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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Advanced EHR Use Shows Potential to Lower Patient Costs

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

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


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


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

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

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

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


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

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

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


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

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


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


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

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


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

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

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EMR vs EHR – What is the Difference?

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

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

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

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


What’s the Difference?

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

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

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


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

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

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


Benefits of EHRs

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

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

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

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Introduction to Electronic Health Records (EHRs)

Introduction to Electronic Health Records (EHRs) | EHR and Health IT Consulting |


Overview of the EHR

The Electronic Health Record (EHR)– then called the Electronic Medical Record (EMR) or Computerised Patient Record (CPR)– received it first real validation in an Institute of Medicine's (IOM) report in 1991 entitled "The Computer-Based Patient Record: An Essential Technology for Health Care. IOM drove home the idea that the EHR is needed to transform the health system to improve quality and enhance safety.
The speciality of family medicine has also stated that the EHR is a core technology for the future of family medicine in the Future of Family Medicine Project. This project outlines a "New Model" of care for family medicine with the EHR as "the central nervous system" of that model. The EHR becomes a tool through which the family medicine office can transform practices to meet its needs and the needs of its patients. Enhanced workflows and access to information make the practice of medicine more efficient for physicians and their staff. Decision support and automated reminders help the practice deliver safer and higher quality care to patients and the community.
The EHR is about quality, safety, and efficiency. It is a great tool for physicians, but cannot ensure these virtues in isolation. Achieving the true benefits of EHR systems requires the transformation of practices, based on quality improvement methodologies, system and team based care, and evidence-based medicine.


Basic Terminology

The following is a list of basic terms you will need to know as you navigate the EHR market:


  • Certification - This relates to a national effort to "certify" various requirements for EHR software. The Certification Committee for Health Information Technology (CCHIT) is tasked with determining what basic "must have" features EHR systems contain in order to be "certified."
  • Electronic Health Record (EHR) - This term refers to computer software that physicians use to track all aspects of patient care. Typically this broader term also encompasses the practice management functions of billing, scheduling, etc.
  • Electronic Medical Record (EMR) - This is an older term that is still widely used. It has typically come to mean the actual clinical functions of the software such as drug interaction checking, allergy checking, encounter documentation, and more.
  • Integrated EHR - This refers to an EHR that is integrated with practice management software. Typical choices include purchasing a fully integrated product which performs all the functions of practice management software, or a stand-alone EHR which is compatible with an existing practice management system.
  • Structured and unstructured data entry - There are several ways of entering data into your EHR as you practice. These include dictating straight into the software (voice recognition), templates, and writing (handwriting recognition).
  • Templates - Pre-structured portions of the software for common and/or basic visits. These templates fill in a standard set of data which you may then customise for each individual visit. Templates can be used with dictation, writing, or choosing among a menu of options formulated for each specific template.


Potential Benefits of an EHR


Potential Productivity and Financial Improvement

  • Fewer chart pulls
  • Improved efficiency of handling telephone messages and medication refills
  • Improved billing
  • Reduced transcription costs
  • Increased formulary compliance and clearer prescriptions leading to fewer pharmacy call backs
  • Improved coding of visits

Additional potential benefits may include: population management and proactive patient reminders; improved reimbursement from payers due to EHR usage; and participation in pay-for-performance programs.


Quality of Care Improvement

  • Easier preventive care leading to increased preventive care services
  • Point-of-care decision support
  • Rapid and remote access to patient information
  • Easier chronic disease management
  • Integration of evidence-based clinical guidelines


Job Satisfaction Improvement

  • Fewer repetitive, tedious tasks
  • Less "chart chasing"
  • Improved intra-office communication
  • Access to patient information while on-call or at the hospital
  • Easier compliance with regulations
  • Demonstrable high-quality care


Customer Satisfaction Improvement

  • Quick access to their records
  • Reduced turn-around time for telephone messages and medication refills
  • A more efficient office leads to improved care access for patients
  • Improved continuity of care (fewer visits without the chart)
  • Improved delivery of patient education materials


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Benefits of EHR for patients & healthcare providers

Benefits of EHR for patients & healthcare providers | EHR and Health IT Consulting |

As more healthcare facilities, from hospitals to private practices, move from paper charts to electronic medical records, the benefits will increase to both practitioners and patients: Electronic health records can be accessed on demand, and can potentially save lives.


Benefits to Patients

Electronic health records contain significantly fewer errors than paper records, according to experts.

Communication between physicians can be greatly improved with the use of EHR, allowing each party full access to a patient’s medical history rather than a snapshot-type overview from a current visit. This access allows for a more in-depth evaluation, and enables doctors to reach an accurate diagnosis more quickly.

In addition, electronic health records can make it easier for doctors to follow up with patients and track continuing care, both under their supervision and that of the patient’s other doctors.

"I can quickly and easily pull up test results in the exam room to review with my patients," Sandhya Pruthi, M.D., of Mayo Clinic in Minnesota says on the Mayo Clinic website. "I also can verify when they had past exams or procedures. I can even show them results of their imaging tests on the screen."

At the very least, electronic health records can save time during a doctor’s office visit. And in case of emergency, these records can provide critical, life-saving information to emergency care providers.

People who find themselves in mass casualty situations, such as natural disasters, can benefit greatly from electronic medical records. Healthcare providers can use EHR in an emergency situation to get a more accurate picture of a patient’s medical history more quickly than with traditional means.

Catastrophic events have demonstrated that patients in these situations are often confused and frightened, making it easy to forget personal medical details. Every second counts during an emergency, so having access to a patient’s medical history, blood type and allergy information, when the patient is unable to communicate can be the difference between life and death. Also, the digital format can make quick access more scalable.


Benefits to Healthcare Providers

When a patient is under the care of multiple doctors, tracking his or her history, including allergies, blood type, current medications, past procedures and other relevant information, can be problematic when relying on paper charts. The use of electronic health records allows multiple care providers, regardless of location, to simultaneously access a patient’s record from any computer. The electronic record can provide up-to-the-minute information on the patient’s full history, including current test results and the recommendations of other physicians, allowing more efficient collaboration on multiple facets of a patient’s care.

Medical practitioners can quickly transfer patient data to other departments or providers, while also reducing errors, which yield improved results management. Both patients and employees often respond positively to these process improvements, as it can help keep a facility’s schedule on track.

Reducing medical errors is obviously of tremendous benefit to both doctor and patient. An electronic health records system of information eliminates the problem of lost and/or misplaced patient files while also naturally eliminating data errors that can occur from transcription.

According to experts, the advantages of emergency health records produce a marked increase in the health-related safety of patients.


  1. Less Paperwork and Fewer Storage Issues

    In the healthcare industry, administrative duties represent a significant amount of time and costs. Clinicians and staff can spend a large portion of the workday filling out and processing forms. Because they are paperless, EHRs streamline a number of routine tasks. As the amount of paperwork decreases, the required storage space also declines. With instant storage and retrieval of digital EHRs, healthcare providers may see their offices become less cluttered, as storage needs decrease and efficiency rises.

  2. Increased Quality of Care

    EHRs provide the ability to exchange complete health information about a patient in real time. Accurate, up-to-date and thorough information naturally leads to a higher quality of care, from better diagnoses to reduced errors.

    By sending automatic reminders for preventative visits and screenings, EHRs can help also patients better manage their conditions and participate more fully in their healthcare.

    When it comes to medications, paper prescriptions can be lost or misread, leading to errors in dosage or even the wrong medication being dispensed. Electronic prescribingallows physicians to communicate directly with the pharmacy, reducing errors and saving time by eliminating lost prescriptions. Patient safety is also improved, as electronic prescribing automatically checks for potentially dangerous drug interactions.

  3. Financial Incentives

    Procuring the necessary equipment, hiring the personnel to implement it and training staff on new procedures to transition to EHR can be costly for healthcare providers. Fortunately, financial incentives are available to help organizations recoup their investment.

    Through the Medicare EHR Incentive Program and the Medicaid EHR Incentive Program, eligible providers (EPs) can earn incentives for the adoption and meaningful use of EHR technology.

  4. Increased Efficiency and Productivity

    EHRs can be more efficient than paper records by allowing centralized chart management, and quicker access to patient information from anywhere with condition-specific queries.

