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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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.


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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.
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Stephen Lopez's curator insight, December 14, 2016 7:03 AM
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Health System to Integrate Cerner Revenue Cycle With EHR

Health System to Integrate Cerner Revenue Cycle With EHR | EHR and Health IT Consulting |

Olathe Health System, one of the largest providers in the Midwest announced it will integrate its existing enterprise-wide EHR with Cerner Revenue Cycle. The relationship expansion will deliver advanced integration between Cerner’s clinical and financial solutions enables streamlined coordination of care across inpatient and outpatient facilities, as well as independent physician practices. It also is designed to enhance the patient billing experience by enabling data to flow through the system in near real-time.


Additionally, Olathe Health System will implement a suite of Cerner oncology solutions designed to provide care teams with the necessary tools to manage complex medication orders. Olathe Health System will also implement RxStation®, Cerner’s automated medication dispensing device.


“The potential patient benefits and outcomes are truly what drive our business actions, including this decision to expand our health IT system,” said Randy Rahman, vice president and CIO of Olathe Health System in a statement. “Our goal is to bring our organization onto one platform to work toward becoming one of the most integrated and progressive health care providers in the region. We understand the value that Cerner’s system-wide integration can provide to Olathe as we strive to develop the best patient experience and satisfaction possible.”

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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 |

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 |

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 |

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 |

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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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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Mobile EHR Platform for Large Medical Practices

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

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 |

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 |

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 |

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. 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.

Technical Dr. Inc.'s insight:

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