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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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How Patient Access to Doctor Notes Affects Physicians

How Patient Access to Doctor Notes Affects Physicians | EHR and Health IT Consulting | Scoop.it

Releasing physician notes to patients is scary for many doctors. Common concerns include patient misunderstandings regarding the health information included in the note, damaged physician-patient relationships due to the content included, and a flood of questions from patients who are confused about clinical terminology.

But presenters at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago said it's time to put those concerns to rest.


The presenters, Jan Walker, assistant professor at Beth Israel Deaconess Medical Center and codirector of the OpenNotes initiative; Amy Gleason, chief operating officer at CareSync; and internist Susan Woods, director of patient experience and connected health at the Veterans Health Administration, agreed that providing patients secure online access to physician notes is a win-win for all parties.

Here are three key findings they shared during their presentation:


1. More patients want — and expect — access to physician notes.
During the presentation, Walker shared results from a one-year Open Notes demonstration project funded by the Robert Wood Johnson Foundation. About 100 physicians from Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center participated in the project, affecting more than 13,000 patients in multiple locations.


Jan Walker In the demonstration project, patients received an alert that their note was ready to view as soon as the physician signed the note (and they received another alert prior to patient visits).

Walker acknowledged that one big question prior to starting the project was whether patients would be interested. Ultimately, over the course of the 12-months, 82 percent of patients at Geisinger who had a visit to their provider opened at least one note.


Notably, that included older patients, sicker patients, and less educated patients. In fact, patients with no more than a high school education looked at notes at same rate as everyone else, said Walker.

Ninety nine percent of patients said they wanted to continue having access to physician notes, and 85 percent said availability of physician notes would influence their future choice of providers.


2. Patients report positive results when they can view physician notes.
So what effect did that increased access to physician notes have on patients? The study suggests a positive one. About three-quarters of the survey respondents said they take better care of themselves, understand their health better, feel more in control, take their meds as prescribed at greater rates, and feel better prepared for patient visits, said Walker.


Other positive results Walker said patients reported included:

• Improved recall of the patient visit and improved ability to adhere to follow-up recommendations, because looking at the note helped patients refresh their memory.


• Improved trust between patients and their physicians because it removed the "mystery" of what the physician was writing in the record.

 
• Improved ability of patients to be prepared for their next visit and to engage in shared decision making.


3. Physicians report positive results when patients can view their notes.
While many of the physicians reported concerns regarding how patient access to notes would affect their work flow, very few actually saw these concerns come to fruition, according to Walker.


Only 2 percent reported longer visits, 3 percent reported spending more time on patient questions, and 11 percent reported spending more time on documentation. In fact, Walker commented that a common question received from physicians who were participating in the demonstration was whether the access to physician notes feature was on, because they weren't getting questions from patients about the notes. 


And, contrary to the fear that patients might be confused, unnecessarily worried, or offended by the notes, only one percent to eight percent of physicians reported these problems, said Walker.

Perhaps most telling is that, at the end of the 12-month demonstration, none of the participating primary-care physicians stopped participation, even though that was an option. "We really believe this is the right thing to do," said Walker.


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EHRs Improve Mortality Rate and Increase Patient Satisfaction

EHRs Improve Mortality Rate and Increase Patient Satisfaction | EHR and Health IT Consulting | Scoop.it

Electronic health records (EHRs) have been adopted by thousands of hospitals. HealthIT.gov reported that nine out of 10 of all eligible hospitals achieved meaningful use through December 2014.

Once hospital staff members and physicians became accustomed to EHR technology, they and their patients reaped the many benefits offered by switching from paper to digital health records, including:

  • Patient information being more complete.
  • Diagnoses being more accurate.
  • Better data, leading to quicker and safer decision-making.
  • More convenience for patients with shorter wait times.
  • Integrated data improving the coordination of care.
  • Greater efficiencies leading to significant cost savings.
  • Fewer medical and medication errors.
  • Improved patient outcomes.

The cost savings and convenience delivered through EHRs are certainly valuable, but their positive contributions to patient care are even more noteworthy.

Predicting Mortality Rates
Studies show that EHR use yields significant clinical benefits. In one study conducted from 2010 through 2012, HIMSS Analytics and Healthgrades found that hospitals using advanced EHRs were better at predicting mortality rates.

