EHR and Health IT Consulting
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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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What's Best Way to Boost Health Information Exchange?

What's Best Way to Boost Health Information Exchange? | EHR and Health IT Consulting | Scoop.it

A new report to Congress recommends steps to ease the secure sharing of patient information, paving the way for better coordination of care and improved patient outcomes. For example, the report recommends the creation of incentives to help overcome the "blocking" of data exchange or reluctance to participate.


Although the federal government has spent $31 billion so far on HITECH Act incentives for hospitals and physicians to "meaningfully use" electronic health records systems, Congress has been scrutinizing whether the investment has paid off in enabling the sharing of health information.


Some security and privacy experts say that while the report spotlights some of the key barriers to secure health information exchange, some of the concerns may be overstated.


For instance, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, says intentional information blocking among healthcare providers is generally not a widespread problem.


"There are bad apples in every group of humans, and healthcare providers are no exception," he says. "In my experience, malicious information blocking for competitive purposes is very, very rare, and is certainly not a big factor or even a major factor impeding health information exchange. The biggest impediment to information exchange up until now has been lack of demand. That has changed, and now that we have strong demand, we're seeing the market respond and I expect interoperability to grow dramatically over the next couple of years."

Report Findings

The Health IT Policy Committee, which advises the Office of the National Coordinator of Health IT, recently submitted its Report to Congress: Challenges and Barriers to Interoperabilityas mandated by Congress.


The report delves into the various technical, operational and financial challenges that the healthcare sector faces in achieving health information exchange. Among the issues related to privacy and security listed in the report are:


  • Misunderstanding about HIPAA and other privacy laws has led some to refrain from sharing information.
  • Applying privacy laws that were originally designed to address paper-based processes to today's electronic transactions has been problematic.
  • Designing electronic systems and rules to accommodate varying state privacy and security laws has been challenging.


The advisory panel makes four key recommendations to accelerate health information exchange:


  • Develop and enhance incentives that drive interoperability and data exchange, such as by focusing on delivery of coordinated care. For example, payers could decline to reimburse for medically unnecessary duplicate testing that could have been avoided if information was shared.
  • Develop and implement health information exchange vendor performance measures for certification and public reporting;
  • Set payment incentives to encourage health information exchange. Include specific performance measurement criteria and create a timeline for implementation.
  • Convene a summit of major stakeholders co-led by the federal government and the private sector to act on ONC's recently unveiled 10-year interoperability roadmap.


Information Blocking

Drilling down on the report's recommendations pertaining to payment incentives to help accelerate interoperability, the HIT Policy Committee specifically addresses the problem of information blocking, which involves healthcare providers refusing to share of clinical information.


Sometimes information blocking is related to misinterpretations and misunderstandings about HIPAA and other privacy laws, the report notes.


"There are many examples where misinterpretations of complex privacy laws inhibit providers from exchanging information that is permitted under HIPAA," the report notes. "Also, many providers do not fully appreciate that the HITECH Act gives patients the right of electronic access to their EHR-stored information. As the Centers for Medicare and Medicaid Services defines new payment incentives ... it should incorporate mechanisms that identify and discourage information blocking activities that interfere with providers who rely on information exchange to deliver high-quality, coordinated care."

Other Recommendations

The document also outlines some previous recommendations made by the HIT Policy Committee to ONC, including:

  • Explore regulatory options and other mechanisms to encourage appropriate sharing of certain sensitive information, including substance abuse and mental health data;
  • Provide guidance about best practices on the privacy considerations associated with sharing of individuals' data among HIPAA covered entities and other community organizations;
  • Guide efforts to establish "dependable rules of the road" and to ensure their enforceability in order to build trust in the use of healthcare big data.
Overcoming Privacy Hurdles

David Whitlinger, executive director of the Statewide Health Information Network of New York - the state's health information exchange - says privacy and security issues clearly represent some of the biggest hurdles to overcome before achieving nationwide data exchange.


"Privacy and security regulations vary across different states, and those difficulties are exacerbated even more in sharing sensitive health data, such as mental health, substance abuse, HIV, reproductive health, and information about minors," he says. EHR platforms don't easily support compliance with varying laws when data is exchanged, he notes.


But he points out that industry players are discussing the use of various technologies that "tag" sensitive information so that patients have more control over what part of their health records can be shared among healthcare providers. Also under discussion are policy issues such as "giving patients complete control over their data, so that they ultimately make the decisions about what subsets of data they'll share," he notes.


Tripathi says the biggest barrier to health information exchange, from a privacy and security perspective, "is the heterogeneity of privacy rules that any particular provider faces, which has a paralyzing effect on electronic information exchange."


For instance, in Massachusetts, HIV and genetic test results require consent from patients for each disclosure, he notes. "So even though a Direct [secure email] transaction doesn't require any special consent, certain types of payloads may trigger other consent requirements. So ... as a healthcare provider ... I will hesitate to send out anything until I understand which laws pertain and whether that data my EHR sends triggers any of those other laws."

What's Next?

Members of Congress now must decide whether to act on the HIT Policy Committee's various recommendations.


An aide to Sen. Lamar Alexander, R-Tenn., chair of the Senate Committee on Health, Education, Labor and Pensions, says in a statement provided to Information Security Media Group: "Sen. Alexander is focused on making electronic health records something that physicians and hospitals look forward to instead of something they endure, and he looks forward to hearing what recommendations [the HIT Policy Committee] outlined in [the] report."


While the report notes that steps could be taken to begin implementing various recommendations within the next six months, some healthcare IT experts say it could take years for comprehensive health information to be securely and readily exchanged among healthcare providers by using health information exchange organizations and EHR systems.

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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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NYC Hospitals Face Massive Problems With Epic Install

NYC Hospitals Face Massive Problems With Epic Install | EHR and Health IT Consulting | Scoop.it

A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.


In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.


The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.


Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.


With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.


The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York PostHHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.


So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.


The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.


HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.


What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.


On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

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Burke Autrey's curator insight, September 21, 2016 10:56 AM
Tracking companies who bring in Interim executive talent when it counts... Congratulations to Clinovations and HHC who clearly see the value of tapping into interim executives.
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CMS Chief to Address ICD-10 Implementation in National Call

CMS Chief to Address ICD-10 Implementation in National Call | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) continues gearing up for the October 1 ICD-10 compliance deadline with Acting Administrator Andy Slavitt scheduled to address the ICD-10 transition during a national provider call later this month.


On August 27, Slavitt will provide a national implementation update as the nation reaches the five-week countdown to October 1. Also scheduled to speak are American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman and American Hospital Association (AHA) Director of Coding and Classification Nelly Leon-Chisen.


Two recent surveys show industry-wide progress toward a successful ICD-10 transition in October. In July, the 2015 ICD-10 Readiness reportpublished by AHIMA and the eHealth Initiative stated that half of respondents had completed test transactions with payers or claims clearinghouses.


Despite these positive findings, the report also revealed that ICD-10 preparation gaps still remain for many providers in the area of testing and revenue impact assessments. Only 17 percent indicated that they had completed all external testing. Similarly, only a minority of respondents (23%) have contingency plans related to ICD-10 go-live.

More recently, latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI) showed physician practices to be lagging behind their counterparts.


As compared to seven-eighths of hospitals and health systems ready for October 1, less than a half of physician practices indicated they would be ready. This disparity was also evident in the area of provider impact assessments. Only one-sixth of physician practices had undertaken the assessment versus three-fifths of hospitals and health systems. "This lack of progress is cause for concern as it will leave little time for remediation and testing," WEDI reported.


In a letter to Department of Health & Human Services Secretary Sylvia Mathews Burwell, WEDI cautioned that without a concerted effort the ICD-10 transition could lead to negative consequences for the healthcare industry.