    Communication with other clinicians, insurance providers, pharmacies and diagnostic centers is faster and trackable, which cuts down on lost messages and follow-up calls. Office management is streamlined through integrated scheduling that is linked to progress notes, automated coding and insurance claims. All of these EHR features generate significant time savings, leading to greater productivity.

  5. Better Patient Care

    As explained above what’s good for healthcare providers is often good for patients, too. Streamlined access to a patient’s complete records means no more filling out the same paperwork at each doctor’s or specialist’s office.

    Every provider can see which diagnostic tests a patient has had, along with which treatments worked and which didn’t. Patients are less susceptible to duplicative testing or imaging procedures, because the results and images are all in one place. Better coordination among providers leads to more accurate diagnoses, improved management of chronic conditions and better overall patient care, which should always be the central focus of healthcare provision.

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EHR & Artificial Intelligence Can Reduce Medical Errors

EHR & Artificial Intelligence Can Reduce Medical Errors | EHR and Health IT Consulting |

Electronic health records save lives by collecting patient data in one place. Artificial intelligence takes it a step further by calling on the expertise of multiple doctors.


While I had heard that almost 400,000 Americans die each year because of medical mistakes, in a recent article Forbes contributor Dan Munro underscored that volume when he asked readers to imagine the largest commercial aircraft -- an Airbus A-380 -- crashing every day for a year: The number of passengers who would perish aboard those imaginary crashes compares to the number of patients really dying annually in our hospitals due to blunders.

People who want nothing to change usually dispute the number of deaths. For the sake of argument, let us assume the actual number could be represented, then, by one crash every four days. Even then, surely it is worthwhile trying to figure out how to prevent these errors.

Certainly, procedural failures or pure accident causes some errors but incomplete or incorrect information about the patient is at the heart of a large percentage of these mistakes.

As Munro points out, a major problem is that the current healthcare industry is incentivized by revenue and profits -- not safety and quality. Therefore, as newly re-elected Florida Governor (and former healthcare CEO) Rick Scottsaid at a recent meeting to discuss cutting costs in healthcare, the industry has been unwilling to voluntarily reduce profits. Since safety and quality using current methods would be expensive and slash profits, perhaps electronic health records (EHRs) and health information technology (HIT) could  accomplish the  goals of all stakeholders.

EHRs can maintain patients' complete medical histories, along with all known allergies and medications. The record should travel with patients, no matter where they go for treatment. Doctors do not have to rely on the patient's fallible memory at every encounter. The record speaks for patients, even if patients are incapacitated for any reason.


We must recognise that doctors often face points of no return -- and patients get no second chances. Choosing the right medicine or treatment is frequently a game of probabilities. Choose the right medicine and the patient will live. Choose the wrong one and the patient will die. This is why even the most qualified doctors often seek second or third opinions before embarking on a risky treatment plan. Doctors have told me countless stories about their ability to save patients because a complete EHR was available. In these cases multiple doctors were able to view the same information at the same time, often while residing thousands of miles apart. They collaboratively agreed on the best option -- and saved the patient's life.


EHRs also facilitate artificial intelligence. A patient's medical history often is full of reams of data; manually winnowing through that information is a daunting task. Today, teams of top doctors help develop artificial intelligence systems that can quickly determine if a proposed medicine, food, or medical procedure will likely cause the patient greater harm than good. This will reduce a large number of medical mistakes.


There is no cause for concern. Decisions suggested by artificial intelligence systems developed by top-notch doctors likely are more accurate than decisions made solely by humans. Watch Vinod Khosla discuss this fascinating issue. All doctors are not created equal. As Khosla pointed out, studies show that if you give the same data on a patient to a random group of 10 doctors and ask them if surgery is recommended, half will choose surgery while the other half will choose not to perform surgery.

If artificial intelligence systems are built using the medical minds of the doctors that choose the right answers, these technological solutions sift through an incredible amount of data and provide more medically reliable recommendations. Of course, a human doctor still makes the ultimate decision. However, the doctor has the benefit of a large amount of data analysis and is much more likely to make a decision based on complete information, not incomplete data.

Perhaps EHRs plus AI will save many more lives and dramatically reduce medical errors without increasing costs too much.

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How Medicine has centered on Healthcare IT Discovery ?

How Medicine has centered on Healthcare IT Discovery ? | EHR and Health IT Consulting |

With the federal government spending tens of billions of dollars to push healthcare providers to install electronic health record systems, health information technology has been at the forefront of innovation in the healthcare industry for most of the past decade.

So it came as no surprise that the rise of health IT figured prominently in reader choices when they were asked which innovations are making the biggest differences in healthcare today—or will in the future.

Information technologies took three of the top five spots out of 31 possible choices. There were 543 respondents to the online poll. Each voter could make up to 10 selections in the poll taken to help celebrate Modern Healthcare's 40th anniversary.

Electronic health records topped the innovations list, chosen by 53% of respondents. The internet ranked No. 3, chosen by 48%, and big data was No. 4, selected by 46%.

The intertwined healthcare payment/clinical reforms of accountable care and population health management placed No. 2 with nearly half (49%) of survey participants selecting them as a top innovation. Stem cell therapy ranked No. 5, with 43% of respondents choosing it.

An American Hospital Association survey shows 96% of U.S. hospitals now have an EHR. But even some of the biggest boosters of EHRs say they and other health IT systems are merely promising tools in a complex healthcare innovations armamentarium.

“We want to take advantage of all this data and make it applied at the point of care,” said Dr. Paul Tang, co-chairman of the federally chartered Health IT Policy Committee and chief health transformation officer for IBM's Watson Health division. His firm's goal is to harness the computing power of the Watson supercomputer and use big data to deliver actionable intelligence to EHRs for the purpose of population health improvement. “You can see how I'm wrapping in No. 2 and No. 4 to make No. 1 more potent,” he said of the survey responses.

There also were dissenters. EHRs, while significant, shouldn't have been ranked first, according to Dr. William Bria, chairman of the Association of Medical Directors of Information Systems, a professional organization for physician informaticists. While he has been promoting their use for decades, he said he believes the poll overestimated the importance of EHRs to healthcare because patients weren't surveyed. “No one is going to throw it (the EHR) away,” he said. “But to say the EHR is the alpha and the omega—no, it's not.”

As healthcare moves toward more patient-centered care, Bria said, the importance of the EHR will fade and other technologies will become more useful. Bria cited devices that monitor, support and advise the patient, or secure provider-patient communication tools. “The internet has won the battle,” he said. “Everybody's got access to it. The idea is we've got to directly communicate with the patients with it.”

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Health IT: Supporting Us as Caregivers

Health IT: Supporting Us as Caregivers | EHR and Health IT Consulting |

Being a caregiver is hard, but health IT can help caregivers manage a loved one’s care. From tracking multiple medications to having all your health information in one place, health IT and new mobile technology are proving to be valuable resources to patients and people like me, those of us who take care of a loved one.

As a child, I was always oblivious to the difficulty of navigating the healthcare system. My mother coordinated my care and made sure I visited the appropriate doctors at the appropriate time. That changed in 2008, towards the end of my senior year in college, when she was diagnosed with End Stage Renal Disease. I was stunned by the amount of work and the responsibilities that came to me as my mother’s caregiver and “medical home.”

For starters, I had no information about my mother’s medical history—she was the superwoman and glue that held our household together. So when I was asked about family history and who her primary care physician was, her ER nurse and doctor were met with my tears and endless blank stares.

How was I supposed to know?

The healthcare system did not care that I didn’t know and my level of readiness was not their concern. My life was transformed and from that day forward, I was dubbed caregiver—care coordinator and documentarian extraordinaire for my sweet mother.

The life of a caregiver is not glamorous—no one aspires to be a caregiver because it usually signals something has gone terribly wrong. More than 90 million caregivers across the U.S. provide nearly $450 billion worth of unpaid care annually. Many of these caregivers are full-time workers. Younger Americans between the ages of 18 and 29 make up 36% of the family caregiver population.

As a family caregiver it means the decisions you make have a direct impact on your patient’s daily comfort and their overall quality of life. We perform both complex medical and nursing services like medication management and wound care for our loved ones, but also the mundane tasks like bathing. I’m frequently responsible for coordinating her care and making sure the proper pieces of health information flow between her primary care doctor and the myriad of specialists.