Researchers studied 32 different procedures across 4,500 acute-care facilities, and evaluated the associated mortality rate. They then examined the hospitals’ EHR use, and concluded that those using more advanced EHRs were better able to predict mortality rates for most conditions, including stroke, heart attack, COPD, pneumonia, respiratory failure, and stomach and intestinal surgery.

Positive Clinical Outcomes
Through the HIMSS study, researchers also found that hospitals with advanced EHRs captured more patient information. And perhaps most interestingly, the mortality rates of the advanced-EHR hospitals actually improved for heart attack, small intestine surgery and respiratory failure.

How could EHRs lead to positive clinical outcomes? With improved data capture, physicians can better monitor additional patient risk factors, base their decisions on more complete information and manage patient care more effectively.

Healthcare professionals across the country are documenting lives saved thorough EHRs, particularly due to the universal anytime, anywhere access to a patient’s health record.

It’s clear that building improved care models and eliminating errors through missing, delayed or incomplete paper records have been a game-changing outcome of EHR use.

Increased Patient Satisfaction
Although physicians may not always communicate to patients the many benefits they can experience with EHRs, they have proven to be significant:

  • Efficiency is probably the most noticeable advantage, which becomes clear when patients are awaiting test results or diagnoses. Primary care physicians and specialists no longer need to contact each to obtain important information, or wait for a lab to send test results; lab results are now sent electronically to healthcare providers, and often directly to patients, as well.
  • Convenience is achieved through quicker appointment setting, as well as shorter office wait times as result of improved pre-visit communication.
  • Health improvements stem from more frequent reminders of important preventative measures, such as diabetes and cancer screenings.
  • Patient engagement often improves, especially when doctors use EHRs to educate patients about their health.
  • Increased time spent with the physician, as a result of reducing the time spent searching for charts or tracking down patient information.

When patients feel their time is respected, and understand the status of their health, they are more satisfied with the care they receive.

Successful EHR Implementation Yields Important Results
What is more important in healthcare than saving lives? By leveraging the power of EHRs, healthcare providers have the potential to continuously improve patient outcomes and decrease mortality rates, while improving the physician-patient relationship.

Implementing advanced EHRs equals a win for those on both sides of the screen.

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The documentation solution your patients want you to adopt

The documentation solution your patients want you to adopt | EHR and Health IT Consulting | Scoop.it

Remember the Latin phrase “Primum non nocere”? It means “First, do no harm.” Most of us physicians committed to it when reciting the Hippocratic Oath, back when we were first embarking on our careers in medicine.

Sadly, today’s technology threatens this sacred physician-patient relationship. Electronic health records (EHRs), although much-needed, have created perverse, unintended consequences for the patient experience.

To be clear, EHRs are inherently good.  They’re the backbone of better-coordinated care, more structured health data, and improved health outcomes. But it’s now a well-documented fact that physicians are burdened by the cumbersome clerical work that’s often brought about by implementing and using EHRs.


And the real victim of these unintended consequences is the patient.

The hallmark of a positive patient-physician relationship is a narrative — one that’s told by the patient and heard by the physician. EHRs have interrupted these two-way conversations.

Now, many patients speak to physicians’ backs as they type furiously to capture data into EHR systems. Physicians are no longer active participants in patient narratives, but rather data capturers who are more concerned with clicking boxes than actively listening and processing. Patients are frustrated. Physicians are exhausted. Satisfaction scores are gloomy.

But there is a way around these problems.

Medical scribes are a fast-growing solution for removing technology from the patient-physician relationship. Why should highly-trained physicians devote 44 percent of each clinical day to data entry and clerical tasks? With an estimated 20,000 scribes currently working across the U.S., physicians are discovering documentation assistants as a way to preserve the sanctity of the patient-physician relationship while reaping the many benefits of EHRs.

Recently, our scribe staffing team received a call from a private practice in North Carolina. The physicians wanted to know how soon they could bring on medical scribes. Why? Because their patients told them to. They’d experienced the benefits of scribes at another specialty group in the area and were now demanding the same positive, face-to-face interactions with their doctors elsewhere.

Granted, some oppose scribes as a solution. Challengers describe hiring scribes as Band-Aids and encourage physicians to instead advocate for product improvements and advancements.

