EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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3 best practices in healthcare IT security: How Group Health Cooperative does it

3 best practices in healthcare IT security: How Group Health Cooperative does it | EHR and Health IT Consulting |

The one thing we learned for sure in 2015 was that healthcare has become a target for hackers across the globe. Over 100 million healthcare records were compromised in data breaches in 2015 and research firm IDC predicts that 1 in 3 individuals will have their healthcare records compromised in 2016. Acording to John Halamka, CIO of Beth Israel Deaconess in Boston, 2015 has been filled with denial of service attacks, hard-to-detect malware, and a skyrocketing number of personal internet connected devices at the same time that HIPAA enforcement has expanded. 

An important feature of these attacks on healthcare is the apparent involvement of overseas actors, including nation-states. Nigeria and the Baltic States are  well-known sources of phishing attacks for profit. State-sponsored actors from the far-east are now said to be targeting healthcare records. A recent episode on the 60 Minutes TV show reported on industrial espionage on a staggering scale involving the Chinese government. If the report is to be believed, the Chinese are stealing valuable intellectual property, spying on competitors, and hacking into government servers.

Why healthcare? Why now?

One reason for the increase in attacks on healthcare is that as other sectors such as retail and financial services have become more sophisticated with IT security processes and tools as well as the value of credit card data going down.  As a result, the hackers have turned their attention to “softer” targets with more valuable data such as healthcare as the logical next step. Within healthcare, payers have been hit more than providers. As opposed to gathering fragmented data from individual hospitals, hackers choose to target Payers because of the opportunity to gain access to state-level population medical records, or even more. In other words, a better return on risks and effort involved.

First, the good news – IT security budgets are increasing across the board. With most of the Meaningful Use (MU) work and ICD 10 preparedness out of the way, this one big CEO-level issue is getting more funding. And when there is funding available, there is a tendency to throw money at technology and tools. However, the question is whether additional funding will by itself solve the fundamental issues of information security in healthcare.

Chris Grant, Chief Information Security Officer at Seattle-based Group Health Cooperative (GHC), a non-profit health system that serves nearly 600,000 members, believes that “It’s not just about technology tools. You can’t buy your way out of trouble on this.”

Best practices from GHC

Grant has taken an approach to combat IT security threats that provide insights into best practices that are emerging in healthcare IT security practices.

-- Process vs. Tools: At GHC, Grant constantly prioritizes between process and tools – in layman’s terms, between firefighting and “building code” upgrades. His team focuses on understanding incidents, early containment, and automation at the incident response level. Using a number of detection and monitoring tools, the GHC team identifies risks and focuses on remediation areas. Vulnerability scans combined with penetration tests designed to identify specific sets of vulnerabilities, and tools such as Splunk, a technology that records and analyzes system logs, enable reuse of the data for improved security results.

-- Analytics: Another best practice is the use of analytics for correlations and geo-locational hot spotting. We have all experienced alerts from Google whenever we try to log into Gmail from an overseas location. At GHC, they have taken it a step further to develop correlations between log-ins from multiple locations and have created a scoring system that manages validations and exclusions based on the location disparities for the user at the time, answering potential questions like, “How can Scott be accessing his account from Florida and England at the same time?”

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-- Data Privacy: This is an issue that is closely related to IT security, especially in healthcare. Health systems are required to monitor access to EMR data as a part of MU requirements. Grant and his team have built a production application and framework on the Splunk platform that uses a set of medical record access scenarios to identify potential privacy violations and triage them using a weighted score model for GHC’s privacy team to take further action.

Existing and new challenges

IT environments in healthcare tend to be outdated and the top priority for most CISO’s is the protection of the legacy environment. Organizations need to be really good at firefighting, quickly, and can take time to towards upgrading the “building codes” – identifying and remediating system vulnerabilities and configuration issues. Penetration tests, according to Grant, and other traditional IT security practices tend to be reactive to security incidents with limited ability to identify key aspects of an attack by hackers. The focus of healthcare IT security functions, like other verticals with critical data to protect, should be the lateral movement, or system to system movement, of a would be cybercriminal set on finding and exfiltrating data.

The governance model in health systems is also changing, with IT security increasingly considered a risk function and not a technology function – albeit with a strong appreciation of technology and an ability to work in tandem with CIO organizations. The talent shortage for IT security pros will make such collaborations – with internal as well as external partners – key to success.

At the same time, as enterprise IT interacts more with external systems, including cloud-based vendor platforms and the proliferation of connected medical devices and the Internet of Things (IoT), the mandate for IT security will expand to address new vulnerabilities. The Medtech industry, in particular, seems unaware of the enormity of the risks that their devices can cause for the rest of the healthcare system. In some ways, healthcare IT security may soon need to be called IoT security.

IT security is now a national security issue, in many ways. With the heightened focus on Healthcare data, best practices are emerging that will ensure that our data and our healthcare system is well protected.

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EHRs and the Problem of Efficiency 

EHRs and the Problem of Efficiency  | EHR and Health IT Consulting |

Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.

There’s a fine line between efficient and lazy.

Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.

Four things I do to fight the downside of efficiency:

  1. Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I’ve typically crossed the line.
  2. Build narrative. My HPI and impressions represent an identifiable stream of thought. I don’t use smart phrases in my HPI or impression.
  3. Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
  4. Stay aware. All of this is a struggle for me. But my discussion and thinking around this makes me aware of it. And that’s the first step to staying on top of it.

All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don’t be fooled. Take any doctor from the analog age, give him a two glasses of wine and he’ll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analog pulldown.

Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.

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Trends Impacting EHR Costs 

Trends Impacting EHR Costs  | EHR and Health IT Consulting |

EHR Cost

Electronic health records systems can be (and often are) costly. This is true for a variety of reasons. The expenses of implementing an EHR are driven by costs associated with system design to training and everything in between. Even so, health records systems have seen a dynamic history of prices trending from the very expensive to the very affordable. Understanding these market fluctuations requires a quick look at some of the most substantial trends in EHR design and adoption.


Many variable factors influence EHR cost. Watching the environment of the market in the health records industry can help to clarify some of the EHR pricing variations.Three significant trends to follow are open source systems, API usage, and customization in EHR systems.

  • Open Source and Do-it-Yourself Implementation (Downward Trend)

Despite their initial popularity, particularly with respect to their low cost, open source EHR systems do require a higher degree of technical capacity early on, and some may also lack the functionality delivered by paid, packaged systems. These systems are among some of the most affordable EHR solutions, with little or even no upfront costs in some cases. However, financial investment is typically seen at a later stage in implementation, training, upgrades, and maintenance.

  • API – Application Program Interface (Downward Trend)

Interfacing software systems through API-driven models has also seen a deceleration, partly due to the complexity of bridging numerous systems. However, a decrease in API-driven models can also serve to drive up costs in health records as a result of adecrease in interoperability and an increase in proprietary systems.

  • Customization (Upward Trend)

The more adoption of EHR systems in the healthcare industry will lead to more customization. Practices continue to realize that a one-size-fits-all approach to EHRs is detrimental to workflow, revenue cycles, and usability. But with customization comes the increased costs of creating systems tailored by specialty or individual practice.



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3 Frequently Missed Factors For Choosing An EHR

3 Frequently Missed Factors For Choosing An EHR | EHR and Health IT Consulting |

Modern physicians operate in a fast-paced, constantly-changing world.

Between dealing with regulation changes, insurance billing complexities and simple business requirements, the precious time and attention of doctors seems to be stretched thinner than perhaps ever before.

To help them manage such a demanding environment, most physicians everywhere are now turning to advanced technologies such as Electronic Health Record (EHR) software to maximize their practice’s efficiency.

Doing research on which is the ‘best’ option can be mind-numbing.

Currently today there are over 700 EHR options in the marketplace, and that number is growing steadily. Aside from the technical capabilities, and the simple functions that are required, here are 5 important factors to consider before investing in an EHR for your clinic.


1) Features and Functions

This may seem an overly obvious factor, yet it can be overlooked. Before you begin to search for an EHR, consider exactly what you want it to do for you. What will it make easier in your clinic? Will it remove some manual tasks from your teams daily routines?

