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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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Medical boards keep wary eye on doctors' social media posts -

Medical boards keep wary eye on doctors' social media posts - | EHR and Health IT Consulting |
A survey of board executives finds that inappropriate communication with patients is among online behavior by physicians that could lead to an investigation.


When doctors go to social media websites, they may want to think twice about posting patients’ photos without permission.

Using the images could be considered unprofessional conduct by a state medical board, according to a new study.


Other online physician behavior viewed as troublesome by boards: citing misleading information about clinical outcomes; misrepresenting credentials; and inappropriately contacting patients.

The survey of 48 state medical board executives, published in the Jan. 15 Annals of Internal Medicine, found that these social media activities likely would prompt a board investigation of a doctor. The study concluded that physicians should never engage in such behaviors.

“When you post something publicly online, it’s something that could be online in perpetuity,” said study co-author Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, which represents 70 boards that oversee MDs and DOs.

What triggers an investigation?

One of the survey’s 10 hypothetical vignettes of social media posed to medical board executives shows a photo of three doctors, drinks in hand, at a hospital holiday party. Forty percent of executives said a complaint to the board about the posting would trigger an investigation — a “low consensus” among survey respondents.

But 73% took issue with a vignette of a doctor who posted photos of himself intoxicated.

71% of state medical boards have investigated doctors for violating professionalism online.

Getting a “moderate consensus” among respondents of posts that would prompt an investigation were a scenario of a physician’s blog that used potential patient identifiers and a vignette about discriminatory language on a doctor’s Facebook page. The least troublesome of the 10 vignettes was a doctor’s blog describing a clinical encounter with no patient identifiers (only 16% of executives said it would lead to an investigation).

“People can really do a lot to stay out of trouble by applying common sense and avoiding the trap that you can do something online you wouldn’t do in real life,” said study lead author Ryan Greysen, MD, MHS. He is an assistant professor in the Division of Hospital Medicine at the University of California, San Francisco, School of Medicine.

Previous research has shown that doctors and medical students can get in trouble online. An article co-written by Dr. Greysen in the March 21, 2012, issue of The Journal of the American Medical Association found that 71% of state medical boards had investigated doctors for violating professionalism online. A study, also co-written by Dr. Greysen, in the Sept. 23, 2009, issue of JAMA said 60% of medical schools had incidents of students posting unprofessional content online.

Guidance for doctors

In 2012, the federation issued guidelines to help doctors maintain professionalism when using social media. That guidance discourages physicians from interacting with patients on social networking sites such as Facebook and says doctors should adhere to the same principles of professionalism online and offline.

Delegates to the American Medical Association Interim Meeting in November 2010 adopted policy on social media use that advises medical students and physicians to be professional online. They should keep appropriate boundaries when communicating with patients online and respect patient confidentiality, the policy says.

The Annals study notes that improper behavior online can do more than spark a board investigation; it can lead to loss of employment or lawsuits by patients over privacy violations. The study said greater awareness of potential pitfalls is needed among doctors to avoid unprofessional behavior online.

To avoid problems, Dr. Greysen said, physicians should apply the same ethical and professional conduct online that they do in their daily actions offline.

“This may be a wake-up call to some doctors, not only to the value of Internet communication, but also to the dangers,” Dr. Chaudhry said.

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Social Media milestone to improve ehealth

Social Media milestone to improve ehealth | EHR and Health IT Consulting |
Social Media milestone to improve ehealth

New technologies are about to transform healthcare all over the world thanks to the interesting opportunities that content sharing and a wider people communication offer. For instance, personal health record (PHRs) development lead by multiple public organizations and private companies worldwide (such as uPatient by Medtep) will make personal health management easier while this tool takes the most of technological opportunities on communication.

Getting an open and uninterrupted patient-physician communication through PHR use is the best way to digitalize healthcare and improve its quality and value but, along that, Social Media creates a very comfortable and easy to use place to share and create content. In medical context, this content is developed mainly to make personal health management easier or softer and in most cases it is published by old patients related with different kind of diseases or medical issues. 



The point of sharing experiences and knowledge among people is a way of expressing empathy and offer some kind of “psychological” help to those who are living health worries but this relationship should never be used to make self-decisions to treat these difficulties without professional consultation.

Even if shared social experience can be useful to treat minor diseases, in front of serious maladies a patient must always access toprofessional assistance. Ehealth introduction does not replace the need of doctors or physicians in all the cases. Social Media contents and technological tools such as health apps (in which mhealth is based) are attractive and valuable resources to be used in healthcare but human resources are the more reliable and most experienced or educated ones who can treat people professionally.


Precisely, this point makes these resources taking part in Social Media an important way to improve healthcare quality and reliability. Healthcare related content in Social Media should be validated by professional institutions and controlled afterwards. Many technology or social based organizations or businesses are currently creating digital places and resources where to help on personal health management. But, since most of these agents do not have consistent medical support, content validation policies would be required if risky medical self-making decisions turn a real danger for human healthcare.


Social Media is a great tool for improving healthcare quality but professional assistance is essential to secure this positive development. Until this reality comes true, all Social Media consumer need to be careful and objective when consuming these contents.

This is the recommendation Medtep community would like to express.

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A Digital Health Manifesto: the future of healthcare, possible today

A Digital Health Manifesto: the future of healthcare, possible today | EHR and Health IT Consulting |

It’s easy to get excited about the future of healthcare. Thanks to advances in web and mobile technologies there is tremendous potential to create exciting new health services.  Hundreds if not thousands of apps are being developed that touch on practically all aspects of healthcare, targeting patients-consumers, clinicians, administrators, insurance companies, researchers and healthcare authorities.