I’ve essentially become my mother’s medical home, making sure that she followed up with the home care agency when she was discharged from a hospital-stay, or bringing a summary of the last doctor’s visit from her primary care physician in Maryland to her nephrologist in Washington, D.C.

There are also a number of co-morbidities associated with a disease like ESRD, so making sure she has an assigned specialist to monitor her heart, vision, nutrition, etc. was something I needed to stay on top of. Yes, she had a primary care physician, but the reality is, as a caregiver I’m much more sensitive to her needs.

Health Information Technology has been an extremely useful tool in managing/coordinating my mother’s care. The road wasn’t easy, the learning curve was steep, but I’ve been using a number of mobile health applications to help manage my mother’s overall wellbeing a little better. I am much more efficient and have learned to save a lot of time.

With the help of these different health applications, I can compile the summary notes from her visits and document questions I have about her care so that when she does need to see her doctor, the questions are well-informed and very specific. The number of readmissions due to her kidney disease and diabetes has decreased dramatically—from 14 readmits in 2011 to two only admissions so far this year. When healthcare professionals in the hospital can’t seem to talk to one another or share notes, I at least have all the up-to-date insurance information, prescription lists, and her physician contacts centralized in one place.

The other benefit I’ve experienced is with the coordination of her social services. I’ve found there’s a disconnect between the health component and human services. My mother’s diagnosis and disability meant she had to stop work. The best way to describe the coordination of social services, pre-health IT, is “baptism by fire” (no kidding). However, with mobile apps, like Blue Button, I’ve been able to do some of the financial reconciliation on her Medicare claims data, often required for some of the social services offered at the state level.

Health Information Technology can be fun (really). Health IT has helped me become more efficient—I’m now using a number of food apps to get ESRD-friendly recipes (we have to be mindful of things like acid, and potassium among other things). I’ve also downloaded applications that provide us with at-home exercises/activities.

It’s been a rewarding experience as an ONC team member. I’ve had the opportunity to use the tools and better understand the policies that are digitizing health care in a way that offers patients (and their families) better access, better health and lowered costs. As we continue our work on the implementation of meaningful use stage 2, aligning our program work with patient-centered models like ACOs and the medical home.

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Using patient-generated information to improve health and care

Using patient-generated information to improve health and care | EHR and Health IT Consulting |

Providers base their care decisions on a wide variety of patient information, such as patient and family history, vital signs, reports of symptoms or response to treatment.  This information traditionally is created in a visit to a provider or laboratory, but there are increasing examples of information being created by the individual or caregiver outside the clinical setting and reported to the provider.  This information is known as patient-generated health-information (PGHI) or patient-generated health data (PGHD). 

PGHD has been described as health-related data created, recorded, gathered or inferred by or from patients, family personal caregivers or designees to help address a health concern.  This data could be an observation, a test result, a device finding, a confirmation or a change/correction/addition of data in the patient’s existing health record.

While PGHD is not new, there are no widely accepted practices or policies to define its best use, much less to support its growth as a valued health care tool.  Beginning in 2012, ONC initiated a series of policy activities to advance knowledge of the field and promote implementation.   As 2013 draws to a close, we are pleased to report that a lot of progress has made.  A report from a Technical Expert Panel, convened at our request by our cooperative agreement partner the National eHealth Collaborative, captures the breadth of issues and opportunities for wider use of patient-generated information.  Their work contributed to positive discussions by the HIT Policy Committee and HIT Standards Committee in their respective December meetings about including a PGHD objective in Meaningful Use Stage 3, which is still under development.

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Few Ways How EHR Can Stop Physician Burnout In Its Tracks

Few Ways How EHR Can Stop Physician Burnout In Its Tracks | EHR and Health IT Consulting |

Physician burnout isn’t fun. It can lead to increased errors and lower-quality care for patients – and in some cases, consequences for patients are irreversible. Some physicians equate EHR use with more homework, believing the common misconception that spending extra hours each night, finishing up notes, addressing inboxes, and catching up on messages and emails, is inevitable. It’s not. While many physicians feel that technology, along with government regulation and the tremendous change in the healthcare industry, adds to today’s main burdens contributing to burnout – optimizing the right EHR software will actually greatly increase a physician’s efficiency.


A good EHR will serve your workflow, not hinder it; a sophisticated, integrated EMR system will function as a useful physician tool. When all of the components of your software speak to each other seamlessly, the stream of your practice as a whole improves.


Part of making sure your EHR helps you evade burnout (rather than cause it) is learning how to utilize the entire system optimally. You should strategize your EMR use and need to document. Your EHR needs to do everything from allow you to flow efficiently through a chart to improve your revenue cycle time. Optimize all of these functions and you’ll increase your profits and overall quality of patient care. That way, you can enjoy all of the reasons you really became a physician – and go home at a reasonable hour.


Choose your practice’s EHR champion: Figure out who on your team is an EHR power user – this is your technology leader. Just watching his or her process will help you by giving you a plethora of tips and shortcuts to dramatically speed up your process.


Delegate: Allocate duties and tasks in your EHR that don’t require your specific talents or skills to other members of your team, or explore the option of hiring a trained scribe. Use your team; don’t try to do everything on your own. Sharing your workload within your EHR is one of the easiest ways to start alleviating burnout. Begin conversations with your team members on how you can work together to share documentation duties.


Choose a cloud-based EHR with full functionality on an iPad: You shouldn’t have to chart from home – or record the same notes twice.  When your EHR is designed for an iPad, you can chart at the bedside or exam room while maintaining eye contact with your patients. Perform a complete SOAP note and chart from anywhere you can connect to the Internet, from your iPad or iPad mini (in addition to any mobile device, tablet, laptop or desktop platform). You can choose to touch, talk or type, depending on what method will be fastest and more efficient for you. Dictation functionality is built in and can be used to replace typing for faster data entry and you can prescribe and check your schedule from your smart phone. Mobile medicine is paramount to efficiency in your practice.


Make sure the system you choose is truly integrated: Piecing together a patchwork structure of tools that don’t speak to each other well will only make for a clunky, inefficient and frustrating process. When your system is seamless across the EHR, Practice Management, Clearinghouse and Patient Portal, you will cut down on errors and a lot of redundant manual data entry.


Use and optimize your integrated patient portal: Correct use of a sophisticated patient portal will undoubtedly reduce clutter and save time. When patients check in well before their visit, and enter their histories and current medications themselves, your staff members can spend their time on other duties – and the patient’s information will be organized before their visit. Having easy access to their lab results and the ability to electronically communicate with your practice will also save time you or your staff spends on phone calls.


Blueprints: Software is meant to be automated. While templates are helpful in the automation process, blueprints take the level of sophistication and flexibility steps beyond templates. Your system should provide the blueprints and customization you need. You should be able to repurpose old encounters as favorite blueprints, making them easily accessible.


Coding: Using an EHR with advanced ICD-10 coding features and enhancements will save you time by guiding you to the most precise code appropriate for the clinical presentation of your patients. An efficient ICD-10 code search and conversion tool will eliminate many hours you would otherwise spend manually looking up codes, especially when the coding requirements become much more stringent late in 2016.


e-Prescribe: Most EHR systems have an e-Prescribing module, but did you know that over 200 EHRs borrow their interface from a third party? Working on an EHR that has a fully integrated e-Prescibing interface will enhance workflows and save time. In addition, providers should only work with e-Prescribing modules that have been awarded the Surescripts White Coat Quality “seal of approval.” Remember, high quality electronic scripts reduce the time providers spend managing rejections or phone calls from their local pharmacist.


Alerts: Alert overload kills productivity. Alerts should only be disruptive to a workflow in the case of a serious patient health risk, like a drug to allergy alert. Less critical alerts should be subtle, enough to notice but not disruptive to workflows. MediTouch Health Maintenance alerts are a good example, they are obvious enough to have prevented a case of colon cancer (see our blog post about how our Health Maintenance Alert helped a patient receive the care he needed) but not disruptive to the typical SOAP charting workflow.


Don’t employ a dinosaur-era EMR system. When you choose state-of-the-art software, your EHR should cut the effects of burnout for every member of your practice. MediTouch is cloud based, truly integrated, with mobile-friendly interfaces; optimizing all of MediTouch’s features will help your practice run smoother so that you can get home on time.