Yes, EHRs do need to better suit physician users’ needs. But we can’t wait for vendors to improve their products. Physicians and patients need help now, if for no other reason than to preserve those all-important patient-physician interactions. And there’s no guarantee future EHR improvements will significantly decrease the amount of time spent documenting patient data. Scribes are a proven, viable, long-term solution.

In fact, many physicians (including myself) used medical scribes long before EHRs were widely embraced. And you can bet those early adopters will continue to employ scribes even after EHR systems are fully optimized. Direct, engaged interaction with patients is simply too great a sacrifice to make without their assistance.


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Not All Patient Portals Are Created Equal

Not All Patient Portals Are Created Equal | EHR and Health IT Consulting | Scoop.it

Patient Portals are a trending item in the healthcare industry, but what does the term “Patient Portal” really mean?  And more importantly, what can a Patient Portal do for you?

In reality, the patient portal moniker has become a confusing industry catch-all; patient portals from one vendor may provide entirely different levels of service and interactivity than another.  Adding to the confusion is the fact that both may still fail to offer the services that you as a provider are looking for.  The truth is, some portals are very limited, offering only a very basic login and access to patient history.  Other portals, however, are highly functional game changers that interact seamlessly with workflow and offer everything from intuitive check-in to patient reminders, self-registration and even payment options.

Five must-have features in a patient portal

So let’s clear the patient portal fog. Below are a few efficiency-making functionalities you should be looking for when in the market for a patient portal.

1)      Electronic Patient Entered Data & Interoperability

What is the point of a patient portal if your staff is still required to enter patient data?  This is redundant. To leverage the speed and efficiency of technology, information your patients fill-in should automatically and seamlessly get entered and verified in your existing systems of record. The portal could then pull information from your existing systems to provide access to your patients, even from past appointments. One powerful, efficient portal will interact with your entire office, no matter what technologies you already have in place.

2)      Pre-registration From Anywhere or Any Device

While patients are accessing the portal from home, they can also register for appointments remotely.  This allows patients to arrive for an appointment with registration complete and fully entered.  Additionally, higher-functioning portals allow document uploading and payment options so your patients can walk-in and focus on what matters most, getting treatment.

3)      Patient Estimates & Payments

Get accurate insurance, payment and co-pay estimates and accept payments through your portal. Some portals harness accurate estimation and eligibility software that makes billing less complicated and allows for quicker payments, by allowing patients to pay from anywhere while using the portal.

4)      Custom Workflow

Optimize and tailor your workflow and electronic registration to the fastest possible output of YOUR individual practice. Healthcare practices are highly individual and unique; no two offices have the same workflow.  It is likely an out-of-the-box portal geared for one practice will not sufficiently meet all of you needs. Quality vendors, however, will tailor your electronic registration process to match the exact needs of your practice.

5)      Patient Engagement

Quality patient portals automatically remind patients of appointment times, exams, billing etc.  Reminder intervals can be selected by staff or individualized by the patient to suit what serves them best.  Portal reminder features gives office staff freedom from phone calls, letters and email, and automatically notifies patients for you. This results in higher front office productivity and patient interaction, while significantly reducing over-bookings and the costly no-show appointment.

Armed with this knowledge, you can find a patient portal that is specifically geared to your office.  Quality patient portals meet unique needs and use seamless technology to interact with existing infrastructure to create a highly functioning, efficient office while adding immeasurable value to the patient experience and your bottom line.


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Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog

Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog | EHR and Health IT Consulting | Scoop.it
As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital, home or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people (patients) are not paramount to the equation.

If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, at the keynote speech at HIMSS 13 (the national Health IT conference), it was announced that the “The blockbuster drug of the 21st century is Patient Engagement”.

While the mantra is strong, the industry seems to conflate “patient engagement” with “consumer engagement”, which in my view are two distinctly different propositions. Consumer engagement is predicated on the fact that there is choice, a free market and low barriers. As consumers, we can swing by the Apple Store and pick-up a Jawbone bracelet to monitor our exercise activity and sleep patterns, perform an in-home ECG screening with AliveCor’s iPhone Heart Monitor, or self-assess symptoms and find an appropriate doctor using the BetterDoctor service..

