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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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Mobile EHR Platform for Large Medical Practices

Mobile EHR Platform for Large Medical Practices | EHR and Health IT Consulting | Scoop.it

drchrono Inc., an mobile EHR provider of practice management, revenue cycle management (RCM) and medical API platform on iPad, iPhone and web, has upgraded its platform to meet the needs of larger medical practices and provider groups.

The upgrade includes a built an RCM team with its own RCM platform, RCM Pro, optimising the workflow of coders, billers, and billing managers making managing multiple practices more fluid. Almost all RCM companies are service organisations that don’t build any software and instead use 10-20 different EHR platforms that their customers were already using along with many spreadsheets exposing practices to a great deal of human error. The RCM Pro platform is solving the medical billing problem with a technology solution instead of using a human workforce. drchrono has been able to build software to streamline and drastically reduce the amount of human labor involved in getting doctors paid from insurance companies and their patients. drchrono has developed a strong software base thanks to the input given by its RCM customers on its iPad EHR solution and have the ability to automate the RCM workflow.

Additionally, drchrono includes these features to meet the needs of larger practices:

  • Advanced Security – technology and servers have been upgraded for HIPAA compliance and data security including two-factor authorisation
  • Surgical Centre Medical Billing – hospital grade surgical centre/institutional billing UB04 for Ambulatory Surgical Centres (ASC).
  • Full Service RCM – Dedicated team for claim processing and collection. RCM Service include medical coding, handling denials, rejections, payment posting, Patient AR, and statements.
  • Real-time Business Intelligence Tools – a comprehensive group of advanced charting and reporting options to give the C-suite a complete view of the business.
  • White Label Patient Portal – industry leading PHR on patient is now available with a practice’s own logo and URL. Includes messaging and payment processing and applications for smart phones and tablets.
  • Kiosk Check-In – easy iPad check-in application is now ready with a Kiosk mode for improving data intake and patient experience.
  • Admin Controls – custom settings allow for consultant view and multiple user types with different access levels plus audit logs, giving executives complete control over who can see or make edits in the system.
  • Advanced Patient Education Material – easily access practice specific patient educational material sup loaded by the practice or access a database provided by drchrono’s partnership with the Mayo Clinic.
  • EPCS (electronic prescription of controlled substances) – approved by the DEA, EPCS and eRx are immediately accessible in every workflow on the web, iPad, and iPhone with additional tools to prevent controlled substance abuse. The eRx system includes a drug formulary so the doctor can choose the best option for the patient. Further the eRx system is bi-directional letting the doctor know the prescription has been successfully received by the pharmacy in real-time.
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Fast Track EHR Software Comparison Guide

Fast Track EHR Software Comparison Guide | EHR and Health IT Consulting | Scoop.it

Electronic Health Records, often synonymous with Electronic Medical Records (read the difference here), are a major resource for medical businesses. With advancements like the HI-TECH Act, the federal government has incentivized and recommended EHR systems for modern healthcare offices. EHR software suites help with everything from patient records, to documentation of clinical work, diagnosis and procedure codes, and more. These comprehensive software packages help doctors to manage health information in a digital way, and make it more portable for transfer between provider offices.

 

EHR Requirements and Needs

As you compare EHR systems, healthcare offices should consider the specific ways that this type of digital record can help with the day-to-day work that goes on in an office. How health information managers interact with EHR technology is what will make or break an office’s relationship with a vendor product. It’s important to understand what an office is looking for and how an EHR product will help to fill those needs.

 

A User-Friendly Interface

First of all, EHR solutions need to be user-friendly, so that they accommodate more efficient work processes. Key pieces of information need to be accessible and transparent. Patient identification needs to be easy.

One big consideration in shopping EHR systems is how doctors and nurses can use this software to generate chart notes, complete a diagnosis, or look up things like family medical history. When there is a clear and accessible interface with intuitive controls, the software package will really make a difference in a medical office. Otherwise, it can actually have a negative effect on a health care provider’s operations. Prospective buyers can look at templating, as well as the sets of tools and controls, to see how well an individual vendor option accomplishes these goals.

 

Integrity of Data

It’s also important to make sure that an EHR system provides for security and compliance with industry standards, whether using on-premise or EHR systems. The U.S. Health Insurance Portability and Accountability Act or HIPAA mandates privacy for personal health information. The EHR system has to be able to keep data safe in a digital format. IT has to provide those particular controls that have been written into U.S. law to protect the privacy of patients in a digital world.

 

Supporting Patient Care

There are also a variety of features in Electronic Health Record solutions that are focused on the patient. Some of these are sometimes called ‘patient portals,’ where individual patients can go and look at test results, medical histories and even things like appointment reminders. The patient portal helps the office to create a digital relationship with each patient, and makes it much easier for someone to manage their healthcare needs, both short-term and long-term care.

 

EHR Comparison Shopping

How do you find the EHR vendor that’s right for your business?

When it comes to buying EHR software, you have to be able to look at systems side-by-side and make apples to apples comparisons. SelectHub is a selection platform that helps medical professionals who compare EHR systems to understand the features and functionality that each vendor offering provides.

With a detailed look at vendor options on SelectHub, those who are responsible for practice management can see how the software is delivered to the office, what helpful features it includes, and where potential problems might lie. This is one of the first steps to getting into a discussion with a vendor about things like downtime and maintenance for electronic health record systems.

Looking for the right EHR systems might seem like a very complex decision to make, but being able to compare vendors can help doctor’s offices to be confident about their choices, and enter into an agreement with an EHR vendor with peace of mind, feeling like they’re starting off on the right foot with this important milestone in digital record adoption.

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4 Remote EMR Training Considerations

4 Remote EMR Training Considerations | EHR and Health IT Consulting | Scoop.it

A new system implementation is an exciting time for an organisation; knowing how to properly operate and use it once it’s implemented is of the utmost importance. There are several different methods that can be used when developing an EMR Training Program.  An increasingly popular choice is to utilize remote training.Before deciding to implement a remote training strategy, there are several factors that need to be taken into account. The HCI Group’s David Bell has taken part in several successful training projects and has first-hand knowledge of what to expect during a remote training project. In today’s post, he shares with us what to anticipate when it comes to remote EMR Training.

 

1) Web-Based Training as a Useful Tool

Web-based training, also known as WBT, is a tremendous tool that remote training has to offer. Through WBT, physicians are able to go through practice scenarios and take practice tests on what they learned. What makes WBT so great is that it can teach you click-by-click, in a workflow manner. So, in an ambulatory setting, the WBT will take you click-by-click through the process of associating a diagnosis with an order. This method gives you wording while it educates you and will educate you on various things, such as how to modify the diagnosis you associated to the order, often with great live video walking you through the solution. WBT is very useful in helping you retain the knowledge you have already learned, as well as the knowledge that you pick up in your practice scenarios.

 

2) Provider Informatics Can Be Hugely Beneficial

Another helpful aspect of remote EMR Training comes in the form of provider informatics. For instance, you might have the option to watch a video from an informatics provider that demonstrates workflow, functionality and optimisation. Typically, providers learn more efficiently if they are hearing information coming from another provider who has experienced a similar situation while working with patients using the new EMR. If you have a doc who’s practising inputting notes into the system, it will be beneficial for him to view a clip showing how to use shortcuts to lessen the time it takes to type up the notes. If you use the shortcuts to do your Physical Exam (PE) and your Review of Systems (ROS), you will save valuable time by taking advantage of provider informatics tools.

 

3) The Need to Market WBT

Unfortunately, organisations often fail to successfully market WBT . Informatics often forgets to remember to teach end users that WBT is a tool for them to be able to learn on their own, should they forget orders or forget how to place a diagnosis. There are videos available that can show the end users this; however, due to the fact that they are not marketed well, physicians may go through a whole training program without knowing that they are available. Letting your end users know that these informational videos are available is a very important step into continuing physician education.

 

4) Making Additional Training Materials Easily Accessible

Make sure that is easy to locate additional material that corresponds to remote EMR Training. For example, at the nurse’s desk, they should have an open booklet that shows screenshots of how to access WBT from the monitor that they are using. End users are often unaware of additional training materials that will walk them through processes step-by-step and help them gain further knowledge of the EMR.

Remote EMR Training has become increasingly popular as of late due to the fact that it is more easily accessible to people with complicated schedules and is often more cost effective. While remote training clearly has its advantages, you must pay special attention to ensure that it’s being used to its full advantage. By developing a good internal marketing plan for WBT and making sure training materials are easily accessible, remote EMR Training can be a very useful tool for your organisation.

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Can an EHR Help Save Time? Yes… with These 7 Savvy Tips

Can an EHR Help Save Time? Yes… with These 7 Savvy Tips | EHR and Health IT Consulting | Scoop.it

There are few things more frustrating than wasted time—especially in the workplace. Most of us want to be productive—to feel as though we’ve accomplished something or made a difference. We certainly don’t want to be slowed down by technology. Neither do physicians, many of whom are afraid to make the transition to an electronic health record (EHR) system for this very reason.
Anticipated loss of productivity continues to concern physicians considering a transition to an EHR system. In fact, 59% of office-based physicians who haven’t yet adopted an EHR say loss of productivity is one of the biggest barriers, according to a 2014 report published by the Office of the National Coordinator (ONC).

Here are seven tips for how physician practices can stay on track—and not lose precious time—during and after an EHR implementation. 

1. Ensure that the practice has the proper connectivity and speed to complete all tasks.Practices that lack the necessary bandwidth will experience extreme slowdowns even despite proper planning and execution. HealthIT.gov provides several bandwidth recommendations, depending on the size of your practice. Note that these are minimum bandwidth speeds based on the Federal Communications Commission recommendations.

2. Choose an EHR system that meets Meaningful Use requirements. According to a 2011 National Ambulatory Medical Care Survey, EHR systems that meet MU criteria are more likely to save physicians time on certain tasks:

  • Eighty-two percent of physicians with an EHR system that meets MU criteria agree that e-prescribing saves them time, compared with 67% of physicians whose EHR system does not meet MU criteria.
  • Seventy-five percent of physicians with an EHR system that meets MU criteria agree that their practice receives lab results faster, compared with 61% of physicians whose EHR system does not meet MU criteria.

3. Advocate for time-saving features. Talk with your EHR vendor to ensure that it can provide the following:

  • Relevant clinical content. This includes specific checklists, documents, and tools that support your specialty.
  • Copy-and-paste functionality. When used appropriately (i.e., with validation of data), practices save a considerable amount of time.
  • E-prescribing. This includes the ability to enter prescriptions using multiple parameters as well as easily search for pharmacies and transmit information.
  • Patient portal. Patients can use the portal to access lab results, schedule appointments, pay bills, request refills, and message physicians directly.
  • Patient summary screen. This includes a list of medications, current conditions, and outstanding care items.
  • Templates. This includes templates designed for most common diagnoses and/or procedures related to your specialty.

4. Choose your hardware carefully. A wide variety of options are available from handheld devices to desktop workstations. Decide what option is best for your preferred workflow and style. Many physicians find that going mobile at the point of care is most efficient because they have access to information immediately wherever they see the patient.

5. Take a test drive before you buy. Physician practices don’t have the time, money, or staff members to offset significant drops in productivity. User friendliness is in the eye of the beholder, meaning physicians and all other staff members must see the product in action before a final decision is made. Ask for a product demonstration or trial log-in. Does anyone anticipate productivity slowdowns as the workflow changes? If so, address these concerns with your vendor.