Something is clearly happening in healthcare, but a more fundamental question is, will technology enable a radical improvement in the quality, productivity and accessibility of healthcare. It’s an important question because the future of healthcare, from a budgeting and staffing perspective, is in fact not looking good. In most developed nations healthcare costs have been increasing rapidly (and faster than GDP) due to the rising costs of drug development and the increasing prevalence of chronic illness (in turn due to ageing populations). Those cost drivers aren’t about to disappear–and this while the world economy itself is suffering from chronic illness.


The future of healthcare may look exciting from a gadget perspective but there is in fact a real danger that healthcare in many countries will first get worse before it gets better. Hence the importance of the question: will technology-driven innovation be the right medicine, radically improving quality and productivity just when we need it?  Unfortunately, the answer to that question isn’t simple. There are technical issues, legal issues, policy issues and business model issues to address.


However, looking at the state of technology and medical science today, we at HealthStartup Europe do imagine a radically different and vastly improved healthcare experience, especially from a consumer-patient perspective. It is a healthcare experience that should, in principle, be possible today if we found a way to deal with the various obstacles more rapidly.


Let’s call this vision of a better healthcare experience a digital health manifesto (feel free to contribute to the manifesto – comment below or via Twitter and Facebook and we’ll update the text).

A Digital Health Manifesto

1. A transparent market for healthcare services, based on cost, outcomes and reputations

We expect access to a transparent market of healthcare services provided by hospitals, clinics, GPs, psychologist, life/health coaches and so on.  With ‘transparent’ we mean knowing who they are, how (cost)effective they are based on objectively gathered costs and outcomes data and how satisfied their customers/patients are. Ideally, we will be using one of several competing recommendation engines that suggest caregivers and healthcare programs relevant to my current health needs and location.

2. Access to remote/mobile health services

We expect many if not most of our interactions with healthcare providers to be done on a remote basis via online tools. This means we reduce the number of face-to-face interactions (and thus reduce travel, time spent in waiting rooms), while simultaneously increasing the total amount of time ‘connected’ to the healthcare system via remote monitoring technology and diagnostic services. An obsolete reimbursement model and regulatory framework should not be the reason why we have to sit in waiting rooms and neither should it prevent us from gaining access to more frequent and/or ongoing services that can be provided efficiently on a remote basis.  Thus, we expect access to a globally competitive market of remote diagnostic services, including genetic testing, tele-consultations and remote monitoring of health indicators (e.g. cardiac, blood pressure, sleep, etc).  We are willing to give these services access to our medical records and data if it improves their diagnostic and predictive power. And if we are chronically ill (or in need of geriatric care) we expect to stay at home for as long as is medically and technologically possible. We are willing to take more responsibility for our care, if we have the (monitoring/tele-health) tools and information to be able to do so.

3. Access to updated/complete electronic health records, medical knowledge and decision support tools

We expect our care givers to have access to the best and most up to date clinical information and medical decision making tools. These include accurate and always-up-to-date medical records, diagnostic tools, treatment guidelines and research results.  As patients we also expect to have access to such information, as a basis for constructive doctor-patient communication.  We do not tolerate medical errors.  We expect data-driven care; and we expect to have access to that data too.

5. Access to certified personal health record services, devices and wellness apps that integrate with electronic medical records and are accepted by clinicians

We expect access to a competitive market of certified and interoperable personal health record systems, devices and wellness services that can help us achieve our personal health and fitness goals.  ‘Certified and interoperable’ in the sense that these services can plug into clinical medical record systems and are accepted by clinicians. We want to take a more proactive and goal-orientated approach to our health, and we expect our general practitioner to help us in that regard.

6. All my anonymous health data available to researchers

We expect medical researchers and scientists to have access to our health records data – it is our data and it should be put to good (and meaningful) use.

The trouble with health data transparency

It’s disconcerting that the vision described above isn’t yet a reality.  It could be and it should be. The data is out there.  Also, there are thousands of developers and entrepreneurs clamoring to create powerful, user friendly health devices and apps.  The trouble is, a lot of the data while ‘out there’ isn’t yet accessible or being used optimally (meaningfully). Medical records are locked up in closed legacy IT systems. Doctors and hospitals have few incentives to share data and invest in open technologies. Current reimbursement models, privacy legislation and security concerns deter investment in new technologies and new ways of working.  A lack of standards and the fact that most new gadgets and apps are single-purpose products means that we’re not yet seeing powerful ‘ecosystems’ of synergistic products and services emerge.

Where are the platforms?

Looking at the history of recent technological progress it is clear that open standards and APIs (e.g. TCP/IP and HTTP for the web, Apple’s iOS for mobile apps, Facebook’s API for social gaming) have been instrumental in unleashing waves of innovation. Something similar is needed in healthcare. Imagine if developers had access to open or partially open data platforms that link up health/medical records, medical research data/results, treatment guidelines, and body-monitoring data.  The resulting boom in clinical informatics, clinical decision making tools, collaborative EHRs and other ‘Dropbox for health‘ type tools will put us on the path to data-driven care and likely lead to radical gains in healthcare quality and productivity. It will make our digital health manifesto a reality as opposed to a dream.

We all have responsibilities

To get there, all stakeholders in the system have responsibilities:

Policy makers need to focus on standards setting, ‘open data’ services and improved reimbursement systems (creating the right incentives).

Healthcare providers and their IT partners need to start opening up their systems and transition from a document management approach toward a patient-relationship/communication approach.

Medical information publishers such as academic journals and medical associations need to take a more innovative approach to IP and content distribution, so that the world’s medical knowledge is made instantly available to those who need it.

Startups need to think beyond single-purpose products and explore how they can plug into the existing healthcare plumbing and link up with other synergistic developers.

Progress certainly is being made. For example, the US government has introduced legislation to encourage the interoperability of health information while other public authorities are building open data service platforms (e.g. Almere Data Capital/the Dutch Health Hub).