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How Health IT Enables Safer Medical Travel & Tourism 

How Health IT Enables Safer Medical Travel & Tourism  | EHR and Health IT Consulting |

IT innovation, global medicine and frustrated medical patients drive the demand for medical travel. But telemedicine also improves patient care and the customer experience of medical travelers. Once again, we welcome medical IT entrepreneur, Agha Ahmed, Managing Partner of GHIMBA, as we explore how IT innovations help patients get high-quality healthcare outside of the USA.


How do IT innovations help provide services that medical travelers can benefit from?


IT helps deliver safe medical care and a pleasant trip to facilities overseas. For more than 20 years, IT innovations have improved patient care worldwide. Now, these innovations are helping medical travelers, too.


How so?


In telemedicine and m-health, telecommunications, mobile devices and information technologies provide clinical health care at a distance. (M-health is the practice of using mobile technology in healthcare.) There are three important devices and software capabilities that help deliver the promise of medical travel:


  • First, there are electronic media records. With an EMR system, it’s easy to gather patient clinical notes, diagnostic scans, medical administrator records, and discharge summaries in digital form. By automating and streamlining clinical workflow, IT cuts the time and effort needed to maintain information and create the data trail needed for medical audits and QA procedures.


  • Then, there are smartphones. Our familiar hand-held computers are becoming an important enabler in the cloud-based healthcare infrastructure. An EMR system deployed in the cloud can make a smartphone a virtual healthcare wallet. Patients can access their medical records from a smartphone and share the information with overseas healthcare providers.


  • Finally, data mining and analytics. Data mining and analytics technologies combine, prepare and search massive data stores gathered from many sources. Combined with analytics software, a cloud-based EMR system provides easy access to the knowledge and insight that overseas doctors can use to identify medical problems. And, patients can learn about cost-effective treatment for specific diseases and conditions without leaving home.


These innovations work with participants in the medical travel industry to deliver value to patients and business opportunities to entrepreneurs.


What’s the most important thing that IT provides patients and entrepreneurs?


Powerful data sharing and analysis, anywhere in the world. Cloud computing and modern IT devices make it easy to transfer, analyze and share massive amounts of medical data, quickly and safely. IT contributes medical services that patients and overseas healthcare providers can be confident in. There are three notable capabilities.


  • IT makes comprehensive medical information accessible. All patient-related data is stored in a single, authoritative source in a cloud computing center. Centralized data management makes it easier for qualified medical travel solution providers to identify gaps in information and synchronize the data and people involved at each step in patient care.


  • IT helps patients get the best care available. By hosting medical records, cloud computing centers become part of an ecosystem, which includes globally accredited hospitals and clinics. Healthcare providers anywhere in the world get easy access to medical information before patients arrive. Or, patients can use their smartphones to download information when they arrive. When highly qualified practitioners analyze and share medical information, patients benefit.


  • IT provides patients with a smoother, more pleasant trip. Internet data searches and medical travel solution facilitators reduce the time, effort and worry of finding, traveling to and engaging medical facilities overseas.


Cloud computing and other IT innovations can help make offshore treatment a safe, cost-effective alternatives to U.S. healthcare. These innovations can be used with medical travel facilitators and solution providers to deliver world-class medical services.


Where can we find out more about IT and medical travel?


Telemedicine is a major topic in an upcoming conference, the Medical Travel and Global Healthcare Business Summit in Tampa, Florida. If you’re wondering about medical travel business opportunities, you’ll want to check out the conference, which will be held on June 14th through 17th. The summit is designed for healthcare and wellness providers, IT services business leaders, and hospital and clinic administrators.


The conference discusses business and technical aspects of medical travel, including how IT, telemedicine and m-health support travel logistics and patient care. The emphasis is on finding and making the most of the many business opportunities available to entrepreneurs and healthcare industry professionals.

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Richard Stern's curator insight, July 8, 2016 9:15 AM

Safety and Health are priority issues when travelers have business travel needs on a regular basis. Technology innovations contribute to the likelihood of a better outcome.!

Should You Test Your EHR Data Backup and Restore Process?

Should You Test Your EHR Data Backup and Restore Process? | EHR and Health IT Consulting |

It’s common knowledge that backing up data for your medical practice is critical forprotecting against devastating losses of patient data in the event of a natural disaster, system glitch, or hardware failure. But practices should go further than simply backing their data up; testing these backup and restoration processes is just as important for ensuring data safety as the initial backup itself.


Why Backups are Important


For practices that utilize EHRs, having backups is critical for a number of reasons. While the first scenario that many imagine is a catastrophic loss of data resulting from a server malfunction or local event, this is not the only reason to have a data backup.

Experts recommend backups to protect againstsecurity breaches or viruses, to provide continuity of care across multiple providers or in the event of an outage, andthe protection ofvaluable assets for research and analytics.

Medical practices should establish scheduled, automatic backups as well as perform manual backups after making any system changes.


Your Backup is Only as Good as its Restore


When preparing an EHR data backup procedure, it’s important to remember that the value of your backup is congruous to the quality of the restore. A backup is no good if the restore is incompatible with current hardware or software, which is just one example of what can go wrong.


Particularly for practices using an EHR vendor, it’s essential to confirm compatibility of the restore with current systems. This restore must also be promptly accessible, and establishing synchronization with an EHR vendor is importantfor this timeliness. Checking post-restore integrity as a routine part of testing can ensure that once your restore is complete, your data will be accessible and useable.


How Will You Know if Your Backup is Good?


One of the most effective ways to know if your backup is good is to run a test. The test should exercise the system using common work processes that access multiple types of data.  The worst case is when a practice believes they have beensuccessfully backing up their data, only to find out that the backups are incomplete.


Other restore fail scenarios include practices that have discovered that theyhave only been backing up their software (URL:, not their data. This kind of loss can be devastating for patients and providers alike, and regularly running tests can protect against these situations.


Scheduling Your Backups


Aside from testing the functionality of backups,strategically determining the times that these systems will run will prevent interference with staff or clinic activities. Frequency also depends on how much data the practice can afford to lose. If a backup runs weekly, this means that a worst-case scenario could result in the loss of six days’ worth of data.


Depending on practice volume, agenda, and other factors, setting goals and quantifiable standards for backups ensures alignment with best practices.




Protection against disaster-borne data loss, along with the convenience of external management,has led many practices to choose third parties or their EHR vendor to administrate backups.  Don’t rely on external entities to validate your backups.  Internally test and verify your systems restore process too.


At ZH Healthcare, our BlueEHS services offer complete peace of mind with multiple layers of protection, including automated backups and “snapshot” components which can be used to restore your systems quickly. In addition, we offer on-demand download access from the cloud, and in-house data storage. 



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Is Your EHR On The Right Track ?

Is Your EHR On The Right Track ? | EHR and Health IT Consulting |

Medical Records Briefing (MRB) is conducting its benchmarking survey on electronic health record implementation, and we would appreciate your input. Please take a few moments to complete this survey.


To show our thanks, we will select one respondent at random to win a complimentary HCPro webcast of his or her choice. To enter to win, please include your contact information at the end of the survey once you have answered the questions.


Entering your contact information will also enable us to email you the results of the survey along with commentary from industry experts. The results will also be featured in the October 2015 issue of MRB. The link below will take you to the survey’s website; simply click on the link to answer the survey questions online.


If the click-through does not work, please copy and paste the URL below into the address bar of your browser.

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The Critical Importance of Comprehensive EHR Survey Data 

The Critical Importance of Comprehensive EHR Survey Data  | EHR and Health IT Consulting |

In order to respond to the question of survey populations, I would like to provide a summary of the survey oversight and governance process as well as a more detailed explanation of the methodology that American EHR uses to conduct EHR surveys.


  • American EHR Partners is a vendor neutral eHealth data organization that has been collecting information around EHR systems for over 5 years. Over 5,800 verified clinicians surveys have been completed since the launch of the site in 2010. All of the data collected is free for physicians and professional associations. American EHR Partners does not endorse any products or services. The program provides ratings on certified EHR systems. Ratings are based primarily on surveys of physicians conducted through their professional societies. Ratings are displayed on all EHR vendors regardless of their participation in the program.