EHRs can streamline the daily activities of a clinic, simplifying functions such as scheduling, billing and reporting, while still meeting the demands of the government, insurance companies and patients alike. (You may like to refer to this comprehensive list of functions as a starting point).

Therefore, writing a list of what you want and need is a great place to start. Choose 5-10 key features or functionalities that are essential for you. Then choose another 5-10 that are nice to have. Taking time to consider your individual needs will help you narrow the field dramatically, and reduce the chance you are being sold on the sizzle, rather than the steak.


3)Design, Flow and Usability

Design is about much more than color schemes and logos. It is about the overall feel, and ease of use of the software. Believe it or not, good design can make an EHR a pleasure to use, or a nightmare.

As Dr Joseph Cramer explains “Color, space, placement, size, shape, and form all guide how one looks at the medical record. Information is not all the same. Monotony is not only boring; it is dangerous for care if everything is hidden in the same dull camouflage.”

Consider the way it feels to use the EHR software. Does each screen flow logically? Is it easy on the eye? Can you adjust or change the layout or text sizes? Do the repeated functions you are using daily feel cumbersome or overly complicated?

Think about how much gmail changed the way we use email. Small simple innovations within an EHR can make a huge difference. Having to click through several screens to be able to save records, or source data can become an incredible burden when you do it hundreds of times a day.

According to Jess White from Health Care Business Tech, “Providers who aren’t comfortable with entering information in an EHR are more likely to make mistakes that can affect patient care. And an EHR that’s too difficult to work with can decrease efficiency.”

Keep this sense of flow and usability top of mind when testing an EHR.



The future of all EHRs is going to be determined by who can connect them together. Today the challenge of interoperability is still a huge issue, and whilever the EHR vendors limit access to third-party apps, this will continue.

Even in 2016, this factor may still be a nice to have, but according to D’Arcy Guerin Gue writing for  HealthIT Consultant, “The industry’s road to interoperability is paved with bumps and ruts. With certified EHRs now in place throughout the country, it’s a front and center concern. This is because interoperability is only practical if  EHR  usage has reached enough critical mass to make the possibilities realistic, including providing the basis for common standards for data sharing.”

Seeking out an EHR that has a plan for interoperability, and connection to useful apps is another factor to consider to future-proof your clinic.

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The Pros and Cons of Customizing Your EHR 

The Pros and Cons of Customizing Your EHR  | EHR and Health IT Consulting |

Customizing an EHR can offer incredible benefits to a medical practice, but it is critical to understand the cost-benefit analysis of customization before implementation for the benefit of the practice and the health of its patients.


To Customize of Not to Customize

One of the first questions to ask before deciding to move towards a customized EHR is about the health or the efficiency of an existing system. Are there currently bottlenecks in flow? Would EHR customization better support “meaningful use” and best practices? Do providers and staff find themselves frustrated on a routine basis with data entry or records management? If so, it may be time to consider a tailored records system.

Despite the benefits of customization,there are associated costs which must also be weighed in the decision-making process. Resource consideration is important when deciding if customization is appropriate, for example. Are the resources (both time and financial) available? Creating a cost-benefit analysis can help to determine whether or not to adopt a customized EHR system.

Pros of Customization

Designing and implementing a customized EHR system has many incredible benefits. Custom modules lead to better capturing of data and improved accuracy of that data. SuchEHR system impact affects not only practice flow, but also health outcomes.

Another important benefit of a customized records system is utilization by providers and staff. With a system carefully tailored to the needs of the practice (and in-turn its staff), practice-wide adoption can become much easier. It is no coincidence that staff will be eager to use an EHR system that’s more functional; when appropriate screens and modules appear when and where they are needed, and the system is tailored to the flow providers desire and follow, staff is more invested.

Cons of Customization

Despite its advantages, practices need to be aware of the cost of implementing a customized EHR system, both in terms of time and financial investment. The cost of implementation can by high, which is a common barrierto EHR customization for practices. This cost comes in the form of financial investment, but also the investment of time.

Adaptation and training take commitment on the part of providers, staff, and administrators, and customization management requires thoughtful and careful leadership. Other points of consideration include long-term system changes such as updates, as vendor updates down the line may create rifts with interfacing custom systems. Careful communication with a vendor before customization about future changes is key to best prepare for such events.

Understanding the advantages and costs of implementing a custom EHR system is an important step in deciding if customization is right for your practice.


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Tips for Changing EHRs and Transferring Patient Data

Tips for Changing EHRs and Transferring Patient Data | EHR and Health IT Consulting |

One of the challenges of choosing a new EHR is considering the long-term investment.

Implementing any new system into a medical clinic is a potential short-term disruption, so there needs to be an assurance that your decision to change EHR services will serve you well moving forward.

The rapid pace of technological ensures that most doctors will switch their electronic records system throughout their career.

Some doctors start building a medical practice with a budget, and then become ready to pay more for a full service EHR. Others are simply dissatisfied with their current system and want to move to something more suited to their needs.

Very often the big issues that arises is with data continuity. Changing EHR systems should ideally mean that you retain access to your previous patient records. But this is not always the case. The fear of transferring data and losing vital information is a real threat.

With the recent growth in cloud-based EHRs, your patient data is no longer stored on a local server in-house, rather it is under the care of the EHR vendor.

The good news is that the ease of transferring medical records has been steadily improving over the last several years. The recent wave of federal regulations relating to Meaningful Use includes a set of standards developed to enable electronic referrals and cross-provider communication.

These standards describe the specific structure and elements of a patient record, so that any two EHR applications which adhere to the standards, should be readily able to exchange patient data from one to the other.

The creation of these standards makes it easier to transfer patient care data from one provider to another. This technology process is also used to import all patient records from one EHR to another.

For any two EHR applications, it is unlikely that all data will transfer over seamlessly. You need to check with your new vendor which information is essential.

Start with Structured Data.

This includes ICD9 Diagnosis codes, medication lists, procedure lists, allergies, and immunizations. Detailed chart notes and SOAP-type templates can prove to be difficult because the data is unstructured, and free text format may not transfer easily from one EHR technology to another.

In order to meet Meaningful Use certification, EHR vendors are required to be able to produce this data in a standardized, structured format for any given patient. However, they are NOT required to be able to automatically export all data for all patients.

With some EHR vendors, they may charge a processing fee for creating an export file of all of your patient data. A new EHR vendor may also charge you a fee for importing previous data.

This fee will vary based on the volume and complexity of your previous record set.


Testing the new System

Once the data transfer has been the second step is testing. Anyone familiar with the process will tell you the the transfers are rarely executed perfectly on the first round. So be patient and persistent.

It is necessary to perform careful quality testing to validate that your data in the new environment is accurate, just like in the old environment.

The simplest way to do this is to select a small test group of your patient population and manually verify that everything is exactly correct for those people. Check both systems to see that everything is correct and orderly. Ensure that you check more than contact information, also review medication lists, procedure lists, allergy lists, and immunization lists. Detailed chart notes and SOAP-type templates can also show if the data has transferred effectively.

If you find an error in the record of one individual, chances are that it is a systemic problem that is affecting many other patient records in your population.

If you identify any problems, you will then need to work with both EHR vendors to determine the origin of the issue and correct it. This can be time consuming, but also worth fixing early.

Even with cloud based date, and modern EHR systems, data transfer can still be a challenging process for any provider to undertake.


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Why Does an EHR System Cost So Much? 

Why Does an EHR System Cost So Much?  | EHR and Health IT Consulting |

Electronic health record (EHR) systems are an enormous investment. This investment comes in the form of time, labor, and of course, money. Whether a medical practice chooses to host an on-site EHR system or subscribe to a web-based system, these costs demand significant planning and preparation.

Understanding the cost breakdown of an EHR system can help a medical practice not only prepare for the financial investment but also generate implementation focus.

What is the cost of an EHR?

Estimates of EHR costs have ranged anywhere from $15,000 to $70,000 per provider. Many factors drive this expense.

First, the development and design of the system itself is a concrete contributor to the value of electronic medical records. EHR cost is also affected by the degree of interfaces and integrations it offers, particularly with respect to other health records systems.

Implementation decisions also impact the cost. Practices implementing an in-house, locally-hosted system, have higher costs than for those adopting a web-based SaaS (Software as a Service) model.