"We assert that if the industry, and in particular physician practices, do not make a dedicated and aggressive effort to complete their implementation activities in the time remaining, there is likely to be disruption to industry claims processing on Oct 1, 2015," the organization stated.


Around the same time, CMS provided clarification about ICD-10 flexibilities it make available to providers following a joint statement with the American Medical Association (AMA) in June. The major ICD-10 flexibility is the federal agency's decision not to reject claims coded incorrectly in ICD-10.


"Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code," the federal agency stated. "The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service. Submitters should follow existing procedures for correcting and resubmitting rejected claims."


Here's a quick look at the agenda for the MLN Connects Call:


  • National implementation update, CMS Acting Administrator Andy Slavitt
  • Coding guidance, AHA and AHIMA
  • How to get answers to coding questions
  • Claims that span the implementation date
  • Results from acknowledgement and end-to-end testing weeks
  • Provider resources


As the entire healthcare industry counts down to October 1, CMS appears ready to ramp up its activities.

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IT, EHR systems go dark at 13-hospital system

IT, EHR systems go dark at 13-hospital system | EHR and Health IT Consulting | Scoop.it

The computer system, including the electronic health record platform, at a 13-hospital health system went black this week, resulting in a 20-hourlong outage.


BJC HealthCare, in St. Louis, Missouri, reported a computer outage Tuesday afternoon that impacted its IT systems across 13 hospitals. 

All IT systems went dark, "including clinical, revenue cycle, e-mail, word programs and other applications," hospital spokesperson June McAllister Fowler told Healthcare IT News.


As for what caused it? The health system's IT department is still working with an external vendor to do a root cause analysis, she said. Applications were brought back online 20 hours later on July 29.


"There are no indications that either patient data or employee information was impacted by the technology issues," said McAllister Fowler. During the downtime, clinicians and health system employees resorted to manual paper-based patient management processes.

The financial implications of BJC HealthCare's computer system outage might not be pretty. In fact, a single minute's downtime for an organization can be hugely costly. Groups that experience data outages should expect to hand over $7,900 per minute of outage time, according to a 2013 report published by Ponemon Institute and Emerson Network Power.


Healthcare organizations on average can expect to pay $690,000 per outage incident, representing a whopping 41 percent increase since 2010. Of course, those numbers depend on myriad factors including complexity of IT systems and length of downtime, but it's still no small bill.


These costs include business disruption costs, which average to nearly $239,000; just shy of $184,000 in lost revenue costs; and end-user productivity shortfalls, pegged at $140,543, according to the data. The report also underscores UPS system failures, accidental/human errors, cybercrime, weather and water/heat or CRAC failure as accounting for the majority of outages.  


This is not the first reported outage this year. Back in March, the two-hospital Rideout Health in Northern California saw its McKesson electronic health record system go dark for about a week, due to a HVAC burnout. Health system officials cited HVAC units in an off-site data center following one of them burning out and the other overheating shortly after.


Boston Children's Hospital also reported back in March that its EHR had crashed and was down for about five days, citing a hardware issues related to data storage

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Patient Engagement, Security Top the List among Hospitals

Patient Engagement, Security Top the List among Hospitals | EHR and Health IT Consulting | Scoop.it

Today the American Hospital Association (AHA) and the College of Healthcare Information Management Executives (CHIME) released the results of its HealthCare's Most Wired™ Survey, which illustrated that data security and patient engagement are the most important concerns among the country’s hospitals.


This survey focuses on analyzing health IT adoption among hospitals across the country and studies how health IT can be used to improve value-based healthcare metrics. Hospitals are currently taking more aggressive approaches to ensuring patient data remains private and secure.


“With the rising number of patient data breaches and cybersecurity attacks threatening the healthcare industry, protecting patient health information is a top priority for hospital customers,” Frank Nydam, Senior Director of Healthcare at VMware, said in a press release. “Coupled with the incredible technology innovation taking place today, healthcare organizations need to have security as a foundational component of their mobility, cloud and networking strategy and incorporated into the very fabric of the organization.”


Due to the Stage 2 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs, more hospitals have pushed forward patient engagement measures as well. The results from the survey show that 89 percent of Most Wired hospitals offer patient portal capabilities, 67 percent established a method for integrating patient-generated data, and 63 percent include patient tools for managing chronic disease.


“We commend and congratulate this year's Most Wired hospitals and their CIOs for improving care delivery and outcomes in our nation's hospitals through their creative and revolutionary uses of technology,” CHIME CEO and President Russell P. Branzell, FCHIME CHCIO, stated in the release. “These Most Wired organizations represent excellence in IT leadership on the frontlines of healthcare transformation.”

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Is Dual Coding an Effective ICD-10 Training Strategy?

Is Dual Coding an Effective ICD-10 Training Strategy? | EHR and Health IT Consulting | Scoop.it

With the October 1 deadline only a mere three months away, following an effective ICD-10 training strategy is of the utmost importance in order to receive standard reimbursement from the Centers for Medicare & Medicaid Services (CMS) as well as other insurers.

One ICD-10 training strategy that a particular medical care organization followed is to dual code diagnostic records and claims in both ICD-9 and ICD-10 coding sets. The Journal of AHIMA reported that the health information management department at Baystate Health has been coding records in ICD-9 and ICD-10 since the beginning of 2014.


This type of dual-coding ICD-10 training strategy has been effective at showing healthcare professionals how the new coding set compares with the older ICD-9 codes. Recently, the organization has taken it one step further. Baystate Health’s new ICD-10 training strategy is to spend one day per week coding in only ICD-10.


This extra time spent on only coding via the new diagnostic and procedural codes will help the healthcare staff at this facility understand what their workflows will be like by the ICD-10 transition deadline on October 1, 2015.


It may benefit more healthcare organizations to use this ICD-10 training strategy and spend some time coding in only ICD-10 before the deadline takes place. The way Baystate Health has developed the new strategy is by having one individual complete the necessary codes in ICD-10 one day per week while another professional codes the same record in ICD-9 immediately afterward.


There are a variety of benefits when it comes to coding in only ICD-10 and preparing for the October 1 deadline. Instead of having to switch back and forth between two coding sets, healthcare professionals will be able to focus more on the new codes during a longer time period.

Healthcare providers should be prepared for the October 1 deadline as it is unlikely any more ICD-10 delays will take place. While there are a variety of organizations that have attempted to postpone the deadline or put an end to the coding transition altogether, the Centers for Medicare & Medicaid Services (CMS), the Coalition for ICD-10, and other federal agencies seem focused on sticking to the deadline regardless.


“Calls for a safe harbor or grace period based on code specificity appear to be a reaction to physicians’ fears that there will be a huge uptick in claims denials if non-specific codes are reported,” the Coalition for ICD-10 reported. “However, these fears are refuted by the results of CMS’ recent end-to-end testing, which showed only a 2% denial rate associated with ICD-10-related errors, thus demonstrating that the transition to ICD-10 will have a minimal impact on the rate of claims denials.”


“A safe harbor for the use of non-specific codes is unnecessary and detracts industry attention from getting ready for the ICD-10 compliance date. There is no evidence supporting the need for a safe harbor,” the Coalition for ICD-10 continued.

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Help Your Medical Practice Hire Well: 15 Tips

Help Your Medical Practice Hire Well: 15 Tips | EHR and Health IT Consulting | Scoop.it

Busy physicians and office managers usually don't look forward to going through the hiring process. Not only are they concerned about finding the right candidate for the position, but it is an arduous process that can drag on and impact their ability to keep the practice running smoothly during the interim.

Here are fifteen tips on what you can do to hire right, the first time.


Before the interview


1. Review the job description.

To determine whether or not the job description needs to be revised, review the job description with the employee who is leaving to learn if the job responsibilities have changed. In the process you may discover that some tasks listed are redundant or can be automated.