Healthcare providers are taking steps to open up their systems (e.g. the US Department of Veterans Affairs’ blue button initiative).  EHR providers too are beginning to open up their datasets to external developers (e.g. EHR company PracticeFusion is working with Prior Knowledge to open up the dataset to developers and entrepreneurs).  And EHR providers like Avado and PatientsKnowBest are trying to build systems that are more patient-doctor collaboration tools than clinical document management or bill-generating tools.

Startups too are beginning to think about APIs.  For example, data storage and file sharing company FolderGrid is not only focused on building a secure (HIPAA-compliant) system but is also trying to create an open platform on which other IT developers can build.  Makers of body-monitoring gadgets like GreenGooseare releasing APIs so that 3rd party developers can build apps on top of their platform.

And the path to data-driven care is being cleared by companies such as Humedica, Archimedes and Predilytics who are developing advanced analytical and decision-making tools for doctors and providers.

Initiatives such as these are exciting but the digital health revolution, from a data integration perspective, is still clearly in the starting blocks. Many challenges around technology, business models, strategy and policy remain.


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E-prescribing continues rapid growth

E-prescribing continues rapid growth | EHR and Health IT Consulting |

ONC examined changes in rates of physician e-prescribing, pharmacy capability to accept e-prescriptions and the volume of e-prescriptions,   at the national and state level between December 2008 and June 2012.


Some of the findings include:

In December 2008, 7% of physicians in the U.S. were e-prescribing using an EHR; by June 2012, almost half (48%) of physicians were e-prescribing using an EHR on the Surescripts network.As of June 2012, twenty-three states had more than half of their physicians e-prescribing.States that had the highest growth in percent of physicians e-prescribing using an EHR include New Hampshire, North Dakota, Wisconsin, Iowa, and Minnesota from December 2008-June 2012.Massachusetts (77%), New Hampshire (74%), and Iowa (73%) had the highest rate of physicians e-prescribing through an EHR.From December 2008 to June 2012, nineteen states increased the percent of physicians e- prescribing through an EHR by 50% or more.The growth in e-prescribing has not been limited to physicians. In the same period, the percent of community pharmacies enabled to accept e-prescriptions grew from 76% to 94%.Wyoming, Nebraska, and Kansas had the largest increases in community pharmacies enabled to accept e- prescriptions.The vast majority of pharmacies are enabled to accept e-prescriptions in Rhode Island (97%), Delaware (98%), and Nevada (96%).


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The four key areas of EHR implementation

The four key areas of EHR implementation | EHR and Health IT Consulting |

Failing to adequately plan for and manage change on the scale of an EHR implementation can send the cost of change soaring.


Effective change management starts at the beginning, with a thorough analysis of existing processes, to provide clarity up front about what works and what doesn’t.


This enables informed choices when considering updates to the hardware infrastructure or changes to record-keeping processes. Wisely investing this time up front will help minimize office downtime and implementation costs later.


Given the scope and complexity of an EHR deployment, you’ll need more than a standard IT project plan to ensure a successful rollout. Your project plan should cover every important activity and major milestone.


Give yourself the time to analyze, implement, train, and practice—and then take it step by step. Think through the entire process, articulate your needs to your vendor and build in a thorough follow-up phase to make sure everything is running smoothly.


The four key areas of change management to help your practice ensure a smoother transition are:


 • Assessment: Careful assessment of existing processes and infrastructure is essential to putting your practice in a strong position to support a new EHR system.


• Resources: Managing resources well ensures you’ll build a capable team with a strong leader and responsive vendor.


• Accountability: Clearly assigned roles and responsibilities provide accountability throughout the project and build commitment at every level.


• Logistics: A well-thought-out plan can minimize the risk of missteps in an inherently complicated, time-intensive process.


EHR implementation has the potential to be an arduous, drawnout and expensive process—but it doesn’t have to be. With careful planning and effective change management, your team can make a streamlined transition that will ultimately benefit both your practice and your patients, from back-office operations to quality of care.


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Organisation Capability's curator insight, January 10, 2014 6:24 AM

Brilliant article that highlights common "watch outs" and common mistakes during change management iniatives.!

The digital transition to EHR - is it worth it?

The digital transition to EHR - is it worth it? | EHR and Health IT Consulting |

When it comes to using electronic health record (EHR) software, whether in a traditional practice or a multidisciplinary office, it usually comes down to just one question: Is it worth it?


For the vast majority of cases, the answer is Yes.



Great efficiency, lower expense;Increased collections;Improved third-party audit results;


Worth the effort?


Not all software is created equal, so choose your system wisely, accounting not only for what you need in your clinic now but also for how you see your clinic down the road.


For a limited time, the government is prompting you to adopt EHR software in your practice through funds provided by the HITECH Act (part of the American Recovery and Reinvestment Act). You can collect up to $44,000 over the next five years by adopting certified EHR, depending on your Medicare-allowed charges submitted each calendar year.


No doctor should implement EHR software solely for the incentive. But if you’re already considering it, the incentive is icing on the cake.

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Are EHRs an expensive crutch that deter direct patient-physician communication?

Are EHRs an expensive crutch that deter direct patient-physician communication? | EHR and Health IT Consulting |

We often hear - "EMRs are plagued by problems and inefficiencies that harm patient care and potentially, security and privacy--some day when they are perfected and work the way physicians work, we will flock to them. Data access can be more convenient, but data entry is terrible."


Kenneth Mandl, associate professor at Harvard Medical School and Boston Children's Hospital Informatics Program, and one of two authors of an article published this week in the New England Journal of Medicine, agrees.