Regulatory requirements, compliance, and certification, are also a significant source of EHR cost. Testing and certifications to meet Meaningful Use requirements or updates to align with changes such as ICD-10 are examples of how these areas influence EHR cost.

Once selected by a client or practice, user interfaces, customization, implementation, and training also contribute to EHR cost.

Evaluating Cost of EHR

                                                      EHR Cost

One of the very best sources for evaluation of EHR pricing is the vendor. During this stage, it is important to scrutinize options with a critical eye to truly evaluate what an electronic records system delivers.

Questions such as “How will data migration or input from paper charts impact pricing?” or “What is the training timeline and volume?” can help your practice to determine value vs. cost for a particular vendor.

This step requires doing appropriate research beforehand on the scope, features, and requirements you’re looking for in an EHR.

Understanding Cost and Value of EHR

High costs should equate to high value. This is true of any service, and healthcare HITaaS (Healthcare  IT as a Service) is certainly no exception. Experienced vendors should be able to provide clients with a thorough understanding of the value of their systems and services as well as the cost. This value translates into meaningful benefits for your medical practice, both immediately and down the line.

EHR value should be measurable with concrete metrics including documentation accuracy, workflow efficiencies, and more. And while this means that vendors are responsible for exceptional service, it’s important to remember that you can’t knock cost without knowing the expected value.



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5 EHR Benefits We Seem to Have Forgotten About

5 EHR Benefits We Seem to Have Forgotten About | EHR and Health IT Consulting |

Here are a few of the guaranteed EHR benefits:

  1. Legibility of Notes: Physicians' handwriting has been the topic of many jokes. While it’s funny to joke about, it’s not funny if you’re the physician receiving one of those illegible notes or the billing office trying to get paid based on some illegible chart note. The beauty of an EHR is that the notes are all typed in a font that can easily be read. The whole issue of physician handwriting goes out the window.
  2. Accessibility of Charts: Charts are more accessible in an EHR in two distinct ways. First, the concept of a lost chart basically disappears in the EHR world. When you want the chart, you search by the patient’s name or other identifier and instantly have access to the patient chart. No more searching through the chart room, the lab box, the nurses’ box, the box on the exam room door, etc. for the lost chart. Second, the chart can be accessed from anywhere in the world. Gone are the late night phone calls which require you to drive to the office to view the chart. An EHR can be accessed anywhere you have Internet.
  3. Multiple Users Accessing the Chart: How quickly we forget the fact that only one person could use the paper chart at a time. In fact, entire workflows were created around the fact that two people couldn’t work on the paper chart at the same time. In an EHR, the nurse, doctor, front desk, HIM, and billing staff can all work on the chart at the same time.
  4. Disaster Recovery: Many people are afraid of disaster situations with their EHR. While this is an important topic, an EHR can be so much better in a disaster than a paper chart. If your chart room goes up in flames, what could you do? Not much. Your charts were lost. In the EHR world, you can easily create multiple backups and store them in multiple secure locations including secure offsite storage. This takes some thoughtful planning to do it right, but EHR makes it possible to store multiple copies of your data which minimizes your risk of lost data. This is so much better than a paper chart in a disaster. With a cloud-based EHR this redundancy is often built in, and there is little or nothing you need to do.
  5. Drug to Drug and Allergy Interaction Checking: Yes, we’ve had Epocrates in our pocket for a long time. That was a huge improvement over those stacks of books on the shelf. However, EHR takes that one step further. Your EHR knows about your patients’ list of allergies and the drugs they’re taking. These extra pieces of information can provide a much deeper analysis of any drug you’re looking to prescribe. I don’t remember a prescription pad ever alerting you to an issue with an allergy when you were writing the script.

Obviously this is just a small list of the guaranteed benefits. We could create an even longer list of the possible, probable, and future benefits of an EHR as well.  I’ll just cap it off with one simple example. How are you going to handle pharmacogenomic medicine on paper? It’s coming. The simple answer is that you’re not doing pharmacogenomics on paper. You’re going to need technology, and it will likely be connected to your EHR.

While I still don’t think we’ve realised all of the benefits that we could have (and many might say should have) from an EHR, we shouldn’t forget the many benefits an EHR has already provided. Far too often we evaluate our current EHR implementation against the perfect EHR as opposed to the alternative. EHR software has already provided a lot of benefits, but the most exciting thing is that we’re really just getting started. The future benefits will be even more impactful than the benefits we’re receiving today.

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Healthcare Innovation: Why You Need an Innovation Team

Healthcare Innovation: Why You Need an Innovation Team | EHR and Health IT Consulting |

Healthcare Innovation is the creative adoption and usage of technology that works to improve the quality of healthcare by enabling personalised care models to predict when adverse healthcare conditions may occur and to better manage the health status of a patient real-time. Obviously the adoption and implementation of innovative tools will require significant changes to existing patient care models and organization restructuring to focus on personalised care.

Advancing technologies can enable better patient interaction, wellness management processes, and predictive analytics that focus on keeping patients healthy. As these technologies advance, so will the needs and methods that healthcare facilities have become accustomed to. So, what can your organization do to keep up with the times and use innovation to better their facility?

HCIs Senior Vice President of Innovation and Technology Solutions, John McDaniel, has a framework for how to establish and build an innovation team – from the Chief Innovation Officer to an innovation council, and eventually up to an innovation center.

1) CEO's and the Board

Before getting into the team that will be responsible for directing and managing innovation within your organization, it is important to keep in mind that a healthcare facility must first get their CEO, executive team and Board of Directors to see eye-to-eye with the idea. After all, the agents of change within a healthcare organization are ultimately the CEO and the Board of Directors.

Innovation is a change in the way an organization most likely has done business for a long time, and this change will probably cause some members of your staff to be skeptical. A change in the way an organization has done things may be faced with some resiliency, but the world is changing, technology is changing, and it is the responsibility of the CEO to make the decision for the better of their organization. Creation of an Innovation Strategy is essential and will assist the CEO and the Board with finding the right candidate to be their Chief Innovation Officer.

2) Chief Innovation Officer

When using innovation to influence a healthcare facility, one of the first things that must be done is establishing a Chief Innovation Officer. Innovation is a journey, not a destination, and the Chief Innovation Officer will be responsible with creating the roadmap for this journey, as well as being able to think outside the box with relation to how healthcare is traditionally delivered. This individual will be the internal champion at the executive level for innovation and change, and will have an understanding of the process of healthcare today, as well as what it’s going to evolve into.

In addition, the Chief Innovation Officer is going to need to be a great communicator who can work within a team concept. They will need to be able to use their understanding of information technology and the clinical process in order to work with constituents to create the roadmap for their innovation journey. It can be very challenging to find an individual who exhibits all of these qualities – however, there are a number of organisations who have found resources such as these who are doing an outstanding job in helping transform organisations into a new models of care. They cannot do this alone, however, which is why they will look to create an innovation council.

 3) Innovation Council

An innovation council should consist of a combination of information technology, operations resources, planning resources, and clinicians. In addition, a good practice when forming an innovation council is to include at least a patient or two, because they will have a first-hand understanding of how they feel patients should be engaged, or how patients would like to be communicated with from a clinician (whether it be something such as TeleHealth or in person). Build a process or methodology around engaging with operational resources, clinical resources, and anyone else who is a constituent of your services.

Once your council has been assembled, you can begin to build a process where ideas are germinated and can be presented electronically. Your innovation council can then look at these ideas and begin to sift through them and decide whether or not they make sense based on your organisations strategic plan, or if they could be a current operational improvement, for example. They will then decide which ideas they will move forward with, and put together a high-level business case of what your organization will need to invest, what the change opportunity is, and how it can affect revenue. This innovation council will ultimately be the oversight for the organization in bridging operations with where the future of healthcare is going.

4) Innovation Center

The ideas that your innovation council has conceived and approved will need to be tested, and that is where the innovation centre comes in. Say, for instance, your innovation council has looked at 25 different projects, and needs to see how they will work. The innovation centre can build or test these new solutions, and can see exactly how they will impact the operations today, and how they will help to transform your organization into the future. The innovation centre is a lab, basically, that allows your organization to engage with partners to either provide a solution to a problem that you will be addressing or work towards the development of something completely new.