  • Ratings are only displayed once a minimum number ‘n’ of survey responses have been received; the current minimum value is ten ratings. The rating scores are aggregated from the relevant questions asked on the physician user surveys, and these questions are available to the public. The ‘n’ is presented for all product ratings to assist the user when interpreting the rating data.


  • From time-to-time, American EHR Partners develops reports based upon the data collected.


  • American EHR Partners has a stringent governance process. Four advisory groups have been established to provide feedback on the American EHR Partners program. These are: Physician Advisory, Professional Society Advisory, EHR Vendors Advisory and a Healthcare Stakeholder advisory that includes national organizations not represented in the first three advisory groups.


  • All professional society participants, automatically have a seat on the society advisory group. The purpose of this advisory board is to guide American EHR from a specialty and subspecialty perspective and to provide guidance on education, collaborative initiatives and future development in relation to specialty and subspecialty physician groups.


Survey sample selection


When conducting a survey in conjunction with a professional society partner, for example the Physician Use of EHR Systems report, a randomized sample of members from each participating organization are surveyed. As the professional society partners are regularly surveying their members on a variety of topics, and in order to prevent over-surveying, each provides a random sample of members with active email addresses in order to conduct the American EHR survey. Each survey group receives an initial invitation to complete the survey as well as 1-2 reminders. Because the sample is selected randomly from the member database, we expect that some individuals will not be using EHRs. These individuals are excluded in the survey registration process. While it is desirable to be able to survey an entire professional organization’s membership, this is not possible due to the number of additional surveys that each organization conducts of their members as well as the issue of survey fatigue.


Prior to collection of data for the Physician Use of EHR Systems  report, an extensive review process was undertaken to update the American EHR survey in conjunction with the American Medical Association, American College of Physicians and the American Academy of Family Physicians. In particular, American EHR worked with AMA Market Research staff to formulate new questions designed to examine the economic impact of EHR use and the role of scribes. In order to keep the overall length of the survey at its current level, AMA and American  EHR agreed to eliminate questions that were not effective and/or addressed in other parts of the American EHR  survey.


When the 155 question survey is conducted, all physicians are verified either directly in conjunction with their professional society through a verified sample, against the AMA Physician Masterfile or in limited situations through a manual process.

Due to the comprehensive nature of the EHR survey, the survey takes approximately 20 minutes to complete. However, the detailed nature of the data collected also provides key insights into the adoption and use of EHR systems by clinicians in varying practice sizes and by specialty.


We stand steadfastly behind the methodology, process, collection of data as well as the interpretation of the results as presented in our most recent report. In particular, we believe that the ability to survey physicians in conjunction with their professional organizations provides the most relevant and representative information on actual experiences in the use of EHRs.

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Using Electronic Health Records to Help Coordinate Care

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


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

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


Problems with the Current Paper-Based System

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

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

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


Barriers to the Widespread Adoption of Electronic Health Records

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


Standardisation of Clinical Information

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


Cost of Implementation and Maintenance

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


Physicians’ Readiness to Adopt the EHR

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


Privacy Issues and Patients’ Concerns with Information Sharing

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

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

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


Legal Liability

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


Current Clinical Data-Sharing Activities

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



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


Ambulatory Clinical Physicians

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

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


Institutional Providers

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

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


Health Plans and Insurers

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


Disease Management Companies

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


Federal Health Programs and Agencies

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


Regional Initiatives

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

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


Remaining Stakeholder Concerns and Possible Solutions

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

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



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

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

5 reasons a physician should consider EHR 

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

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


Benefits of using EHR’s

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


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


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


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


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

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


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

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How to choose the right electronic health record (EHR) consultant

How to choose the right electronic health record (EHR) consultant | EHR and Health IT Consulting |

You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the exact reimbursement process will not be known until the fourth quarter of this year, at the earliest.
Nonetheless, there is a growing field of people who call themselves “EHR consultants.” They promise to advise you on which system to purchase for your needs, help set up and integrate the necessary hardware and software, and perhaps even troubleshoot any on-going problems you may have. Sounds tempting, right?


The difference is in the details
Let me stress that many EHR consultants are legitimate and can provide valuable services at a reasonable price. But there are some pitfalls to avoid. First, let’s define the difference between a consultant and a reseller. A consultant should be completely independent and have no relationship, financial or otherwise, with the vendors they recommend or refer to you. Conversely, a reseller receives payments from an EHR vendor for providing leads or getting a practice to purchase that specific EHR. An ethical consultant (ie, a reseller) will let you know upfront that they have a fiduciary relationship with one or more vendors, and then you can make an informed decision on the advice they provide. Many consultants and EHR/technology “experts,” however, quietly arrange kick-backs with various EHR vendors and fail to disclose this conflict of interest to their perspective clients.

There is one quick way to tell if you’re dealing with a consultant or a reseller. A reseller’s services should be free to you because the vendor is picking up the tab by paying the reseller a percentage of the sale, or some other pre-arranged fee. You know in advance that a reseller is going to steer you toward a particular product, and you can thus take what they say with the same healthy dose of skepticism that we apply to information we receive from drug reps.

On the other hand, if you are paying for services and recommendations, then you are dealing with a consultant who should be giving you unbiased advice. Unfortunately, a good number of consultants accept fees from doctors but then also receive referral fees from vendors for sending them potential clients. These payments may be in the form of cash, discounted hardware and software, or anything else of value.


The wild frontier
The EHR industry is relatively young and appears to be one of the exciting growth areas in an otherwise slumping economy. But this has resulted in a Wild West-like frontier where the various players (eg, vendors, consultants, resellers, state and local groups, and other agencies) can say just about anything without disclosing anything. And many IT companies and other consultants (even physicians seeking to earn some extra money) have agreements with software companies to receive payment for steering potential clients toward a specific vendor. Surprisingly, many of these otherwise honest people feel that if they aren’t specifically asked if they receive compensation from vendors (whether it be for directing leads, providing a recommendation, reselling, or even providing consultant services to the EHR vendor), they don’t need to share this information with their client or colleague.

You need to ensure that the information you receive from these “experts” is unbiased and based on the reasonable approach of matching your practice’s needs with the available solutions. A few key steps could save you tens of thousands of dollars in hardware and software expenses, not to mention the frustration of being cajoled into purchasing an overpriced and unusable EHR that you’ll regret later:


• When considering an EHR consultant, ask them pointblank if they have any relationship with one or more vendors, and ask exactly how those relationships work.

• Ask the consultant how many practices of similar size and specialty they have helped in the past, and get at least three different practice names and contact information to confirm that they were pleased with the consultant, would recommend their services, and would use them again.

• For smaller practices, be especially wary of consultants who also sell IT hardware and/or technical support. In my experience, IT consultants tend to recommend significantly more complex (and expensive) hardware and software than is necessary for the average small medical practice.


The third point deserves a bit more discussion, since many of the consultants in the EHR space also provide IT services and sell computers, servers, and other hardware. The main problem with hiring an IT consultant for guidance is that all too often these technologically -minded people push equipment and policies that are significantly more expensive and complex than is reasonable to run a small practice.

In my experience as an EHR vendor, all too frequently when an IT consultant is used, the practice ends up not only spending much more on hardware than my non-IT-consultant practices, but they have much less of an understanding of their system and thus an inability to troubleshoot issues that arise from time to time. In fact, Amazing Charts (my EHR company) recently raised prices for additional providers because we found that larger practices tend to have overly complex technology infrastructures based on the recommendations of their IT consultants. These systems take more time and energy to troubleshoot, and much more frequently, hardware and network issues are the source of the difficulties that lead to downtime.


Everybody does it, right?
Even big companies can be guilty of up-selling unnecessary equipment to small practices. For example, Amazing Charts used to recommend our users contact Dell to get advice and affordable systems. While Dell certainly makes good and affordable hardware, many of our clients called Dell and ended up directed to Dell telesales representatives who regularly scared them into purchasing big servers, tape backup systems, and other equipment because they were a “medical practice.” Most of the up-selling of robust servers and other equipment is completely unnecessary if you perform regular data backups and follow basic networking guidance.

When a consultant does recommend a specific product, whether an EHR system or anything else, do some online research to find out what others have to say. The American Association of Family Physicians has a good site for researching EHR software (ie, the Center for Health IT). Message boards can be another useful research resource, if you have time to sort through all the garble.