6. Once you have it, use it. As with anything, practice makes perfect. One study found that as interns use EHR systems, they become more proficient at it. Another study found similar results—as novice EHR users gain more experience with technology, they become qualitatively better at using it. The bottom line is that physicians certainly won’t gain productivity if they don’t become accustomed to using the EHR system.

7. Delegate and/or automate certain tasks. For example, ask medical assistants to perform first-level reviews of electronic lab results and flag information that requires a physician’s attention. Consider sending automated messages to patients prompting them to set up appointments for annual visits or other preventive services.

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Integrating EHR Use into Patient Engagement

Integrating EHR Use into Patient Engagement | EHR and Health IT Consulting | Scoop.it

The rise of EHR use and health technology has posed some challenges in boosting patient engagement and patient-centred care, but providers are increasingly rising to these challenges and developing strategies to overcome them.

 

In a recent study published in the Journal of the American Medical Informatics Association, researchers examined the barriers providers face in engaging their patients while navigating their EHRs. Through interviews with physicians and nurse practitioners at four different Veterans Affairs outpatient primary care clinics, the research team identified two categories of patient engagement barriers.

The first was meeting patient demands, including engaging the patient, meeting their specific needs, and meeting their psycho social needs. Specifically, providers were concerned with fostering healthy and respectful communication with their patients by actively listening to them, meeting their eye contact, and forging strong relationships.

Providers also sought to meet patients’ psycho social needs, a lingering demand at VA primary care clinics.

“The VA, in particular, has a higher prevalence of psycho social problems among its patients, such as Post-Traumatic Stress Disorder (PTSD),” the research team explained. “When interacting with patients with mental health needs, a higher level of sensitivity is required.”

Additionally, physicians have an added workload when treating patients with psycho social problems, including answering a set of nine standard questions in their EHRs.

Providers also reported several EHR demands, including detailed patient documentation, pop-up alerts, and notifications. There is often a lot of activity on an EHR screen, and providers need to navigate all of that to perform the necessary tasks.

Trouble arises when EHRs have usability issues. These systems are reportedly difficult to navigate, and pose several problems when a provider is looking for a specific part of the EHR or trying to accomplish a certain task.

From these two demands come a difficult conflict. Providing ethical, emphatic, and patient-centred care is both a personal priority for providers, as well as a financial one in a value-based reimbursement setting. However, with the rise of the EHR Incentive Programs, providers must work diligently to meet certain EHR use benchmarks.

 

While this conflict is an oft-cited one, the researchers acknowledged that there was little information regarding how providers overcome patient engagement and EHR use challenges. During their investigative interviews, the researchers determine some of the providers’ best practices for integrating their EHRs into a patient-centred care encounter.

Between working outside of the care encounter and trying to use the EHR as a tool to boost patient engagement, providers reported some strategies to improve patient-centred care.

Documenting between clinical encounters

One of the foremost strategies to integrate EHRs into patient-centred care was to document in the EHR between the care encounter. Several providers reported skipping lunch or working beyond traditional office hours in order to document outside of the clinical encounter, freeing up their time with the patient for patient-centred care.

“In our interviews, the majority of providers performed EHR work outside of patient visits to alleviate time pressure,” the researchers reported.

“These outside-of-visit EHR activities include previewing, documenting, reviewing, and finishing notes. Based on their priorities, schedule and work habits, some providers spent more time previewing patients’ notes before visits. Similarly, some providers manage the competing demands in the exam-room by documenting in their notes after the visits.”

 

Document template use

Providers also worked to streamline the documentation process through the use of EHR templates. By using pre-filled templates, providers only needed to focus on individualised patient information, and were able to take more time during the visit to focus on patient needs.

Some providers said the use of templates also worked well to remind them of data collected from past care encounters that they may have wanted to follow up.

 

Using the EHR as a patient engagement tool

Some providers reported that they seamlessly integrated the EHR into the care encounter as a patient engagement tool. Through screen sharing, providers were able to show patients their own personal health data, educating them on their well-being. Providers specifically used graphs and other visual elements to engage their patients.

 

Bolstering patient buy-in for technology

While there was no reported evidence that patients did or did not like EHRs in this study, providers reported that making patients aware of the benefits of the technology made them more understanding of providers’ split focus between them and the computer screen.

 

“Thus, some providers articulated EHR activities with the patients to gain their understanding and buy-in for EHR use during visits,” the researchers noted. “This transparency in communication helps alleviate demands from patients. Most providers feel that once they establish patient buy-in of anticipated EHR activities, both providers and patients are more at ease with EHR use.”

 

Providers practice general multitasking

Beyond specific efforts to integrate EHRs into clinical practice, a majority of providers also attempted to generally multitask. According to the researchers, providers began small talk while documenting in the EHR, or entering patient data while the patient was speaking.

Overall, this help providers meet both patient and EHR demands.

While there are undoubtedly notable benefits to physician EHR use, providers still need to focus on strategies to integrate their technology into clinical workflow. According to the research team, these tips will go a long way in boosting patient satisfaction, all while bolstering EHR use in the physician’s office.

“By identifying the challenges providers have encountered with the use of the EHR, and strategies they use to overcome these challenges, we were able to gain a better understanding of the providers’ behaviours in exam rooms, thus providing more concrete suggestions to balance the demands,” the researchers concluded. “We believe that, if used strategically, EHRs can have the potential to facilitate patient-provider interaction and patient engagement.”

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Electronic Health Records Security and Privacy Concerns

Electronic Health Records Security and Privacy Concerns | EHR and Health IT Consulting | Scoop.it

The healthcare industry is constantly evolving. This includes the tools healthcare professionals utilise in order to provide quality patient care. Older individuals may clearly recall when doctors would jot down notes on a form inside of a manila folder. That was the patient's medical file. Over the course of the past few years, patients have seen physicians use a computer to update medical files. Most familiar with the industry understand that this is due in large part to the belief that electronic health records (EHR) have many advantages.

Furthermore, the majority is aware of the American Recovery and Reinvestment Act (ARRA) that stipulates that all healthcare organisations must implement the use of electronic health records by 2015. If this mandate is not satisfied, penalties will ensue. Therefore, healthcare professionals have no choice but to march into the digital world.

This mandate also coincides with the Health Insurance Portability and Accountability Act (HIPAA), which obligates all healthcare organisations to protect the interests of its patients.

One of the most advantageous features involved with electronic health records is security. While there are skeptics lingering in the industry, reputable electronic health records specialists understand the importance of confidential medical files.

 

Security and Privacy Concerns

As with any online digital format, concerns of breach exist. Internet hackers possess a digital power that frightens individuals looking to conceal sensitive data. There have been cases in which medical information has been accessed by unauthorised users. While this does not occur all too frequently, the occurrences are enough to plant some cynicism in the minds of physicians and patients. These are valid concerns.

If confidential records end up in the hands of a person not privy to the information, the consequences can be overwhelming. Breach of medical records could lead to identity theft, which can destroy a person's finances, credit and reputation. Victims could seek litigation against the healthcare practice in which the breach occurred. If the breach affected multiple patients, the practice is headed down a long road of legal tribulations.

This is why reputable records management companies have worked hard to provide top-quality security within their software in order to try to eliminate the risk of breach.

Another security concern lies within the conversion from a paper-based filing system to electronic health records. There is a potential for misplacement of data throughout this process. However, professional electronic health record vendors formulate transition strategies in order to essentially eliminate data misplacement.

 

How to Ensure Security and Privacy

During the transition phase, the EHR vendor must work closely with the healthcare provider for a smooth and secure transition. The company should provide some type of comprehensive user guide for the users in the provider's practice.

There are six ways in which electronic health record entities can provide superior security and privacy solutions once the EHR is implemented.

1) Enhance administrative controls

  • Update policies and procedures
  • Guide employees through the stringent privacy and security training process
  • Run background checks on all employees

2) Monitor physical and system access

  • Create physically inaccessible systems to unauthorized individuals
  • Have exigencies in place for data recovery or restoration
  • Provide identification and verification requirements to all system users
  • Access the list of authorized users
  • Supply passwords and personal identification numbers (PINs)
  • Provide automatic software shutdown routines

3) Identify workstation usage

  • Set privacy filters at each workstation
  • Distinguish the different capabilities of different workstations

4) Audit and monitor system users

  • Identify any weakness in the system
  • Detect any security breach or attempt at a breach
  • Regularly audit all authorized users
  • Issue specified punishments to employees not following compliance guidelines

5) Employ device and media controls

  • Construct a security plan for data disposal
  • Remove data from reusable hardware
  • Track all reprocessed hardware
  • Back up all data from all hardware

6) Apply data encryption

  • Disguise all data inside medical files through cryptography

Reliable electronic health records companies apply these enhanced security and privacy protocols. Perhaps the most important security protocol is data encryption, which causes data to become unreadable to outside sources.

 

Electronic health records specialists also provide remote storage and data backup systems. While this may not necessarily present as strong of a defence against hackers and data breaches as data encryption, it provides security for healthcare organisations against the potential of software failures or natural disasters that could destroy or damage files.

 

Can Patients Gain Access to EHRs?

According to HIPAA, patients have certain rights regarding their electronic medical records. The mandate states that patients may:

  • Request a copy of or gain access to their medical records
  • Request a rectification of any typographical errors or incorrect information
  • Receive notification about the usage of the medical records as well as who has access
  • Select the communication method with the healthcare provider
  • Receive notification if an unauthorized user gains access to any medical information
  • File a complaint with the Office for Civil Rights if there are any suspected violations from a healthcare provider
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Implementing electronic health records in hospitals: a systematic literature review

Implementing electronic health records in hospitals: a systematic literature review | EHR and Health IT Consulting | Scoop.it

Background

The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementer.

 

Methods

A systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analysed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: written in English, full text available online, based on primary empirical data, focused on hospital-wide EHR implementation, and satisfying established quality criteria.

 

Results

Of the 364 initially identified articles, this study analyses the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: EHR context, EHR content, and EHR implementation process.

 

Conclusions

Although EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementer in developing effective EHR implementation strategies for hospitals.

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rob halkes's curator insight, October 18, 2016 7:31 AM

"Implementation" a continuous concern when in healthcare ;-)

Certainly when it comes to electroniuc health care records and/or personal records.. See the literature review here!

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Why EHR Training is Crucial for Success

Why EHR Training is Crucial for Success | EHR and Health IT Consulting | Scoop.it

Transitioning to a new EMR system is more than simply swapping hardware or adding computers to exam rooms; it changes the way you do healthcare. But despite the well-known importance of a thoughtfully designed implementation process, end-user training is often under-emphasised. From small, single-provider practices to large organisations; end-user training for EMR systems is essential to support efficiency, best practices, and even patient safety.

 

EHR Training Starts with Dedication

There are countless ways an EHR training program affects overall implementation. But one key advantage of carefully planned training is the opportunity to foster buy-in and commitment from administrators, providers, and staff. Providing examples and evidence of similar practice’s success stories, or improved patient outcomes following computerised provider order entry (CPOE) implementations, can be great ways to encourage dedication to the implementation of a new electronic health records system. Using training as an opportunity to revisit “big picture” goals throughout the process can help maintain enthusiasm and minimise frustration as individuals are charged with learning a great deal of information in what can sometimes feel like a very short period of time.