2. Look for internal candidates.

Let staff know you are on the search and ask if they know someone who might be a suitable fit. You'll also want to open the position to internal staff that may be qualified and looking to climb the ranks. Just be sure they go through the same process as outside candidates to ensure you get the best person for the job.


3. Post the position as soon as possible.

Electronic job postings are quicker and cheaper, and tend to draw the best results. Your hospitals and medical societies may have job boards on their websites. The costs to post on Craigslist, LinkedIn, Indeed, and other classified job search websites is reasonable and yields an immediate posting.


4. Use employment applications.

Require applicants to complete an employment application that asks questions not answered in a resume, such as ending pay rate and the reason the applicant left each position. You can also ask for a list of professional and personal references, and require a signature allowing you to contact past employers.


5. Act quickly.

When candidates with impressive resumes respond to your ad, cull them quickly and don't postpone the interview. Applicants are on the move and the good ones get snapped up quickly. Also, you want to get someone hired as soon as possible, to allow time for proper orientation and training.


During the interview


1. Review job applications prior to interviewing.

Jot down any employment voids or other questions that come to mind when reviewing the applicant's resume, and be sure to address them during the interview.


2. Ask open-ended questions.

The results of the interview itself will be more effective if you allow the employee to relax and become engaged. Ask open-ended questions and pose problem-solving scenarios to identify their approach to resolving conflicts and determine how well they communicate.


3. Ask about strengths and weaknesses.

Ask job candidates what they see as their greatest strengths, what areas they feel they may need to improve on, and what makes them unique as a candidate.


4. Discuss salary with strong candidates.

For those candidates that are rating well during the interview, review the job description and discuss their salary expectations.


5. Communicate follow-up process.

End with letting candidates know what your follow-up process will be and when you will be making a decision.


After the interview


1. Don't skip reference checks.

Do not assume conducting past performance reference checks are a waste of time. Human resource departments may refuse to answer many of your questions, but if you obtain the applicant's permission to contact previous immediate supervisors you can learn a lot. Make the phone call efficient: verify dates of employment, pay rate, title of position, attendance record, and ask the key question, "Would you rehire this person?"


2. Don't ignore red flags.

If candidates don't interview well or if they give vague or contradictory information they should not be considered for employment.


3. Don't postpone the essentials.

Be sure all human resource details are handled the first day of work: hiring forms signed, benefits explained, policies reviewed, etc.


4. Address training needs upfront.

Failure to establish training goals and assign a trainer, or failing to meet with new employees regularly (during their first month) to discuss their progress or assuage their concerns, can sabotage results.


5. Roll out the welcome mat

Your medical practice is a thriving and busy environment. Don't let a new employee feel like he has been thrown in the lion's den. Start off by announcing the new person to existing staff members. Ask every one of your providers to introduce themselves to a new employee, during their first encounter. Keep communication open and give your new staff members the training, respect, and support they need to succeed.

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ICD-10: A Patients Perspective

ICD-10: A Patients Perspective | EHR and Health IT Consulting | Scoop.it

With ICD-10 coming in 111 days, as a patient I start to stress out about how it might impact me.  A physician once told me that “90% of physicians are already doing the required ICD-10 documentation, but they just need to add laterality in order to be more specific”.  Sounds simple, but is this statement truly accurate?  And if not, what will the downstream impact be to patients?


Let’s deep dive into the patient experience in the current ICD-9 world.  A simple health maintenance exam with vital signs (pulse oximetry included) and a urine dip would generally be covered by many insurers.  In the ideal world, this occurs without any added hassle to the patient, but what if the urine dip is “abnormal” and gets sent for a culture with an ICD-9 code of V70.0 (Routine General Medical Examination)?  The culture likely won’t be covered and the patient may eventually receive a bill for services that otherwise would have been covered by the insurance company had the test been associated with the correct supporting diagnosis.  A patient without insight into medical billing may just pay out of pocket without further research into why the services were not covered by the insurer.  In some cases however, a patient with a medical background may be savvy enough to recognize the problem was related to an incorrect ICD-9 code assignment. 


Given the abnormal urine dip, the culture should have been billed with a problem code and not a health maintenance code.  Had this been done, the patient may not have been responsible for the entire balance of the culture. The patient in this example notified her provider’s office of the problem, and even explained to the billing personnel how to fix the problem.  Six months later, she was still stuck in the midst of what I will label as “healthcare gridlock”.  The insurance company would pay for the culture if a problem code were submitted, but the billing office couldn’t change the code without the doctor first adding the appropriate documentation to the record.


If provider documentation isn’t clear and concise enough to get to an appropriate ICD-9 code now, then fast forward to October 1, 2015 when ICD-10 is relevant, who suffers?  Sure the provider’s office will not receive adequate payment (or none at all) for services rendered, but will the patient be left to pick up the pieces?  If we can’t get it right in ICD-9 (and the aforementioned scenario seems to happen far too often) then how are we so confident that those 90% of providers will get it right in ICD-10?  Rather than assuming that risk and potentially putting patients in difficult financial situations, wouldn’t it be helpful to add prompts to your existing EHR so that providers are clear on what MUST be documented to reach an appropriate ICD-10?  With all of the initiatives and mandates that providers are subjected to these days, we can help ease their transition to ICD-10 by customizing your EHR templates to support thorough and efficient ICD-10 documentation workflows.


When all is said and done, if it isn’t correctly documented, then it wasn’t done (at least that is what a coder might have to assume) and chances are that the patient will have to eat some portion, or even the entirety, of the bill.  With Galen’s Clinical Documentation Improvement service offering, our goal is simple – to make sure your organization is well prepared for ICD-10 so you can get paid and patients do not have to suffer.

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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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Will Altering EHR Incentive Programs Raise EHR Implementation?

Will Altering EHR Incentive Programs Raise EHR Implementation? | EHR and Health IT Consulting | Scoop.it

While the HITECH Act and meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have truly increased the number of healthcare providers implementing and utilizing EHR systems, new research suggests that these federal regulations may have also led to specific disparities in patient care. A study stemming from Weill Cornell Medical College found “systematic differences” between doctors who were avid participants in the EHR Incentive Programs versus those who did not invest as much time and resources into meeting meaningful use requirements.


The study was published in the June edition of Health Affairs and analyzed more than 26,000 doctors across the state of New York. Additionally, the researchers looked at payment data from the Centers for Medicare & Medicaid Services (CMS) and the state Department of Health.


The payment data analyzed in the study stemmed from the years 2011 to 2012. The results show that participation in the Medicaid EHR Incentive Program increased by 2.4 percent during those two years. However, participation in the Medicare EHR Incentive Program rose much more quickly, showing a 15.8 percent increase in the number of providers taking part in the program and implementing certified EHR technology.


The results show that early and consistent provider participants in the EHR Incentive Programs have more financial capacity, better organization and resources for supporting EHR implementation, and previous experience using health information technology.


While meaningful use requirements pushed EHR adoption forward, the process of using the systems on a constant basis had a new set of challenges that some providers were unable to attain, the researchers said. However, the differing rates of participation in the EHR Incentive Programs is leading to higher quality care at some physician offices while others are lacking and administering lower quality healthcare services.


“The expectation is that physicians and hospitals should be electronic,” senior author Dr. Joshua Vest, an Assistant Professor of Healthcare Policy and Research at Weill Cornell Medical College, said in a public statement. “How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don’t have the resources or capability to adopt EHRs.”


The researchers explained that there is a “digital divide” among different healthcare providers due to the participation in the EHR Incentive Programs. These results may play a role in the future of healthcare policy. Since there are certain providers who dropped out of the Medicaid EHR Incentive Program, it may behoove federal agencies to make some significant changes to the objectives within this particular program in order to keep providers participating.


“Electronic health records are vital not only because of their ability to efficiently provide physicians with a comprehensive portrait of and decision support for their patients, but also to drive new healthcare delivery models that can improve the value and quality of clinical care,” Dr. Rainu Kaushal, Chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell, said in a public statement.

