the Institute of Medicine (IOM) published a report analyzing the effects of paper health records and making a case for the use of EHR systems. The report also covered challenges to EHR adoption such as costs, privacy and security concerns, and a lack of national standards.


In 2000, the IOM also published its infamous report To Err is Human in which the high rates of medical errors were discussed and health IT systems were addressed as a potential solution. The history surrounding health IT will likely impact the future of EHRs, as the same principles toward better quality of care, lower costs, and improving patient health outcomes are at the forefront of EHR adoption.

EHRIntelligence.com spoke with three leaders in the healthcare IT industry to discuss the future of EHRs and the trends to expect over the coming years. Bob Robke, Vice President of Interoperability at Cerner Corporation, mentioned the importance of healthcare data sharing across multiple platforms.


“We’re moving out of the era of EHR implementation and adoption and into the era of interoperability,” Robke said. “Now that we’ve automated the health record, the next phase is connecting all of the information in the EHR. We need interoperability and open platforms to accomplish this.”


The functionalities possible in future EHR systems will also focus greatly on interoperability and Big Data. As telehealth functions spread across the country, patient health outside of the medical facility will be greatly considered.


“Interoperability has the potential to unlock a richer set of data that clinicians can use to help improve the care they provide to patients,” Robke explained. “More than ever, clinicians will need access to information about the patient’s care that happens outside of their four walls as healthcare moves from fee-for-service to value-based models.”

When asked what healthcare trends are affecting the design of EHR systems, Robke replied, “There is a lot of exciting work being done to advance open standards that enable information stored in one EHR to be accessed by other systems. A good example of this is the work being driven by the Argonaut Project to advance the development and adoption of the FHIR standard. We’re big supporters of the SMART on FHIR approach that allows information to be accessed from directly within the EHR workflow, and are enabling that within the Cerner EHR.”

Health information exchange and EHR interoperability will continue to impact the future of EHRs over the coming decades, as the healthcare industry continues to strive toward meaningful use of health IT systems. Robke spoke on the benefits of health information exchange and the strategic actions of the Commonwell Health Alliance, which is geared toward nationwide healthcare data exchange.


“Interoperability is a critical next step in the EHR world. Interoperability can provide clinicians with the data they need to manage the health of their populations and truly put the patient at the center of care,” Robke explained. “For interoperability to succeed, it will require all of the different information system suppliers coming together to find ways to connect their platforms, like those vendors who have joined together in the CommonWell Health Alliance. The great thing about CommonWell is vendors representing 70 percent of the acute market share in the U.S. have joined together to make interoperability a reality.”

When discussing how telemedicine and population health measures will affect the future of EHRs and the development of health IT platforms, Robke stated: “Connecting different information sources are key to successful telehealth and population health management strategies. Health care organizations need to access a patient’s full health history regardless of where that care was provided or what information system houses that information.”


“And yet, when it comes to results, there is an alarming failure in the healthcare industry.  Despite huge investments in enterprise systems, venerable healthcare organizations failing even at the basics like exchanging information electronically, communicating amongst care teams, and engaging patients,” Bush elaborated on the topic. “Some are even going bankrupt!  The shortcomings of software – the cost, the inability to share information at scale, the demands for onsite management and maintenance, and the sluggish pace of innovation—are chiefly responsible for this.”


The revenue cycle in the healthcare industry will also have a great impact on the future design of EHR systems and trends within this sector, Bush explained. The costs of investing in complex technologies will affect the future adoption rates while the financial incentives of the Medicare and Medicaid EHR Incentive Programs will also stimulate hospitals and physician practices.


“That’s why I believe that health care leaders are going to start thinking in terms of the total cost of driving results, not the total cost of ownership, when they contemplate the HIT of the future,” Jonathan Bush explained. “It’s crucial in the current landscape to adopt a cost calculation that accounts for labor and operational costs across several departments, as well as the opportunity costs of an underperforming system. As CIOs and health system boards are increasingly held to account for their investment decisions, I think we’ll start to see a new model for total cost of ownership emerge—and a fleet of next-generation services emerge to keep up.”