 

EHR Training Will Help You be Successful

Insufficient end-user training, along with poorly focused and ineffective EMR implementation, can (and does) lead to adverse consequences in medical practices. These consequences can range from loss of efficiency to medical errors, affecting both a practice itself and its patients. Loss of productivity and job satisfaction can result from inadequate training, but it can also affect a practice’s bottom line as well. Following the purchase of an EHR system, providers rightfully expect a significant ROI through benefits such as fewer billing and coding errors, more efficiency, and more productivity. These benefits are at risk in the event of ineffective training, serving as the culprit for the grievance that an EHR system is somehow not working the way it should.

 

The Benefits of Quality Training

Even the best EMR system in the world won’t function properly in the absence of well-trained users. As electronic medical records systems proliferate in the healthcare industry, the benefits of developing confident providers through an effective training period are becoming more and more evident. In fact, the importance of end-user training for EHRs has led to the rise of increased related coursework in medical schools and other healthcare provider training programs. Benefits of effective EHR training programs include increased charting and coding accuracy, along with improved productivity and efficiency that benefits both providers and their patients. The practice also benefits from a solid return on its initial investment for years to come.

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3 Things You Need To Know Before Beginning Your EHR Training Program

3 Things You Need To Know Before Beginning Your EHR Training Program | EHR and Health IT Consulting | Scoop.it

With all of the organisational change that occurs during an implementation, it’s easy to unintentionally overlook some key aspects of setting up an EHR Training Program. Classroom training and back filling will lead to added, and sometimes unexpected, costs. Additionally, remember that your staff must be trained before they can sign on to the new system. Among other things, failure to keep these factors in mind can result in lost time and may affect your budget. In this post, The HCI Group’s EVP Bob Steele offers three key points to remember during the on-going process of an EHR Training Project.

 

1) Acknowledge that EHR Training is Amongst the Highest Cost Phases of Your Project

First and foremost, you must accept that training will be one of the highest cost phases of the implementation. The pre go-live training phase will be your end users’ first impression of the system and must introduce a high volume of information in a short period of time. It will affect all aspects of their daily work lives and responsibilities; it can be quite a stressful change if training is not managed well.

You will have costs associated with the appointment of SME’s, analysts, and staff experts for the development and scheduling of the training curriculum and processes. You will incur costs for training the trainers (staff), as well as back filling for their regular duties while they perform training duties. This can become quite expensive as you begin to consider the number of back filled staff required. The final consideration is the costs associated with the actual training of facility staff, sometimes requiring education of over one thousand staff members and providers.

EHR training may include pre-classroom self-studies, classroom training, and, in some cases, simulation labs – all of which can take anywhere from 4-6 hours to 2-3 days, depending on position and job responsibilities. Again – depending on Service Line Area – these positions may need to be back filled, which will add cost.

One way to avoid the cost of back filling is by utilising third-party vendors. While third-party vendors may seem to be the more expensive option, the cost of training and relieving facility trainers, as well as having to back fill to cover their regular duties, may turn out to be more costly.

 

2) Scheduling and Flexibility Within Your EHR Training

Day-to-day Patient Care (Safe Patient Care) and business operations must go on. Match the total number of end users to be trained with your available classrooms and computers to determine the number and amount of classes to be offered. Hands-on computer classroom training is imperative. Remember, back-fill or relief from regular responsibilities is not an option for some (especially the provider group). Consider weekend, evening, and even night shift classroom training to accommodate end user needs.

A good practice is to incorporate a variety of learning methods and methodologies to address all types of learners. This includes self-studies, web-based training, simulation labs, mock go-lives, and of course, traditional classroom and hands-on training. Try to avoid disruption of daily responsibilities as much as possible and increase overall compliance numbers of those who are successfully trained by go-live. One of the best ways to ensure your staff is adequately trained is to enforce “no training, no sign-on.” Before users can access the new system, they absolutely must have completed their training program.

 

3) EHR Training is a Never Ending Process

Understand that training is a never-ending process. After go-live, training and training costs will transition from a project cost to an ongoing operational cost. There will be continuous training of new staff hires and providers, as well as frequent system and application upgrades. Medicine and Industry standards and changes in areas such as clinical best practices, quality measures, and meaningful use will also be prevalent. Training is an ongoing journey, so it is important to have a well-oiled and independent facility team to carry on the process.

Training is a pivotal part of any new EHR implementation. Keeping these three key aspects in mind will help your organisation prepare for this important phase and the challenges it can bring. These principles make up a small piece of the EHR training process.

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Cost Benefits of EHR

Cost Benefits of EHR | EHR and Health IT Consulting | Scoop.it

About $19.2 billion of the $787 billion American Recovery and Reinvestment Act (ARRA) that President Obama signed in 2009 is directed as an electronic medical records stimulus. The administration is working to complete the movement to EMR integration because it believes there are many benefits of electronic medical records use, including streamlining patient care and providing long-term savings in the health field. The electronic medical records stimulus also provides financial incentives to help physicians convert to the paperless electronic medical record systems, but reports have found that even without the incentives, there are real benefits of electronic medical records and electronic health records integration.

 

Benefits of Electronic Medical Records to Medical Practice Operations
By storing health information electronically through electronic medical record systems, health care providers are able to finish their patient charting quicker, allowing for the scheduling of more patients. This heightened efficiency of this type of medical records storage fosters a more effective medical practice. Having instant access to electronic health records allows providers to chart during their patient encounters as opposed to several hours later. In theory, this enhances accuracy of the patient’s health record.

Proponents of EMR/EHRs also argue that digital medical record storage helps prevent filing errors. Most paper patient records are not backed up in a secondary location. Medical records storage through digital means eliminates any threats of losing the patient health information in an emergency. Many electronic medical record systems are backed up every day automatically and are accessible almost anywhere in the world.

 

Cost Benefits of EMR / EHR
Besides improving care for patients, another advantage of EMR integration is that it can reduce costs for physicians. Unnecessary staff expenses and storage costs are eliminated with electronic medical records storage because they take up less space and are more easily accessible than paper versions. Additionally, the cost of medical record chart materials are replaced by inexpensive maintenance costs, which helps pay for the investment over time.

A 2003 study by the University of California that focused on solo and small group physicians found that though results greatly varied, some physicians saved up to $20,000 per year through electronic medical record systems adoption.

“More successful users decreased transcriptionist, medical records, data entry, billing, and receptionist costs,” states the report.

 

About 42 percent of active family doctors have already installed at least preliminary electronic medical record systems, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. Though not all physicians have seen the benefits of electronic medical records implementation promoted by the government, many firms have begun to leverage the advantages of EMR, bringing their patients higher quality care for less cost.

 

“I’ll never go back to the old system,” Dr. Jennifer Brull, a family doctor in rural Kansas, told the New York Times. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”

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Physician Mobile Users More Satisfied With EHR System

Physician Mobile Users More Satisfied With EHR System | EHR and Health IT Consulting | Scoop.it

Even though only 26% of physicians access their EHR from a tablet or mobile device, those users are more satisfied with their EHR system, according to the new EHR. User View Survey from Software Advice. The survey polled nearly 600 physician users about their current EHR systems’ key benefits and challenges and their future healthcare IT investment plans.

Fifty-eight percent of users who accessed their EHR from a mobile device were “very satisfied” with their EHR, compared to 28% of non-mobile users.

 

Mobile users may be more satisfied with their systems because they were less affected by common EHR challenges in learning to use the system. Thirty-nine percent of mobile users expressed that learning how to use their EHR system was challenging, compared to 58% of non-mobile users. The report said that this discrepancy may be because mobile users take their mobile devices home and learn to use the EHR system outside of normal working hours.

 

Plus, physicians embrace using smartphones, as 47% of physicians already use mobile devices for clinical purposes, and most physicians (89%) use smartphones to communicate with hospital staff. A 2013 Black Book Rankings survey found that 83% of doctors would use mobile EHR apps to update charts, check labs and order medications if their current EHR vendor made those features available for mobile.

 

When asked what EHR modules and applications physicians planned to invest in more heavily in the future, EHR User View Survey respondents said they were most interested in increasing their investment in patient portals (36%), followed by e-prescribing, health information exchange and lab integration.

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Using Electronic Health Records to Help Coordinate Care

Using Electronic Health Records to Help Coordinate Care | EHR and Health IT Consulting | Scoop.it

Abstract

The use of electronic health records that can securely transmit patient data among physicians will help coordinate the care of 60 million Americans with multiple chronic conditions. This article summarises the different organisations in the United States that are developing this technology. It discusses some of the problems encountered and the current initiatives to resolve them. The article concludes with three recommendations for enhancing care coordination: (1) a common health record, such as the Continuity of Care Record, to facilitate the exchange of clinical information among health providers; (2) regional governance structures to encourage the exchange of clinical data; and (3) payment by purchasers of care, both public and private, to physicians for using electronic health records.

Appropriate medical care for people with multiple chronic conditions requires that clinicians be able to communicate with one another about their patients. Unfortunately, in today's medical care system, many clinicians are unable to communicate easily and efficiently with their colleagues. In a series of reports, the Institute of Medicine (IOM) named ineffective care coordination as a cause of poor care and initiated a series of reports recommending electronic health records as one way of improving its quality (Institute of Medicine 2003b; Institute of Medicine, Board on Science Technology 2001). The greatest burden stemming from this lack of easy and effective care coordination is for the 60 million Americans with multiple chronic conditions (Anderson and Knickman 2002).

 

Problems with the Current Paper-Based System

Participants at a joint IOM–Kaiser Permanente Institute for Health Policy conference in 1992 agreed that the paper-based information systems still used by most clinicians are not well suited to good-quality care, especially for persons with multiple chronic conditions (Raymond and Dold 2002). The conference concluded that paper-based systems supporting clinical care are limited as information storage and retrieval systems and have high rates of failure in retrieval and illegibility; that human memory–based medicine is increasingly unreliable; that the capture of clinical data has become necessary for billing, appointment scheduling, prescription refills, and results reporting; and that consumers’ expectations for improved care and service are rising. Their proposed solution was the creation of electronic clinical information systems.

Increasingly, the medical care field is recognizing that it is far behind most other industries in using electronic data (Shortell et al. 1996). At one end of the continuum is the highly visible and advanced use of technology such as the remote sensing of bodily functions and the revolution in radiology and surgery based on the ability to digitize and communicate information (McDonald et al. 1999). At the other end of the continuum are the communication methods used by the majority of U.S. clinicians, who rely on paper medical records and coordinate care by “playing phone tag” with other clinicians and social service providers caring for the patient.

Some provider groups recognised the benefits of better communication years ago and developed a prototype EHR. The Computer-Stored Ambulatory Record (COSTAR), one of the first EHRs, was created in the early 1970s at Massachusetts General Hospital (Smithline and Christenson 2002). Some settings, primarily highly integrated networks, have realised the benefits of EHRs. Unfortunately, the level of EHR use among ambulatory care physicians still is low, with estimates in 2002 ranging from 10 to 14 percent of family physicians and 22 percent of all physicians operating as solo practitioners or in small groups (Loomis et al. 2002).

 

Barriers to the Widespread Adoption of Electronic Health Records

Five of the most important barriers to the widespread adoption of EHRs that would allow clinicians to share information about patients easily and effectively are (1) no common format or standard for recording clinical information, (2) the high costs of implementation and maintenance, (3) no demonstrated clinical and/or financial benefits for ambulatory care physicians participating in shared information systems, (4) patients’ concerns about information sharing and possible loss of privacy, and (5) physicians’ concerns about legal liability.