There are already some very good innovation centres out there, and they work to develop new products that can create a huge ROI in their organization, and have begun to take those and resell them. In some instances, the revenue that came from these resold technologies and applications was even greater than the annual revenue that was associated with patient care. They work with sophisticated, new concepts such as 3D printing, wearables, biomedical devices and their example is a great indicator of how beneficial innovation can be to a healthcare organization.

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Five Ways Healthcare Data Analytics Can Help You 

Five Ways Healthcare Data Analytics Can Help You  | EHR and Health IT Consulting |

A few days ago, the Human Health Services’ (HHS) Office of Inspector General released a report highlighting the 10 biggest management and performance challenges the healthcare industry is facing, and yet again, EHRs and health IT have made it to the list. Healthcare is complex and the challenges we face today might take years to overcome, in the transition from fee-for-service to value-based care, data analytics has a huge role to play as the building block of the healthcare industry.

Data Analytics has efficiently empowered healthcare organizations to thrive in a value-based world, and is not limited to:

  1. Real-time access to patient’s dataImagine having sorted, structured data easily accessible to physicians – this could be a game changer and save a lot of time simultaneously improving health outcomes. According to a post, many Primary Care Physicians (PCPs) see their patients at an interval of 11-15 minutes. With quick access to patients’ data like medical records, clinicians can rely on actionable insights generated after advanced analytics, and research data to treat their patients.A healthcare system based in Washington was facing the challenge of limited access to data. The process they had for obtaining patient information required them to submit a request to the department overlooking information, and after their request was processed it would present a thoroughly checked and validated data which could take two days or even stretch out to as much as a month. By using an analytics application to access real-time data, the wait time for information was reduced by 75-100%.
  2. Data-Driven Decision MakingThe traditional obstacles of compiling and analyzing data persist even with advancing technology. EHR systems are now widespread than they were in the past, with health IT providing interoperability, bigger chunks of data is processed making it convenient for providers to have all of the patient’s vital information compiled into a single record that helps drive improvements with accurate data. The aim is to share data easily.
  • Many providers have reported significant improvements in quality metrics after adopting health IT.
  • As of 2014, about 82.8% of office-based physicians have adopted EHRs, and since 2008, this number has been nearly doubled – from 42% to 83%.
  • The HITECH Act of 2009 grants $19.2 billion to increase the use of EHRs by physicians and hospitals.
  1. Better Care CoordinationData is integral to managing population health, imperative to improving population health and health outcomes. Hospitals are now turning towards data analytics to leverage the massive data and create effective treatment plans. Upcoming payment reforms and the shift to value-based care are serving as the bedrock to the healthcare paradigm shift. A Texas-based health system incorporated analytic tools and saw huge improvements:
  • Depression screenings saw a dramatic increase by 600%.
  • A 75% increment in blood-pressure screenings.
  • More than 700 patient visits were reduced, owing to analytics-empowered nursing.
  • Even though 900 patients every day are managed on an average, clinicians are able to examine the patients through their data and make a well-informed decision.

Analysis of data only takes one so far, after this comes the proper management of data, and the insight to make sense of it to make population health management truly successful.

  1. Improving Quality of Health Care Measuring data with all the quality metrics seems like a daunting task, and many providers are now adopting analytics tool to not only measure data, but to simplify the task of structuring data well enough for reporting. Lots of analytics tools being developed are now equipped with:
  • Analyzing data requirements for pre-defined quality measures
  • Providing initial data assessment and structuring it
  • Calculating quality metrics and payment adjustments
  • Tracking current performance and improving on it through advanced analytics
  • Providing considerable insight into population health

By using health information exchange, a value-focused organization was successful in reducing total office visits by 26.2% and increasing the number of scheduled telephone visits to the hospital by eight times!

  1. Making Way for Further InnovationsHealth IT has created room for innovation and focused development in healthcare, with healthcare companies inspired to adopt advanced technology, the focus is to develop something that makes the healthcare industry future-proof and focused on quality care. Some examples of innovations in the healthcare space.
  • A San Francisco-based company focused on asthma uses a GPS-enabled tracker in inhalers, that uses their location, analyzes the potential catalysts and provides them with personalized treatment plans.
  • A Silicon Valley-based company has created customizable ACO dashboards, which help providers improve their performance in healthcare services delivery using their claims data and aligning it with their goals.

As the healthcare industry moves from fee-for-services to fee-for-value, much has been done to gain the momentum, but to sustain it and grow with it demands healthcare members to tap the massive potential of data analytics. It can transform the current landscape of healthcare, and the future is dotted with several possibilities. Data analytics is still at a relatively early stage of development, but the rate at which advancements are going on, a revolution is underway. It could be the best thing since sliced bread.

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EHRs are legal records that can be used against providers in court

EHRs are legal records that can be used against providers in court | EHR and Health IT Consulting |

Much of the focus on electronic health records has been about their adoption and the requirements of the Meaningful Use program, but many providers may not realise that EHRs also represent legal records that can impact medical malpractice litigation.

While malpractice involving paper medical records often dealt with illegible clinician notes or confusing abbreviations that lead to errors, EHRs often involve other kinds of mistakes, such as those made by hitting the wrong item on a drop down menu, an article in Healthcare IT News outlines.

Another problem with EHRs in malpractice litigation stems from the inability of providers to prove that they made a clinical decision based on information in front of them in the tool. What's more, according to the article, printouts of an EHR, which can run to thousands of pages, do not look the same as when a clinician actually uses the software.


Jodi Daniel, an attorney at Crowell & Moring in the District of Columbia and former policy director for the Office of the National Coordinator for Health IT, says she’s anecdotally heard about physicians settling malpractice lawsuits, not because they were guilty, but because they couldn’t use the EHR to prove that a decision they made was based on the information available to them at the time, according to the article.

“They couldn’t demonstrate what they did and why they did it,” Daniel says. “They were forced to settle to make the problem go away.”

The article notes that there are still no clear-cut standards for the use of EHRs in discovery or as evidence in court. Those interviewed suggest that providers have policies regarding the EHR as a legal record.

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EHR algorithm can help with HIV prevention

EHR algorithm can help with HIV prevention | EHR and Health IT Consulting |

A machine learning algorithm shows promise for identifying, via data in their electronic health records, patients at high risk of developing HIV, according to research presented in New Orleans last week.

The work focuses on identifying patients who might benefit from pre-exposure prophylaxis (PrEP), a treatment to reduce the risk of developing HIV that’s been found highly effective, reports MedPage Today.


Failure to have sexual health and risk evaluations performed as part of routine care poses the greatest barrier to getting more people on PrEP, according to Douglas Krakower, M.D., of Beth Israel Deaconess Medical Centre. Though many physicians lack training or are uncomfortable talking about sexual health, EHR data can provide insight, he contends. A record of sexually transmitted infection testing or treatment suggests someone has had unprotected sex, while a prescription for buprenorphine or methadone indicates a substance use disorder, he said at the IDWeek annual meeting.


Researchers began by looking at more than 100 variables including demographics, diagnoses, drug prescriptions, laboratory tests, and procedures for patients at a large medical practice in Boston. They then compared characteristics and risk factors between newly infected HIV patients with control subjects who remained HIV-negative, according to MedPage Today.

Next, they used logistic regression modelling and machine learning to predict HIV infections, then compared the models to find the best at predicting HIV.

While this sub-population was only 1.1 percent of the clinic’s patients, it represented more than 8,000 patients who might be good candidates for PrEP.

The researchers plan to further fine-tune the algorithm at a community clinic that specialises in care for sexual and gender minorities where PrEP use is more common.