These products represent the innovative eye-candy that dominates the headlines, but I’m here to tell you that none of them are the killer app for patient engagement. They are all important pieces of the puzzle but the kernel of transformation lies in tapping into one of the most under-valued assets in health care, the doctor-patient relationship. Consumers, who strap on monitoring devices and crawl the web for solutions without the guidance of a doctor, are heading down a path towards anxiety – and likely more questionable consumption of healthcare resources. The always available Dr. Google enables anyone to self-diagnose, but what consumers don’t realize is that Dr. Google is an oncologist that often lists cancer as one of the possibilities….more anxiety.

Patients engaging with themselves are a noble aim, for sure, however coupling a patient to their doctor throughout their healthcare journey is simple, elegant, and necessary: essentially we need a Clinical CRM (or PRM – Patient Relationship Management). On the surface this may seem like an improbable proposition, as many doctors are already suffering from Chronic EMR Fatigue Syndrome, overloaded schedules and diminishing payments. They don’t want yet another solution.

Taking human physiology as a metaphor for complex systems (in the spirit of biomimicry), excess sugar in our food supply causes metabolic syndrome and ultimately diabetes – which extracts a huge drag on the body in terms of aging and pathologic opportunities. Our healthcare system is no different; excess technology and proprietary solutions have caused a digital opacity syndrome and ultimately a health care system of balkanized cash vacuums, people suffering unnecessarily and finger pointing. Healthcare is the diabetes of our GDP.

When technology understands what people want from healthcare, our system has a chance. This is not about what the system wants for itself and it’s not about what ‘consumers’ want for themselves; it’s what makes the most sense to achieve the ultimate outcome: a healthy population at the most efficient cost.

We need a new angle, a new dimension, something simple and human that provides demonstrable value; both in the short term and the long run. The good news is that we’re at a once-in-a-generation moment in time where great change is upon us….and where there is great change, there is great opportunity.

We need a new Healthcare Operating System; one that enables shared ownership between all parties and where innovative ideas fit together like Legos.

The four walls of medicine and the millions of telephones that occupy the space between doctors and patients must evolve.

It has failed to scale. Grab the eraser and let’s start all over. Please.

I have a few ideas…perhaps the next blockbuster drug of the 21st century is Physician Engagement…(wait, what?). Yep, if we do not get physicians involved and engaged in a new model and we try to commoditize them, we will have failed to appreciate the important role they play. There is plenty of talk about “the algorithm will see you now”. Meh.

People have always lived in tribes and relied on other people for help; physicians are people, too. While we (and I believe I speak for many physician) are as frustrated as patients about the oligopolistic and opaque healthcare system, we really just want to help people…and we need technology to work with us, not around us.

Jordan Shlain is a physician in San Francisco and a founder of HealthLoop.
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EHR Data, Decision-Making Ultimately Lie in the Patient’s Hands | EHRintelligence.com

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

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

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

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

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

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

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

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

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



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3 guaranteed ways to improve patient satisfaction

3 guaranteed ways to improve patient satisfaction | EHR and Health IT Consulting | Scoop.it

With roughly 1 billion in Medicare reimbursement dollars being tied to patient satisfaction, it’s no wonder the focus on patient experience is swelling. Of course there are other factors fueling the focus — the proliferation of online physician ratings websites, ACOs, and CG-CAHPS to name a few.

Over the past decade I have visited 100+ different inpatient and outpatient practices.  Ironically, the patient experience varies even more than the spectrum of low to high end hotels I’ve stayed in.  The facilities that truly stood out as creating a fantastic experience had three things in common. Not surprisingly, none of them are new techniques. In fact, they are all taught in medical schools around the country. Why then do so few practices implements these concepts, especially when research suggests each of these are highly correlated to patient satisfaction?


Here are the three key strategies I have seen measurably improve patient experience. Call me out in the comments if these haven’t improved your scores.

1. Sit down with your patients. Most providers would like to double the amount of time they spend with each patient. Though that typically isn’t possible, it is amazing how simple it is to have your patients perceive that you spent double the amount of time with them. A University of Kansas study showed that when you pull up a chair, patients perceive that you spent roughly double the amount of time with them vs. when the physician stands for the visit. It makes sense, sitting creates a different level of engagement with a patient. They recognize that you are prepared to listen and focus on their health. Take a load off and sit when you are with a patient. That 2 minutes turns into 4 and a 10 minute visit feels like 20 minutes to them.