 

Standardisation of Clinical Information

The need for a common standard to record and transmit clinical information is widely recognised, with solutions currently being developed by both public and private entities. The Institute of Medicine has addressed the importance of standardisation in several reports and cited the standardisation and use of EHRs as a priority (Institute of Medicine, Board on Science Technology 2001; Institute of Medicine 2003b). The National Health Information Infrastructure, a federal office within the U.S. Department of Health and Human Services, has been established to provide advice and assistance to the department and serves as a forum for interacting with the private sector. Federal health information interoperability standards have been proposed by the federal government's Consolidated Health Informatics Initiative and the National Committee on Vital and Health Statistics and were adopted by the secretary of Health and Human Services for messaging, electronic exchange of clinical laboratory results, standards for retail pharmacy transactions, standards allowing health care providers to plug medical devices into information and computer systems, and standards enabling the retrieval and transfer of images and associate diagnostic information (National Committee on Vital and Health Statistics 2003). The secretary announced the use of these common standards by the Centers for Medicare & Medicaid Services (CMS), the Veterans Administration, and the U.S. Department of Defense as well as an agreement to make Systematized Nomenclature of Medicine–Clinical Terms (SNOMED) a universal health care terminology, available to U.S. users at no cost through the National Library of Medicine (U.S. Secretary of Health and Human Services 2003). Private foundations have helped develop these standards by involving vendors and leaders in the academic fields of clinical data sharing (ehealth Initiative 2002). While these steps are significant, the widespread adoption of these standards will require the willingness of the current owners of EHR systems to find the money to make conversions where necessary and to design EHRs that will attract buyers.

 

Cost of Implementation and Maintenance

Transferring to an electronic data system where none exists is a major undertaking, requiring a change in work flow, finding a reliable EHR vendor, investing capital in hardware and software, converting records, and training staff. The financial and time costs vary, depending on the extent of the clinical and administrative functions to be managed by the system. Costs also are based on whether the system is purchased outright, leased, or rented. The time that the physician spends entering data at each patient encounter also must be considered. This may be only two or three minutes per patient but may be a major obstacle to the widespread implementation of the system, given most clinicians’ tight time schedules.

 

Physicians’ Readiness to Adopt the EHR

Physicians need to be convinced that the EHR will enable them to provide better medical care to their patients. Studies of various aspects of electronic clinical data systems have shown that the adoption of an EHR is associated with better health outcomes or processes leading to better outcomes in controlling infection (Fitzmaurice, Adams, and Eisenberg 2002), improving physicians’ prescribing practices (Teich et al. 2000), reducing prescription errors through direct physician order entry and decision support (Kaushal, Shojania, and Bates 2003), preventing serious medication errors in hospitals (Bates et al. 1998; Gandhi et al. 2003), and detecting adverse events in hospital and ambulatory settings after they occur (Bates et al. 2003). Bates and Gawande (2003) have described how information technology leads to many of these safety improvements, such as providing access to information, requiring information and assistance with calculations for dosage of medicines, monitoring, offering decision support, and rapidly responding to and tracking adverse events.

 

Privacy Issues and Patients’ Concerns with Information Sharing

The 1996 Health Insurance Portability and Accountability Act (HIPAA) affects many aspects of health care information technology and data sharing. The dual intent of HIPAA is to improve administrative efficiency in the health care sector as well as to increase patient privacy protections. The common impression is that HIPAA discourages the sharing of clinical information. However, the administrative simplification rules required by HIPAA may encourage the creation of information systems that can communicate with other systems.

A greater barrier may be the patients’ unwillingness for their clinical data to be shared. One perspective is reflected by the growing numbers of persons with chronic conditions who are being educated to manage by themselves their daily medications or treatment regimens. For such patients, full electronic access to all their medical records offers an opportunity to join their physicians in managing their disease. Several health systems, including the Veterans Administration, are promoting patients’ access to electronic records (Geisinger Health System 2004; Kilbridge 2002). In contrast, Fowles and colleagues (2004) found that only a third of patients were very interested in reading their medical records. Little is known about patients’ attitudes toward sharing their clinical data with different providers. Some patients may want to withhold certain information from doctors, such as a history of mental illness or sexually transmitted diseases.

Over time, patients may come to believe that poorly coordinated care is a significant detriment to a good quality of care and can be rectified in part by better communication among physicians. If this happens, it would motivate health plans and physicians to adopt an EHR. The Foundation for Accountability, a nonprofit national organisation, is actively advocating accountable and accessible health systems “where consumers are partners in their care and help shape the delivery of care” (FACCT 2004).

 

Legal Liability

The legal liability of physicians relying on data from other providers has not been established. For example, case law offers little guidance on the liability of a physician for acting on clinical information made available but not requested. Similarly, there is uncertainty about whether an e-mail message from a patient constitutes part of a medical record for which the physician may be liable (Blumenthal 2002). To assuage these concerns, physicians may need to be educated by legal experts about medical risk management (Grams and Moyer 1997) or actual legal protection. Guidelines and the active involvement of the medical liability industry in designing electronic data systems may be necessary as well.

 

Current Clinical Data-Sharing Activities

Despite these obstacles, both the public and private sectors are moving forward in adopting systems that share information among multiple clinicians. Next we describe these electronic data exchange activities in seven sectors: patients; ambulatory care physicians; institutional providers; payers, including managed care and commercial insurers; disease management companies; the federal government; and regional initiatives.

 

Patients

Purchasers, providers of care, and government regulatory agencies are increasingly acknowledging the concerns of people with chronic conditions. The Institute of Medicine, bringing together health care professionals and policymakers to improve the quality of care for persons with chronic conditions, has repeatedly advocated computer-based personal health records. The Foundation for Accountability recommends electronic data sharing that allows the consumer full control over and access to his or her health information. The Patient Safety Institute, a national nonprofit organisation, is promoting a common record controlled by both the patient and the health provider (Patient Safety Institute 2001).

 

Ambulatory Clinical Physicians

There is little empirical evidence of the extent of the adoption of EHRs or the direct value to physicians of shared patient clinical data. One study surveyed medical groups and independent practice associations with 20 or more physicians to determine the extent to which groups use organised processes to improve the quality of care and whether external incentives and clinical data systems were associated with the use of a larger number of care management processes (Casalino et al. 2003). The survey results showed that the percentage of physician groups’ use of clinical systems varied by the functionality: standardised problem lists (18%), progress notes (9%), medications prescribed (24%), medication-ordering reminders and/or drug interaction information (15%), laboratory results (40%), and radiology results (30%). Fifty percent of groups reported no clinical information technology capability. The authors concluded that the government and private purchasers of health care could increase use of care management processes by offering external incentives to improve health care and by helping physician groups improve their clinical electronic information capability.

Professional associations are becoming involved. Most speciality societies have addressed the barriers and benefits to members of electronic clinical data sharing. The American Academy of Family Physicians, for example, has taken the lead in an initiative to promote inter-operable EHRs (American Academy of Family Physicians 2004). Designed mainly for solo or small-group practices, the model recommends vendors who have agreed to make an EHR capable of transmitting Continuity of Care Records via a secure Internet connection.

 

Institutional Providers

Health systems, academic medical centres, community hospitals, and home health agencies are building information systems that link multiple providers. A number of well-known health systems and academic medical centres, such as the LDS Hospital in Salt Lake City and Brigham and Women's Hospital in Boston, have developed their own integrated electronic clinical record systems (Doolan, Bates, and James 2003). A number of hospitals in Indianapolis use the Regenstrief Medical Record System (McDonald et al. 1999).Geisinger Health System (2004) in central Pennsylvania has created a fully integrated medical record with electronic communication with the primary care physician that also is accessible to the patient and the family caregiver. Partners Health Care has created a clinical data repository that allows data to be shared across several hospitals in Boston as well as community health centres and community-based physicians (Partners Health System 2004).

Community hospitals are taking advantage of generalised software systems that provide direct clinician order entry, results reporting, and an EHR, as well as administrative functions. One vendor reports that it has implemented its basic system in over a quarter of the country's 6,000 hospitals (Meditech 2004). This basic system allows for the creation of an EHR within a hospital. In addition, several hospitals are migrating into ambulatory settings by integrating the medical record in the physician's office into the hospital's medical record. Future plans would include in the record any information collected in the patient's home and other community settings, thus enabling the coordination of care across settings.

 

Health Plans and Insurers

Insurers, managed care organisations, self-insured corporations, and self-insured unions are major purchasers of care and are committed to providing high-quality and less expensive health care. A leading example of data sharing from the managed care sector is the Clinical Information System (CIS) that Kaiser Permanente is implementing throughout its organisation (Kaiser Permanente 2003). Kaiser's EHR includes demographic and benefit data, pharmacy data, and transcribed reports such as radiology, discharge summaries, history and physical examinations, operative reports, consultations, surgical pathology, cytology, and outpatient laboratory results. The clinician can use the system to confer with other providers, thereby better coordinating the patient's care. Eventually, patients will be able to interact online with their medical team. An evaluation of the pilot phase of the outpatient system found that the clinicians’ acceptance was high, with 95 percent of visits entered and 70 percent of prescribing and laboratory and radiology test ordering on the system (Chin and McClure 1995).

 

Disease Management Companies

Disease management companies use electronic tracking systems to improve care by monitoring the condition of patients assigned to them by insurers. Typically, insurers employ disease management companies to manage their patients with chronic diseases in an attempt to keep the disease under control so as to prevent the recurrence of symptoms and the use of expensive health services. Nurses contact the assigned patients to monitor their symptoms and periodically consult with the patients’ physicians regarding the appropriate care plan. If the disease management companies’ EHRs were able to link with the physicians’ EHRs, the nurse managers, primary care physicians, and specialists could better coordinate their care.

 

Federal Health Programs and Agencies

Medicare spends more than two-thirds of its funds providing fee-for-service medicine to people with five or more chronic conditions who see an average of nine ambulatory clinicians during one year (Partnership for Solutions: Better Lives for People with Chronic Conditions 2002b). Pay-for-performance models are being tested in which the payer offers an incentive to the care provider to improve quality by reimbursing a set amount for each complex patient when the physician provides evidence that certain standards of care have been met (Centres for Medicare & Medicaid Services 2003). This model is similar to a pay-for-performance model implemented with the sponsorship of Bridges to Excellence, a nonprofit organisation of employers, providers, and health plans (Bridges to Excellence Working Group 2004). Several innovations in reimbursement from CMS are in the demonstration phase, and the Medicare Prescription Drug, Improvement, and Modernisation Act of 2003 provides for more demonstrations of reimbursement systems and EHRs to enhance coordination of care (U.S. Congress 2003). The Agency for Health Care Research and Quality (AHRQ), which has been the lead federal agency in supporting research on information technology (Fitzmaurice, Adams, and Eisenberg 2002), will be awarding $50 million in grants to “support organisational and community-wide implementation and diffusion of health information technology [HIT] … and to assess the extent to which HIT contributes to measurable and sustainable improvement in patient safety, cost, and overall quality of care” (Agency for Healthcare Quality and Research 2003).

 

Regional Initiatives

Communication systems can be integrated into the closed systems just described, in which there is a centralised authority. In open settings, which are typical of most health care in the United States, the challenge is greater. Possibly the most comprehensive approaches to inter-operable EHRs are the regional initiatives that attempt to enrol all providers within a given geographic region. If successful, they will be able to offer an integrated clinical record with the exchange of clinical data among providers caring for a defined population. The Regenstrief Medical Record, for example, evolved from a single hospital-based clinical information system to a system that currently uses the Internet to connect all five Indianapolis hospital systems and a total of 11 geographically separated hospitals.