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2017 EHR Incentive Program Details

2017 EHR Incentive Program Details | EHR and Health IT Consulting |
The 2009 American Recovery and Reinvestment Act set up established payment adjustments under Medicare for eligible hospitals, who are not users of Certified Electronic Health Record Technology (CEHRT). According the CMS, hospitals that don’t demonstrate meaningful use for an EHR reporting “period associated with a payment adjustment year will receive reduced Medicare payments for that year.
 October 1st 2014 marked the first payment adjustments for eligible hospitals and now over 4,800 eligible hospitals may participate in the EHR incentive programs.
Straight from CMS
1.     What is an eligible hospital?
2.     How does a hospital demonstrate meaningful use in order to avoid a payment adjustment?
  • An eligible hospital demonstrates meaningful use by successfully attesting through either the CMS Medicare EHR Incentive Programs Attestation System through its state’s Medicaid EHR Incentive Program attestation system.
3.     How have hospitals received incentives payments? Are incentive payments still available? 
  • The Medicare Electronic Health Record (EHR) Incentive Program provides incentive payments for eligible acute care inpatient hospitals that are meaningful users of certified EHR technology.
  • Incentive programs are run by state.
  • The Medicaid EHR Incentive Program provides for incentive payments for eligible acute care hospitals and children’s hospitals.
4.     What is the FY 2017 EHR Eligible Hospital payment adjustment?
  • Eligible hospitals that are not meaningful EHR users are subject to a payment adjustment beginning on October 1, 2016.
  • This payment adjustment is applied as a reduction to the applicable percentage increase to the Inpatient Prospective Payment System (IPPS) payment rate, thus reducing the update to the IPPS standardized amount for these hospitals.
  • Eligible hospitals receive the payment adjustment amount that is tied to a specific fiscal ye
5.     How many hospitals successfully demonstrated meaningful use for the 2017 payment adjustment year?
  • In total, 98% of eligible hospitals and CAHs across the country have successfully demonstrated meaningful use at either Stage 1 or Stage 2.
6.     Is there an exceptions process for hospitals that did not demonstrate meaningful use?
  • Eligible hospitals may apply for hardship exceptions to avoid the payment adjustments.
  • Applications must be submitted no later than April 1st of the year before the applicable payment adjustment year.  The time period for hardship exceptions for the 2017 payment adjustment closed on April 1, 2016.
  • Hardship exceptions are granted on a case-by-case basis and only if CMS determines that requiring an eligible hospital to be a meaningful EHR user would result in a significant hardship.
  • Eligible hospitals are able to apply for hardship exceptions in: Infrastructure, New eligible hospitals, Unforeseen Circumstances, 2014 EHR Vendor Issues and Patient Access and Medicare Protection Act (PAMPA)
7.     Does a hospital have to achieve meaningful use each year to avoid the payment adjustments or can it avoid the payment adjustments by achieving meaningful use only once?
  • Eligible hospitals must demonstrate meaningful use every payment year according to the timelines detailed above in order to avoid Medicare payment adjustments.
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Two-Factor Authentication for Electronic Health Record (EHR) Apps

Two-Factor Authentication for Electronic Health Record (EHR) Apps | EHR and Health IT Consulting |

EHR Access Security

What are EHRs? EHRs are real-time, patient-centered records systems that make information available to authorized users that need to access, update and maintain them frequently for patient care - but making sure only authorized users are allowed access is part of the health IT security battle.

Only 16 percent of healthcare organizations are using one-time passwords with two-factor authentication, according to Healthcare Information Security Today’s survey, 2013 Outlook: Survey Offers Update on Safeguarding Patient Information (PDF). The report quoted Mark Combs, CISO survey participant from WVU Healthcare:

Designing for App Security with Two-Factor Authentication

Securing EHR applications with a two-factor authentication method that doesn’t impact provider workflows can strengthen access security. Using a two-factor method tied to a mobile app on your smartphone provides an easy way to authenticate using a device you already have, while push notifications give you fast access with just one tap to gain access.

And under federal regulations permitting the e-prescription of controlled substances, the regulations require the use of two-factor authentication, according to Health app developers should pay attention to security requirements of the industry to provide marketable apps and modules that will actually work for their clients.

Integrating two-factor with existing applications or platforms is easy with Duo’s APIs for Developers. Focusing on building access controls into health IT applications with two-factor authentication can help prevent healthcare data breaches.

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Tips for Doctors Switching to a new EHR in 2017

Tips for Doctors Switching to a new EHR in 2017 | EHR and Health IT Consulting |

When doctors consider switching to a new EHR, there are many variables. It is important to be aware of the pros and cons before switching to a new EHR.

In the past 8 years the growth has EHR adoption has skyrocketed, from 9% in 2008, up to 83% in 2015.

However not all doctors are satisfied with their EHR. In fact due to EHR satisfaction rates dropping in the past few years, many doctors are thinking about switching to a new EHR in 2017.

To assist with this task, here are x tips to help doctors make the switch to a new EHR.

1. Find a simple system

The reality is that most people who operate the EHR system in your practice are not IT trained professionals. They may basic computer literacy (typing, emailing, web navigation) but aren’t likely to be able to manage detailed reports or streams of data.

Looking for an EHR with a user-friendly, customizable interface is a great first step. In basic terms, the harder it is to figure out how to use, the less likely you will get full benefit from switching to a new EHR.

2. Don’t follow old routines

Just because an older EHR system has 5 steps to complete a task, doesn’t mean this should be the accepted norms. Look for an EHR that can automate simple tasks (e.g. reminders, messaging, schedule confirmation) so that your team can focus on more important details.

It is very clear now that paper-based processes aren’t the most efficient, but the same is true for. many long established EHR systems. Look for new innovations and automations to make your workflow and day simpler.

3. EHR Training and Support is essential

If you and your staff are not properly trained when switching to a new EHR, then you are likely going to limit yourself greatly. There are so many nuances and technical shortcuts that proper training and support can offer you. Make sure everyone receives as much training as they need. Keep in mind that support is the invisible value that is a part of implementing a new EHR. in fact, any EHR that doesn’t provide support as a part of the setup or monthly fees is not likely to be a great match for your medical office. The cost saving initially may lead to a loss of productivity and revenue down the track.

4. Look for the ability to connect with patients

While your staff may receive training, often patients have no idea that you have moved to a new EHR system. For them, they may be comfortable with a paper based system, or phone calls to confirm appointments. If this is the case, take special care to coach your established patients through the new EHR process. Doing so will ensure a smooth transition and a better relationship between the doctor, team and patient.

While it may seem costly and time consuming, switching to a new EHR can open up new opportunities to your medical office. It can automate old systems, reduce costs, and even increase revenue. Look at a wide variety, but choose an EHR that is simple, up-to-date and good value for the services provided.

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3 EHR Optimization Benchmarks Your Practice Should Be Using

3 EHR Optimization Benchmarks Your Practice Should Be Using | EHR and Health IT Consulting |

Following the implementation of an electronic health records (EHR) system, optimization should be the next critical objective for a medical practice. One way to plan a road-map for optimization is to generate benchmarks.

Below are three important benchmarks to help your practice determine if you’re getting the most out of your EHR system.

  1. Computerized Physician Order Entry Indicators

Some of the most important benchmarks in EHR optimization center around computerized physician order entry (CPOE) indicators. These indicators are critical for identifying the efficiency of an EHR, and complying with Meaningful Userequirements. Fortunately, these are often easy to benchmark. For instance, one indicator for a practice with a high volume of electronic prescribing is the number of pharmacist calls regarding contraindicating medications. This indicator is simple to follow, and can inform a practice whether or not an EHR system’s Clinical Decision Support (CDS) alerts or notifications are effective.

Other CPOE indicators that are simple to follow include anything from provider and staff logins to printer use and more. Bottlenecks in data entry can also indicate issues with in-house adoption and areas that could benefit from optimization.

Setting benchmarks for these indicators are an important way to track post-implementation optimization for an EHR system.

  1. Alignment and Standardization of Use

One very common area in need of optimization post-EHR implementation is standardization of workflows. Technicians, nurses, medical assistants, providers, and staff may all do the same task differently. While there will always be slight variation in workflows between team members, major differences (i.e. printing and scanning a document rather than importing data electronically) can lead to large gaps in optimization further down the road. Fortunately, this is measurable, and can be an important indicator to monitor as you optimize your EHR system. Striving for benchmarks within certain tasks and workflows, such as importing medical histories or documenting in-office medications, can help to clarify standardization (or the need for standardization) within a medical practice.

  1. Revenue Cycle Management Indicators

Successful implementation of an electronic records system should reflect financial benefits as well as positive workflow and improved patient indicators. Therefore, important benchmarks in EHR optimization include Revenue Cycle Management (RCM) indicators. Leveraging costs per provider vs. clinic volume before and after implementation (taking into consideration training and adoption periods) can help clarify areas that need further optimization. This may involve taking a closer look at EHR pricing models and what the practice’s needs are heading into the future, along with considerations such as personnel volume, clinic growth, federal reimbursements, and more.