He points out that we're in an EHR "trap": vendors, he says, have perpetuated a falsehood that EHRs must use specialized IT software, and that the EHR must have all-in-one functionality.


The article points out that only some components of an EHR need to be specific to healthcare, and that others, such as documentation tools and cloud storage, can be generic and often are better than what is being offered.


The industry should rely on a standard database format and standard apps, and use technologies that are common in other industries.


There's no reason we can't integrate different software systems into EHRs. We can use different platforms and software; we do it every day.


Demand that products be allowed to integrate, get data in and out and exposed through different interfaces.  Think of ways to integrate with emerging technologies.


And we'll see more technologies that work side by side.

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Africa's mHealth breakthroughs to pave way for U.S.

Africa's mHealth breakthroughs to pave way for U.S. | EHR and Health IT Consulting |

The United States will look to Africa to gain knowledge about advances in mobile health technologies because Tanzania, among other countries, already has maternal child health and community health worker programs that rely on smart phones.


While it’s still the early days of mHealth and the digital revolution, “we will see huge breakthroughs in Africa and South Asia,” said Jeffrey Sachs, director of the Earth Institute at Columbia University, speaking at a Monday afternoon mHealth Summit 'Super Session' on global implications for mHealth technologies.


“Those breakthroughs will eventually become breakthroughs in the U.S. when it addresses the high costs of its healthcare system and frees up $750 billion a year in waste,” Sachs said.


Mobile phones have been used to deliver messages about maternal and child health to mothers who live in areas that are remote or lack communications and other services. Mobile technology can make a difference, getting critical [pregnancy] stage-based information to expectant moms

Via nrip
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Electronic Health Record Use In US Hospitals Has Doubled In Last Two Years - Medical News Today

Electronic Health Record Use In US Hospitals Has Doubled In Last Two Years - Medical News Today | EHR and Health IT Consulting |
Electronic Health Record Use In US Hospitals Has Doubled In Last Two YearsMedical News TodayThe percentage of US hospitals using health information technology such as Electronic Health Records has more than doubled in the last two years, according...

Via fjms
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Why Hospitals Don't Deliver Great Service

Why Hospitals Don't Deliver Great Service | EHR and Health IT Consulting |
Hospitals try to deliver the best health outcomes. But many also aim to provide high levels of customer service, and they're falling short. They need a culture change.


Hospitals try to deliver the best health outcomes. That's a given. But many also aim to deliver high levels of customer service. On that latter goal, healthcare systems are falling short. Here's why: Truly improving service demands a culture that intentionally champions a focus on the patient.

Managers must be equipped to drive employee engagement in their departments.


What healthcare systems urgently need are clear intentions and strategies at the leadership level. These will determine whether a service mindset can exist within a hospital. What's more, getting employees engaged and connected to this mission will ultimately determine whether they live out that mindset each day.


Gallup has found that a service-centered culture requires:

a committed leadership team that champions a philosophy that is aligned with serviceemployee commitment to providing outstanding service and qualitythe strategic alignment of the organization's plan, policies, and procedures with the goal of being service-focusedan established process to document and disseminate organizational knowledge and efficienciesan ongoing commitment to improving performance and using proven tactics
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Patients describe what they consider good customer service -

Patients describe what they consider good customer service - | EHR and Health IT Consulting |
Doctors' knowledge and the office experience are more important than price in creating satisfaction, according to a new survey.


When it comes to satisfying patients as customers, practices need well-trained physicians, easy access to patients’ histories and long appointments — or at least the impression of long appointments, according to a Harris Interactive Poll issued Sept. 10.

“As other industries try to build customer loyalty, they are setting certain expectations for service,” said Vaughn Kauffman, principal and leader of the payer advisory practice at the consulting firm PwC. “And consumers are carrying those expectations into health care.”


Harris researchers surveyed 2,311 adults between July 16 and 23. Eighty-four percent had visited a doctor’s office in the past 12 months. Of this group, 83% were satisfied or very satisfied with the encounter. When compared with other service industries, satisfaction scores were higher for restaurants and banks but lower for car dealers and health insurers.


Consultants who work with medical practices say many factors that go into making patients satisfied customers are easier to address than they sound. It’s important to do so, however, because satisfaction is becoming more critical in health care. Keeping patients happy can play a part in earning quality pay and persuading patients to come back and refer the practice to others.


95% of patients say the amount of time spent with a doctor is an important satisfaction factor. 

For instance, 97% rated a doctor’s knowledge, training and expertise as important or very important with regard to creating a positive customer experience, although this factor is not readily changeable.


“That’s a given,” said Meryl D. Luallin, a partner with the SullivanLuallin Group in San Diego, which works with practices to improve the patient experience. “Patients take a doctor’s skills and training for granted. When you board a plane, you don’t stop by the cockpit to ask to see the pilot’s license. Patients typically make the assumption that somebody at the practice has already vetted the doctor.”


Other factors important to patients are easier to tackle. For example, 94% considered a physician being able to access a patient’s medical history as important or very important. Experts on the patient experience said this issue can be improved at practices with paper charts if physicians view them before entering the exam room. For physicians with electronic medical records who are not able to access the information until they are in the exam room, consultants suggest an introduction to the patient and then a brief explanation along the lines of, “I’m going to review your records, and then I’m going to give you my undivided attention.”


“It’s a little more challenging with electronic records because of the way a physician accesses the chart,” Luallin said.


This may help patients feel as if they have had a longer visit. Ninety-five percent in the Harris survey said time spent with the doctor is important or very important in being satisfied with the experience, but this does not necessarily mean lengthening appointments, which may be impractical or financially impossible for a practice. Consultants suggest that physicians sit in front of a patient rather than stand. Physicians who don’t look as if they are about to run out the door may give patients the impression of a longer visit.