An example of a regional solution explicitly designed for clinical data exchange is currently being used in Santa Barbara, California. This project, developed over four years with $10 million in financial support from the California Health Care Foundation and the Robert Wood Johnson Foundation, was designed to improve the quality, clinical efficiency, and safety of health care by making inter- and intra-organisational, patient-specific information more readily available at the point of care (California Health Care Foundation 2004). In 2004 the data exchange was composed of 12 health care organisations, with a central policy-making council, technical and clinical advisory committee, and data alliances. Data alliances are multiple provider organisations that agree on and coordinate data-sharing goals and technical standards and business rules to facilitate implementation. The number of participating physicians in the data exchange will be critical to determining the value of this model.

 

Remaining Stakeholder Concerns and Possible Solutions

Before EHRs that can connect with other health providers will be widely adopted, a number of policy issues must be resolved. In this section of our article, we summarise the concerns and possible solutions from the perspective of patients, physicians, institutional providers, and payers and examine those issues that must be resolved in order for these systems to be implemented broadly.

Patients with multiple chronic conditions must recognise that their care will be better coordinated if information is shared with all their providers. The consumers’ interest in quality of care—specifically, the reduction of adverse drug events, unnecessary hospitalisations, and unnecessary tests—may become the primary motivation to improve electronic communication among clinicians. The public's concerns may persuade the purchasers of care to make these changes. The challenge will be mobilising the 60 million Americans with multiple chronic conditions to demand the coordination of their care.

 

Conclusion

Health providers, policymakers, and payers who have a high stake in improving the medical care system in the United States recognise that EHRs offer the possibility of improving the quality of care through better coordination while controlling health care costs. With new emphasis and priority from the federal government, the public will be made aware of these benefits. Large closed health systems have successfully implemented inter-operable electronic health records and are learning what is effective as well as where different approaches are needed. Nonetheless, there are significant barriers to adopting an EHR, particularly by those physicians who have the major role in terms of time and cost invested in implementation. To replicate this success in the larger open health care arena of the United States, we have three suggestions: agreement on a common health record, a geographic governance structure that can offer a common solution for a geographic region, and reimbursement for the costs by payers for health care. These suggestions, aimed at encouraging the use of electronic health records, will improve the quality of care for all patients and greatly improve the coordination of care for the 60 million Americans with multiple chronic diseases who see many different physicians.

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Austin Dodd's curator insight, September 14, 2016 2:11 PM
This article is talking about a rising advancement in the record keeping of doctors everywhere. It tells about how having a universal electronic medical data keeping system will help doctors be able to treat people. I think this should happen because all of someones past medical history should be looked at for bettering their treatment.
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5 reasons a physician should consider EHR 

5 reasons a physician should consider EHR  | EHR and Health IT Consulting | Scoop.it

The time has come for medical practices that have not yet converted their paper files to Electronic Health Records (EHR) to do so. Those practitioners who are unable to demonstrate meaningful use, as it is defined by the Health Information Technology for Economic and Clinical Health (HITECH) Act, will experience reductions in their reimbursement claims to Medicare and Medicaid.

 

Benefits of using EHR’s

According to the health information technology website provided by the federal government, there are a number advantages to practitioners who use EHRs. Some of those include:

 

1. Quality of patient care is improved: The patent’s information is found in one place and accessible to all care providers relevant to the particular patient. Electronic referrals make it faster for necessary follow-up care to be performed and the doctor to whom the patient has been referred has immediate access to the patient’s information. Medical errors are reduced and prescribing of medications is more reliable.

 

2. Patients have more participation in their own care: Patients are able to access their own medical records and get test results as soon as the results are completed and entered into the EHR. Patient portals allow patients to interact online with their health care provider. This may result in earlier diagnosis and treatment.

 

3. Provides for more accurate diagnoses and treatment: When a physician has access to the most complete and up-to-date health care information, as is available with EHRs, it results in more accurate diagnosing. The records will include alerts to a patient’s allergies and any adverse interactions with prescription medications.

 

4. Improves the coordination of patient care among providers: As technology has advanced, and medical treatments improved, patient care often involves teamwork among several practitioners, such as primary care doctors, specialists, physical therapists, nurses, ancillary health care providers and pharmacists.

Using EHRs allows each provider to have immediate access to care provided by other practitioners and reduces fragmentation of piece-meal information. It also reduces medication errors and repetition of tests.

 

5. Increases the efficiency of the medical practice and cuts costs: Major cost savings are found in decreasing the amount of paperwork. There is a reduction in duplication of testing. Using EHRs to send prescriptions saves time. Money is saved by not needing medical transcription services. Paper files to do not have to be managed by retrieving them and re-filing them. EHRs provide for more accurate billing and coding to reduce problems with reimbursement claims.

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What Is a Patient Care Portal and How Does It Help Medical Practices?

What Is a Patient Care Portal and How Does It Help Medical Practices? | EHR and Health IT Consulting | Scoop.it

Following the introduction of electronic medical records, patient care portals were developed to improve how patients and healthcare providers interact and to give patients access to their own health information so that they can take active roles in maintaining healthy lives.

These so-dubbed “portals” are simply Web-based tools, and it is possible to have one that exists as a stand-alone site, an integrated service with your medical practice or a part of your EMR system. No matter the type of platform that you choose, your patient portal can provide your patients with secure online access to medical details and increase their engagement with you while affording you several benefits as well.

 

Rapid Growth

More and more health care providers have introduced their own patient portals since the medical industry shifted focus to patient-centred care, and an increasing number of patients are signing up and actively using the service. Of the 74,368 disadvantaged adult patients monitored during a two-year study conducted between April 2008 and April 2010, 16 percent obtained an access code to their medical providers’ portals, Among those patients, 60 percent activated their accounts, and 49 percent used their accounts two or more times. Later studies show that activation and use has increased.

 

Increased Office Efficiency

Implementing a patient care portal for your medical practice can increase efficiency in your office through direct messaging between you and your patients. As of June 2014, about 35 percent of family practices were using portals to educate patients, and 41 percent were using it for other messaging purposes. This can save time for receptionists and nurses, especially since the messages appear in real time.

 

Streamlined Workflow

Having a patient portal can also streamline workflows in your office. Rather than your receptionists and nurses dealing with simple, non-urgent questions over the phone, your office staff can move these communications online to reserve the phone lines and their time for answering and dealing with more urgent health care needs.

 

Promotion of Telemedicine

Patient portals can reduce the number of unnecessary patient visits to your office, allowing you to fit in more patients who really need to see you. This can help facilitate telemedicine, which allows patients to consult with you through the messaging system. For example, instead of a patient scheduling an appointment to see you for a change in medication doses, the patient could ask you about it over the patient portal. Using this feature allows you to keep that appointment open for a patient who has an illness and requires a diagnosis and prescription or immediate medical care. More than 25 percent of family practices were using patient portals for prescription-related purposes as of June 2014.

 

Fewer Medical Errors

When receptionists or other staff in a medical office take phone calls, they have to relay to you the information that the patients give them. This sometimes leads to misinterpretations of patient needs and medical issues. Being able to receive written messages from patients allows you and your staff to correctly interpret what your patients need so that you are well informed and can make the appropriate decisions.

 

Other Benefits

In addition to the four benefits above, having a patient portal and patients who actively use it allows you to send them reminders for appointments or to schedule an appointment for a yearly checkup. This reduces the chances of your patients forgetting.

It can also be used to provide your patients with billing information, consent forms, educational materials, and test results to keep them informed. Sending them educational materials and test results can save time from having to explain every detail during the office visit. This will allow you to see more patients every day. If your patients have questions, they can ask for more details via the patient portal or wait until their next visit.

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How Can You Use Your EHR to Prevent Heart Attacks and Strokes?

How Can You Use Your EHR to Prevent Heart Attacks and Strokes? | EHR and Health IT Consulting | Scoop.it

The Electronic Health Records (EHR) Innovations for Improving Hypertension Challenge, launched by the Office of the National Coordinator for Health Information Technology (ONC), is part of Million Hearts, a national initiative to prevent one million heart attacks and strokes by the year 2017. Co-led by the Centres for Disease Control and Prevention (CDC) and the Centres for Medicare & Medicaid Services (CMS), Million Hearts brings together communities, health systems, nonprofit organisations, federal agencies including ONC, and private-sector partners from across the country to fight heart disease and stroke. This HIMSS Ask the Expert article is being published in May which is National Stroke Awareness Month and High Blood Pressure Education Month. In case you have not yet seen it, we strongly recommend that you read the Cardiovascular Care High Performers report, that was issued in support of Million Hearts, which highlights health plans and physician practices nationwide that have achieved excellent results in cardiovascular care, including high rates of hypertension control, cholesterol management and smoking cessation. 

The goal of the EHR Innovations for Improving Hypertension Challenge is to gather specific descriptions of Health Information Technology (HIT) tools and approaches used by individual practices to implement an evidence-based blood pressure (BP) treatment protocol that has led to improvement in practice-wide blood pressure control (Phase 1), and identify models for quickly and widely spreading these to other practices (Phase 2). A comprehensive clinical decision support (CDS) approach supports these five protocol elements:

  1. Blood pressure measurement/recording
  2. Blood pressure follow-up
  3. Initiation and titration of medications
  4. Patient engagement
  5. Workup/referral for poor control

 

On Friday, January 23, 2015, there was an outstanding webinar on the EHR Innovations for Improving Hypertension Challenge. The agenda was as follows:

  1. Million Hearts Blood Pressure Protocols – Hilary Wall, MPH
  2. Phase 1 winner: Green Spring Internal Medicine – Holly Dahlman, MD, FACP
  3. Phase 1 winner: Vibrant Health Family Clinics – Christopher Tashjian, MD, Mary Boles, LPN, Rosanne Matzek, Care Coordinator
  4. Challenge Phase 2 – Adam Wong, MPP

 

The webinar recording and slides are posted on the EHR Innovations for Improving Hypertension Challenge web page. We strongly recommend that providers, EHR support personnel, and healthcare organisation leaders listen to this webinar. The two winners of Phase 1 of the challenge, Green Spring Internal Medicine and Vibrant Health Family Clinics, discuss what they did to dramatically improve hypertension control in an effort to prevent heart attacks and strokes. In these presentations, there are several best practice ideas that you might find helpful for treating your patients. The tools of both Phase 1 winning practices can be downloaded from the EHR Innovations for Improving Hypertension Challenge web page. 

Using Health Information Technology tools to improve hypertension control will help us to reach the Million Hearts national goal of preventing one million heart attacks and strokes by the year 2017. It is far better to prevent heart attacks and strokes than to be faced with having to treat them. Much success in using Health IT to be an invaluable enabler in your prevention efforts!

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How Can Electronic Health Records Be More Patient-Centered?

How Can Electronic Health Records Be More Patient-Centered? | EHR and Health IT Consulting | Scoop.it

We live in a world where an app notifies me if my flight changes times or gates. I can take a photo of a check and deposit it. With two clicks on my watch I can pay for groceries, apparel, and more. Yet, as health care providers, we use electronic health record (EHR) platforms that look, feel, and navigate like something from Windows 95.

For an industry that routinely boasts about technological advancements, it’s embarrassing that we are using EHR tools from a decade ago.

When it comes to how health care organisations are working (or coping or struggling) with EHRs, it’s an understatement to say that we live in interesting times. What we once hoped would be a trans-formative tool for health care improvement is too often a source of confusion, frustration, and — worst of all — potential harm to patients.

