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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Digital medicine: Patients are stuck in the precarious middle

Digital medicine: Patients are stuck in the precarious middle | EHR and Health IT Consulting | Scoop.it

The use of computers in everyday medical practice has finally reached the tipping point.

 

EHRs are secure digital repositories of patient information–doctors’ notes, lab and X-ray reports, and letters from specialist physicians. They are an electronic version of the paper chart. Newer, more advanced EHRs are integrated systems and allow doctors to order tests, generate bills, communicate with patients, and run analyses on aggregate patient data. In hospitals, nurses use EHRs to administer and record medication dosing and document other patient care activities.

 

Though medical practices have a high burden of proof to claim their bonus–the Department of Health and Human Services is still in the process of fully defining just what constitutes ‘meaningful use’–there is now conclusive evidence that the carrots are working. Recent data demonstrates that solo and two-doctor offices, which still comprise over half of all medical practices in the U.S., have seen the biggest jump in EHR adoption over the last six months. These small shops are reaching the conclusion that they must participate, as they risk being left behind technologically and financially.

 

As a practicing primary care doctor, I feel I am slowly being pulled into the apostate camp. Our apostasy is not about EHRs; that game is all but over. Rather, there’s a pervasive sense that our use of technology has become a wedge between doctors and just about everyone else: Nurses. Other doctors. Worst of all, our patients.


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MHealth Identified as Major Growth Sector in Healthcare - Especially with Support from FCC

MHealth Identified as Major Growth Sector in Healthcare - Especially with Support from FCC | EHR and Health IT Consulting | Scoop.it

Some well-known companies – as well as lesser known firms – stand to benefit from the growing demand for mobile health technology.


Mobile health (mHealth) involves the monitoring of patients or providing them with various forms of healthcare using mobile technology. There is exchange of data, images and video and the use of mobile networks, devices and applications.


And the sector’s technology is becoming more popular, with growing acceptance by physicians.

 

Companies like Qualcomm, Intel and Apple, as well as smaller firms like Fitbit Inc., and Entra Health Systems, stand to benefit from this trend.


One example of expansion in this sector is Qualcomm, which invested $100 million in its subsidiary, Qualcomm Life Inc., in 2011, according to a company statement. The division is focused on improving the capabilities of medical devices.


According to a recent report from iData Research, the U.S. patient monitoring market was valued at over $3.1 billion in 2011 and will grow to almost $4.2 billion by 2018.


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The need for long-term digital retention in eHealth

The need for long-term digital retention in eHealth | EHR and Health IT Consulting | Scoop.it

Although the price for storing data may be falling there are additional economic challenges in ensuring digital content remains understandable for future generations. Guaranteeing long term usability for spiralling amounts of data produced or controlled by organisations with commercial interests is quickly becoming a major problem, says Michael Wilson, Secretary, UK e-Infrastructure Leadership Council.

 

Wilson gave some excellent background on the subject during Thursday's e-health session at eChallenges presenting findings from the ENSURE project which is examining economical solutions for long term digital preservation in user cases (healthcare, clinical trials, and finance).

 

Digital medical data serves a different purpose depending on the stakeholders. Health records and data can be preserved for the benefit of patients, their families and future medical research. Over time, the reasons for collecting specific data-sets may also change. Medical imaging data takes up to 30% of the digital universe. Each record has it's own formula (e.g. pathology images are saved in DICOM). In a further 10-20 years, software will inevitably have changed but virtual environments can preserve the software to make the data useful (e.g. associated manuals, hardware, operating systems). There are of course risks in preservation associated with different strategies, and this is what ENSURE is researching (i.e looking at cost/value of different strategies, how to automate the lifecycle, as well as scalability options of leveraging new technologies such as cloud technology).

