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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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EHR Data Interoperability Needs Strong Security Platforms

EHR Data Interoperability Needs Strong Security Platforms | EHR and Health IT Consulting | Scoop.it

Within the healthcare industry, EHR data interoperability has become all the rage, as medical providers, the federal government, media, and health IT vendors continue discussing the impact and benefits of interoperable, electronic patient records. In fact, more EHR vendors and developers are starting to bring interoperable products in front of providers.


For example, the medical device manufacturer Smiths Medical will be revealing its management software with an interoperability platform at the Association for the Advancement of Medical Instrumentation (AAMI) Conference taking place between June 5 and June 8 in Denver, Colorado, according to a company press release.


In addition to the new developments within the health IT field regarding EHR data interoperability, the Office of the National Coordinator for Health IT (ONC) has published public commentsto its nationwide interoperability roadmap.


“I am very opposed to this,” one respondent stated. “It proposes to repeal federal law that allows state legislatures to enact true medical privacy laws for citizens. It views patient data as public property rather than personal property. It has uses of data that many patients will not accept.”


The comments show how controversial EHR data interoperability is currently among consumers across the nation. Patient data privacy and security is, as always, at the forefront of the discussion and federal agencies continue to address its importance.


As ONC along with the Centers for Medicare & Medicaid Services (CMS) release proposed meaningful use requirements, there are some entities that have found EHR data interoperability stressed under the Stage 3 Meaningful Use proposed rule to be overly complex to implement among the industry.


Recently, the American Medical Association (AMA) has sent a letter to both CMS and ONC expressing its concerns over the complexity within Stage 3 Meaningful Use requirements that may impair EHR data interoperability. The inadequacies in building up sufficient health information exchange systems throughout the nation could lead to negative impacts on population health management efforts as well as overall quality of patient care.


As privacy and security continue to impact the ongoing reforms toward effective EHR data interoperability and health information exchange, the AMA underscored the security risks that EHR technology poses on the medical sector and patient safety.


“Another area where attention is lacking is how to address the growing privacy and security risks related to EHRs and other technology. Between 2010-2013 there were almost a 1,000 significant data breaches affecting 29 million patients, two-thirds of which involved electronic data. Moving to an electronic environment has greatly increased the probability of cybersecurity threats and breaches of patient data. Already, we have seen major institutions experience large data breaches that affect thousands of patients, as well as new cyber-attacks that cause EHRs to go dark literally for days,” theAMA letter stated before CMS and ONC rule makers.


“Rather than address these concerns, the proposed rule tries to highlight the numerous technology advancements that can be used and added to EHRs. It, however, fails to address how this may increase the risk for privacy and security problems… Before expanding the program to include additional technology and other requirements, we believe that the immediate need for greater protection of patient information must first be addressed.”

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Study: Scribes Have Positive Financial Impact

Study: Scribes Have Positive Financial Impact | EHR and Health IT Consulting | Scoop.it

Many hospitals, and some larger medical practices, have been using scribes to capture medical documentation within EMRs — leaving the provider free to make old-fashioned eye contact with patients.

Using the scribe might sound like a crude workaround to techies, but it’s been a hit with emergency department doctors, who prefer to focus on their brief, critical encounters with patients rather than the hospital’s expensive toy.


While it was clear from the outset that doctors loved having a scribe to support them, there’s been scant evidence that the scribe was anything other than an added cost.


A recent study, however, has concluded that at least from a Case Mix Index standpoint, scribes can have a meaningful impact on a hospital’s revenue.  The study, which evaluated the use of scribes between 2012 and 2014 across a group of hospitals, concluded thatthe scribes save money and boost patient-doctor communication.


The study, which was designed to capture the impact of medical scribes on a hospital’s CMI, linked Best Practices Inpatient Care Ltd. with Advocate Good Shepherd Hospital, Advocate Condell Medical Center and hospitalist-specific medical scribes from ScribeAmerica LLC.

Kicking things off to a good start, ScribeAmerica and Best Practices put scribes through a jointly-developed course that emphasized workflow, productivity and accurate inpatient documentation. The researchers then tallied the results of using trained scribes over a two-year period in the two hospitals.


From 2012 to 2014, researchers found that for both Advocate Condell Medical Center and Advocate Good Shepherd Hospital, CMI values climbed after medical scribes came on board.  Advocate Good Shepherd’s CMI grew by .26 and Condell Medical’s CMI rose .28. These are pretty significant numbers given that a CMI growth of 0.1% typically translates to a gain of about $4,500 per patient. In this case, the hospitals gained roughly $12,000 per patient.


These findings make sense when you consider that using scribes seems to have served its purpose, which is to be extenders for providers who’d otherwise be hunched over an EMR screen.

Researchers found that inpatient physicians at the two hospitals studied were able to cut time spent on chart updates by about 10 minutes per patient on average. This profit-building effect is enhanced by the fact that scribes often get discharge summaries prepared immediately, rather than within 72 hours as is often the case in other hospitals.


That being said, it should be noted that the study we’ve summarized here was co-written by the CEO of Best Practices, which clearly invested a lot of time and effort training the scribes for the specific tasks important to the study.


Still, the study does suggest, at minimum, that scribes need not necessarily be written off as an expense, given their capacity for freeing providers for billable clinical activity. Ideally, IT vendors will develop an EMR that doctors actually want to use and don’t need an intermediary to work with effectively.  But until that happy day arrives, scribes seem like they can make a difference.


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ICD-10 implementation: Examining the potential aftermath

ICD-10 implementation: Examining the potential aftermath | EHR and Health IT Consulting | Scoop.it

It's up to health information management leaders to help their facilities understand what to expect when the ICD-10 deadline hits Oct. 1, six months after that and beyond, according to anarticle published in the Journal of the American Health Information Management Association.


The article examines what doctors and hospitals can expect beyond October in three phases:


  • Implementation to six months: A drop in coder productivity is expected across the board, though facilities that have practiced dual coding or engaged in end-to-end testing will be much better off, the article notes. There's a big difference between learning a coding system and being able to understand clinical factors of a diagnosis. Pat Maccariella-Hafey, director of education at Health Information Associates, says organizations should focus on making sure coders have a strong understanding of the guidelines of ICD root operations. Training should continue well after Oct. 1, and HIM departments will need to be prepared to defend their code assignments for accurate and timely reimbursement.
  • One to five years post-implementation: Sandra Kersten, a senior consultant for eCatalyst Healthcare Solutions currently assigned as an ICD-10 project manager at a Chicago-area hospital, foresees a permanent reduction in coder productivity, making it a smart move for hospitals to invest in extra coders. This is an opportunity for students and less-experienced coders, according to the article, because no one will have that much experience with ICD-10. Maccariella-Hafey foresees coders becoming more educated in the clinical aspects of medicine and surgery. And the benefits of more precise, accurate data from ICD-10 are expected to be felt within the overall healthcare system as well, providing a better view of the quality of patient care and patient self-management.
  • Five to 10 years later: A major expectation about ICD-10 is that it will help stimulate programs like patient-centered medical homes, value-based purchasing, and accountable care organizations by giving the government and care management organizations better data to work with. Everyone stands to benefit from improved data quality, according to Maccariella-Hafey. Researchers and public health-monitoring organizations are expected to be able to compare data apples to apples for global disease monitoring.


Some organizations still believe there will be another ICD-10 delay, while the American Medical Association has backed legislation to ban the implementation altogether.


In addition, House lawmakers are calling on the Centers for Medicare & Medicaid Services to make any ICD-10 contingency plan they may have public.

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