 

The Biggest EHR Challenges

  • The primary focus of today’s EHR design is the long list of regulatory reporting and billing requirements. One example is ensuring we get “full credit” for the “patient education” Meaningful Use requirements. Each time a provider generates a note in the record, they have to check a box indicating that “the patient understands their diagnosis and treatment.” Instead of focusing on the care outcome, documentation has been the measurable event. I challenge the assumption that checking this box results in greater patient understanding.
  • Clinical decision support has been a big focus as Meaningful Use evolves. Pop-up alerts in the EHR when clinicians miss critical steps for high-risk events are valuable, for things like ensuring ventilator bundles are in place. Alerts do not make sense, however, when there are too many of them — for example, reminders about the dozens of ways to assist someone with the control of their weight, blood pressure, or diabetes. Reminders like these add work and distract from conversation with patients as providers bury their faces in computer screens to make sure they record all of the measurable requirements during the 15-minute office encounter. Better documentation does not necessarily lead to better health care.
  • The requirement to exchange patient information between vendors is a nightmare. Various EHRs assign different codes to medications, care events, education events, labs, etc. Interfacing between these data sources to standardise all of it is extremely difficult. Resolving these conflicts will be a huge but necessary undertaking. This is a problem which exists mainly because the design focused on vendors and organisations, and not on the people served

 

Opportunities to Use the EHR to Improve Quality and Safety

By using customer behaviour data, the retail industry can predict if you are going to get married, divorced, have a child, go to college, or buy a home. They do this by identifying patterns. Yet, despite all the data at our disposal, we in health care cannot seem to recognise a negative health care trajectory (let alone what to do about one). Why? Because the technology we have focuses on disease, payer models, and standardised clinical protocols.

Health care has the opportunity to do something very different as we move into the future, but only if we change this mindset. We don’t need to do more work; we need to better analyse the work we already do.

For example, at South central Foundation in Alaska, we analyse data from a patient-centric perspective. As the customers we serve move between different care settings (e.g., the ER, office practices, pharmacies, labs, mental health counselings, the hospital, etc.), our master index has unique identifiers for each of them that can help us identify patterns. We can link these patterns to measurable outcomes in cost, satisfaction, and visit types. Using this data, we can then attempt to create new models of risk prediction based on measurable events, like the amount of medication prescribed and dispensed, or admissions and readmission to the hospital.

Imagine looking at the data on the collective behaviour of the clinicians in your entire organisation and directly comparing this to clinical costs and outcomes of the people you serve. Health care is not about the organisations and people that provide care — it’s about the patients — and thus we need to start working more as one health care team, instead of dividing ourselves into specialists, acute care, primary care, etc.

 

The Risk of Retrofitting

As we create new EHR systems, the struggle will be to avoid the temptation to “copy and paste” the old world into the new one. Simply moving the same practices developed for paper-based records into an electronic records platform would be a failure of such magnitude that it would take years to undo.

Think of it like spending $300,000 on the latest technology for a home theater system and connecting it to a VHS player. This is not what we want or need.

Until the health care industry can be truly patient-centric — that is, focused on the people we serve and not on making money — we are not going to change.

While there is risk in all new organisational behaviour, there is also risk in avoiding change. In the rapidly evolving health care environment, staying the same creates more risk than it avoids.

South-central Foundation’s approach to redesigning our health care system focused on asking the people we serve what they wanted. They requested bold changes, including same-day access, integration of mental health care, a single medical record across all disciplines, complementary medicine, traditional healing, workout facilities with exercise and wellness coaches, domestic violence and addiction support programs, and a medical home focused on the family. Many of these programs, even today, still have no reimbursement and the organisation had to make the choice between quality focused on the consumer, or revenue driven by an older model of care. As a result, however, South-central has achieved unprecedented results, including a more than 50 percent drop in ER visits, hospital days, and specialist visits; an employee turnover rate of less than 12 percent (annualised); and more than 90 percent customer and staff overall satisfaction rate.

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Do You Have an Extendable EHR?

Do You Have an Extendable EHR? | EHR and Health IT Consulting | Scoop.it

One of the clear benefits of using a EHR is the inherit extendibility that comes with the territory. You can easily connect the centrally-hosted EHR with any number of partner services and every customer feels the benefit. This model is in stark contrast to on-site, server-based solutions where each practice would require a dedicated and custom connection to each partner.

 

This is one of the reasons why older EHR systems were slow to adapt and offer new capabilities and one reason why EHRs are quickly becoming the new standard. EHRs that leverage have the ability to offer a marketplace of partner solutions that can literally be turned on in seconds, with no complex integrating, interfacing, or infrastructure requirements for the customer. It is just plug and play, much like a Swiss army Knife with an unlimited set of extensions.

 

This translates into the ability for an independent practice to change its practice model and adapt its EHR system to meet its changing needs. Let’s say your practice is looking to be more consumer-centric and offer on-demand telemedicine services to limited “VIP” customers. In this case, you would go to the EHR marketplace, find a telemedicine service provider, and request to sign up for the new service. Once you are signed up, there is no additional setup required to use the new solution. The integration is already in place. You are essentially just turning it on.

Many such add-on capabilities are generally available through the top EHR platforms. The flexibility EHR vendors have allows them to focus their attention on building their capabilities while partnering with other highly innovative companies that excel in their specific area of focus.

 

Other examples of marketplace tools that can help practices maximise efficiency by adding solutions to the EHR include:

  • Patient check-in and payment kiosks
  • Electronic drug couponing
  • Enhanced patient statements

As the industry shifts from fee-for-service to value-based care, even more technology and service partners will become available to ease the transition to new contract and care delivery models. For example, a practice might add a solution to support programs like chronic care management (CCM) or advanced reporting for MACRA’s alternative payment models (APMs).

 

So it makes perfect sense to review your EHR’s extendibility now in preparation for all the changes that will be coming down the road in the next one to two years. If you are looking for a new system, be sure to check out the marketplace and ask vendors about plans for additional partners to meet the coming changes.

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How EHR data can bolster quality improvement process review

How EHR data can bolster quality improvement process review | EHR and Health IT Consulting | Scoop.it

Electronic health record data can identify gaps in maps used for quality improvement for high-risk processes such as hospital discharge when using the Failure Mode and Effects Analysis (FMEA) approach, a new study has found.

 

FMEA uses process maps of clinical workflows for risk assessment to identify ways a particular process might fail and where those points of failure might be. It relies on topic experts and clinical representatives who map out each step and who is expected to perform it, according to there search published in the Journal of the American Medical Informatics Association.

The researchers, from Northwestern University and elsewhere, extracted data on admissions to a cardiology unit and formed a mock committee to develop a FMEA process map for patient discharge. They then compared who was expected to perform each task with what the EHR data revealed about it.

However, gaps in knowledge and experience might lead to errors, the researchers add.

 

They note that the EHR generates information about daily workflow including names, titles, times and activity details. It can help identify people who most frequently perform a process and might have the most knowledge of problems that could occur.

And while an organisation might try to pinpoint who has the most important insight into a process, the EHR might help identify those with other perspectives.

 

In this research, 35 percent of tasks were completed by people other than those listed on the process map, including people in 12 categories not identified as part of the discharge workflow.

The EHR data also showed some tasks listed as one activity on the process map were made up of multiple components completed by different people, and that some of these sub-components did not appear on the process map.

They concluded that using EHR data might strengthen the FMEA process and might be useful for other quality improvement initiatives as well.

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EHRs can reduce errors & improve patient safety

EHRs can reduce errors & improve patient safety | EHR and Health IT Consulting | Scoop.it

When health care providers have access to complete and accurate information, patients receive better medical care. Electronic health records (EHRs) can improve the ability to diagnose diseases and reduce—even prevent—medical errors, improving patient outcomes.

A national survey of doctors who are ready for meaningful use offers important evidence:

  • 94% of providers report that their EHR makes records readily available at point of care.
  • 88% report that their EHR produces clinical benefits for the practice.
  • 75% of providers report that their EHR allows them to deliver better patient care.

 

EHRs can aid in diagnosis

With EHRs, providers can have reliable access to a patient's complete health information. This comprehensive picture can help providers diagnose patients' problems sooner.

 

EHRs can reduce errors, improve patient safety, and support better patient outcomes

How? EHRs don't just contain or transmit information; they "compute" it. That means that EHRs manipulate the information in ways that make a difference for patients. For example:

  • A qualified EHR not only keeps a record of a patient's medications or allergies, it also automatically checks for problems whenever a new medication is prescribed andalerts the clinician to potential conflicts.
  • Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient's life-threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious.
  • EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.
  • EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years.

 

Risk Management and Liability Prevention: Study Findings

EHRs May Improve Risk Management By:

  • Providing clinical alerts and reminders
  • Improving aggregation, analysis, and communication of patient information
  • Making it easier to consider all aspects of a patient's condition
  • Supporting diagnostic and therapeutic decision making
  • Gathering all relevant information (lab results, etc.) in one place
  • Support for therapeutic decisions
  • Enabling evidence-based decisions at point of care
  • Preventing adverse events
  • Providing built-in safeguards against prescribing treatments that would result in adverse events
  • Enhancing research and monitoring for improvements in clinical quality

 

Certified EHRs May Help Providers Prevent Liability Actions By:

  • Demonstrating adherence to the best evidence-based practices
  • Producing complete, legible records readily available for the defence (reconstructing what actually happened during the point of care)
  • Disclosing evidence that suggests informed consent

 

EHRs can improve public health outcomes

EHRs can also have beneficial effects on the health of groups of patients.

Providers who have electronic health information about the entire population of patients they serve can look more meaningfully at the needs of patients who:

  • Suffer from a specific condition
  • Are eligible for specific preventive measures
  • Are currently taking specific medications

This EHR function helps providers identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes.

For example, providers might wish to identify:

  • How many patients with hypertension have their blood pressure under control
  • How many patients with diabetes have their blood sugar measurements in the target range and have had appropriate screening tests

This EHR function also can detect patterns of potentially related adverse events and enable at-risk patients to be notified quickly.

 

Studies Show: Better Patient Outcomes With EHRs

 

Using EHR Prompts & Reminders to Improve Quality of Patient Care 

High Patient Satisfaction

  • 92% were happy their doctor used e-prescribing.
  • 90% reported rarely or only occasionally going to the pharmacy and having prescription not ready.
  • 76% reported it made obtaining medications easier.
  • 63% reported fewer medication errors.

 

High Provider Satisfaction

  • Reduced overall rate of after-hours clinic calls.