2. First impressions matter — and the provider is not the first impression 90 percent of the time. Your front desk staff most often interact with patients first. Hire the nicest, most courteous and professional front desk staff you can and then pay to train and retain them. Perhaps the largest complaint category online (after insufficient time listening or in the room with the patient — see point 1) is a rude front desk. If you struggle to find customer service focused individuals, look to the concierge clinics, spas and wellness clinics. You may even consider restaurant employees who have a reputation of excellent customer service and thrive on creating a great experience for their customers. Bring them onto the team and make sure they know their number 1 job is to be cheerful and helpful on the phone and in the office. Help them set appropriate expectations with patients when they come in. Let them get up and interact with the patients in the waiting area if your patients do have to wait. Offer patients water or otherwise make them as comfortable as possible. Ask for and listen to ideas from them to improve the experience.

3. Be on time. The quickest way to get a negative review is to not respect the patient’s time. I’ve even seen patients send physicians a bill like this person did for their wait time. The most damage is done when a provider inadvertently tells patients that their time is not important.

For example, one classic online review indicated that the physician told the patient about the jog he just finished while the patient had been waiting for hours. Sorry for the wait just doesn’t cut it in cases like that. If you can’t be on time, set expectations — have your front desk staff kindly inform the patients that you are running a bit behind. (Can I get you some water or something?) Apologize and explain when you can why you are late — especially if you were spending time with other patients. Then take a seat, listen, and provide quality care.



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Survey Reveals Patients' Perspectives on EHRs

Survey Reveals Patients' Perspectives on EHRs | EHR and Health IT Consulting | Scoop.it

I spend a lot of time studying and understanding EHRs. I am a “superuser” within both the inpatient facility in which I have medical staff privileges, and in the private outpatient practice. I made the leap to EHRs more than two years ago, and haven’t looked back.

I can honestly say that the two EHRs I use have improved patient care, documentation, accuracy, and quality of life for me. I realize that systems vary, but I feel fortunate that I have good tools for accessing and using the EHR.


We seem to always talk about the EHR from the perspectives of the provider, facility, and the system. But what about the patient? That seems to be an afterthought in this process. How can we leverage the data that we are collecting and storing to make the patient's experience more inclusive and meaningful to improve the health or our communities?


The National Partnership for Women and Families just published a survey that demonstrates that patients also value the EHR, and are eager for more access and features in better understanding their healthcare and options.


Here are some of the key findings from the survey of 2,045 U.S. adults:

• Eighty-five percent to 96 percent of all respondents found EHRs useful in various aspects of care delivery, while only 57 percent to 68 percent saw paper records as useful.

• Patients’ online access to EHRs has nearly doubled, surging from 26 percent in 2011 to 50 percent in 2014.

• Patients want even more robust functionality and features of online access than are available today, including the ability to e-mail providers (56 percent); review treatment plans (56 percent), review of doctors’ notes (58 percent), and and review of test results (75 percent). They also want the ability to schedule appointments (64 percent), and submit medication refill requests (59 percent).

• Patients’ trust in the privacy and security of EHRs has increased since 2011, and patients with online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) than those with EHRs that don’t include online access (67 percent).

• Different populations prefer and use different health IT functionalities. For instance, Hispanic adults were significantly more likely than non-Hispanic Whites (78 percent vs. 55 percent) to say that having online access to their EHR increases their desire to do something about their health; and African American adults were among the most likely to say that EHRs are helpful in finding and correcting medical errors and keeping up with medications. Specialized strategies may be necessary to improve health outcomes and reduce disparities in underserved populations.


In many ways, the survey findings really surprised me, as this is the first time that I have seen substantial survey data about how patients see the whole process of the EHR. Their understanding of the utility of the EHR was refreshing.


Some findings raise concerns, however. Patients' desire to have more electronic access may be problematic. Think of the increased workload in responding to a new access point, and the potential for misunderstandings and conflict in care plans if diagnostic data and records can be viewed unfiltered and without the assistance of the care provider.