When asked what functionalities he thinks health IT systems will be able to obtain in the future, Bush replied: “Malleable IT strategies available from the cloud will reinvent what we ever thought HIT was capable of.  I agree with a recent IDC report and its vision for a future filled with ‘3rd Platform EHRs’ capable of functions we just don’t see in software today.”


“Those functionalities would include easy access to data; population-wide analytics; and network intelligence that crowd sources the wisdom of many to improve overall performance,” he continued. “These functionalities are already being built in to service value-based care organizations.  The promise is better healthcare in an accountable care environment.”


Next, the Athenahealth CEO discussed the importance of connectedness and interoperability when it comes to the design of EHR technology and future trends in health IT.


“Connectedness is a huge barrier to humanity in health care, as well as to the design of intelligent IT systems,” Bush said. “Achieving connectedness, or the meaningful use of health IT, isn’t reliant on getting all providers onto one system.”


“I believe that the one-size-fits all mantra is finally waning and that healthcare will continue to demand what I like to think of as the ultimate ‘backbone’ solution: lightweight technology that can unite data across multiple platforms and support advanced levels of care coordination and connectedness. That sort of infrastructure is not only more cost effective, nimble, and future-proof; it’s also best for patient choice and access and — ultimately — quality care.”


Some of the typical trends that are affecting the future of EHR technology include telehealth, population health management, accountable care, and health information exchange. Population health management in particular will affect the development of analytics software and statistical measurements vital for demonstrating healthcare quality improvements.


“The arrival of population health is, and will continue to be, huge. It’s trending in M&A, has wound its ways into vendors’ capability descriptions, and is on the required ‘must support’ list for healthcare organizations of all sizes,” Jonathan Bush explained.


“To do population health correctly, EHRs will need to gain insight into patient populations, translate that insight into meaningful knowledge for care teams, and enable a new standard of connectedness to manage and deliver care. To do such complex, hairy, and crucial processes, EHRs will have to leverage a combination of software, knowledge, and work.  Software alone simply isn’t cut out to do the job.”


EHRIntelligence.com also spoke with Practice Fusion Founder and Chief Executive Officer Ryan Howard about future trends in EHR design. Howard spoke about the importance of data sharing among health IT systems.


“The single biggest trend will be cloud-based EHRs. The biggest single problem in the space is not deployment of EHRs. It is sending data back and forth whether it’s for quality and accountable care or sharing data with a payer or a lab or other doctors,” said Howard. “In every spirit of this, data from EHR needs to be shared with another EHR system.”


“The challenges of that is to install software offsite. Most of the major competitors have enterprise solutions. The data is incredibly difficult to get out. A cloud-based model inherently has an exponential cognitive scale that allows it to do this easily,” Howard explained. “In our case, when we connected to Quest, every doctor on our platform has a connection to Quest now because they’re all the same multi-tenant cloud-based systems. I think the biggest problems in health IT will be solved by simple integration into the cloud.”


Howard was of the same opinion as the other CEOs when it comes to the functionalities EHRs will need in the coming years. Interconnectedness, interoperability, or the efficient sharing of health data between disparate systems will become a necessity in the quest to improve patient care and health outcomes.


“The biggest single thing [that will affect the future of EHRs] is that systems need to seamlessly connect to each other,” the Practice Fusion CEO stated. “Most of the systems are pretty robust, but I think the major cloud-based systems will need to interoperate. I think the major cloud-based vendors in the marketplace will connect and all their doctors will be able to interoperate. I think all the doctors will migrate to cloud-based systems.”


“This is only possible in a web-based or cloud-based model where the population data is in one place,” Howard said. “There’s very little value in doing this in a solution that’s installed in the doctor’s office. In that situation, all the data isn’t in one place and, in a population health management program, you’re constantly rolling out new rules and tackling new chronic conditions.”


When asked what healthcare trends will affect the design of EHR systems, Howard replied: “Population health management in addition to the electronic health records role in enabling telemedicine will all be key in the marketplace. Unless you have the patient’s record which only exists in the EHR, then there will be very little value on the telemedicine platform.”