The most important take-away from this month’s column is to make sure that your independent EHR consultant is not actually shilling for someone else. Get it in writing so you have some legal recourse if you make a purchase and have buyer’s regret a few months later

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Data exchange growing through EHR adoption, new study finds

Data exchange growing through EHR adoption, new study finds | EHR and Health IT Consulting |

 New research, published today in Health Affairs, from the Office of the National Coordinator for Health Information Technology (ONC) show that health information exchange (HIE) between hospitals and other providers jumped 41 percent between 2008 and 2012.


The research – authored by National Coordinator for Health Information Technology Farzad Mostashari, M.D., and ONC researchers – indicates that six in 10 hospitals actively exchanged electronic health information with providers and hospitals outside their organisation in 2012.


The research suggests that electronic health records (EHRs) and health information organisations (HIOs) are complementary tools used to enable health information exchange. Stage 2 Meaningful Use, which requires eligible hospitals to exchange with outside organisations using different EHR systems and share summary of care records during transitions of care, can help accelerate hospital use of HIE as a means to enhance care quality and safety.

“We know that the exchange of health information is integral to the ongoing efforts to transform the nation’s health care system and we will continue to see that grow as more hospitals and other providers adopt and use health IT to improve patient health and care,” said Dr. Mostashari. “Our new research is crystal clear: health information exchange is happening and it is growing. But we still have a long road ahead toward universal interoperability.”


Highlights of the new study show:

  • 58 percent of hospitals exchanged data with providers outside their organisation in 2012 and hospitals’ exchanges with other hospitals outside their organisation more than doubled during the study period.
  • Hospitals with basic EHR systems and participating in HIOs had the highest rates of hospital exchange activity in 2012, regardless of the organisational affiliation of the provider exchanging data or the type of clinical information exchanged.
  • The proportion of hospitals that adopted at least a basic EHR and participated in an HIO grew more than five-fold from 2008 to 2012.
  • Between 2008 and 2012, there were significant increases in the percent of hospitals exchanging radiology reports, laboratory results, clinical care summaries, and medication lists with hospitals and providers outside of their organisation.
  • 84 percent of hospitals that adopted an EHR and participated in a regional HIO exchanged information with providers outside their organisation.
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EHRs and healthcare interoperability: The challenges, complexities, opportunities and reality

EHRs and healthcare interoperability: The challenges, complexities, opportunities and reality | EHR and Health IT Consulting |

Communication gaps and data-sharing challenges are pervasive in healthcare, persisting between different providers, hospitals and payers, and even various departments within a health system. While technology promises a future of connected networks and free-flowing information, the challenge remains bridging the gap between data silos to improve patient care.


Connecting the plethora of data sources relevant to patient outcomes and care management is overwhelmingly cumbersome. The burdensome task of integrating all of these data sources distracts organizations from their core competency, effectively acting as a blockade to healthcare innovation. Clinical health records, including both primary care and hospital visits; payment information and history; patient-generated health data; pharmacy and prescription information; patient and family-health history; genomics; clinical-trial data; and so on – all of this information needs to be easily accessible digitally for providers as well as patients to realize the full potential and promise of interoperability.

Traditional EHR companies such as Cerner, Meditech, and Inter-systems are building patient-management tools that will help coordinate a patient's care beyond the four walls of any one health system. Healthcare technology leaders, like the aforementioned, are taking steps to capture patient-generated health data from outside of the clinical setting and bring it back into the patient's clinical story.


A common misconception is that EHRs are the lone solution to interoperability. EHRs were not designed as open systems that can easily pull in information from outside the clinical setting or connect data across multiple providers. Rather, these tools were created to coordinate patient care within a hospital, replacing paper records and filing cabinets. EHR vendors are unfairly blamed for the fact that healthcare is not more interoperable. Like any technology company, they build what their customers want to buy. EHRs are a part of the overall solution to interoperability; really, all healthcare technology is only part of the means to which we will achieve interoperability. Changes to physician workflow and new models of care – working in parallel with technology such as EHRs, patient portals and care management tools – are necessary for interoperability to be fully achieved.


We need buy-in from physicians and administrators to build care programs utilizing this technology. Too often, care teams are spending their time calling other providers about patient information, faxing paper records and trying to coordinate care efforts across a disjointed and disconnected system. This is a drain on resources that could be better spent with patients on site or remotely monitoring patients with chronic conditions. We need a network connecting this data to create more effective workflows, care coordination, and prevention-based models of care.


Whatever you choose to call it (interoperability, data liquidity or care coordination), we need data to flow easily throughout the healthcare ecosystem to improve the lives of patients. Expecting EHR vendors to solve this challenge alone will further delay an already long-overdue solution. We need all stakeholders – patients, physicians, technology companies, providers and payers to challenge existing conventions in order to make interoperability a reality.


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Is your hospital really paperless?

Is your hospital really paperless? | EHR and Health IT Consulting |

It is tempting to believe that your hospital is now paperless once you’ve implemented an electronic medical record (EMR) system or completed an EHR conversion. While EHRs are the biggest step toward going paperless, most organizations still manage volumes of paper which prevents the establishment of a truly integrated care team – one in which all information is available to all providers in near real time. Organizations that are not completely paperless cannot meet HIMSS Stage 7: a full digital environment where all clinical documents are available electronically within 24 hours of creation or receipt. Documents such as outside records, telemetry strips, ancillary results, signed consents, and “shadow charts” that are part of a patient’s overall record often remain on paper, and leave healthcare organizations with paper to manage and a disjointed care environment. The good news is that going paperless can be achieved in a variety of patient care settings and with minimal disruption.

Eventually it will be possible for patients, healthcare staff and clinicians to enter all data into a patient’s EHR and little or no paper will be required. Until then, improved workflows and exciting new technology can support going virtually paperless. Interested? Then keep in mind a few facts, and don’t let them go as you consider implementing at your facility:

1.     With the right technology, scanning can take LESS time than filing to a paper chart

2.     Scanning is a form of clinical documentation, it is NOT an “administrative task”

Paperless Is Possible

At Freed Associates, we’ve worked with several healthcare organizations, both large (400 beds) and small (30 beds), to implement a decentralized Point of Service (POS) scanning model to create paperless systems that are improving  quality of care, safety and performance. This POS model required the real time scanning of thousands of pages in clinical and registration settings.   It eliminated virtually all paper, and expedited the creation of a single and complete EHR.  Physicians and care providers no longer have to wonder where documents are or when they will be viewable in the chart.

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Progress on Adoption of Electronic Health Records - Health IT Buzz

Progress on Adoption of Electronic Health Records - Health IT Buzz | EHR and Health IT Consulting |

Since the American Recovery and Reinvestment Act – which included the creation of the Medicare and Medicaid EHR Incentive Programs – was signed into law, the nation has seen unprecedented growth in the adoption and meaningful use of electronic health records (EHRs). Between 2009 and 2012, EHR adoption nearly doubled among physicians and more than tripled among hospitals. Every month, thousands of providers join the ranks of hospitals and professionals that have adopted or are meaningfully using EHRs. As of October 2013, 85 percent of eligible hospitals and more than six in 10 eligible professionals had received a Medicare or Medicaid EHR incentive payment. Moreover, nine in 10 eligible hospitals and eight in 10 eligible professionals had taken the initial step of registering for the Medicare or Medicaid EHR Incentive Programs as of October 2013.


The Centers for Medicare & Medicaid Services (CMS) today proposed a new timeline for the implementation of meaningful use for the Medicare and Medicaid EHR Incentive Programs and the Office of the National Coordinator for Health Information Technology (ONC) proposed a more regular approach to update ONC’s certification regulations.

Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.

This new proposed timeline tracks ongoing conversations we at CMS and ONC have had with providers, consumers, health care associations, EHR developers, and other stakeholders in the health care industry. This timeline allows for enhanced program analysis of Stage 2 data to inform the improvements in care delivery outcomes in Stage 3.

The proposed timeline for meaningful use would have a number of benefits, such as:

  • More analysis of feedback from stakeholders on Stage 2 progress and outcomes;
  • More available data on Stage 2 adoption and measure calculations – especially on new patient engagement measures and health information exchange objectives;
  • More consideration of potential Stage 3 requirements;
  • Additional time for preparation for enhanced Stage 3 requirements;
  • Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization.