On the other hand, the EHR seems to provide at least some of the tools that a provider needs to improve health outcomes and reduce healthcare disparities among diverse populations. It was good to see that the EHR was seen by some ethnic populations as a way to motivate them to be healthier and to take more responsibility and control of their healthcare.

Much has yet to be learned and uncovered in the wake of the push to automate and digitalize the health record in the United States. Sometimes the law of unintended consequences can work in the favor of the healthcare system.


One fact remains for all providers, learning to survive in the post-EHR world, and acquiring the skills needed to become efficient in the use of the EHR, have never been more important. There is no going back to the paper record.


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What Factors Encourage Physician HIE Adoption, Use?

What Factors Encourage Physician HIE Adoption, Use? | EHR and Health IT Consulting | Scoop.it

Physician HIE adoption hinges on the ability of health information exchanges (HIE) to deliver complete and accurate patient data as well as a return on investment closely tied to meaningful use.

More than 90 percent of physicians value the access to trusted patient data sets, but more than two-thirds (69%) are unable to trust patient information available to them from health information exchanges (HIEs), according to a Black Book HIE survey.

The latter statistic represents a significant gain since 2013 when 97 percent of physicians indicated that they lacked trust patient records exchanged electronically using HIEs either because they deemed these records incomplete or inaccurate.

These findings come at a time when more and more physicians have achieved HIE readiness with the increased adoption of EHR technology. According to Black Book, physician groups with at least ten practitioners are most poised for HIE adoption based on their EHR adoption and implementation rates:

  • 95.8%: 50+ physicians
  • 89.4%: 20-49 physicians
  • 73.2%: 10-19 physicians
  • 56.2%: 2-9 physicians
  • 39.1%: 1 physician

Additionally, physicians are preparing to invest significantly in adopting and expanding their HIE capabilities in the coming year. This coincides with 67 percent of physicians realizing that a lack of provider interoperability is an obstacle in the way of improving patient care — a 20-percent drop from 87 percent in 2013.

Moreover, large/multispecialty will contend with integrated delivery networks, health systems, and academic medical centers in terms of their financial commitment to HIE spending in the next three years. Eighty-nine percent of the former intend to increase their HIE spend in 2015 and are projecting an 100-percent increase in 2016 before it dips back to 92 percent in 2017; meanwhile, IDNs, health systems, and academic medical centers will have their HIE spend taper off significantly by 2017.

Hospital HIE use should serve as an indication of the HIE needs of physicians moving forward. Currently, 82 percent of hospitals report exchanging patient data with “siloed HIE providers,” with slightly less than that number (75%) making use of limited direct messaging functionalities.

When choosing an HIE, physicians are overwhelmingly concerned with achieving meaningful use regarding their return on investment (ROIs) goals: 90 percent. A sufficient gap emerged between this goal and the next three:

  • 35%: Turnaround of ancillary results
  • 23%: Improved performance on risk contracts
  • 22%: Improved eligible & disability determination

Also factoring into a choice of HIE in this organization’s sustainability. Potential end-users are most concerned that HIEs are in their advanced state of operations (100%), have complete pilots stages (100%), and are currently transmitting data via stakeholders (98%). The capacity for supporting data analytics (45%) and quality reporting (42%) and being independent of federal or government funding (41%) are also important characteristics of a sustainable HIE. Patient access to health records and data, on the other hand, is not one such characteristic (10%).

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Lava Kafle's curator insight, February 20, 2015 3:17 AM

Deerwalk #DidYouKnow #Physician #HIE Health #Information #Exchange #Adoption 

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The Value of Healthcare Portals for Patient Engagement

The Value of Healthcare Portals for Patient Engagement | EHR and Health IT Consulting | Scoop.it

More and more, doctors and patients are relying on the internet to interact with each other. Using healthcare portals accessible on the web has revolutionized communication and substantially reduced the number of phone calls that are needed.

The experience of one Montana patient, is typical. He pointed out that, “If I need a prescription renewed or have a question for [the doctor], you hop on the portal, and his nurse usually has an answer back to you within an hour.”

Are Patients Willing To Use Portals?
According to MarketWatch.com, a survey conducted by Xerox showed that both boomers and millennials are very open to using healthcare portals to give and receive medical information. Millennials grew up with electronics and are at home with the internet. Over 43% said they would use their smartphones to access information. They showed the strongest interest, over 57%, in reviewing their medical records.