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Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls

Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls | EHR and Health IT Consulting | Scoop.it

With the ICD-10 implementation deadline only three and a half months away, it is beneficial for healthcare providers to continue their last-minute preparations for the coming ICD-10 transition. The Centers for Medicare & Medicaid Services (CMS) includes a variety of tools and resources for providers to utilize when getting ready for the ICD-10 implementation deadline.


From the Road to 10 website to videos and expert columns, CMS is working toward preparing healthcare providers for the coming ICD-10 implementation deadline on October 1, 2015. In a video called “ICD-10: Getting from Here to There – Navigating the Road Ahead,” Dr. Ricardo Martinez, Fellow of the American College of American Physicians, discussed how the International Classification of Diseases (ICD) version 10 is a significant improvement over the more outdated ICD-9 codes being utilized across healthcare facilities today.


The video also went over key steps that small medical practices should incorporate when preparing for the ICD-10 implementation deadline. In particular, providers will need to understand how the new codes will differ from the older ICD-9 codes.


“As a practicing physician, I see the limitations of ICD-9 every day and why input from the medical community into the development of ICD-10 has been so valuable,” Martinez explained. “ICD-9 is outdated – even antiquated by today’s practice standards – and it limits the speed and accuracy with which I can gather information, gain insights, and, more importantly, care for my patients.”


“Today, ICD-9 doesn’t even address laterality, which signifies if a condition affects the left or the right limb,” continued Martinez. “On a professional note, when recently faced with a complex patient who had an acute stroke in history of a previous stroke, we had to search through many old records to determine whether that old stroke was left or right side, wasting valuable time that could have been dedicated to patient treatment. With a single code, ICD-10 will provide us with more detail. Better data makes better care possible.”


“To help small provider practices and other healthcare professionals with the transition to ICD-10, the Centers for Medicare & Medicaid Services is actively working with physicians, industry leaders, and others,” Martinez mentioned. “Healthcare has been using the international classification of diseases for over a century to identify and track diseases and help us improve our care for our patients.”


“Although most of the world transitioned to ICD-10 years ago, the currently used version of ICD-9 is fundamentally unchanged since its implementation in the United States in 1979,” Martinez stated. “One major limitation of ICD-9 is that it predates many modern technological advances and clinical terminology reflecting the use of CT scans, for example, which were also invented in 1979. Therefore, an update was necessary to account for these innovations in medicine.”


“For years, practitioners noted the need for increased specificity within clinical terminology, documentation, and coding to accurately represent the care provided to their patients,” Martinez clarified. “Under sponsorship of the World Health Organization (WHO), a group of physicians developed the basic structure for ICD-10. Then, each specialty provided input on the subset of procedure or diagnosis code needed. Addressing both the changes in medicine and the need for increased specificity, ICD-10 will capture greater detail in the clinical encounter for each patient.”

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EHR: A Lesson in 'Wants' vs. 'Needs'

EHR: A Lesson in 'Wants' vs. 'Needs' | EHR and Health IT Consulting | Scoop.it

I've been able to dodge the EHR bullet for a long time, but no longer. It has taken 18 years for the hospital where I see patients to finally implement a system. Today is the day it "goes live" (an oxymoron if ever there was one). Lord only knows how we managed to survive for the past 18 years without this piece of absolutely "vital" technology.

Will the patients be better off? Will the doctors be better off?

From my own experience, patients want:

• Competent doctors – I'm satisfied that we have them.

• Access to care – I don't think the new EHR will affect that, unless it takes away flexibility to overbook or see walk-ins. There are indications that this may well be a problem.

• Convenience – Our amenities are attractive but the amount of "red tape" is not. Once they arrive, they get financially screened, wait to see the doctor, wait for the doctor (resident) to do the obligatory computer entry and review everything with the attending, wait in the lab, and then wait in the pharmacy. Neither our old computer system nor our new one help to speed up these steps, therefore I presume that visits will take as long, if not longer, than before.

• Communication – Historically, our patients tend to move frequently and have been hard to reach. Cell phones have helped a lot. Still, the level of communication is sub-optimal. The resident's schedules are filled with teaching conferences and limited by the work-hour rules. They have little time to actually keep tabs on, and in touch with, the patients. I had these same problems with my physician until he started communicating through a patient portal. Our new system does not currently offer a patient portal.


From my own experience as a doctor, the thing that keeps me from doing my best is my memory. Like everyone else, my short-term memory can only keep track of four things to eight things at a time. In the course of a complex encounter, many more than eight things occur to me that I intend to do for the patient. Unfortunately, by the time I've started charting the visit and writing the orders, most of those things have slipped my mind.


If an EHR is going help me, it should have a powerful, easy-to-use means of creating reminders (especially while I'm working directly with the patient), receiving them in a timely, unobtrusive manner and responding to them. From what I can see, our new system offers no help here.


The other thing that I need is also related to memory. Our new system has functions scattered over a myriad of tabs, screens, and forms. We have been given pages of printed instructions that we are supposed to remember to follow because the system can't or won't guide us, but even if we remember everything, just finding it is a challenge. If we forget to follow the instructions, the patient may suffer.

Here are a couple of examples of the things we're admonished to remember:


• "Choose the right note type." (There is a long list devoid of descriptions. Which ones are "right"?)

• "If a stat or timed order is submitted with the default collection priority set as 'nurse collect:no,' the order will not appear on the nurse's task list, which could delay sample collection. Thus, it is imperative that each provider ordering stat or timed lab tests verify the collection priority, and if necessary, change the 'nurse collect' order detail to 'yes' before signing/completing the order."


People simply cannot remember to do dozens, or hundreds, of things, without some sort of assist. An EHR should provide that assist, and without it, care quality can only suffer.


 As author Jeff Davidson said in "The Complete Idiot's Guide to Getting Things Done": "When your brain is always engaged, when your neurons are always firing, when you find yourself in a continual mode of reacting and responding, instead of steering and directing, the best and brightest solutions that you are capable of producing rarely see the light of day."


As a technology, using a typical EHR limits the number of patients that a physician can see. Organizations that use EHR have been forced to lengthen visits and hire more doctors. Operating costs have mushroomed are represent real dollars. The "benefits" of EHRs are mostly intangible. It will be interesting to see if the intangibles justify the billions of real dollars that are being spent on this stuff. At the moment, though, it's hard to see that either the patients or the doctors are noticeably better off.

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Meaningful Use Audits: An Update

Meaningful Use Audits: An Update | EHR and Health IT Consulting | Scoop.it

The lion’s share of the CMS EHR incentives have been paid out, especially for those who participated on the Medicare side of the incentive program. The Meaningful Use (MU) incentives are winding down but it is prudent to keep an eye on the rear view mirror and make sure you are up to date on past MU documentation. One of the more common questions we are asked at Meaningful Use Audits has to do with how long after attestation can a CMS Meaningful Use audit take place. What is the look back period? How long does an Eligible Professional (EP) or Eligible Hospital (EH) need to keep their “book of evidence” in a handy place? When it is OK to breathe easy?


Our friends at CMS tell us: “Eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) should retain ALL relevant supporting documentation (in either paper or electronic format) used in the completion of the Attestation Module responses. Documentation to support attestation data for meaningful use objectives and clinical quality measures should be retained for six years post-attestation.”


So six years post-attestation is the period in which an incentive recipient needs to be prepared to respond to an audit. What are the chances you might be audited for an early attestation, say back in 2011 or 2012? I’m not a gambler and have never been too good at calculating odds but I was recently contacted by an EP who had received an audit engagement letter from the gang over at Figliozzi & Company. That EP had never been audited before and received the letter just a few week ago in early September 2015. The audit was for a 2011 attestation. That’s right, the audit was going all the way back to the 2011 attestation. There was scant guidance and clarification from CMS in those early days of MU and I imagine an EH or EPs “book of evidence” could be a bit on the slim side.


