EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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3 Key Areas to Address During EHR Optimization

3 Key Areas to Address During EHR Optimization | EHR and Health IT Consulting |

If you have ever purchased a new home, you are rarely 100% satisfied when you move in. You may want to add some new furniture, paint a few walls, update the flooring or even do a complete remodel. When implementing a new Electronic Health Record (EHR), many times the need to “get the system live” as soon as possible, results in a rushed implementation of basic functionality and “out of the box” workflows.


There is not always time to look at current issues and identify ways to improve processes. Many times the current problems are merely transferred into the new system. Even if you love everything about your new EHR, Optimization of the system will always be necessary due to factors such as advances in medical treatment, compliance & regulatory changes, adding of new specialties and more.


Whether it is your existing EHR or a new system, for optimization to be effective, experts with clinical, operational and technical experience will need to look at how the system is working. You may have such experts employed, or you may need to bring in consultants. Either way, these experts will assess how users are interacting with the EHR and if they are having functionality and/or workflow issues. Sometimes, problems can be addressed by merely providing additional training, especially if new features and functionality have been deployed.


By taking a thorough look at the system and its users, experts can determine what improvements need to be made.

Below are three areas to take into consideration: 

  1. Governance: A strong governance structure is critical to having a successful optimization plan. Requests for changes to the EHR must be prioritized and evaluated.  An agile governance group made up of the right members, should meet monthly to review all requests and prioritize according to the overall needs of the organization.
  2. Training:  A comprehensive training program is a critical factor that impacts the usability of the EHR. Many times organizations provide new employee training but do not offer any “ongoing” or “refresher” training. Supplemental training can increase basic and advanced knowledge of the system and improve efficiency. As system upgrades and new functionality are implemented, users should have an option to attend classroom training. eLearning can be helpful, but there is no substitute for hands-on classroom training where the user can ask questions and get answers.
  3. Communication: Organizations should have effective and comprehensive communications regarding training, new functionality, and any other changes to the EHR. The creation of a formal enterprise-wide communication plan using a variety of forums and a broad spectrum of communications resources is essential. Being proactive versus reactive such as having the EHR topic as a standing agenda item at a section and other scheduled MD meetings can be very useful.
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drchrono preps EHR, PHR for Apple Watch

drchrono preps EHR, PHR for Apple Watch | EHR and Health IT Consulting |

The first developer to make an EHR exclusively for the iPad is now aiming to be the first choice for physicians and patients looking to make the most of their new Apple Watches.

When the Apple Watch first becomes available from select retailers April 24,  Mountain View, Calif.-based ambulatory EHR developer drchrono will be ready – just as is it was five years ago, when a newfangled contraption called the iPad first hit stores.

At HIMSS15 in Chicago this past week, Daniel Kivatinos, drchrono's co-founder and chief operating officer, demonstrated new software for the Apple Watch that had been in the works for months – since Apple first put out the software development kit for the device.

"The moment they release the SDK, we can build a simulator app, even though we don't actually have the physical hardware," said Kivatinos. "We did the same thing with the iPad: When we heard about the iPad in 2010, we downloaded the SDK prior to the actual hardware being released.

"The moment the physical hardware came out for the iPad, we released the app in the app store," he added. "Same situation here: The moment the physical hardware comes out, our app will be available."

Kivatinos says drchono plans to be among the first to offer an integrated EHR as soon as Apple Watch becomes available. He's excited about the device's potential to transform the office experience for doc early adopters, offering a new twist on real-time communication between physicians and their patients.

"We've thought about this a lot: What is our company, what do we do?" said Kivatinos. "Over the past several years we've realized we're creating wearable health records for doctors and patients."

With close to 70,000 physicians and more than 4 million patients registered on the drchrono platform, he said, both groups are poised to enjoy the benefits of this unique way of interaction.

"This is a completely new experience," he said. "For the first time, doctors are going to have information given to them with their hands free: A doctor could be administering a shot, picking up a child, moving an elderly person – looking at the information while doing whatever it is they need to do."

Likewise, said Kivatinos, patients should be drawn to experiencing their personal health records through a device on their wrists, using drchrono's app to schedule appointments, get medication reminders and manage their chronic diseases: "Apple creates a very nice experience for patients. It's not just about usability, it's about enjoyment."

The app will enable docs to view a patient information at a glance, respond to messages via quick text and see eRx refill requests – offering a wearable extension of the drchrono iPhone and iPad apps, according to drchrono.

"Doctors are incredibly busy; drchrono on Apple Watch gives them insights about their practice and patients just by checking their wrist," said CEO Michael Nusimow in a press statement. "Its simply amazing to have a hands-free way to gather quick insights about a patient."

Plenty of other vendors have already readied software for the Apple Watch's release, of course, and many of them were showcasing it at HIMSS15. Epic, Cerner, athenahealth, Vocera, Mayo Clinic and more all announced apps – or plans for apps – at the show.

Kivatinos said he's confident drchrono's early leadership among curious early adopters of Apple technology will keep them well-positioned among physician practices.

"If you look at the early days in 2010, we put our (iPad) app out the first week and had thousands and thousands of docs download it," he said. "It took some of our competitors years to get to that point."

Physicians "want innovation, but they want it to work," said Kivatinos. "We had one doctor who bought a $100,000 EHR, and came to us a week later and said, 'This doesn't work. What do you guys have?' He literally just junked it. If it doesn't work, they're just going to walk away."