More than two-thirds of older patients have chronic conditions that require visits to the doctor. In fact they account for two-thirds of the U.S. healthcare budget. Over 50% of people in the boomer age group said they would be interested in getting access to medical care and information by using a portal.

There is no question that both patients and doctors want to use the portals. Here is a look at how they will continue to revolutionize the patient and doctor relationship in the coming years.

Communicate More Effectively
Having electronic records stored online lets both the physician and the patient look at what is recorded. Both can more easily spot trends. For example, blood sugar spikes or cluster headaches might be happening during periods of family upsets. Knowing the correlation can help with creating an effective treatment plan.

If a patient is worried about how his new prescription is affecting him, he can easily connect with the nurse or doctor to ask if what he is experiencing is normal. It is quick and easy, and lets the doctor makes changes early. If the process needs to be done by phone, the patient often just waits it out instead of calling because it takes so much effort.

Reduce the Number of Phone Calls
Patients can book appointments quickly online. This substantially reduces the number of calls the front desk has to field during the course of a day.

It helps streamline the process of working patients in for a visit, especially when combined with robo-calls to remind them it is time for their next appointment. While the ability to talk to a live person is appreciated by patients, having the ability to accomplish certain things online adds another great layer of customer service to patients.

Get Prescription Refills
With healthcare portals, it is easy for a patient to request that a refill prescription be sent to the pharmacy. He can do it online 24 hours a day, 7 days a week, whenever he becomes aware that he is running low.

Likewise, physicians and staff can approve refills at any time, making it more likely the pharmacist will get the ok for the medicine in a timely manner. It can also help to reduce patient wait times, since prescription refills can be handled outside of the patient’s office visit.

Share Records with Specialists
Portals simplify the process of asking a specialist to review a patient’s case. This results in better care and getting expert advice quickly. According to the blog on Healthcare IT News, the most advanced portals provide accurate, easy-to-use data for physicians, as well as the ability to share it securely with specialists.

Healthcare portals are making doctor-to-patient and doctor-to-doctor communication easier, quicker, and more accurate. It results in better diagnosis, more consistent care, as well as less frustration and more trust on the part of patients.


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EHR audit catches snooping employee

EHR audit catches snooping employee | EHR and Health IT Consulting | Scoop.it
Electronic health records not only enable faster access to real-time patient data; they also make it a heck of a lot easier to catch snooping employees who inappropriately view patients' confidential information, as one California hospital has observed this past week. 
 
Officials at the 785-bed California Pacific Medical Center in San Francisco – part of Sutter Health system – notified a total of 844 patients Jan. 23 after discovering a pharmacist employee had been inappropriately snooping on patients' medical data for an entire year.

The incident was discovered after the hospital conducted an EHRaudit back in October 2014. when it was first discovered only 14 individuals had had their PHI compromised. 

Following an "expanded investigation," hospital officials discovered the HIPAA breach was significantly larger than they had originally found, with 844 additional patients being identified as having there information inappropriately accessed. The staff member, whose employment has since been terminated, snooped on patient records from October 2013 to October 2014, including patient demographics, clinical diagnoses, prescription data and clinical notes. 
 
As officials pointed out, the hospital has "reiterated to all staff that policy allows them to access patient information only when necessary to perform job duties and that violating this policy may result in loss of employment," they wrote in a Jan. 23 press notification. 
 
The biggest way to avoid the employee snooping problem? Audit your users and the data, said Suzanne Widup, senior analyst on the Verizon RISK team, who spoke to Healthcare IT News in spring 2014 on Verizon's annual breach report. "You need to know who has the data, who has access the data, and you need to monitor it," Widup pointed out. "When you see organizations implement some sort of auditing scheme, suddenly they start finding a lot of stuff they couldn't see before."
 
This snooping incident at California Pacific Medical Center is far from an isolated event. As more hospitals conduct more regular EHR audits, cases like this are only increasing in number. 
 
One of the more egregious incidents was reported by the five-hospital Riverside Health Systemback in December 2013. Following a random company audit, officials discovered an employee had unrestricted access to Social Security numbers and clinical data of close to 1,000 patients for a period of four years. 
 