Making Benchmarking Actionable

Benchmarking may begin as a method of determining the efficiency of an EHR system, but it doesn’t stop there. Monitoring indicators and determining strategies to achieve those goals also aligns a practice with the many objectives of electronic health records in the first place: improved patient safety, thorough documentation, and more efficient workflows, to name a few. Therefore, making benchmarking actionable is critical for the health of the entire practice and its patients. Creating teams to address issues with optimization and working through kinks in workflows after benchmarking and monitoring is the next step to operating a truly successful EHR system.

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Critical Roles in EMR Training Success 

Critical Roles in EMR Training Success  | EHR and Health IT Consulting |

Every component of a successful electronic medical records system implementation requires a thoughtful, strategic approach. Naturally, this includes EMR training, and one of the best places to start is to establish roles and expectations for all parties involved to ensure smooth implementation and effective training. It’s important to remember that internal management is just as important as vendor support, and below are just some of the important in-house roles to assign before beginning training.

  • The Executive Sponsor: Visualizing the Big Picture

For any project, either through a small business, large corporation, healthcare organization, or anything in between, the executive sponsor must be an individual who understands the organization’s needs and goals thoroughly. Often involved with management, the executive sponsor must have a big picture perspective, and for ” For this role, knowledge of how the EHR system will interface with the organization is more important than technical know-how.

  • The Project Coordinator: Pursuing EMR Training Outcomes

Unlike the executive sponsor, the project coordinator manages day-to-day issues with groups and individuals. The project coordinator should be a leader who understands the technical side of implementation sufficiently to serve as a knowledge source for the rest of the organization. Ownership of EHR training and its outcomes is critical for this role, and the assigned individual must be able to take accountability for this crucial stage of implementation.

  • Roles of Providers and Other Billable Staff

      EMR Training Success

EMR training roles do not end at the management level. For providers, billing staff, nursing, technicians, QA specialists, and others, key training roles exist that can complement an EMR training program – only if managed properly. Physician super users as trainers or guides during an EMR training program, for example, have demonstrated mixed results. One significant benefit of assigning physician super users is having an in-house expert who understands not only technicalities in the EHR system and how they relate to the individual clinic or practice, but who are available as a resource for providers and staff. Clinician super users should not, however, become a primary resource for information, as this can quickly lead to frustration and significant training gaps.

Always Consider Your Training Strategy

The Office of the National Coordinator for Health Information Technology (ONC) reviews three training strategies commonly employed by healthcare organizations during EMR implementation: super user training, role-based training, and process-based training.

Naturally, the selected training strategy will affect the structure and roles of your training team and roadmap. In all of these strategies, however, a common underlying theme is assigning training roles to individuals who can serve as an information resource for others who perform similar tasks.

Leverage Expert EMR Training from Your Vendor

In many cases, the EHR vendor itself provides expert trainers. Leveraging an EHR vendor is important throughout the implementation process, and this certainly applies to the training period. From classroom-style sessions to one-on-one instruction, different EHR vendors may provide various types of training to help you and your staff achieve fluency in your records system.

At ZH Healthcare, we understand training to use EMR isn’t complete until a healthcare organization feels confident in its utility. Our HITaaS (Health IT as a Service) system BlueEHS includes training to fit your unique needs and customization choices.

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Why EHR Customisation Matters 

Why EHR Customisation Matters  | EHR and Health IT Consulting |

Electronic health records shouldn’t be frustrating. However, many providers are finding themselves disappointed or aggravated by EHR systems that don’t provide the tools they need to support the very best care for their patients.

In fact, the American Academy of Family Physicians has noted a 30 percent decrease .in physician satisfaction with EHRs within the past five years. Reasons for this dissatisfaction include inefficient systems, deluges of tools that don’t apply to their practice or even generic modules that lead to inaccurate documentation.

Fortunately, customisation presents a key solution to these issues and much more.

Your Practice, Your EHR

Every practice is unique, and this should be reflected in each health records system. An EHR system for a small practice will need to operate differently than that of a large practice. Layouts, prescriptions, scheduling, patient education, and countless other EHR tools should reflect the needs of providers and their patients. Customised EHR systems impact not only the efficiency of providers and their staff but also the experiences and health outcomes of patients.

The Impact of EHR Customisation

Tailoring electronic health records to the unique needs of an individual medical practice impacts all parties involved, from the physicians and their staff, to administrators, to patients. For physicians, customisation can result in improved specificity and accuracy of data, whether with a patient or reviewing records outside the exam room.

EHR customisation examples can include setting dosage parameters, accommodating in-house test results, or even modifications to make the system mimic familiar and intuitive paper charts.

A system that is carefully tuned to the needs of a specific practice is far more efficient for users, and saves time for both providers and patients alike. And those specific needs are naturally different across-varying specialities. An ophthalmology practice, for example, would likely benefit from a very different EHR layout than a physical therapy practice or an urgent care clinic.

Not only can the speed and ease of utility improve with the adoption of a customised EHR, but also the quality of that data and accuracy of the information. A 2006 study illustrated that after customising EHRs, more than 50%of surveyed practices reported improved accuracy and quality of records. More accurate records and data means better patient care and ultimately better health outcomes.

Configuring the Best EHR

Determining the configuration of a system to maximise its usefulness and alignment with best practices requires careful planning. Resources who can help a medical practice ideally customise their systems include EHR vendors and third-party consulting firms, and of course, in-house experts such as providers and administrators who understand the practice’s needs and challenges best.

Customisation of a EHR system is an effective method of improving practice efficiency, accuracy, and communication for a medical practice.

What could make an EHR built for your practice? The Impact of EHR Customisation and How it works in configuring the best EHR for the Doctors.
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The Promise of Tomorrow’s EHR 

The Promise of Tomorrow’s EHR  | EHR and Health IT Consulting |

Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.

Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare.  This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital’s inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians’ needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.

To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is “not well.” In fact, EHRs are creating as much frustration as benefit.  Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It’s no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians’ professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there’s an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians’ use of EHRs.

Today’s EHRs have done little more than “pave the cow paths.” We’ve gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it’s optimized for and native to the technology that enables it.

Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it’s only going to increase.  As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, “Getting access to personal health information is the start of engaging patients to be full partners in their care.”

Patients of the (near) future are going to choose alternate care if they experience poor administrative practices, or if they don’t feel a connection with their doctor. And patients will know when technology inefficiency negatively impacts their quality of care, whether it’s due to admin issues or diagnosis.

In the coming decade we will begin to realize the benefits of computing and genomics in determining patient care. For example, modern medicine delivers anesthesia based on a number of factors, such as height, weight and age.  But people metabolize it very differently, and you can’t know how an individual will react unless you look at the genome. For the 20 percent of people for whom drugs do not work, it’s usually because of their specific DNA. But since this is something we’re currently not tracking, physicians are left to trial and error. Doctors should know what works for each type of person—perhaps based on what has worked for similar people in similar situations in the real world in the past.

On the technology side, EHR vendors aren’t going to get us to the next step. We must look to data, data scientists and innovative start-ups. Medical research and development is poised to move from a traditional molecular “hypothesis/proof” model to a data-centric “observation/analysis” model, in which it’s possible to do a trial without a (clinical) trial. Upwards of 90 percent of Americans are willing to share their medical data to benefit care and treatment research. We currently have enough institutions with enough data to build algorithms and apply them to other populations in such a way that we can change—and dramatically improve—healthcare.

It’s time to make healthcare work better for both patients and providers. Leveraging the innovative, ground-breaking tools we have at our disposal will propel healthcare quality and efficiency forward. Making EHRs and other healthcare IT as intuitive to use as Uber, Foodler or Google Maps will not only improve the quality of care, it will help to enhance the overall healthcare experience for everyone involved in it.



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7 Ways Telemedicine Can Improve Value Based Care & Lower Your Costs

7 Ways Telemedicine Can Improve Value Based Care & Lower Your Costs | EHR and Health IT Consulting |

Telemedicine is something that’s existed as a concept pretty much since the invention of the phone. Every form of effective long distance communication has been and can be used for medical consultations, whether between professionals, or between a professional and a patient. It was the recent advances of the Internet however, that brought telemedicine to the limelight and made it a hot topic of discussion.