“It’s all in the body language,” Luallin said.


Other surveys have suggested that consumers are less price-sensitive about health care than other industries but are more attuned to the service aspects. For example, a report on 6,000 consumers issued in July by PwC found that 69% said price was the No. 1 driver when considering leisure airline travel, but this was true for only 8% considering health care services. Forty-two percent said personal experience was the most important factor when choosing a doctor or hospital, but this was true for only 17% considering an airline ticket purchase.

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5 Ways Pinterest Can Be Used for Patient Education in Healthcare | ParkerWhite Brand Interactive

5 Ways Pinterest Can Be Used for Patient Education in Healthcare | ParkerWhite Brand Interactive | EHR and Health IT Consulting |

Pinterest is an image-driven social network that has rocketed in popularity in the last couple of years. Pinterest works as a way to visually organize things on the Internet via “Boards,” which act kind of like folders, to organize thoughts into certain categories or interests. As more and more people use the Internet to search about healthcare, Pinterest is a way to organize the information they find, also allowing for them to share content easily with others. The other potential benefit from Pinterest is to reach people when they’re in various Internet “mindsets.” It can be a way to reach the patient when they’re not necessarily concerned with a particular problem at the moment (i.e. searching for specific health information for an issue they have right now). Pinterest can provide a medium for reaching patients to remind people of the many aspects of their life in which health plays an important role.


Pinterest is a good medium for patient education because many people learn best visually. Images can help convey information that would be much harder to digest in words. It can also serve as a good reference, and is more shareable.


1. How the body works2. How medical procedures work

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Patient Engagement and Use of Electronic Health Tools

Patient Engagement and Use of Electronic Health Tools | EHR and Health IT Consulting |

To accelerate adoption of electronic tools for increasing patient engagement the Center recommends the following:

Build awareness of benefits of electronic tools for patient engagementDevelop and disseminate principles, standards, policies, strategies, and best practices for using electronic tools to engage patientsBuild awareness of benefits of health care-related electronic tools among consumersIncrease federal, state and private sector incentives for the use of electronic tools to support engagement of patients in their healthcare

The report acknowledges the challenges to increasing patient engagement including:

Need for additional training and education on patient engagement in medical schools, residency programs, and continuing medical education programsDeepening patient-centered care and engagement at the cultural levelTaking steps to limit the amount of time in a traditional office visitCost and complexity of reaching out to and engaging individuals outside of an office settingAddressing communication needs of under served populations
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The Social Business of Fighting Disease

The Social Business of Fighting Disease | EHR and Health IT Consulting |

Whilst social media tools have primarily been used for commercial ends, there is a growing stream of evidence showing that it has scientific and social benefits as well. Nowhere is this more so than in the tracking and prevention of diseases.


For instance Google Flu Trends tracks search queries and applies its trending algorithm to gain an understanding of where flu outbreaks are occuring. A 21 month study by John Hopkins University found that the app was exceptionally good at predicting when hospitals would start to see people coming in with flu symptoms.


Primary investigator of the study, Dr. Richard Rothman, said that the results were promising for “eventually developing a standard regional or national early warning system for frontline health care workers.”


Social media context


It could be argued however that social media is a better method of tracking the spread of infection because it provides you with better context. Back in January the American Journal of Tropical Medicine and Hygiene reported that tweets and other public ‘status updates’ were a better way of determining the spread of cholera in post-earthquake Haiti than official channels. The research was conducted by scientists at Children’s Hospital Boston and Harvard Medical School and with over 6,000 people having died from the disease in Haiti, it has serious implications in terms of disaster prevention.


“When we analyzed news and Twitter feeds from the early days of the epidemic in 2010, we found they could be mined for valuable information on the cholera outbreak that was available up to two weeks ahead of surveillance reports issued by the government health ministry,” said Rumi Chunara, PhD, of the Informatics Program at Children’s Hospital Boston, Research Fellow at Harvard Medical School, and the lead author of the study. “The techniques we employed eventually could be used around the world as an affordable and efficient way to quickly detect the onset of an epidemic and then intervene with such things as vaccines and antibiotics.”

Via nrip
Luca M. Sergio's curator insight, December 20, 2012 10:26 AM
so much potential from the social space to identify disease trends and act at an early stage ....!

Patient data revealed in medical device hack

Patient data revealed in medical device hack | EHR and Health IT Consulting |

Researchers have exploited critical vulnerabilities in two popular medical management platforms used in a host of services, including assisting surgeries and generating patient reports.

The dangerous, unpatched flaws within the Philips Xper systems allowed researchers, within two hours, to develop an exploit capable of gaining remote root access.


From there, attackers gain administrative access to patient data stored in connected databases.

The affected machine can operate any medical device which uses the ubiquitous HL7 standard.

"We have a remote unauthenticated exploit for Xper, so if you same see an Xper machine on a network, then you can own it," Billy Rios, a researcher at security start-up Cylance, told SC Magazine Australia.

The holes were so severe that the U.S. Department of Homeland Security (DHS) and Food and Drug Administration (FDA) stepped in to pressure Philips to fix the system.


"We've dropped exploits before on medical systems like Honeywell and Artridum, but we've never seen the FDA move like that," he said. "It was quicker than anything else I've seen before."

After initial bids to contact Philips failed, Rios and colleague Terry McCorkle sought assistance from DHS, the FDA and the U.S. Industrial Control Systems Cyber Emergency Response Team (ICS-CERT). 

Two days later, Marty Edwards, director of the control systems security program at DHS, told the researchers the agency would from then on handle all information security vulnerabilities found in medical devices and software.

The announcement comes five months after the U.S Government Accountability Office said in a report (PDF) that action was required to address medical device flaws, adding that the FDA did not consider such security risks "a realistic possibility until recently".