 

Using EHRs to Improve Quality of Care 

Improved Quality of Care Screenings

  • Breast Cancer
  • Diabetes
  • Chlamydia
  • Colo rectal Cancer

 

Increase in Services

  • Blood pressure control for patients with hypertension
  • Breast cancer screenings
  • Recording of body mass index and blood testing for patients with diabetes

 

Using EHR Decision Support to Improve Asthma Care and Compliance 

The Study

  • Cluster randomization of clinics
  • Intervention: Clinical decision support (CDSClinical decision support) embedded in EHR

 

Outcomes

  • 6% greater use of controller medications (preventive or maintenance medications to help prevent asthma symptoms from occurring)
  • 3% greater use of spirometry (a common office test used to diagnose asthma and other conditions that affect breathing)
  • 14% greater use of asthma care plan
  • Spirometry improved by 6% in suburban practices

 

EHRs Transforming the Clinical Process 

A community hospital in Vermont recently implemented and EHR and reported:

  • 60% decrease in near-miss medication events
  • 20% increase in completion of daily fall assessment helping to avoid prolonged hospital stays
  • 25% drop in the number of patient charts needing to be pulled for signing orders and dictated reports

 

Using EHRs to Improve Documentation and Coding

  • Based on level of medical decision-making, ~50% of visits under-coded
  • Rural family practice implementing EHR + Practice Management (EPM) system
  • Increased case mix (type or mix of patients treated by a hospital or unit) by 10% over 2 years from 1.34 to 1.47
  • EHRdocumentation templates in multi-specialty clinic
    • Increased use of ICD code 99214 by 11%
    • Average billable gain of $26/patient
    • Increased revenue by >100K during the study period
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How to Know if Your EMR Training Was a Success

How to Know if Your EMR Training Was a Success | EHR and Health IT Consulting | Scoop.it

The importance of end-user training cannot be overemphasised for a successful electronic medical records system implementation. While this information is nothing new, administrators and providers may still find it difficult to determine when EMR training has been effective. Fortunately, there are performance indicators and measurable outcomes that can help you determine whether or not an EMR training system has worked for your practice.

  • Did EMR Training Increase Accuracy?

There is well-documented evidence of EHR systems positively affecting medical practice structure and processes following an effective implementation. In this way, coding accuracy can be a very good indicator of successful training of end users such as providers and their staff. Trends in inaccuracies, such as incorrectly coded patient histories, medication dosages, and more can reflect gaps in training where users need additional instruction or support.

 

  • Are There Variations in Workflow?

 

Naturally, there will always be some variation in workflow between providers and staff based on personal preferences and style. However, significant variations in identical processes (i.e. medication orders, pharmacy refill requests, or charting items) can be evidence of a critical training gap. One common contributor to such variations is an updated training curriculum, either offered internally or through an EHR vendor, resulting in providers who received two different training programs for the same system. Such differences are a good indicator of where training gaps can be closed.

 

  • Is There a Reduction in Billing Errors?

 

One critical and easily quantifiable indicator of successful EHR implementation is billing. A successful training program will result in proper and correct coding from billing staff, along with confidence and competency navigating coding regarding insurance, office procedures, Medicare and Medicaid variations, and more. Quantifying billing errors before, during, and after “go-live” can help a practice optimise its EHR system and demonstrate palpable benefits and returns from a successful implementation.

 

  • Have Your Providers and Staff Accepted the Records System?

 

One of the many benefits of adopting an EHR system is increased efficiency and productivity, which is best fostered by system acceptance. Acceptance indicators include feedback from the staff and providers themselves and affect overall morale and EHR utilisation. Once providers and staff are receptive and committed to the EHR system, efficiencies can be observed and quantified through waiting room times, technician workup duration, and other measures. These are helpful indicators to determine the overall efficiency of a medical practice, and can also reflect the success of an end-user training program for the records system.

Applying EMR Training Indicators to Optimisation

Following EMR training indicators is a great way to ensure that end-user training has been effective. But there are other benefits to these analyses as well, and tracking training outcomes can become a significant part of optimisation. Following the implementation of an EHR system, optimisation is critical to ensure that you’re getting the most out of your records system.

At ZH Healthcare, we understand that a successful EHR implementation relies on confidence and competency from all providers and staff. That’s why we offer unique, tailored training for our Health IT as a Service (HITaaS) systems like BlueEHS, and are readily available with dependable support before, during, and after implementation. Contact us today to learn more about our medical records training and support services, and discover how we can transform the way you do EMR.

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Successful EHR Implementations: Attitude Is Everything

Successful EHR Implementations: Attitude Is Everything | EHR and Health IT Consulting | Scoop.it

Commitment to success, engagement from all concerned and a shared interest in continuing improvement can take you far.

Kenneth G. Adler, MD, MMM

Previously I wrote a “how-to” article describing how to achieve a successful electronic health record (EHR) implementation.1 I sorted the dos and don'ts of implementation into three categories that I called team, tactics and technology, and focused on the teamwork, knowledge and skills needed to succeed. I still find that paradigm useful.

In the past few years, however, I've been able to observe a number of EHR implementations around the country. In addition to my full-time family medicine practice, I work as an IT medical director for a large primary care group in Arizona that to date has implemented an EHR in 23 unique office practices. Previously I consulted for the now inactive DOQ-IT (Doctor's Office Quality Information Technology) program, which was designed to help small practices select and implement EHRs, and I now consult independently around the country on new and troubled EHR implementations.

The new lesson I've learned is this: Attitude matters. A lot. It may not quite be “everything,” but the right attitude will help bring you far on your EHR journey.

 

Defining success

Implementing an ambulatory EHR is a complex, challenging process. One can surf the Internet and find poorly substantiated claims that anywhere from 10 percent to 50 percent of EHR implementations fail. Often these claims are purely speculative, are based on events that occurred many years ago or really refer to inpatient EHR failures. Limited research has been done in this area, and what has been done has been poorly designed.

My opinion, based on observation and conversation with others involved in health IT, is that ambulatory EHR implementation failures, as defined by never using or ceasing to use all of the purchased software, are quite unusual. On the other hand, not fully using purchased ambulatory EHR functionalities, or using them ineffectively or inefficiently, is quite common. I've observed sites that still have paper charts after years of being on an EHR, despite having scanning capability. I've seen sites where some doctors use all the functions of an advanced, comprehensive EHR effectively, while their partners refuse to do anything on it but review data. I've seen sites where even active problem lists aren't completed, much less past medical, surgical, family or social history lists. To my surprise, I've seen e-prescribers who don't bother to update or complete their medication lists. And frequently, I've seen sites where health maintenance functionality is ignored.

These commissions and omissions do not necessarily mean that an EHR implementation has failed, but they do mean that the EHR ends up not being used anywhere close to its maximal effectiveness. They are what can be called “partial implementations” rather than successful ones.

 

Principles of success – the five fold path

Buddhism may have an eight fold path, but the path to EHR nirvana (or contentment, at least) is only five fold. So the good news is that it's easier to successfully implement an EHR than to become a Buddhist monk. The first three elements on the EHR path are really attitudes – full commitment, extensive engagement and the desire to see continual improvement. The fourth element is having the necessary resources. The fifth element is having the requisite knowledge.

With regard to the first three elements, not only must your implementation team and organisation leadership share these attitudes, but you must also be able to promote them throughout your organisation.

 

Commitment

Commitment means the willingness to invest the time and money needed to make the implementation successful – to do whatever it takes. Doing so really needs to be viewed as a long-term investment. Fortunately it's an investment that will likely pay bountiful dividends if done well.

As a successful implementer, you will need to commit adequate capital both for quality software and hardware. You will need to commit to spending a lot of time planning every step of the process. And you will need to commit to adequate training – both initial and ongoing – which costs both time and money. Too often practices skimp on initial training, leaving users with limited skills. Even more often, practices offer no ongoing training, not realising that the skills to become expert rarely come after just two, four or even eight hours of initial training.

Why are successful implementer committed? Hopefully it's not just because they fear failure. I suspect that they truly believe that their EHR will fundamentally improve the quality of the care they provide and the efficiency of their practice.

If you are unconvinced of that and aren't sure the effort is worth it, I encourage you to pause. Seek out leaders of successful implementations and see what they've done and how their practices are running. Hopefully that will inspire you.

 

Engagement

Many implementations suffer from a lack of end-user engagement, particularly physician engagement. The implementation process is viewed as a burden, and physicians typically want to delegate it to their administrative staff. That may seem reasonable. Physicians should focus on seeing patients, after all. But this isn't financial software. It affects every aspect of how physicians practice their craft, and if they aren't involved in the selection and configuration of the software, they are likely to resist and resent the behaviour changes the software demands. Plus the decisions made in selection, setup and new workflow design are likely to be of lower quality than they should be, absent input from physicians and other end users.

Clinical staff members tend to follow the example of the physicians with whom they work. If physician engagement is low, staff engagement will likely suffer as well.

You can increase engagement several ways. First, insist on involvement of your end users, especially the physicians, from the start of the implementation or, better, from the start of the software selection process. Second, offer frequent, informative and even repetitive communication. Third, through your communications, help people set reasonable expectations. Finally, conduct your decision-making process in a fair and open manner.

 

Improvement

Those who implement EHR systems successfully believe that whatever they are doing now can be improved. They aren't satisfied with the status quo, and they desire to try new things – if it will help them achieve their aims. They are flexible, and although they may not like change, they accept it as necessity. Put in management lingo, folks with this attitude are believers in and practitioners of continuous quality improvement. I'm not sure how people acquire this attitude, but if you believe that your practice is as good as it can get, I challenge you to look deeper.

 

Resources

Three resources are critical – quality software, strong vendor support and a sound technical environment. Yes, there is a difference in quality between various EHR products. And, yes, some vendors provide better support than others. So take your time during the selection process. It can make a large difference. Likewise, be sure you've invested in appropriate hardware, bandwidth and technical support. If you've outsourced the technology component of your EHR by using an ASP (application services provider) or SaaS (software as a service) arrangement, make sure that the vendor you hired has a proven track record for high network availability and responsiveness in correcting technical glitches.

 

Knowledge

Knowledge is important, but the easiest of the five elements to acquire. Your vendor should be a key resource. Pay close attention to the vendor's advice about what it takes to implement the system successfully. After all, the vendor has seen lots of implementations. You will probably see only one. You may also find the implementation article that I wrote in 2007 helpful.

 

An acronym to remember

Here's an acronym that might help you remember the five principles of a successful EHR implementation. CRIKE. (Imagine that you are in the northern reaches of Australia and unexpectedly encounter a ravenous, twelve-foot crocodile. You start to say “CRIKEY, MATE” – but just don't have time to finish.) Remember: Commitment, Resources, Improvement, Knowledge and Engagement.

Successful implementation is a moving target. Once you master one set of functionalities and workflows, new ones are likely to come along. Having strong individual and organisational commitment, end-user engagement, desire to improve, resources and knowledge will help lead you to turn your EHR into an awesome, indispensable tool that helps you do what you do best: take care of patients.

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New pact to make electronic health records 'work better'

New pact to make electronic health records 'work better' | EHR and Health IT Consulting | Scoop.it

The Obama administration on Monday night announced a new agreement with major hospital systems and leading electronic health record vendors to make it easier for patients to access those digital records, reduce barriers to sharing the information between health providers, and standardise technology that would better allow communication across the platforms containing patient data.

The agreement involves vendors that provide 90 percent of the electronic health records (EHRs) to U.S. hospitals, as well as health-care systems in 46 states, including the nation's five biggest private health systems.

 

More than a dozen professional health organisations also have signed on to the agreement, the latest step in the transition from a system that once relied on paper to document a patient's medical history to one that relies on electronic bytes for that task.

The pact, which has three main commitments, represents an effort by the Obama administration to speed up an ongoing effort to make digitised records more effective in helping treat patients and improve portability of the electronic data.

Despite that effort to date, EHRs are not always readily accessible, not always usable in the form that providers receive them and not always easy for the patient to understand, said Dr. Karen DeSalvo, national coordinator for health information technology at the U.S. Health and Human Services Department.

DeSalvo said the pact "reflects a shift in the way that [EHR] developers and providers are willing to do business."