The critical questions? "Is it usable, is it designed well, can I just put information into it and walk away quickly? Can I just do my rounds? I don't want this thing in my way."

The company touts different "modes" for the Apple Watch app, depending who's using it and how. "Glance" offers a quick view, giving docs a snapshot of their patient schedule for the day. "Short Look Notifications" can display brief messages generated from the EHR app. "Long Look Notifications" offer a doctor a view of the app itself.

Kivatinos says he's "100 percent" certain the Apple Watch is going to catch on in a big way among consumers – and his customers.

I wonder aloud whether the embrace might be more tepid – something akin to a new form factor such as Google Glass, which found limited acceptance among the general public, but is still enjoying innovative clinical use cases.

Kivatinos says he's convinced it's an Apple to oranges comparison. Glass, with its temple tapping and head nodding, necessitated a new and sometimes questionable type of social etiquette, he said. The "experience was a little different: harder to set things up and install," he said – to say nothing of the cost.

"I bought a Google Glass. It cost $2,000 with prescription lenses," he said. "$2,000 and $350 is a drastic difference. Price point is so critical."

Whether it's docs looking for easy access to vital signs, staff messaging, e-prescriptions and labs; or patients looking for an attractive and convenient interaction to manage their meds or schedule appointments, he's convinced the Apple Watch will find favor among folks and physicians alike.

"The interest is amazingly high," he said.

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Measure Your Medical Practice Staff Tech Skills

Measure Your Medical Practice Staff Tech Skills | EHR and Health IT Consulting |

Before you begin training staff to use a new EHR or practice management system, it's a good idea to assess their overall comfort level and experience with using technology. Staff members with low computer literacy should receive basic skills training so they can take full advantage of vendor training during implementation. Without that foundation, they may feel lost and never achieve true proficiency with the new system, experts say. Here is a basic skills assessment survey recommended by CMS. Employees are instructed to indicate how familiar they are with various tasks or skills on a scale from 1 (no experience) to 5 (very comfortable).

Desktop skills:

• Safely turn computer on and off

• Restart your computer if it becomes locked

• Open a program using the Start menu

• Name the basic computer system parts

• Explain the terms: icon, menu, window, click, select, drag

• Use scroll bars and move, resize, and close windows

• Use help screens in the software programs

• Navigate among folders, create, name, and delete folders

• Copy or move a file from one folder to another

• Cut or copy and paste text

Internet skills

• Use a Web browser

• Recognize a URL

• Explain the terms ISP, website, home page, search engine

• Type a URL in an open box

• Use back and forward buttons to move through Web pages

• Create a bookmark

• Locate and click on links

• Use a search engine

• Print a Web page

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How Primary Care Health IT Use Spurs Quality Improvements

How Primary Care Health IT Use Spurs Quality Improvements | EHR and Health IT Consulting |

Strengthening workflow, treatment, and billing processes in primary care is critical to healthcare reform initiatives taking place around the nation. EHR technologies and other health IT systems play significant roles in supporting quality improvements in primary care practices.

The Agency for Healthcare Research and Quality (AHRQ) released a white paperUsing Health Information Technology to Support Quality Improvement in Primary Care –that discusses some key best practices for supporting enhanced quality of care.

The report outlines various health IT tools that can lead to quality improvements in the primary care setting as well as ways to stimulate greater use of health IT among primary care physicians. The key health IT tools primary care physicians will need in their practice include EHR systems, registries, decision support systems, and health information exchange (HIE). Several case studies are also presented to illustrate ways that providers can incorporate health IT in quality improvements.

Over the last six years, the Health Information Technology for Economic and Clinical Health (HITECH) Act has pushed forward the adoption of EHRs, e-prescribing systems, and other health IT tools.

Through the Medicare and Medicaid EHR Incentive Programs, the majority of healthcare providers have adopted health IT systems and are working toward quality improvement within their practice. The Patient Protection and Affordable Care Act also spurred healthcare reforms such as the integration of Accountable Care Organizations (ACOs).

AHRQ spoke with a panel of eight health IT experts to establish ways of incorporating health IT tools and advancing the development of quality improvements in the primary care setting. The organization also spoke with clinicians from an independent primary care practice, a large academic primary care facility, and a health information exchange that supports primary care establishments.

The researchers from AHRQ uncovered four factors that lead to the effective use of health IT tools in pursuit of improving the quality of primary care. These four factors are:

  1. A practice culture committed to health IT
  2. High-functioning health IT tools capable of tracking
  3. Knowledgeable staff with experience in health IT and quality improvement
  4. Workflows and practice processes that incorporate health IT

Both financial incentives and training assistance from health IT experts are key to garnering these four factors for a primary care practice. The Centers for Medicare & Medicaid Services (CMS) has already been utilizing this finding by offering meaningful use incentives and ICD-10 testing to ensure providers are on track with federal health initiatives.

One example of how health IT can be used for quality improvements in the primary care setting comes from Foresight Family Physicians, which has been operating for 25 years in western Colorado. The facility began transitioning to electronic records starting in 2004 and adopted a full-scale EHR system in 2007.

“Foresight currently uses health IT for quality improvement in several interrelated ways. First, the practice has a standing QI team, which includes four people who meet every two weeks for 1.5 hours,” the AHRQ report states. “To identify gaps in care and needed preventive health screening, the front office staff runs approximately 15 daily registry reports for all patients with appointments that day. This process generates reminders for patients who require screenings for depression, are due for a colonoscopy or mammography, have a body mass index over 30, and other concerns.”

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