How they did it

Once an extensive 200Gb forensic imaging process of the Windows-based platform had completed and the system was booted into a virtual machine, it took the researchers "two minutes" to find the first vulnerability.

"We noticed there was a port open, and we started basic fuzzing and found a heap overflow and wrote up a quick exploit for it," Rios said. "The exploit runs as a privileged service, so we owned the entire box - we owned everything that it could do."

The researchers suspect the authentication logins for the system, one with a username Philips and password Service01, are hardcoded and unchangeable by users, but when they warned Philips, the company refuted the claim.

The Xper Physio monitoring 5 platform was formerly used by a Utah hospital and purchased from an unnamed reseller, which sold the Dell Blade-like machine for a cut-rate of $200, delivered to Rios' home address.

That move broke the resellers' contractual obligations with Philips, which requires the return of unwanted devices ostensibly to safeguard against such security gaffes.

"That you need to jump through some hoops to get the hardware is not some sort of defense," Rios said. "That's security through obscurity."

The dealer was reported to the DHS, and the equipment was returned to Philips.

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The Future of Medical Records

The Future of Medical Records | EHR and Health IT Consulting |

Electronic medical records are not working like they should -- or could -- according to a new analysis in Health Affairs that revisited previous predictions for the EMR revolution and found disappointing results, in terms of efficiency,saved costs, and patient care.


The practical concerns pointed out by the study include ease of use and ability to share information across systems. But another important metric -- the corollary to questions like Would You Want to See Everything Your Doctor Writes About You?" -- is, What would you, the patient, do with that information provided you were granted access?


The federal government took the Department of Veterans Affairs' current record system, which "looks and feels like a receipt," and challenged designers to reimagine the Continuity of Care Document, an EMR output used to describe a patient's health history.


Technology is "only a tool," as an expert who helped push for the adoption of EMRs under President Obama told The New York Times. "Like any tool, it can be used well or poorly." 


Here are some ways it could be done very, very well, as put forward by entrants:

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4 top trends that will shape digital health

4 top trends that will shape digital health | EHR and Health IT Consulting |

This was a big year for digital health transformation, especially for advances in personalized and connected care. Looking back at 2012, these are the four trends that I think will ultimately have the greatest impact on the future.


Proliferation of personalized mobile health technologies. Many will remember 2012 as the year when mobile health apps and sensors took off. In 2012, the FDA approved the first iPhone-enabled blood glucose meter for sale at retail stores in the United States.


Maturation of the Big Data ecosystem in health care. The massive growth of the volume, velocity, and variety of digital health data creates both manageability issues and opportunities for greater patient insights.


Rise of health startup accelerators. Through a network of mentors with medical, business development, and technology expertise, new startup accelerators/companies are incubating the next wave of digital health innovators.


Emergence of health care exchange and alternative care delivery platforms. Individual insurance market exchanges, including the online exchange program which California is implementing, could be leveraged by millions of uninsured people and bring care providers new patients who were previously uninsured.


Sean Chai is director of innovation technology the Innovation & Advanced Technology Team at Kaiser Permanente

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EHR vendor selection checklist for small providers

EHR vendor selection checklist for small providers | EHR and Health IT Consulting |

Selecting a quality EHR vendor is important, but just as crucial is the vendor’s ability to tailor its system to your needs.


There are literally hundreds of EHR systems out there for you to choose from, all with different pros and cons. Selecting a quality EHR vendor is important, but just as crucial is the vendor’s ability to tailor its system to your needs.


Here are some points to consider before making a final selection:


1. How much experience does the vendor have with EHR implementation? What type of stability and track record do they have?


2. Assess your physical environment and document it in a detailed list and rank those in order of importance to your organization.


3. Is the EHR system software designed to fit your organization’s needs?


4. Identify the hardware needs of your office and EHR.


5. Does the vendor offer a Software as a Service (SaaS) solution, sometimes called Application Service Provider (ASP)? Or do they require you to use client-server systems, which require a staff member to manage the entire process of updates, upgrades and backups.


6. How much can the vendor prepare for and help you get selected by CMS for Meaningful Use Stage 1 under the Medicare EHR Incentive Program?


7. Will the system be able to scale up if needed for Stage 2?


8. Will their system be relevant beyond meaningful use?


9. Will there be any trouble converting to IDC-10? Are they compliant in all other areas?


10. Can they help you avoid productivity losses and EHR transition issues?


Remember, you can reach out to Regional Extension Centers (RECs) for guidance and resources.

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Survey: MU incentives top motivator for EMR adoption at small practices | PhysBizTech

Survey: MU incentives top motivator for EMR adoption at small practices | PhysBizTech | EHR and Health IT Consulting |

Federal incentives appear to be having the desired effect at the small-practice level, ramping up meaningful use of certified EHR/EMR technology, according to results of a survey released Jan. 9 by Practice Fusion, a company that offers a free web-based EMR to physicians. The report indicated that the incentives, administered by the Centers for Medicare & Medicaid Services, were the strongest motivator for adopting EMR technology among surveyed medical professionals.


The desire to use technology to improve patient care ranked second among motivators for EMR adoption among survey respondents.

Practice Fusion conducted the State of the Small Practice study via Internet survey with a national sample of more than 1,000 practices gathered through the company’s platform. Medical providers were asked to provide responses to a series of multiple choice survey questions based on the previous year’s data.

Sixty-three (63) percent of survey respondents said new technologies like EMR made things easier in their practices. However, those doctors also reported feeling more confusion around the meaningful use incentives than in years prior -- possibly due to heightened Stage 2 requirements.


Forty-five (45) percent of surveyed doctors reported that their practice fared better in Practice Fusion's 2013 report than in 2012, possibly reflecting an improving economy and the influence of EMR incentives. While the majority of remaining doctors reported no change, 16 percent reported that their practice is doing worse – about a 2 percent increase from the 2012 survey.