Expected Timing for Rulemaking

We expect that in the fall of 2014 CMS will release proposed rulemaking (NPRM) for Stage 3 and corresponding ONC NPRM for the 2017 Edition of the ONC Standards and Certification Criteria will be released in the fall of 2014, which will outline further details for this proposed new timeline. The final rule with all requirements for Stage 3 would follow in the first half of 2015.  All stakeholder comments will be reviewed and carefully considered before the release of the final rules.

What the New Timeline Would Mean for Providers

Eligible providers who have completed at least two years of Stage 2 would begin Stage 3 in 2017. We currently anticipate that eligible professionals would begin in January 2017, at the start of the calendar year, and eligible hospitals and critical access hospitals would begin in October 2016, at the start of the federal fiscal year.

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Amazing Steps To Encrypt Your Patient Data

Amazing Steps To Encrypt Your Patient Data | EHR and Health IT Consulting |

Think your practice is too small for a data breach to occur? Think again. It’s vital to stay on the right side of HIPAA requirements for data security. This isn’t always easy and can cost a 
significant amount, but in general, locking down data is less expensive than damage control after a breach.

Breaches of patient information are on the rise—138% from 2012 to 2013, according to breach data reported to the Department of Health and Human Services (HHS). And no system is completely theft-proof. However, there are steps you can take to make your privacy harder to invade. That’s important because many data thieves are opportunists who will bypass difficult targets in search of easier quarry.

  1. Consider hiring a security expert and conducting a thorough vulnerability assessment. It isn’t cheap, but there are payoffs for practices that consider this an investment.
  2. Partner with strong IT vendors and services. Is your EHR as theft-proof as possible?
  3. Encrypt all transmission of electronic private health information, including texts and emails.
  4. The biggest threat to data security in your office could be your most loyal employees. Train your staff to be vigilant about email and web use, and develop a policy for BYOD (bring your own device). Many patients and employees now use their own mobile devices—everything from smart phones, laptops and tabletsto wearables—in the workplace. BYOD policies must ensure patient data remains secure.
  5. At the other end of the technology spectrum, paper-based data breaches still account for substantial amounts of data loss. In 2012, for example, there were 50 reports of data loss to HHS involving paper documents, representing information for 386,065 individuals. If your office still has file cabinets full of paper folders, consider scanning then shredding or removal to a secure storage site.
  6. Many small and midsized medical practices are weighing the pros and cons of purchasing cyber or data breach insurance to mitigate the financial risks of a breach. This might be a good option for your office.
  7. Lead by example. HHS offers CME-eligible online educational programs that can help physicians understand what’s required to comply with HIPAA privacy and security rules.


If a data breach does occur, inform those affected as soon as possible, and identify the information that has potentially been compromised. Keep in mind you won’t be able to do this if you don’t know what data resides in your practice or what systems are networked.

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CywareCo's curator insight, August 26, 2016 6:32 AM
Healthcare security can no longer be ignored. The details of your entire life in the hands of a hacker who is willing to sell it for money will lead to identity theft -!

Electronic Health Record Solutions Don’t Make Errors, People Do It

Electronic Health Record Solutions Don’t Make Errors, People Do It | EHR and Health IT Consulting |

HealthITNews reports that the Centers for Disease Control and Prevention is expressing increased alarm about patient care errors that are being introduced as a result of poorly designed or poorly implemented electronic health record solutions. The US Food and Drug Administration has also be weighing in lately on whether Health IT solutions should be more tightly regulated.


Whether or not more regulatory oversight of Health IT is needed, I suspect many of us have experienced instances where health information about us is found to be in error. I recall when my mother was hospitalized for chest pain that doctors were treating her as though she had been a life-long smoker. In fact she had never, ever been a smoker. At some point in time, information about smoking history had been erroneously entered into the electronic record. Now, the doctors treating her for chest pain were making decisions about the likelihood of heart disease based in part on that information about smoking history. In my own medical records I have also found, and had to correct, occasional errors in medication history, allergies, and immunizations over the years.


Despite this, I would tend to put the blame not on the computer or the software. It is not generally these systems making the errors, but rather the people using them. Sometimes the wrong information has been entered into the system, as in the case of my mother. Sometimes, errors are made because the information being displayed is in the wrong chronological order or is buried in a user interface that is out of synch with real-world, clinical workflow. In both instances, the problem is with people—those who designed the software and those who use it, but not with the software itself or the machines running it. How can we improve on this situation? Here are four ideas:



Involve the Patient Right from the Start


In gathering the information that becomes the foundation of our medical records, we are putting too much burden on caregivers. How much of the complete medical history or SOAP note is information that comes directly from the patient? Chief complaint, history of present illness, past medical history, social, family and occupational history, medications, allergies, review of systems? All of this information is retrieved by “interviewing” the patient. Perhaps it would be more efficient and more accurate if the patient himself entered all that information into a kiosk, or some other kind of fully automated, information intake solution. Surely with today’s technology we could design systems that would do a more consistent and comprehensive patient interview and subsequent documentation of information without taking even a minute of clinical staff time. Patients could then review the information captured about them for accuracy before it was officially entered into their record. 



Ease the Documentation Burden on Clinicians 


We need to ease up on documentation requirements for clinical staff. The patient-centered machine capture solution mentioned above would help remove a lot of the documentation burden. The remaining documentation of the exam, differential diagnosis, and treatment plan could be better facilitated by free text, medical dictation solutions with natural language processing and coding technology on the back end. Nothing is more important that freeing our clinicians of the time currently being spent doing data entry.



Prohibit Templates, Cut and Paste


Templates simply don’t work because it is impossible to template the “patient story” and all of the other nuances of a good clinical exam. Likewise, cut and paste solutions are probably responsible for more medical misinformation and errors than anything else. EHRs should ban “cut and paste” capabilities altogether.



Share Information with Patients


At the end of the day, I believe all information in the medical record should be shared with the patient. The patient is an extra set of eyes, an extra check point if you will, against medical errors. Giving patients complete and full access to the information about them is not only a better way to engage patients in their care, but also a way to help make sure everyone is on the same page about their care. As eHealth advocates proclaim, “Nothing about me, without me!” I think this is sage advice for preventing misinformation and the introduction of errors in our medical records.


I would also be the first to admit that many, if not most of today’s electronic health record solutions are still too hard to use. They have been poorly designed in our attempt to replicate a clinical workflow previously based on paper records. As I have stated many times before, there is a unique opportunity to design solutions that really take full advantage of today’s technology



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Techniques For Matching Patient Record Data Across Disparate EHRs & Other Systems 

Techniques For Matching Patient Record Data Across Disparate EHRs & Other Systems  | EHR and Health IT Consulting |

Some of the most frequent questions I receive these days surround data interoperability and integrating multiple health IT systems. One of the biggest problems in connectivity is matching patient record data and ensuring that the same patient data in different systems is linked properly. Given how many times this topic comes up, I reached out to Cameron Thompson, Acxiom Healthcare Group Managing Director. Acxiom has an interesting method of patient data matching, called persistent links, and when I saw what they were doing for matching consumer records in non-healthcare settings (e.g. marketing) I thought some of you might want to learn about it. Here’s what Cameron had to say about the various techniques for matching patient data:


The promise of secure and seamless exchange of patient healthcare information is powerful. As payers, providers, Health Information Exchanges (HIXs) and Accountable Care Organizations (ACOs) move rapidly toward the full deployment of electronic medical records, healthcare IT professionals are grappling with a fragmented network of systems and data silos. These disparate systems and databases often house redundant copies of patient medical data in multiple formats, which limits the ability to see a true 360-degree view of the patient. The benefits from connected patient data are many, including:


  • Reductions in inaccurate coverage determinations.
  • Intelligent information sharing for clinical decision making.
  • Honoring patient consents and preferences consistently and accurately.
  • Minimizing risks of data breach with a unique health identifier that allows the transfer of patient information but NOT personally identifiable information such as name and address.
  • Reduction in time and effort in administrative processes including billing or claims inaccuracies.
  • Avoiding costly duplication or unnecessary testing.


To reduce these inefficiencies and solve the underlying problem, the new healthcare ecosystem needs an accurate means of identifying and matching patient record data to the correct individual across internal and external healthcare systems, including collaborative care delivery models.