Then, of course, there was the HIPAA breach at University Hospitals just in December, where an employee had been reading confidential medical recordsof nearly 700 patients. What's more, the employee had unfettered access to the records for nearly three and a half years before being discovered and was only caught because the health system had received a snooping complaint. 
 
This kind of employee behavior has long been on the minds of chief information officers nationwide. 
 
In an interview with Texas Health Resources Chief Information Officer Ed Marx this past summer, he told us: "The biggest risk, as much as we talk about the hackers and people trying to get in and steal healthcare data, I think the biggest risk is still the individual employee who maybe forgot what the policy was and does something they shouldn't do."
 
Out of the nearly 42 million individuals that have had their protected health information compromised in reportable HIPAA privacy and security breaches, nearly 13 percent of them involve inappropriate access or disclosure of patient records, according to data from the Department of Health and Human Services. 


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

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

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

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

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

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

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

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



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Patients want more from their EHRs | Healthcare IT News

Patients want more from their EHRs | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

Having established a level of trust and familiarity with electronic health records over the past few years, increasing numbers of U.S. patients are looking for more advanced features from their EHRs, according to a new survey from the National Partnership for Women & Families.


The study, "Engaging Patients and Families: How Consumers Value and Use Health IT," follows up on a similar 2011 report that assessed consumer views toward EHRs. A lot has changed since then, with more and more patients comfortable with the idea of digitized records, and easier online access to health information spurring more patient engagement in their care.

In the past year, more than four in five patients with online access to their health records (86 percent) used their online records at least once, according to NPWF; more than half (55 percent) used them three or more times a year.


"To date, the public discourse on health IT has largely focused on the views of doctors, hospitals and vendors," said NPWF President Debra L. Ness in a press statement. "It is crucial to hear what patients have to say about how they experience EHRs and health IT as they receive care and manage their health."

By repeating questions from 2011, the new survey – which lays out seven strategies to help engage patients and families more effectively in their care – identifies trends in patient attitudes since meaningful use has helped fuel EHR adoption. Its new questions yield data on new topics in discussion for health IT policies and programs, such as patient-generated health data, patient care plans and mobile access.


"Engaging Patients and Families" is not the only new report being updated for the first time since 2011: It comes close on the heels of the Office of the National Coordinator for Health Information Technology's new 2015 Strategic Plan, which was published on Monday for the first time in four years.

"As the National Partnership's new data show, more consumers are accessing, sharing and using their health information, underlining the importance of interoperability of health data and systems," said National Coordinator for Health IT Karen DeSalvo, MD, in a statement. "We are focusing our efforts in these areas to empower individuals to address not only gaps in information exchange and interoperability, but also enable them to take steps to improve their health and better manage their health needs,"

Among other key points from NPWF's report, which polled more than 2,000 patients: Patients' online access to their health records has nearly doubled – from 26 percent in 2011 to 50 percent in 2014.

Still, they want even more functionality, including the ability to email providers (56 percent), review treatment plans (56 percent), see doctors' notes (58 percent) and test results (75 percent), schedule appointments (64 percent); and submit medication refill requests (59 percent).

Patients' trust in the privacy and security of EHRs has increased since 2011, and patients with online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) than those with EHRs that don't include online access (67 percent).

Different populations prefer and use different health IT functionalities. Hispanic adults were significantly more likely than non-Hispanic Whites (78 percent vs. 55 percent) to say having online access to their EHRs increases their desire to do something about their health. African American adults were among the most likely to say EHRs are helpful in finding and correcting medical errors and keeping up with medications.

NPWF suggests that "specialized strategies" may be necessary to improve health outcomes and reduce disparities in underserved populations.

"The views of patients must be front and center as we take the next steps in implementing health IT," said Sandra R. Hernández, president and CEO of the California HealthCare Foundation, which funded the poll. "As we as a nation become more diverse, the imperative to address disparities grows. We need the kind of robust information EHRs provide and the genuine patient engagement they can facilitate."

"We have made progress in leaps and bounds in just a few short years," said Mark Savage, NPWF's director of health information technology policy and programs, in a statement. "But clearly there are barriers still to overcome, and this report breaks down policy implications for the meaningful use program as well as broader delivery system initiatives that must be carried out. And it's an important reminder that meeting the needs of patients and families must always be at the core of health IT design and implementation."



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