In essence, telemedicine can have many forms – it’s used daily by organizations such as Doctors Without Borders to relay different questions regarding troublesome cases from countries across the planet. It’s used for providing medical consultations to places and people that simply don’t have the physical access to a medical professional. And it’s also used to save time for both professionals and patients when it comes to minor problems.

So what are the main ways telemedicine can improve a patient’s health and lower the medical costs of their treatment?


· Easier and faster patient–professional contact. In cases of emergencies, speed is often of the essence. Speed, that face-to-face consultation sometimes can’t provide, but telemedicine can. The amount of lives that have been saved by the swiftness of telemedicine rises astronomically every consecutive year and is hard proof of its benefits.

· Otherwise impossible or near-impossible contact between patients and doctors is made possible by telemedicine. Today, it connects instantly doctors and patients across the globe, making distances meaningless. This not only gives – quite literally – life to many people, but at the very least saves expenses to both sides.

· Telemedicine also provides easier and faster contact between professionals. Instead of doctors having to make decisions without consulting with colleagues, or wasting time in waiting for said consult, Telemedicine allows for quick and effective dialogue between professionals, ensuring the best decision is made as often as possible.

· Multiple studies have found a drastic decrease in the average length of patient’s stay in hospital, as well as in deaths overall due to the usage of Telemedicine. In 2015 a staggering 35% decrease was measured in patients’ average length of stay in ICUs, as well as 30% less deaths than predicted. That’s a difference of both thousands of lives, and huge reduction of hospital expenses. The US Telemedicine Association found that the amount of Americans that have went through any type of remote medical care during that year is above 15 million, with the numbers being even higher in 2016.

· Telemedicine allows for much faster reaction time in both diagnosis and additional examinations. Something like this saves not only the patient’s time (and potentially – live), but also saves the time of the medical professional, helping him or her be more efficient in his/her work. And with time being pretty much the most important resource in the medical field (or at the very least – one of the most important ones), including in First World countries, where hospitals are still frequently overcrowded – this makes telemedicine an invaluable asset.

· Telemedicine is a way for more frequent consultations with professionals. It’s a known fact that the vast majority of health problems escalate because they are usually caught too late. And that is so, because most people don’t like visiting hospitals and doctors, and don’t like spending time for routine examinations. Telemedicine makes prophylactic examinations so easy and quick, that an unthinkable amount of diseases and other health problems that would’ve otherwise gone unseen, are now caught in their earlier stages, when they are easiest to treat.

· Telemedicine is also a very potent way for doctors to interact with the online community and to improve their status as a skilled medical professional.


While these and other pluses of telemedicine are overwhelmingly positive, it’s undeniable that the field still has quite a way to go. Although it’s just as good as face-to-face interaction with the patient in many cases, in some – it’s just not the same. We can unfortunately witness the opposite side of things as well – wrong diagnoses and mistreatment of problems that could have been correctly done in person. However, those things are both eclipsed by the numerous positives of telemedicine, and are subject of improvement. With the advances done in both the online sphere and in medical technology, as well as the continuous refining of the rules of telemedicine, such problems are dropping at encouragingly high rate. Simply put, it’s getting undeniable that telemedicine is going to be a huge part of the future of medicine as a whole.

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An EHR wish list for putting genetic data to work 

An EHR wish list for putting genetic data to work  | EHR and Health IT Consulting |

As genetic testing becomes more common, clinicians are trying to determine how best to use the information at the point of care.

"Repeated genetic test results generated over many months or years are impossible to synthesise into a coherent representation of the patient’s condition without using a discrete, comprehensive or end-to-end technology workflow to support care," says Penn Medicine’s Brian Wells in an article at Healthcare IT News.

RELATED: Stanford, Google Genomics team up on precision medicine

Wells, associate vice president of health technology and academic computing at Penn Medicine, calls for specific features in EHR design to help ensure-genetic testing results are useful.

Among them:

  • Storing discrete genetic markers in EHR. Because community physicians typically have less knowledge about genetic data, clinically actionable variants must be separated from those of unknown significance and stored that way in the EHR. The tests must be stored chronologically and stored with other test results to be most useful.
  • Actionable rule-based alerts. Once stored that way, they can inform clinical decision rules to guide testing and treatment. Patient specific rules can be created to guide drug ordering to help ensure the most effective treatment.
  • Ongoing monitoring of patients for new actionable variants. As genetic knowledge evolves, the EHR needs to provide the ability to look back to find patients who might be eligible for new tests and treatments.

In a recent paper, researchers from the Mayo Clinic cited an increasing number of “fumbles” related to genetic screening due to use of out-of-date databases.

They argued that the healthcare industry must become "wiser users of genetic testing and even wiser interpreters of the genetic test results.”  

"The medical community and community at large need to get a better grasp on genetic testing and precision medicine rather than just using them as buzzwords," said Michael Ackerman, a genetic cardiologist at Mayo. "When used properly, these tests are incredibly helpful. But we must become wiser users of genetic testing and even wiser interpreters of the genetic test results so that we can make wise conclusions."

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 Integration of telemedicine visit data with an EMR 

 Integration of telemedicine visit data with an EMR  | EHR and Health IT Consulting |

Telemedicine is a means of connecting providers with remote or undeserved patients. Proper telemedicine systems are necessary to be able to conduct clinical examinations on a patient remotely. These telemedicine systems typically include an encounter management platform, specialised medical devices and video conferencing network. Importantly, the best telemedicine systems also pair seamlessly with other IT solutions. In this way, treating patients becomes more efficient and dynamic, rather than a technological silo.

Working alongside some of the most common EMR platforms, a telemedicine encounter can smoothly integrate data from a check-up or appointment. Images, EKG reports, vital signs data and other information is saved easily and securely, without disrupting existing workflows.


Business as usual
Practice Fusion found that only a decade ago, roughly 9 in 10 doctors in the U.S. updated and stored patient records by hand. Since then, paper charts and color-coded files have been replaced by EMR systems that are more efficient and more powerful. Telemedicine systems are also being quickly integrated into everyday healthcare services, and the combination of the two is both cogent and seamless .

A telemedicine encounter is easy and simple to navigate for doctors and patients.

Images from a telemedicine encounter can be easily added to a patient's EMR following an appointment. The same is true of X-rays, CT scans and other images, ECG reports, or vital signs data.  By working with existing EMR platforms, telemedicine systems can adapt to a provider's specific workflow. Because saving data and images is so easy, something as simple as an HL7 configuration file can be used to relay information from a telemedicine software platform into and EMR.  This is very much like the way a proper HIE system works. In this way, little needs to be changed in integrating a telemedicine system. This reduces lapses in production when implementing telemedicine into a practice. 

The most recent technology advancement making a significant impact on the world of integration between telemedicine and EMRs is the availability of robust APIs from the best telemedicine software companies.  This means healthcare professionals can work on one platform without having to manage two separate windows or applications, resulting in a much smoother workflow and faster adoption process.


Security and ease of use
EMRs are already leveraged to reduce administrative overhead and the possibility of human errors.  Paired, with telemedicine, the two technologies make it easier for healthcare professionals to manage patient encounters, control privacy and reduce the possibility of data entry mishaps.

The UI during a telemedicine encounter doesn't just make it easy to store patient data, but also works to eliminate misplaced or lost documents during the charting process. That way a doctor can quickly prepare for the next patient without worrying about any mistakes. The best telemedicine platforms come with robust security measures to ensure the patient encounter is private and well-protected from third-parties or sources of compromised privacy. In this way, it is easy to exchange information in real-time and store the data for later reference in an EMR.

An integrated UI also makes it simple for a physician to draw from a patient's EMR during a telemedicine encounter. This makes care more targeted and personal. While a physician is treating a patient using an embedded telemedicine system, an individual's EMR can also be accessed. In this way, an individual's entire health history is available to doctors, even if a patient is dozens or hundreds of miles away. This access to data allows for high-quality care that is more efficient, accessible and coordinated.