I don’t need to tell you what the lesson is here. An occasional glance in the rearview mirror to make sure documentation is intact would not be a bad thing to do.

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Changing the Culture of Healthcare

Changing the Culture of Healthcare | EHR and Health IT Consulting | Scoop.it

Why is it that patients are slow to take charge of their health records? Some articles suggest that management of health information should be a patient-driven initiative and the points that are used to propagate this idea are not without merit. However, the primary reason is a lack of a collaborative effort among patients and providers. It is the responsibility of healthcare professionals – who bear more accountability than ever – to make a concerted effort to drive this change. And, since the technology is available to support this effort, the first step for providers is to embrace their influential role in educating patients on the importance of managing life-long health and wellness.


A Culture of Connectivity:


The healthcare industry is becoming increasingly decentralized and engagement through health monitoring among patients and providers is more possible today than ever. In an article in the Wall Street Journal (“Staying Connected Is Crucial to Staying Healthy”), reporter Laura Landro interviewed Dr. Joseph Kvedar, vice president of Connected Health at Boston-based nonprofit health system Partners Healthcare, about the increasing decentralization of care, as well as the spread of health apps and trackers.


Dr. Kvedar confirmed how, in the new network-based model of healthcare, connectivity is critical to providing the highest level of care, by saying “the ideal way to keep you focused on improving your health is through connectivity and in-the-moment, contextual messaging – messages directed at your specific health needs at the moment you need them.” The result of greater connectivity is higher engagement, but providers must actively pursue initiatives centered around leveraging filtered, personal health data from patients. Health providers need to have an influential role in closing the loop of contextual messages by responding on priority, as demanded by the condition at hand.


A Culture of Convenience:


Platforms that monitor individual patients for ongoing prevention and large populations with multiple chronic conditions, while managing exceptions, can do so with greater coordination. This will also have a positive impact on internal operations by minimizing errors in data as it is exchanged through faster, more secure channels. In turn, this increases staff productivity, minimizes intervention and streamlines patient processing and the overall patient experience within and independent of the clinical environment.


New breakthroughs in technology have helped overcome the traditional challenges of interoperability, making diagnosis and ongoing care more convenient than ever. Portable devices and clingy fitness trackers have contributed to having health vitals available at your fingertips; data that has now become easy to upload and analyze on any platform for possible conditions. And, as a recent article in The Economist states, “…computing power is now being applied successfully in countless small ways, using smartphone and other diminutive devices, to make a big difference to the effectiveness of treatments,” (“Bedside Manners”).


A Culture of Change:


It is up to providers to facilitate this change in the culture, from one of episodic care to an ongoing healthy lifestyle with a “coaching” approach. While it is true that families should manage their own medical records and data, providers should take the lead. Combining live interactions and virtual online coaches as needed, the exchange and use of data will bring significant and actionable insights that are applicable in the daily lives of individuals everywhere.


Taking it one step further, healthy lifestyles within various segments of the population can be promoted by developing and implementing community wide initiatives that leverage vital data monitoring. These efforts can impact greater health issues such as diabetes, blood pressure, early child birth, obesity and other conditions. By adopting a consistent and motivating approach toward shared data exchange processes, providers will be able to better manage and motivate patients, while driving positive, ongoing change at the fraction of the cost of live interactions.


In healthcare, proper use of medical data is critical to optimizing outcomes and lowering costs, but the absence of a truly collaborative effort among patients and providers remains as a barrier to success.


Drivers of Change


is the fact that no simple solution is available and no national initiative – legislative or otherwise – exists to helps fill this engagement void in healthcare. Just as providers are responsible for patient care and satisfaction, so too should they serve as facilitators of patient engagement. By taking this approach, new age health initiatives will reshape the culture of healthcare and lead the industry to a truly preventative system.

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EHR System Satisfaction Declines to 34% Among Physicians

EHR System Satisfaction Declines to 34% Among Physicians | EHR and Health IT Consulting | Scoop.it

Multiple motivations are driving EHR adoption in the healthcare industry from the EHR Incentive Programs to the promise of increased healthcare efficiency. Yet in a recent survey by AmericanEHR Partners and the American Medical Association (AMA), researchers found that physician satisfaction is on the decline.


The report finds that in 2010 a total of 61 percent of respondents were satisfied or very satisfied with their EHR systems. In 2014, after the total number of EHR users has increased, a mere 34 percent of respondents are satisfied.


Additionally, nearly half of respondents reported that EHRs actually decreased efficiency, with 42 percent saying EHR technology made it difficult to improve efficiency, 72 percent stating it was difficult for EHRs to decrease physician workloads, 54 percent saying EHRs increased total operating costs, and 43 percent saying their practices have not yet overcome these challenges.


The report notes that other findings in the survey heavily depended upon whether respondents were satisfied or dissatisfied with their EHR system. This means that there was polarized variation in responses depending upon how respondents felt about their EHR systems. Naturally, respondents who were satisfied responded positively to the survey questions, while those who were dissatisfied did not.


For example, when responding to questions regarding staff time spent processing and refilling prescriptions, 42 percent of all respondents said they were satisfied with their EHR. However, of those who were dissatisfied with their overall EHR use, only 25 percent were satisfied in the processing and refilling prescriptions category. Of those who were satisfied with their overall EHR use, nearly 69 percent were satisfied with the process and refilling prescriptions category.


However, there were some questions all respondents were generally able to agree upon. Merely nine percent of respondents — or 19 percent of those who were satisfied with their EHR — reported that adopting an EHR system decreased their practices’ overall costs. Likewise, only 13 percent of respondents — or 21 percent of those pleased with their EHRs — reported that their EHR technology made a positive impact on a number of their employees.


The report also indicates that primary care physicians tend to be more satisfied with EHR systems than specialists. This is because primary care physicians on average have worked with EHR systems for longer than specialists have, and therefore have figured out the best and most efficient ways to use them. The report also indicated that it took an average of three years for physicians to get used to working with an EHR and to resolve the initial challenges the systems presented.


Shari Erickson, MPH, Vice President of the American College of Physicians Division of Governmental Affairs and Medical Practice, contends that as EHRs continue to be integrated into physician practice, satisfaction ratings will increase.


“Perhaps we are getting over the curve in EHR adoption,” she said. “It may be that as we see more practices that have been using these systems longer we will see satisfaction begin to rise.”

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Groups Call for Final Changes to Meaningful Use Requirements

Groups Call for Final Changes to Meaningful Use Requirements | EHR and Health IT Consulting | Scoop.it

A group of eight hospital associations have joined voices to ask the Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) to move forward with finalizing proposed changes to meaningful use requirements made earlier this year.


"As organizations representing hospitals and health systems across the country, we are writing to urge the Department of Health and Human Services (HHS) to release, in the immediate future, a final rule making modifications to the meaningful use requirements under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for fiscal years (FY) 2015 to 2017," they state in a letter to HHS Secretary Sylvia Mathews Burwell.


CMS first indicated that it was considering reducing meaningful use requirements between 2015 and 2017 earlier this year. In January, Deputy Administrator for Innovation & Quality and Chief Medical Officer Patrick Conway, MD, authored a blog post revealing that the federal agency "intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015."


CMS did not release the proposed rule in question until April and the proposal has made little progress since then which has drawn consideration from multiple industry associations. Just last week, the College of Healthcare Information Management Executives (CHIME)called on the HHS Secretary to finalize the rule.


Now it is the case that the following eight hospital associations have come together to make a similar request:


  • America’s Essential Hospitals
  • American Hospital Association
  • Association of American Medical Colleges
  • Catholic Health Association of the United States
  • Children’s Hospital Association
  • Federation of American Hospitals
  • Premier healthcare alliance
  • VHA Inc.