Multiple systems across the healthcare enterprise produce duplicate patient records that are not easily recognizable as matches. Recognizing that Mary Jane Smith at 123 Elm Road in the 2009 clinical laboratory system is also Mary Collins of 78 Oak Street in the 2011 patient registration system is a challenge for any organization. Identifying a solid method for distinguishing patient information across multiple data systems and combining the data accurately will be pivotal to the effective adoption of Electronic Health Records (EHRs) and successful implementation of Health Information Exchange (HIE).


As organizations take on this challenge, several methods have been identified and considered to recognize an individual. Three leading methods can to be explored to achieve your business goals of continuity and cost reduction. These are:


1. Algorithm or String-Based Matching


An organization can develop an algorithm with string-based matching using identifiers in the existing data to uniquely identify individuals. The benefits of string-based matching include:

  • Recognizable practice – This is a well-known practice and resources capable of creating these programs are plentiful.
  • Options for processing – Algorithms can be created internally and run without sending data outside the organization or an external organization can be identified to conduct the match on the organization’s behalf.

Some of the challenges with this strategy include:

  • Inherent challenges in string-based matching – String-based matching relies on consistencies in reported names and addresses, which tend to change often.
  • Ensuring the accuracy of the data used in the algorithm – Manually entered names and addresses are often laden with inexactness. This makes string-based matching more difficult.
  • Absorbing the costs to develop and enable this identifier across systems – Costs would need to be incurred to develop, maintain and put the identifier into use across systems.


2. State-Issued Number

An organization can use another state-Issued number such as a state of issuance and birth certificate number. Benefits of this method include:


  • Development cost savings – using existing assigned identifiers would save costs on development of a new identifier.
  • Availability – an organization could select an identifier that is already available in many systems.

Some challenges with this strategy include:

  • Inconsistent data fields and record lengths – if state issued numbers are of different lengths this could create difficulty for the programmer creating the data field.
  • Protecting personal information from fraudsters – using a state-issued number could raise concern over identity theft with the proliferation of stolen Social Security numbers. Whether real or perceived, this information being made available opens the door for fraudsters to invade an individual’s privacy.


3. Persistent Links

Healthcare organizations should consider the use of highly accurate match technology that delivers knowledge-based persistent linking. This match technology delivers a set of persistent links a company uses to recognize their patients across a fragmented network of systems and data silos. Persistent Link match technology is regarded as the most precise match technology available to accurately resolve patient identity (such as AbiliTec, the linking technology offered by my company, Acxiom). The link provides a consistent, client-specific ID, across data variations, and it can be applied at all touch points and databases within an organization.


The use of persistent links, created from knowledge-based match technology, can provide:


  • More accurate patient recognition and identity resolution.
  • Greater control and governance around the patient data because each healthcare entity receives a dedicated set of encoded links, specific to their enterprise. This facilitates link transactions, minimizing the amount of personal identifiable information exchanged, aligning with the need for HIPAA compliance. Further, when multiple entities interact (e.g. an Accountable Care Organization between provider and payer) a unique link reconciliation can be processed by the provider in batch or real time.
  • A minimized amount of personal information that a healthcare entity needs to store as they use encoded links to integrate data and recognize patients.
  • Eliminate an upfront investment to develop and maintain identifiers. The first two options I mentioned – algorithms/string-based matching and state-issued numbers – require healthcare entities to develop and maintain the identifiers.
  • · Creation of a refresh cadence based on specific business needs, say monthly or quarterly, reducing non-matching exposure to the cadence latency.


There are also some challenges related to using persistent links:

  • Persistent link application and maintenance will be more costly and an organization needs to be willing to look at the investment in higher quality.
  • The healthcare organization needs to be willing and able to transmit records with personally identifiable information in a privacy compliant manner, such as encryption.


As healthcare organizations move forward by adopting technology to improve patient experience they will find that the accuracy of the data will drive their success. Organizations should consider each of these methods for recognizing patients, each have their benefits and select the method that best meets specific organizations needs.



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Who Owns The Data In Your EHR ?

Who Owns The Data In Your EHR ? | EHR and Health IT Consulting |

The concept of healthcare and EHR data ownership carries many implications for patients, providers, and medical practices. While experts agree that EHR vendors do not own the data, this has not prevented vendors from winning court disputes that resulted in serious financial losses for medical providers.


These considerations make the discussion of data ownership critical for any physician or medical practice that utilizes electronic health records.


Defining Data and Data Ownership


Healthcare data comes from a variety of sources. One is the patient themselves, who individually provide data to platforms such as patient portals. Another is the physician or healthcare team in the form of examination findings and clinical observations. Results from laboratory studies or radiology, along with data from other external healthcare providers or practices, also contribute to EHRs.


The number of parties who lay claim to healthcare data makes grappling with EHR data ownership even more complicated. Patients, providers, vendors, and the medical practice itself all have aninvestment in healthcare data, and there is often uncertainty over EHR data ownership. Amazingly both of these groups report that 20% simply don’t know who owns the data.


Establishing Data Ownership


The best method of minimizing disputes over EHR data ownership is prevention. Measures such as establishing data ownership early, defining terms, and enforcing guidelines are critical to minimizing trouble down the road. With EHR vendors, defining conditions of data exportation in the event the practice wishes to end a business relationship is critical.


For all parties, the concept of access must also be clearly defined. Terms include practice or provider access to data from the vendor’s servers, as well as patient access to healthcare data via portals or other mechanisms. The most common source of disputes is when a party wishes to leave the relationship; either the practice decides to select a different EHR vendor, or a patient wishes to port their data to a new provider.


Vendor Red Flags


For a medical practice, establishing terms of EHR data ownership must begin at the time of vendor selection. Identifying warning signs during this process can help providers avoid much larger issues in the future.


When choosing an EHR, keep an eye out for red flags such as unstructured data formatting (i.e. PDF instead of CCDA), an inability to meet the National Coordinator for Health Information Technology’s certification requirements,or restrictive contracts thatdemand exorbitant financial charges to port data in the event of a vendor switch.


Establishingproductive EHR data ownership for a healthcare organization takes careful planning.


The ZH Healthcare HITaaS (Health IT as a Service) architecture is designed with the needs of medical professionals and their patients in mind, meaning, among other things, that you own your data, and have complete administrative control.



Technical Dr. Inc.'s insight:

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How To Measure What We Cannot See In Healthcare

How To Measure What We Cannot See In Healthcare | EHR and Health IT Consulting |

These days it seems that everyone in healthcare is buzzing about big data and analytics, and no wonder. Transforming, if not reimagining, healthcare is going to take everything we’ve got. Achieving the triple aim of higher quality, better access and lower cost of care cannot be done without being able to measure what we do. As the old adage says, “if you can’t measure it, you can’t improve it”. To that I might add, “if you can’t see it, you can’t improve it”.


Anyone who has walked the halls of a hospital or clinic knows there is no shortage of data. We just aren’t very good at knowing exactly how to get our arms around it. Data is only meaningful if it is organized in ways that we can truly comprehend what it is telling us. Today, the smart money is on technologies that help us visualize and therefore understand data without the need of a PhD in advanced analytics.


One such tool is something we call Power Map for Excel. This 3D visualization add-in is now a centerpiece (along with Power View, Power Query, and Power Pivot,) within the business intelligence capabilities ofMicrosoft Power BI in Excel.


Information workers with their data in Excel have realized the potential of Power Map to identify insights in geospatial and time-based data that traditional 2D charts cannot communicate. For instance, digital marketers can better target and time their campaigns while environmentally-conscious companies can fine-tune energy-saving programs across peak usage times. These are just a few of the examples of how location-based data is coming alive for customers using Power Map and distancing them from their competitors who are still staring blankly at a flat table, chart, or map.


Please take a look at the video below. Then ask yourself, what if instead of mapping U.S. Power Production we were looking at:


  • Syndromic surveillance of the geospatial distribution and severity of an infectious disease


  • A real-time map of a hospital system’s nosocomial infection rate


  • A representation of the incidence of chronic disease plotted against the geographic distribution of toxins in air, soil and water


  • A facilities, capabilities and occupancy map of a region’s readiness for accountable care
Technical Dr. Inc.'s insight:

Contact Details : or 877-910-0004

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