Here's a synopsis of additional key findings from the 2013 survey:

Doctors reported more confusion about meaningful use this year, with 46 percent of doctors claiming “moderate expertise” in 2013 (a 16 percent drop from 2012) and 50 percent (a 6.5 percent increase from last year) claiming “little” or “no” understanding.Meeting meaningful use deadlines was the main motivation for EMR adoption (55 percent), followed by improving care through new technologies (45 percent) and excitement around adopting a new technology (39 percent).Most computers used today in doctors’ offices are 1-2 years old (41 percent), but some practices continue to hold on to older machines -- 4 percent of doctors’ computers are 6 years or older, compared to 3 percent in 2012.Among doctors’ chief complaints, insurance and reimbursement were ranked highest, followed by practice management costs and administrative burdens.

“Small medical practices are critical as the first line of care,” said Ryan Howard, CEO of Practice Fusion, in a press release accompanying release of the survey findings. “As these practices struggle for survival in a turbulent time, we see it as Practice Fusion’s duty to do everything we can to empower them to adopt and utilize new, lifesaving technologies. With an estimated $100 million paid to our doctors so far, it’s clear we’re on the right track."

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ONC map lets users track EHR incentive payments nationwide

ONC map lets users track EHR incentive payments nationwide | EHR and Health IT Consulting |

HHS' Office of the National Coordinator for Health Information Technology at HHS, working in cooperation with the CMS, has posted a set of data-rich interactive maps to track the country's progress on health IT adoption, as spurred by programs created by the American Recovery and Reinvestment Act of 2009.


The main page of the dashboard now includes links to U.S. maps showing provider payment levels under the Medicare and Medicaid electronic health-record system incentive payment programs. On the incentive payment map, visitors can click on a state and see a map speckled by dots of payment recipients.


Each dot produces a pop-up box giving basic information about that recipient. The maps can be layered to show recipients of only Medicare or Medicaid EHR incentive payments, or both.


In addition to EHR incentive recipients, map layers are posted for locations of health IT regional extension centers, state health information exchanges, Beacon Communities, Strategic Health IT Advanced Research Projects, community colleges and universities participating in the ONC Health IT Workforce Program and the workforce curriculum development centers, as well as dozens of other regional health information organizations.


See your tax dollars at work in health information technology: ;

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Engaging Health Care Consumers Through Information Technologies

Engaging Health Care Consumers Through Information Technologies | EHR and Health IT Consulting |

Despite being heavy users of technology in everyday activities such as online shopping and banking, consumers tend to make less use of technology to support their health care decisions. Nevertheless, they are enthusiastic about a technologically enabled health care system that enhances its accessibility, reduces paperwork, increases access to their personal health information, and improves its overall performance.


Effective use of information technologies represents both an unmet need and an opportunity for the health care system to better engage consumers.

Via nrip
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Why Don't Patients Report Medical Errors?

Why Don't Patients Report Medical Errors? | EHR and Health IT Consulting |
Why Don't Patients Report Medical Errors? - The Huffington Post


I was recently browsing through the nearly 200 stories we've compiled with our Patient Harm Questionnaire, when I was reminded again of a troubling truth. Many of the people who suffer harm while undergoing medical care do not file formal complaints with regulators. The reasons are numerous: They're often traumatized, disabled, unaware they've been a victim of a medical error or  don't understand the bureaucracy.


That's a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It's a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.


We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department's inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. "An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths," the IG found, "which projects to 15,000 patients in a single month."


But there's no central system in place to tally and track these events. There's no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.


It's not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine's landmark "To Err Is Human" report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That's information that could save lives.


"You really can't improve what you don't measure," said Dr. Julia Hallisy, president of the Empowered Patient Coalition. "How do you know where to focus your improvement efforts if you haven't measured what's happening in the first place?"


Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called  "sentinel" or "adverse" events. But a July report by the HHS inspector general's office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.

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Patient Experience vs. Patient Engagement

Patient Experience vs. Patient Engagement | EHR and Health IT Consulting |
The patient experience is about perceptions and patient engagement is about actions and behaviors.


The Beryl Institute, a global community of practice and premier thought leader on improving the patient experience in healthcare, defines the patient experience as “the sum of all interactions, shaped by an organizations culture, that influence patient perceptions across the continuum of care.”

Similarly, the Robert Wood Johnson Foundation describes the patient experience as “comprised of research reports and administrative information that reflect quality from the perspective of patients by capturing observations and opinions about what happened during the process of health care delivery. Patient experience encompasses various indicators of patient-centered care, including access (whether patients are obtaining appropriate care in a timely manner), communication skills, customer service, helpfulness of office staff and information resources.”


How is the patience experience measured?

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  The HCAHPS Survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.  HCAHPS is a 27-item survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.

CMS publishes HCAHPS results on the Hospital Compare Website four times a year, rolling the oldest quarter of patient surveys off and the newest quarter on each time. Since 2008, HCAHPS has allowed valid comparisons to be made across hospitals locally, regionally and nationally.


What is the driving force behind improving the patient experience?

Value Based Purchasing (VBP) incentive payments.  The Hospital Value-Based Purchasing Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare.

Hospital VBP incentive payments to hospitals will come from the regular fees Medicare pays hospitals through its Diagnosis-Related Group (DRG) system. Hospitals participating in Hospital VBP will have their base operating DRG payments for each patient discharge across all hospitals reduced by a small percentage each year.

Taking into account the reduction in base Diagnosis-Related Group operating payments to hospitals (1 percent for Fiscal Year 2013), CMS estimates that roughly half of participating hospitals will receive a net increase in payments as a result of this rule, while the rest will receive a net decrease in payments.