“However, if I’m using a telemedicine platform that’s connected to the EHR, I have all that data in real-time. Most EHRs that are certified do drug-drug and drug-allergy checking dynamically in the system. That’s a good example of the value that comes from the platform.”


In predicting the coming impacts in EHR developments, Howard said, “cloud-based systems, population health management, private care management, and big data” are the major catalysts in health IT design.

“I think most vendors don’t have a population health management solution. The challenges of that is that population health does not work unless all the data is in one place,” Howard stated. “For population health management to work, take a look at diabetes. What the system is doing in a population health management model is that it is constantly monitoring your patient on a day-to-day basis.”


If a patient hasn’t had a required test done, “the system should automatically be reaching out to that patient to drive awareness – get them to book an appointment – and the system should also be prompting the physician with the standard of care during the visit.”


more...
No comment yet.
Scoop.it!

Meaningful Use Requirements Impact Adoption of EHR Functions

Meaningful Use Requirements Impact Adoption of EHR Functions | EHR and Health IT Consulting | Scoop.it

As healthcare providers continue to upgrade EHR systems and achieve meaningful use requirements under the EHR Incentive Programs, federal agencies put forward additional mandates like the Meaningful Use Stage 3 proposed rule to advance health IT initiatives within this sector.

Once the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the implementation of health IT systems spread across hospitals and physician practices. After the HITECH Act was established, the federal government developed meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs to encourage physicians to adopt EHR systems.EHRIncentiveLogoweb

The adoption of EHR technology has been steadily rising over the last decade and researchers from the University of Michigan conducted a study to analyze EHR adoption in hospitals across the country.

The study was published in the Journal of the American Medical Informatics Association and used 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data to analyze the rise in adoption rates of EHR functionalities among hospitals.

The researchers looked at whether Stage 1 Meaningful Use requirements pushed forward the earlier rates of EHR adoption. Essentially, the study looked at whether there was a common sequence for adopting EHR functionalities and whether the location or size of a hospital affected this.

The researchers surveyed almost 3,000 hospitals in all 50 states. The results show a similarity in the sequence of EHR adoption across hospitals. The homogeneity score was 0.48, which illustrates moderate-to-strong evidence for similarity among hospital adoption of EHR functionalities.

Patient demographic data, radiology reports, and laboratory reports are some of the first functions implemented in the EHR system while clinical reminders, guidelines, and physician notes were adopted in later years. The EHR functions analyzed include clinical documentation, results management, computer provider order entry (CPOE), barcode, and decision support.

Some other items that had strong homogeneity in the study include medication lists, drug-allergy alerts and drug-drug interactions, nursing assessments, and discharge summaries.

Smaller hospitals were more homogenous when it came to their adoption of EHR functionalities while larger health systems as well as urban and teaching hospitals displayed more diversity.

The researchers also predict that Stage 1 Meaningful Use requirements are leading the adoption of certain EHR functions over others. For instance, incorporating clinical guidelines and medication computerized provider order entry in EHR systems is a key part of the federal rulings, which has increased the adoption of these particular EHR processes.

The study also indicated that meaningful use requirements caused hospitals to adopt clinical guidelines, medication CPOE, clinical documentation functions, and decision support tools earlier than other EHR functions. Meaningful use requirements may have also affected the decisions of smaller hospitals more than larger health systems.

The results show that healthcare providers are putting their resources into meeting meaningful use requirements and earning financial incentives under the EHR Incentive Programs. While this is positive news, it is also important to address the individual needs of each hospital.


more...
No comment yet.
Scoop.it!

What Gets Measured Gets Managed - HITECH AnswersHITECH Answers

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

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

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

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

She asked for support through her network and found me.

Data > Information > Knowledge

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

 

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

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

We had 90 days to turn this around.

Team Work

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

Meaningful Use is a team sport, after all.

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

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

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

Getting Creative with the Portal

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

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

They even told patients what to say:

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

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

The First Big Win

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

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

Non-Percentage Based Objectives

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

Lessons Learned

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

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


more...
No comment yet.