Under the agreement, the participants commit to help patients "easily and securely access their electronic health information, direct it to a desired location, learn how the data can be shared and used, and be assured the data is being effectively and safely used," according to a fact sheet distributed by HHS.

Another commitment is to not "block" information, allowing health providers to share patient records with other providers and the patients themselves, and not unreasonably interfere with such sharing.

The third commitment is to implement federally recognised, national interoperability standards, policies and practices for EHRs.

 

Where to look for better health-care prices

"These commitments are a major step forward in our efforts to support a health-care system that is better, smarter and results in healthier people," said U.S. Health and Human Services Secretary Sylvia Burwell.

She revealed the agreement during a speech Monday at the Healthcare Information and Management Systems Society's conference in Las Vegas.

 

Who loves big deductible health plans

In prepared remarks, Burwell said that "we have made tremendous progress to bring health care into the 21st century," noting that in the past six years there has been a dramatic increase in the adoption of electronic health records, with about 75 percent of all doctors now using them, along with almost every hospital in the country.

"But we still have work to do to get the real value of this information for providers and consumers," Burwell said. "As we look at where our current way of doing things falls short, it's in three areas."

Referring to those areas, Burwell said that "consumer access remains a challenge."

"It's great to have an electronic record, but if that record can't be easily accessed by doctors and patients because of clunky technology, then we aren't consistently seeing the benefit," she said.

Burwell also said that digital patient records are "still too often knowingly or unreasonably blocked" by hospitals or doctors, either because of business practices "or misunderstanding" of the federal health information privacy law.

And, she added, "Without agreement on a common data 'alphabet,' our technology is stuck speaking different languages."

Mary Paul, vice president in the information services division of Ascension, one of the participants in the agreement, said that "interoperability" is "core to the goal" of having providers connect with each other to care for their patients. (Ascension is the largest nonprofit health system in the U.S. and the world's largest Catholic health system.

 

Paul said the development of EHRs has been "a significant journey to go from a process where you collect information in paper form from many different sources."

But she noted that even with the rise of EHRs, "there are a lot of interests to coordinate ... a lot of different parties that really require come coordination."

"I think when the community of providers and suppliers come together to promote the same set of standards, I do think that will make change," Paul said. "What we're trying to do is speak with a single voice, and I do think that's important."

Another participant in the agreement is EHR vendor Athena health. The company's director of government and regulatory affairs, Stephanie Zaremba, gave a lukewarm assessment of how significant the agreement is, at this point.

 

"Signing this pledge must not be regarded as a significant accomplishment or milestone for any stakeholder," Zaremba said.

"Athena health is and always has been committed to the goal of achieving the same ubiquitous information exchange that is commonplace in every other sector of the information economy," Zaremba said. "We have signed the latest government-orchestrated 'private sector commitment to interoperability' and are once again on the record supporting the broad goals of achieving connected care."

"The problem, however, is that one would be hard-pressed to find a stakeholder in our industry that is not already rhetorically committed to those goals," she said. "We are at the point as an industry where we need more action and fewer words. We want to see the [Office of the National Coordinator for Health Information Technology] take a step back and allow the private sector to continue its progress around a 'bottom up' approach to interoperability, not a top-down approach centred around the low bar of federally recognised standards."

 

Premier, a health-care performance improvement alliance of 3,600 hospitals and 120,000 other medical providers, is another participant in the agreement.

Blair Child, senior vice president and spokesman at Premier, said,"Members of the Premier health-care alliance are pleased to join other stakeholders that have pledged to voluntarily implement interoperability and public access standards in health information technology."

But he also said that, "While the pledge is a positive statement of commitment, we continue to believe that legislation is important."

Child added, "We support a public rating system of vendors' technology based on its performance on outcomes measures of usability, functionality and interoperability. We also support the granting authority to investigate and fine vendors who engage in information blocking."

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Benefits of Electronic Health Records

Benefits of Electronic Health Records | EHR and Health IT Consulting | Scoop.it

Electronic health records directly benefit the health care system and society on a whole—they can cut costs and collect data—but currently the greatest benefit is to you. They provide extra safety measures and give you easier access to your doctor and medical information, says Corley.

 

Personal Access 

Electronic records allow you to access your health information from a smartphone, tablet, or computer—no matter where you are. This can come in handy for information that previously may have taken several phone calls to discover. For example, if you forget how to take the medication that your doctor prescribed, you can go online to access your doctor’s notes about how to take it, says Corley.

 

Fewer Errors

It’s not unheard of for doctors to misunderstand, mistype, or otherwise forget a piece of health data. With electronic records, you can check to make sure all your information is correct. “There are a lot of opportunities, if people have a second pair of eyes on their medical information, to reduce the potential for errors as a result of prescribing,” says Siminerio. As an added bonus, electronic records are getting people involved in their health, says Myrie. “It’s enabling and empowering patients in a new way so they can have access to their information,” she says. “They can review it and distill it at their own time and own pace.”

 

Patient Portals 

One of the requirements for government certification for an electronic medical record system is that it must incorporate an online patient portal available for people to easily access their health information. Portals serve as gateways to your test results, current medications, and doctor’s notes. Log on to your provider’s patient portal to schedule appointments, e-mail your doctor, pay your bills, and get health maintenance reminders.

 

Doctor Access 

It’s helpful for your doctor to have access to your medical records from anywhere, particularly in emergency situations. Lizerbram tells the story of an ER doctor’s phone call to a primary care physician who was out of town at a medical conference. The emergency room doctor needed medical information about a patient—and fast. The primary care physician was able to pull up that patient’s history on his iPad and give the ER doctor the information he needed. “The people caring for a patient don’t have to make decisions in a vacuum,” says Corley.

 

Information Exchange 

In an ideal world, all electronic health records would talk to on another—imagine a single, secure site fed data from all of your health care providers’ electronic record systems. While not all electronic health records are able to communicate with each other at this time, the goal is for all of your health information to be in the same place, where everyone involved in your care—such as your primary care doctor, specialists, the pharmacy, hospitals, and urgent care centers—can see your complete history. In lieu of that, you can download your medical records from one doctor to take to a different doctor who doesn’t have your full medical history. “We see this as a collaboration tool,” says Myrie.

 

Maintenance Reminders 

This feature can help the doctor and office staff keep track of when you are due for preventive services, such as an annual dilated eye exam and immunisations. Lizerbram says one doctor’s experience with maintenance reminders underscores their importance. “The reminder prompted the doctor to set the person up for a colonoscopy,” says Lizerbram. “It turned out the gastroenterologist found the patient had stage 1 cancer of the colon, which wouldn’t have been diagnosed until symptoms would have appeared much later.” As a result, that patient had surgery to remove a portion of the bowel and was cancer free without chemotherapy.

 

Medication Interaction 

Electronic records can quickly scan the medications a person is taking and determine if there are any potential drug interactions or allergies that could be a problem. “It would be very hard for a physician to keep track of all those interactions,” says Corley, “where the computer can quickly do it.”

 

Big Data 

“You can take even what’s called ‘big data’ out of the EHR,” says Lizerbram. For example, one study reported in Health IT Outcomes looked at the laboratory results of over 11 million people, and found that a million had diabetes but had not been diagnosed. “You could never get that type of data without an electronic health record supplying the data for some organisation to research and review,” he says. Doctors could do this on a smaller scale in their own practices, too. They could tell the system to run a report for everyone with an A1C over a certain marker, which may help them identify patients with undiagnosed diabetes. There is also great potential for this data to look at a broader population of people than you’d find in a research study, which can provide better safety and efficacy information, says Corley.

 

Health Care Savings 

The greater efficiency and quality of care that’s brought about by using electronic health records may translate to cost savings for the health care system as a whole, says Lizerbram. The information exchange that occurs with electronic records can help eliminate duplicate tests at various doctor’s offices, which can rein in costs. And maintenance reminders can catch disease early, so multiple surgeries and expensive medications may not be necessary down the road. But the savings aren’t limited to the health care system. Corley says that, by helping your doctor prescribe the medications your insurance covers, electronic records may save you money, too.

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Advanced EHR Use Shows Potential to Lower Patient Costs

Advanced EHR Use Shows Potential to Lower Patient Costs | EHR and Health IT Consulting | Scoop.it

Advanced EHR use may lead to significant per patient savings, showing promise for an eventual return on investment, shows a study published in the American Journal of Managed Care.

 

The study included a retrospective analysis of the National Inpatient Sample (NIS) and the HIMSS Annual Survey to examine patient costs and rates of advanced EHR use.

 

For the purposes of the study, the researchers defined advanced EHR use as meaningful use. Those that achieved the benchmarks set forth by the Centres for Medicare and Medicaid Services’ EHR Incentive Programs were categorised as advanced EHR users.

“Such criteria for use are based on previous studies that report improvements in quality,” the researchers explained.

“To qualify as a meaningful user and benefit from the related incentives, EHR systems must include electronic prescribing, health information exchange with other providers, automated reporting of quality data, electronic recording of patients’ history (demographics, vital signs, medication and diagnosis lists, and smoking status), created care summary documents, and at least 1 clinical decision support tool.”

After examining the data, the research team identified 550 hospitals for their study, with 104 of them categorised as advanced EHR users.

 

On average, those 104 hospitals saw a notable drop in per patient costs, with each patient costing $731, or 9.66 percent less than patients treated at other hospitals. Those results take into account patient- and hospital-specific variables.

According to the researchers, such cost savings may be credited to the increased efficiency advanced EHR use may bring.

“Meaningful use requirements are believed to improve the legibility of records, reduce prescription errors, improve adherence to best clinical practice guidelines, improve patient and clinician access to records, and allow exchange of health information,” the research team said. “In addition to gains in quality, EHRs have been predicted to save $81 billion annually through safety improvement and increased efficiency of care.”

 

Despite these results, the researchers recognise that not all EHR users are seeing cost savings, or return on investment. This may be because they are not utilising all of the EHR features necessary to deliver cost-efficient care.

“The staging model that was used demonstrates that cost savings may not be realised until multiple features are included and implemented,” the researchers explained. “Since EHR systems are complex and costly to implement, it is often a multistage process to adopt and use EHRs.”

 

“Thus, hospitals must anticipate that the financial savings may not exist until advanced, ‘meaningful’ use is attained,” they continued. “The majority of hospitals have yet to reach the stage of implementation where cost savings are possible, since they are not using advanced EHRs.”

 

The team also acknowledged the significant up-front costs associated with advanced EHR use, recognising that an initial EHR implementation can run hospitals hundreds of thousands of dollars.

That all said, this data can be used to help build the business case for EHR adoption.

 

“These cost savings will benefit many third-party payers, hospitals, and patients, and incentives such as those provided through the HITECH Act to promote EHR adoption and use will benefit hospitals,” the research team concluded.

“Since many previous studies have shown that EHRs can improve the safety and quality of care in hospitals, the projected cost savings in this study provides additional motivation and builds the business case for hospitals to make the large investment in adopting and maintaining an EHR system.”

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EMR vs EHR – What is the Difference?

EMR vs EHR – What is the Difference? | EHR and Health IT Consulting | Scoop.it

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

 

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

  • Track data over time
  • Easily identify which patients are due for preventive screenings or checkups
  • Check how their patients are doing on certain parameters—such as blood pressure readings or vaccinations
  • Monitor and improve overall quality of care within the practice

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

 

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organisation that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorised clinicians and staff across more than one healthcare organisation.”

The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.

And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

 

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centred care. With EHRs:

  • The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
  • A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
  • The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
  • The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.

So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of difference.

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