According to these organization, the finalized rule is long overdue:

The rule is past due, given that it will affect the current program year for meaningful use. Indeed, under current rules, meaningful use applies to fiscal year performance for hospitals. FY 2015 ends on Sept. 30 — fewer than 60 days from now. We recognize that the Centers for Medicare & Medicaid Services (CMS) also proposed to change meaningful use reporting for hospitals from a fiscal to a calendar year. Under that policy, the last possible reporting period would begin on Oct. 3. However, the proposed rule also allowed other reporting periods for earlier dates in FY 2015. Even if reporting is moved to a calendar year, hospitals need the certainty of a final rule now to determine the best reporting period to choose and begin the process of reviewing performance and ensuring they have met all of the revised requirements.

That is not to say that these hospital groups are content with the provisions of the proposed rule as is:

Other proposed changes, such as making e-prescribing of discharge medications mandatory or adding new public health reporting measures, however, would make meeting Stage 2 more difficult. And, given the delay in the release of a final rule, they would be virtually impossible for hospitals to accommodate. Hospitals simply will not have sufficient time to understand the new requirements, work with their vendors to purchase and implement new or revised technology that would accommodate them, and invest in the training and work flow changes necessary to meet the new requirements.

With the closing of the fiscal year coming for eligible hospitals at the end of September, the hospital groups are concerned that the delayed release of the final rule would impose burdens on these providers and have far-reaching consequences.


"Widespread failure to meet meaningful use due to unrealistic regulatory requirements and insufficient technology will undermine hospitals’ ability to use EHRs to improve care and involve patients in their care. It will also result in significant financial penalties for the hospital field. Therefore, we urge HHS to release a final rule as quickly as possible," they add.

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Using Philosophy, Not Data, To Chart Better in the EHR

Using Philosophy, Not Data, To Chart Better in the EHR | EHR and Health IT Consulting | Scoop.it

Technology is so great, so captivating, and so compelling, it has spawned a kind of irrational exuberance which blinds people to the enduring principles and values that really matter. It’s a phenomenon that’s not unique to computer technology.


Alan Greenspan coined the term irrational exuberance during the dot-com bubble of the 1990s and Robert Shiller wrote a book, “Irrational Exuberance,” that analyzed the phenomenon. In terms of data and information, our current enthusiasm for data in healthcare displays all the features of a speculative bubble.


In the race to provide better care at lower cost, we have been assured that data will win by a head and distracted physicians won't harm anyone in the process. We are collectively gambling billions on this race in which the patients are the guinea pigs, being experimented on without their informed consent. Unknown to most people in healthcare and the government is the troubling lack of credibility in the quality of research being done on the computer science behind medical information and medical records. And this says nothing of the clarity and accuracy with which it is communicated to the public. Shiller said: "Some of this so-called research often seems no more rigorous than the reading of tea leaves." This comment would be relevant to healthcare if a lot of research was actually being done.


Shiller continues, to paraphrase: The answers to these questions are critically important to private and public interests alike. How we value data, now and in the future, influences major economic and social policy decisions that affect not only doctors and patients, but also society at large. If we exaggerate the value of data, then as a society we may invest too much in collecting and storing it, and too little in education, patient care, and other forms of human capital. We might deplete those resources that will be needed to devise new solutions to those conditions that influence the health of the world's population such as Ebola, Dengue and Chikungunya.


The buzz that surrounds technology is not conducive to thinking about principles and values. These are topics that concern ethicists and philosophers and that should help us to remember that:


• Data alone never saved a life. It takes people to do that. Data may help them but knowledge and experience are more important.


• One should not take any risk that is out of proportion to the potential benefit. Whenever possible let the patient decide which risks they prefer.


• One way to avoid doing harm is to be aware of what has happened and what was done before. Remember, insanity is doing the same thing over and over, while expecting a different result. Quality medical records, not data elements, are necessary if physicians are to be adequately informed about the patient's course.


EHRs have drawn the physicians’ focus away from the patient and the task of creating quality medical records, forcing them instead to function as data entry clerks and coders. This creates an ethical dilemma for physicians. Time pressures increase the likelihood that chart notes will be skimpy and uninformative. Both templates and copy/paste increase the chance that the notes will "document" things that were not done or not true, while failing to document things that were done (because it was too difficult to include them). People lose the potential to be informative because the context in which the data arose has been stripped away. It has either been discarded, or scattered in multiple, generally inaccessible locations. Without the relevant context the meaning, the information physicians need to understand their patient's cannot be reconstructed.


This is why the emphasis should be placed not on data, but on the faithful and complete recording of the information that physicians glean from their interactions with patients. In this regard, there is a branch of philosophy called “Pragmatics.” HP Grice (1913-1988), a British philosopher of language proposed the Cooperative Principle that he believed governed linguistic communication. His maxims provide a template, of sorts, that can guide physicians in creating informative, meaningful entries in the medical record. They are:


Maxim of Cooperation. Contribute what is required by the accepted purpose of the conversation.


Maxim of QualityMake your contribution true; do not convey what you believe false or unjustified.


Maxim of QuantityBe as informative as required.


Maxim of RelationBe relevant.


Maxim of MannerBe perspicuous; avoid obscurity and ambiguity, and strive for brevity and order.


To which should be added the calculability assumption:


Calculability Assumption: Whatever an utterance or narrative implies (though not stated explicitly) must be capable of being worked out.


Unfortunately, people apparently believe that technology can insure that a medical record will be accurate, complete and informative and that, if it isn't, big data will come to the rescue. I wouldn't bet on it.

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OIG Found Inaccurate EHR Incentive Payments in Arkansas

OIG Found Inaccurate EHR Incentive Payments in Arkansas | EHR and Health IT Consulting | Scoop.it

The Medicare and Medicaid EHR Incentive Programs were established to improve the quality of care, boost population health management initiatives, and reduce overall healthcare costs, which is known as the Triple Aim of Healthcare. With these goals in mind, it is important to track the progress of meaningful use requirements and EHR incentive payments throughout the healthcare industry.


The Office of the Inspector General (OIG) found a major flaw in the EHR incentive payments completed by the Arkansas Department of Human Services. A total of 14 hospitals received incorrect EHR incentive payments, which resulted in an overpayment of $1.2 million.


An OIG report states that the organization looked at EHR incentive payments among 20 of the highest paid hospitals from November 1, 2011 to June 30, 2013. It was found that the Arkansas Department of Human Services paid 20 hospitals more than $19 million, which covered 65 percent of the total amount paid between the time period of the audit.


“The State agency did not always pay EHR incentive program payments in accordance with Federal and State requirements,” the report stated. “The State agency made incorrect EHR incentive payments to 14 hospitals. Specifically, for 13 hospitals, the State agency made incorrect payments totaling $1,225,734.”


The Arkansas Department of Human Services caused these errors because the agency had foregone following federal requirements with regard to cost report data elements concerning EHR incentive payments. Additionally, the organization failed to review supporting documentation for figures available in the reports.


The OIG recommends several measures that the Arkansas Department of Human Services will need to follow. First, it is important to refund $79,428 to the federal government. Also, the agency will need to modify the EHR incentive payments across the hospitals that received incorrectly calculated disbursement.


Additionally, it is suggested that the Arkansas Department of Human Services review all payment calculations given to hospitals that were not part of the 20 hospitals within the audit. The organization will need to determine whether payment adjustments are needed.


“The State agency did not concur with the recommendation to refund the net overpayment of $79,428 but stated that the incentive payments for 8 of the 13 hospitals had already been adjusted in accordance with our finding,” the report states. “The State agency also stated that it expected the incentive payments for the other five hospitals to be adjusted in accordance with our findings. The State agency also did not concur with our recommendation to work with the one hospital for which the total incentive amount was set aside to recalculate the incentive payment using the June 2009 cost report data.”