The Fiscal Year 2013 Hospital VBP Program consists of two domains including 1) Clinical Process of Care and 2) Patient Experience of Care.  For FY 2013, these weighted values are 70 percent for Clinical Process of Care and 30 percent for Patient Experience of Care.

The Patient Experience of Care score is the sum of a hospital’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) base score and that hospital’s HCAHPS Consistency score.  The Experience of Care domain is broken out into eight equally-weighted dimensions:

Communication with NursesCommunication about MedicinesCommunication with DoctorsPain ManagementCleanliness and Quietness of Hospital EnvironmentResponsiveness of Hospital StaffDischarge InformationOverall Rating of Hospital

What is patient engagement?

To my knowledge, there is no common definition of patient engagement.  I believe patient engagement can be defined as a person’s active participation in managing their health in a way that creates the necessary self-efficacy to achieve physical, mental and social well-being.  This means that healthcare delivery must entice a person to actively participateover the long-term while fostering health related self-efficacy which yields meaningful physical, mental or social benefit.  In only this way can healthcare organizations depend on the active and sustained participation required to improve clinical outcomes.

This definition clearly differentiates the patient experience from patient engagement.  Whereas the patient experience is based on the patient’s perception of quality, patient engagement is based on the patient’s active and sustained participation in managing their health.  The patient experience is about perceptions and patient engagement is about actions and behaviors.  A patient can conceivably be satisfied with their healthcare experience while  having minimal engagement.


How is patience  engagement measured?

Medicare and Medicaid EHR Incentive Programs Proposed Stage 2 Meaningful Use Criteria.  CMS published in the Federal Register the proposed rule which would specify the Stage 2 criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record incentive payments.  Among the many topics addressed in the proposed rule are patient and family engagement measures.

The proposed Stage 2 patient and family engagement measures focus providers and/or hospitals on:

Making visit/inpatient information available to patients timely and onlinePresenting visit/inpatient information in a manner that leads to patients viewing, downloading or transmitting the informationProviding patient-specific education resourcesPromoting patient and provider interactions that lead to patients sending secure messages to their provider

Providing the ability for patients to access and exchange information online seems like a basic, reasonable and early step towards engaging patients.  However, I believe it falls woefully short as an overall measurement of patient engagement.  The proposed patient information access and exchange in and of itself does not create patient engagement, rather,  it creates a channel where patients can engage in some aspects of managing their health. Even when providers meet the proposed Stage 2 measures they will still be saddled with the more complex task of actuallyfostering patient engagement.  So, the really hard work lies ahead for providers and hospitals.


What is the driving force behind improving patient engagement?

The Patient Protection and Affordable Care Act (PPACA) Payment Reform.  The PPACA has many provisions related to payment reform.  These reforms include Medicaid & Medicare payment adjustments, payment reductions, incentive payments, bonus payments, bundled payments and shared savings programs.  Payment reform is increasingly shifting away from fee-for-service to performance based payments.  As such, improved healthcare delivery models have significant dependence on the active and sustained participation of patients post their hospital or provider visits in order to achieve financial targets.  Higher levels of patient engagement will be essential to achieving targeted health outcomes that trigger additional reimbursement.


For example, let’s look at Accountable Care Organizations (ACO).  The website describes ACO’s as groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  The key to this payment structure is to generate healthcare savings through better healthcare delivery which then can be shared between the ACO and the government.  Generating these savings will be significantly dependent on patients actively participating in the management of their health as a means of driving down cost through reduced utilization of services.


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How to budget for a cloud-based EMR system - American Medical News

How to budget for a cloud-based EMR system - American Medical News | EHR and Health IT Consulting |

Health information technology consultant Matthew Grob likes to compare implementing an EMR to buying a car. The sticker price might be $15,999, but once tags, insurance, warranties and other incidentals are added, it'll take at least $20,000 to get it out of the lot. And it will take more than $40,000 over the next five years to keep it on the road.


Similarly, many practices think the price quoted to them by their electronic medical records vendor is the total amount that EMR implementation is going to cost the practice. "And then reality sets in," said Grob, a solution partner with the health care consulting arm of EMC. But careful planning and budgeting can keep practices from sending their bank accounts into the red as the result of EMR adoption.


Many practices are discovering that cloud-based systems -- which eliminate the substantial cost of installing and maintaining servers in the office -- can be less expensive. But analysts said that even those require careful consideration based on cost and necessitate that a practice set a budget before signing a contract. With cloud-based systems, the budgeting is not just about what's spent up front -- it's what spent to keep it on the road.


Click headline to read more--

Via Chuck Sherwood, Senior Associate, TeleDimensions, Inc
MPCIRHC.ORG's curator insight, July 26, 2014 6:39 PM

Cloud based personal Health Care Administration is the wave of the future. As long as it can be made secure and in the hands of the consumer.!

Half of docs nationwide e-prescribe via EHRs | EMR Industry

Half of docs nationwide e-prescribe via EHRs | EMR Industry | EHR and Health IT Consulting |

Just about one half of physicians nationwide are now performing electronic prescribing using an electronic health record on the Surescripts network, with all states producing double-digit increases.


The percent of physicians e-prescribing using EHRs swelled from 7 percent in December 2008 to 48 percent in June 2012, according to a report released Nov. 27 from the Office of the National Coordinator for Health IT.

Surescripts is a leading e-prescribing network, which is used by 95 percent of pharmacies for routing prescriptions, excluding closed systems such as Kaiser Permanente.


Twenty-three states had more than half of their physicians e-prescribing using an EHR, with New Hampshire, Minnesota, Iowa, North Dakota, and Wisconsin experiencing the largest increases since December 2008, according to the report.

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