Technical Dr. Inc.'s insight:
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Dr Ray's curator insight, May 21, 2:55 AM

Integration with EMR is going to increase physician's adoption of telemedicine. Current Telemedicine environment reminds me of early days of EMR, late 1990 and early 2000.!

EHR direct review leaves patient safety gaps

EHR direct review leaves patient safety gaps | EHR and Health IT Consulting |

ONC’s increased oversight of EHRs embodied in new regulations doesn’t go far enough to protect patient safety, according to a new analysis from the Pew Charitable Trusts.

The new rule, released October 14, clarifies ONC’s ability to directly review certified EHR technology and hold EHR vendors accountable for non-conformities.


Both design errors and human factors have contributed to adverse patient safety events, sometimes seen as an unintended consequence of EHRs.


Pew warns that the new rule does not cover gaps in hospitals', doctors' and developers' ability to detect flaws that could put patients at risk because ONC requires only limited testing of EHRs to check for defects before products are installed and there is no comprehensive system to collect information on safety problems.

The analysis recommends two additional steps be taken to improve patient safety:

  • ONC should require vendors to better test EHRs for safety before bringing their products to market and after they are installed and customized to increased detection of flaws beforehand.
  • All stakeholders should come together to identify common safety problems and work together on solutions. Congress should pass legislation to establish this collaborative.

“These additional steps would help detect and prevent safety problems during the development and implementation of EHRs and reduce patient harm related to these products,” The analysis says.


Both design errors and human factors have contributed to adverse patient safety events, sometimes seen as an unintended consequence of EHRs.  

However, providers have been hampered in their ability to communicate safety issues attributable to EHRs for fear of repercussion from vendors, who by contract or otherwise seek to suppress such discussion. Even the EHR vendors’ code of conduct, updated earlier this year, doesn’t promote open discussion of patient safety issues except in certain circumstances.

The rule had received mixed reviews from stakeholders, with some applauding its attempts to improve patient safety and others concerned that ONC is over reaching its authority by delving into safety issues typically the purview of other agencies.

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Pros and Cons of Patients Scheduling Appointments Online

Pros and Cons of Patients Scheduling Appointments Online | EHR and Health IT Consulting |

Many patients are turning to the web to schedule doctor appointments. This trend is becoming more common as we continue to move forward. Its pervasive reach requires our understanding on why patients are scheduling with online booking systems and how doctors can utilise these to create a more efficient practice.


Status Quo
Right now most patients may be looking up and calling primary care doctors and specialists based on their health plan’s directory, and sometimes this doesn’t yield the desired results. It is also time consuming to play phone tag and attempt to work schedules back and forth over the phone, meaning it can be easier for patients to feel frustration when using this method.

Online Appointment Scheduling
Fortunately, there are online scheduling sites where patients can see doctor’s calendars and find the ones that accept their insurance. These scheduling websites have grown a huge demand throughout the patient community. We use online booking agents for travel, and now we are beginning to see them gain popularity within healthcare. So what are the pros and cons of online appointment scheduling?

There are still reservations as patients gain more control over a medical practice’s scheduling system. There is reluctance to allow patients to have full viewing inside of a doctor’s schedule. In addition, some patients may not be equipped enough to make their own appointments with the right amount of detail. Naturally, some doctors are not ready to give patients such control. 

Some concerns doctors are facing with the new automated scheduling systems are the following:

  • Patients won’t understand certain nuances in a doctor’s scheduling system, such as not having an appointment booked after a long string of meetings.
  • Patient’s may not have the kind of medical information to understand how and when they should be scheduled for an appointment, depending on certain questions that medical practices will ask of their health. Is a patient having a problem that requires a routine checkup or are they experiencing something emergent?
  • Clearly there are some nervous responses to be had when considering patient information safety during online interactions. This is a common concern with the handling of any information over the web, whether it be credit card info, identity theft, or HIPPA concerns when doctors communicate with patients online.


Even though there are concerns, it is still important to consider how efficient it can make your practice along with the many other benefits these scheduling systems implement.

  • Online scheduling has allowed practices to save money and the time of certain secretarial positions. No-shows become less common as these automated systems will send up to three reminders to the patients before the appointment.
  • No-shows become less common as these automated systems will send up to three reminders to the patients before the appointment.
  • With proper online security and encryption when using web-based schedule platforms, and the patient and doctor can stay HIPAA secure.
  • When patients receive multiple online reminders from the automated system, there are fewer no-shows.
  • With greater convenience, patient staff satisfaction goes up!

Understanding and utilising online booking mechanisms is a part cultivating an optimised clinical presence. Patients use these to have control and autonomy with their own schedules, while also saving time and understanding their health on a more personal level. Research the different options and decide which kind of e-booking platform would work best for your clinic.
It is important to be mindful of concerns that follow with having an automated scheduling system, but part of allowing these online systems to grow and evolve in a healthy manner requires the input of doctors and clinics. Over time, the refining of this software will help promote the efficiency of practices and their usefulness in today’s healthcare system.

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Tips to Avoid Trouble with Copying EHR Documentation

Tips to Avoid Trouble with Copying EHR Documentation | EHR and Health IT Consulting |

Being able to copy and paste information in the EHR saves time and improves efficiency. But when physicians use the functionality inappropriately, it can also cause significant patient safety issues.

Robert Giannini, NHA, CHTS-IM/CP and Lorraine Possanza, DPM, JD, MBE, of the ECRI Institute, talked about some of these issues and how to mitigate risk during a presentation at the 88th annual American Health Information Management Association’s (AHIMA) annual convention held October 16-19 in Baltimore, MD. The ECRI Institute is a nonprofit organization that applies scientific research to improve patient care and safety.

“Electronic health records aren’t really the cause [of safety issues]—but they do play a role. It’s important to keep that in mind and to be cautiously aware of what’s going on,” said Possanza.

Much of the problem stems from an over-reliance on EHR automation and shortcuts, said Giannini. He reminded attendees that these shortcuts come in many forms, each of which require user validation. Examples of these shortcuts include the following:

  • Selecting data from an original source and reproducing it in another location either by keyboard (Ctrl + C to copy and Ctrl + V to paste) or with a mouse
  • Duplicating a note (i.e., cloning)
  • Bringing forward a portion of a previous note or the entire note
  • Automatically drawing data from another part of the record and inserting it using a specific command (i.e., auto-fill)
  • Automatically populating text in each record (i.e., auto-completion)


When physicians copy and paste information frequently, they run the risk of jeopardising the integrity of the information, said Possanza. “Is that information timely, accurate, and contemporary? It may not be,” she added.

Documentation that is copied and pasted can also lead to an over-abundance of information in the medical record. Physicians may inadvertently overlook important data. Unfortunately, this can lead to diagnostic error, said Giannini.

“The note becomes so big, long, and convoluted that you really can’t tell the true picture of what’s going on with the patient,” he added.

The ECRI Institute’s Copy and Paste Toolkit, a free resource, includes several examples of how physicians use copy and paste functionality incorrectly. Following are a few of them:

  • A physician copies and pastes admissions information, imaging study reports, and labs from a previous day’s notes into current-day progress notes, making the notes difficult to follow and interpret.
  • Communication by email in the patient portal includes information pasted from another patient’s chart.
  • Vital signs are copied and pasted from previous visits into the current-day history and physical exams.
  • Lab information is identified and copied but pasted into the incorrect chart.


Copy and paste compliance: 4 tips
​Possanza and Giannini provided these tips to help practices ensure compliance when using copy and paste functionality in the EHR.

  1. Work with your EHR vendor to ensure that copy and paste information is easily identifiable. This ensures that information can be verified for accuracy, and it facilitates review for edits.
  2. Ensure that you can trace the provenance of copied and pasted material. This allows practices to verify that the information is appropriate and accurate, and it may also increase the potential to defend the record and achieve billing compliance.
  3. Ensure adequate staff training and education regarding the appropriate and safe use of copy and paste functionality. Focus on the benefits as well as the potential patient safety risks from improper use.
  4. Monitor, measure, and assess copy and paste practices regularly. This ensures the integrity of the clinical record, the quality and safety of care rendered, and compliance with state and federal regulations.
Technical Dr. Inc.'s insight:
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Stephen Lopez's curator insight, December 14, 2016 7:03 AM
Contact Details : or 877-910-0004