The Office of the Inspector General plays a major role in ensuring that various medical organizations are sticking to federal and state mandates. Hospitals and other providers attesting to meaningful use requirements under the EHR Incentive Programs will also need to ensure all information submitted to federal and state agencies are accurate in order to receive EHR incentive payments.

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Becoming a Successful Practice Manager

Becoming a Successful Practice Manager | EHR and Health IT Consulting | Scoop.it

The charismatic practice manager starts out by knowing her job and the staff assigned to her, and by planning, setting priorities, and meeting deadlines. But she also is able to communicate what her goals are for the practice and takes the time to explain why certain tasks are required, where the practice is headed, and how it is going to get there. Accomplishing the mission within the capabilities of the practice and the resources allowed, while maintaining high morale, is the goal of every practice manager. An astute practice manager can become a high achiever by applying basic management and leadership principles to the practice of which she is a part. The manager begins this process by becoming as professional in her duties as she can. Here are five aspects of this process:

1. Knowing the job


The basis of successful leadership is making things happen through people, but first a practice manager must know her job. The team she is working with will give her some slack when she is new to the practice, but that slack is rapidly used up if she does not seek to learn all she can about the practice operations. In the long run, staff will care only whether she knows what she is doing, especially in difficult tasks.


2. Planning


Accomplishing the mission requires planning and monitoring. Planning is the development of action steps needed to achieve an objective or goal. The Ability to plan is closely related to the other skills required of practice managers, such as anticipating requirements, establishing priorities, and meeting deadlines. The plan should be flexible enough to handle the changes that inevitably will occur.


3. Implementation


Once the plan is set, the practice manager has to consider priorities and prepare to meet deadlines, because she will never have the luxury of working on only one task at a time. A physician practice is much too dynamic an organization to permit single task operations, and the practice manager has to learn how to keep several balls in the air simultaneously. It is a skill that starts with a plan, just like organizing homework and professional responsibilities at school. Last-minute preparations rarely camouflage the lack of a routine approach to tasks. A methodical daily effort will produce well-qualified and motivated team members as well as an efficient practice. Crisis management and its negative impact on morale must be averted wherever possible.


4. Monitoring progress


A good plan must continually be monitored. There is a military adage that "you get what you inspect, not what you expect." Practice managers should never just assume that a plan is working. Rather, managers must monitor effectiveness by following up on it by becoming personally involved.


5. Motivation


Mission accomplishment and high morale occur in tandem. In other words, good practice managers get the job done and maintain high morale. The ability to get others to respond is a primary leadership requisite. The least a practice manger can learn to do is to delegate effectively. The ability to inspire others to perform is more difficult.

A practice manager must apply fundamental principles of administration and leadership as she learns how to accomplish tasks with her staff. Effective practice management is the ability to influence people so that they willingly and enthusiastically strive toward the achievement of practice goals. Hard work and high morale are compatible and good practice managers can inspire and direct their people under both normal and adverse conditions.

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Preventing Physician Burnout

Preventing Physician Burnout | EHR and Health IT Consulting | Scoop.it

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).


Follow these five steps to significantly improve your work-life imbalance:


1. Identify the five to eight most important aspects of your life (what you value most).


2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).


3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.


4. Plan your time so that you are focused on what you value most.


5. Determine what can be delegated to others.


Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.


So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).


Follow these simple brain-training steps to increase your positivity:


1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.


2. Challenge your negative (typically distorted) thinking, the most common of which are:


• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.


• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.


• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.


• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.


• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.


Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

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Complete independence for a small practice today is unwise

Complete independence for a small practice today is unwise | EHR and Health IT Consulting | Scoop.it

Momentum remains in favor the flow of physicians to employed positions. Is this wisest path for physicians? That is unknown and likely depends upon the particular circumstance. Either way, independent physicians are an increasingly shrinking, yet curiously heterogeneous group. Independent practices vary in size, composition and philosophy. The impact of size (from solo to very large) and composition (primary or specialty care, single or multispecialty and physician demographics) is relatively straightforward, but the consequence of the practice philosophy may be a less obvious and more critical. Practices that wish to remain independent may need to reflect on what it means to be independent today.


Although the composition of the independent practice can cause some complexity, size may be an absolute barrier to survival. Small independent physician groups are quickly becoming an endangered species whereas larger independent practices may be better positioned to navigate the waters of health care today. Being completely independent may simply not possible for small groups (less than four physicians) and is becoming increasingly challenging for mid-size groups (4 to 8 physicians). Why is this the case? Here are a few reasons:

  • Inability to contract with managed care payors on own.
  • Inability to negotiate with vendors to keep expenses down.
  • Insufficient care management and care coordination infrastructure.
  • Inability to compete on convenience or patient experience.
  • Challenges relating to reporting and regulatory requirements.
  • High upfront and ongoing technology expenses.


Complete independence for a small practice dealing with the challenges today is at best, unwise. More strongly, one could conceivably argue that it is bordering on negligence. How can a solo practitioner for instance responsibly compete with sophisticated, well-funded, integrated systems in delivering the high quality, comprehensive patient care that is expected today? What about customer service? How loyal will their patients remain? Can the small independents stave off the convenience and access the retail clinics are offering? Single provider practices and small independents who are continuing to hold on to hope that they will survive, and health care reform will not affect them do so at their peril.


To weather the storm of health care reform and remain independent many small private practices have banded together to form independent practice associations (IPAs). Many successful IPAs have developed infrastructure for value-based contracting and have transformed into accountable care organizations (ACOs). But, what do we know about the independent practices that join these IPAs to maintain and maximize their autonomy? Will this strategy yield the outcome they seek? Are they really, truly independent? In many ways, yes.


Small independent practices may remain in charge of their own billing; they set their own compensation and benefit packages; have autonomy with human resources; flexibility around strategic practice decisions; and can more easily leave an IPA than they could an employed position. But, there are no free lunches. Independent practices that seek the shelter of an IPA must accept the movement towards value-based care. All physicians who wish to remain in practice must embrace the triple aim and endeavor to improve quality, enhance the patient experience and eliminate unnecessary cost from the system. Today physicians must grapple with reporting requirements related to quality measures, closing clinical care gaps, implementing and maintaining baseline IT connectivity for data exchange and working with other actors in the health care neighborhood in a more collaborative manner than ever before.


Physicians who believe they can opt into value-based contracts in order to realize value to their practice without a more significant, philosophical alignment with the triple aim and simply fly under the radar are sadly mistaken. This is a misconception that cannot be tolerated by a high achieving health care organization. Especially if the organization is looking to bring together disparate independent practices where an even higher bar of clinical integration is sought to satisfy the payers.


Participation in population health management through value-based contracts necessitates accountability that is shared by all stakeholders. Physicians must understand that they are accountable to the patients they serve; they are accountable the managed care payer partners, and they are accountable to each other. Poor performers, naysayers or laggards who underperform cannot be accepted if networks of independent physicians are going to be successful. Moreover, this will be counterproductive to their goal of realizing the positive returns successful performance can bring to their own practice and maintaining independence.


Networks all over the country have formed with the goal of bringing these remaining independent practices together for a shared purpose. Many of the independent networks will continue to do everything possible to educate and assist in facilitating successful behavioral and operational changes that yield positive results towards the collective best interest… but, in the end it is up to the individual physician practice to make a choice. What is more important, complete independence or survival?


Teamwork has become a common core value for successful health care organizations, and it is increasingly clear that health care is a team sport. The time has come for independent practices to embrace this, pick a partner and join a team. Many physician networks offer a great value proposition for independent practices that are realistic with their expectations. While physicians may no longer be able to achieve complete independence, as a sensible, viable path, with the right mindset there is still great opportunity in private practice if physicians can accept being almost independent.

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Kareo, McKesson Lead the Way in EHR and Health IT Systems

Kareo, McKesson Lead the Way in EHR and Health IT Systems | EHR and Health IT Consulting | Scoop.it

When healthcare providers are looking to either implement or upgrade their EHR and health IT systems, there are a wide variety of options to choose from. Ever since the HITECH Act was passed and meaningful use requirements were established under the Medicare and Medicaid EHR Incentive Programs, the number of EHR vendors across the industry has skyrocketed. So what is a physician practice to do? How do they choose the best possible solution?


Luckily, the market research firm Black Book offers a variety of surveys that illustrate which health IT systems vendors are truly successful in providing superior solutions. Recently, Black Book announced the results of its four-month user poll determining the highest-ranked EHR and billing software vendors in 2015, according to a company press release.


The survey results based on EHR users show industry trends and disclose the health IT systems vendors who scored highest in billing, claims, and practice administration categories when it comes to the providers’ experience.


Kareo Inc. achieved the highest ranking for both its certified EHR technology as well as its billing software in 2015. This marks the third year in a row that Kareo has achieved this honor of best EHR technology among small physician practices.


“Revenue Cycle management and integrated EHR vendor loyalty among small practice EHR physician practices is still on a significant upward trajectory,” Doug Brown, Black Book’s Managing Partner, said in the release. “The EHR/practice billing vendor’s abilities to meet the evolving demands of interoperability, networking, mobile devices, accountable care, patient accessibility, customization for specialty workflow, and reimbursement are the main factors that the replacement mentality and late adoption remain volatile especially among solo and small practices.”


The results from the Black Book survey come from 33,000 ambulatory groups, physician practice administration staff, and medical records professionals. Investors and those looking to purchase or upgrade their EHR and health IT systems can benefit from these type of surveys, as it offers a broad comparison of the different types of healthcare technology vendors in the market.


Some other EHR, practice management, and billing software vendors who gained high ranking in the survey encompass ADP AdvancedMD, athenahealth, Greenway, HealthFusion, McKesson and NexTech.


“High performing vendors have emerged from the pack as practice implementations succeed and fail, meaningful use attestations are reviewed, and users assess their vendor’s capabilities to meet their individual practice needs, particularly managed care reimbursement and ACO billing ,” Brown said in a public statement. “The majority (70 percent) of smaller and solo practice physicians have still not settled on a technology suite or set of products that delivers to their expectations on meaningful use, clinician usability, and coordinated billing and claims, hence, the relentlessly moving EHR marketplace.”


It is likely that polls like this will push forward greater competition among vendors of EHRs and health IT systems. Over time, we many see new leaders emerge within the health IT industry.

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New Grant Program Advances Health Information Exchange

New Grant Program Advances Health Information Exchange | EHR and Health IT Consulting | Scoop.it

The development of health information exchange institutions is aimed at advancing coordinated care, delivering superior quality of medical services, and improving public health outcomes. Certified EHR technology and health IT systems can enhance the communication channels and connections between different coordinated care settings, which is why EHR interoperability and health information exchange is so important.


In Massachusetts, the Massachusetts eHealth Institute at MassTech (MEHI) announced that a new grant program is available to strengthen technologies and communication channels among various medical facilities in varying regions across the state, according to the public entity’s press release.


The grant program called Connected Communities Implementation Grant Program is currently accepting proposals from groups that are working together to develop effective health information exchange and utilize health IT systems in an effort to advance coordinated care. The grant is meant for improving workflows and giving providers an opportunity to solve the many challenges of coordinated care and transitions of care within their communities.


The hopes behind these type of grant programs and healthcare reforms is that it will achieve better patient outcomes, quality of care, and lower healthcare costs through efficient health information exchange.


“The Connected Communities Grant Program provides us with an opportunity to support impactful health IT programs driven by the priorities in individual communities,” Laurance Stuntz, Director of MeHI, stated in the press release. “Through this approach, our hope is to receive proposals that identify region-specific roadblocks to sharing information, engage a broad cross-section of healthcare stakeholders, and address the unique needs of patients in that community through the use of technology.”


The cooperation and coordination among multiple medical facilities remains a key focus of the healthcare industry especially in terms of long-term and acute care as well as behavioral health services. This particular grant program asks for one or more specialty providers in these areas to send a proposal in order to help further strengthen important partnerships.


Those who receive the grant will initially obtain up to $25,000 from MeHI. The grantees will need to develop a strong action plan, detail health information exchange pathways in a diagram, outline a ‘use case,’ and provide a budget for the anticipated costs.


“Finding ways to improve information sharing and real-time data capabilities, while enhancing providers’ ability to treat patients at the community level, will go a long way toward helping the Commonwealth meet its healthcare cost reduction goals,” David Seltz, Executive Director of the Health Policy Commission, said in a public statement. “We look forward to continuing our work with MeHI and other stakeholders to build a stronger healthcare system.”


The grant program is looking to push forward provider access to clinically important data including laboratory results and discharge plans, better healthcare outcomes, and reduced hospital readmissions along with duplicative tests. Massachusetts medical providers and groups who are interested in expanding their health information exchange capabilities would be wise to send a proposal to MeHI in order to advance the quality of their patient care services.

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Are Policies, Standards Enough to Boost EHR Interoperability?

Are Policies, Standards Enough to Boost EHR Interoperability? | EHR and Health IT Consulting | Scoop.it

In order to truly strengthen EHR interoperability and advance health information exchange across the medical care sector, federal regulations and standards may not be enough to make a difference. The meaningful use requirements under the EHR Incentive Programs and the EHR certification program established by the Office of the National Coordinator for Health IT (ONC) are not enough to move forward EHR interoperability.


Despite the issues surrounding EHR interoperability, David McCallie MD, SVP Medical Informatics at Cerner, writes in a guest blog that the healthcare sector should also look at the many achievements and “lasting advances” of the past several years.


For example, electronic prescribing standards have become well-established and e-prescribing has been implemented in large numbers across clinics, hospitals, physician practices, and pharmacies. Additionally, secure messaging and email has become a standard method of communication, which is replacing the older versions of technology like the fax machine.


Another instance of the successful advancements made in the healthcare industry is widespread adoption of “document-centric query exchange,” McCallie explains. Some ongoing developments in healthcare today include encoding complicated clinical information into summary documents and the move toward API-based interoperability.

“Nonetheless, the refrain we hear from Capitol Hill is that we have failed to achieve the seamless interoperability that many had expected.


This has led to numerous legislative attempts to 'fix' the problem by re-thinking government approaches to the standard setting processes authorized by HITECH,” McCallie wrote. “We should be careful not to overreact in light of any disappointments and perceived failures around interoperability.  There are many things we must improve, but we should not inadvertently take steps backwards.”


The issue at hand, McCallie writes, is that Congress feels that developing and initiating standards alone will lead to better EHR interoperability. While standards are needed, they are not sufficient for gaining true EHR interoperability and healthcare data exchange throughout the industry.


In order to create useful EHR interoperability, McCallie outlines several factors necessary for achieving this goal. First, each standardization must co-exist alongside a business process. Secondly, through real-world testing and validating, a standard can be cultivated.


Thirdly, healthcare institutions must choose to incorporate the standard in their workflow in order to serve a “business purpose,” McCallie explained. Some other important tips to consider are developing strong security frameworks amongst data sharing tools, creating a ‘business architecture’ in which legal entities are considered, and incorporating a governance platform that holds oversight of the business frameworks.


As previously reported by EHRIntelligence.com, another important aspect to improving EHR interoperability is impeding information blocking throughout the medical industry. Currently, Congress and ONC have moved forward in addressing information blocking, which occurs when certain vendors or providers charge large fees for sharing data and providing access to key information.


This tends to harm care coordination efforts among accountable care organizations and long-term care facilities. Essentially, health data exchange and EHR interoperability is needed in efforts to improve the quality of patient care. Along with addressing information blocking, the steps outlined by the Cerner representative should help move the healthcare sector toward enhanced EHR interoperability.

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