 

For researchers, a major flaw in social media is its transitory state. Already one project is examining how to preserve and manage weblogs - Blogforever. Recent studies have revealed that blogs on major historical events have already been lost (see another blog post). BlogForever aims to provide a solution to preserve and organise all blogs especially those that have historical significance - one project partner is CERN with the goal of preserving physics-related blogs. GridCast originated at CERN. The ultimate vision of the project is to preserve collections of blogs in a cost efficient manner safeguarding their authenticity and integrity for users/organisations (e.g. a National Library of Medicine would like to preserve a collection of health and medicine blogs). Other aims include enabling full text searching, tagging, sharing and reusing content.


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Can social media help heal healthcare?

Can social media help heal healthcare? | EHR and Health IT Consulting | Scoop.it
For all of the debate, one thing is for sure: social media in medicine is here to stay. But when it comes to the availability of trustworthy information, we still have a ways to go.

 

How to get more for less? It’s an age-old question and one that is playing out today in our healthcare system. With healthcare reform top of mind these days, everyone is asking how the medical industry can treat patients better for less money. Social media often comes up in these discussions and everyone seems to have an opinion about the risks and rewards.

 

For all of the debate, one thing is for sure: social media in healthcare is here to stay. But when it comes to the availability of trustworthy health information, research suggests that we still have a ways to go. According to a recent Pew Internet survey, four out of five Internet users have searched for health information online,

 

making health one of the most searched topics on the Internet. At the same time, the study also revealed that more than 50 percent say the information they find is “of no help at all.” After all, anyone with Internet access can set up a health blog or answer health questions on Google or Yahoo Answers, no credentials required.

 

As the CEO and founder of Avvo.com, an online legal and health Q&A forum and professional directory, I talk to hospital administrators, doctors and consumers about these issues on a regular basis. When it comes to providing information about health issues and healthcare providers online, I see a massive opportunity for improvement. Ultimately, I think it comes down to two primary actions on the part of the medical community and those providing health-focused social media platforms.

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24% of doctors use social media daily for medical information, study says - - ModernMedicine

24% of doctors use social media daily for medical information, study says - - ModernMedicine | EHR and Health IT Consulting | Scoop.it
Nearly one-fourth of physicians use social media on a daily basis to scan or explore medical information, according to a recently published study in the Journal of Medical Internet Research.

 

The researchers behind the study set out to examine physicians’ level of social media usage for the purpose of exchanging advice, ideas, reports, and scientific discoveries with other physicians.

 

The study was based on emailed survey responses from 485 primary care physicians (PCPs) and oncologists, and it had a response rate of 28%.

 

They found that, whereas just 24% of physicians use social media to “scan or explore” on a daily basis for those reasons, that number jumps to 61% when measured on a weekly basis.

Physicians who use social media to “contribute,” rather than merely scan information, stood at 14% daily and 46% weekly.

 

In terms of what social media applications physicians are using, “restricted online communities” such as Sermo and Ozmosis were the most popular, at 52%. Somewhat surprisingly, Twitter scored much lower, with a 7% usage rate. Facebook was in the middle at 19%.

 

“Respondents might see online communities as a less-risky and higher-quality source of medical knowledge than more broadly open social media applications such as Twitter, LinkedIn, or Facebook,” the authors theorized.

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Coming Next: Doctors Prescribing Apps to Patients

Coming Next: Doctors Prescribing Apps to Patients | EHR and Health IT Consulting | Scoop.it

Before long, your doctor may be telling you to download two apps and call her in the morning.

Lee Perlman, left, and Benjamin Chodor of Happtique, developer of a medical app that can facilitate the writing of prescriptions.
Smartphone apps already fill the roles of television remotes, bike speedometers and flashlights. Soon they may also act as medical devices, helping patients monitor their heart rate or manage their diabetes, and be paid for by insurance.

 

The idea of medically prescribed apps excites some people in the health care industry, who see them as a starting point for even more sophisticated applications that might otherwise never be built. But first, a range of issues — around vetting, paying for and monitoring the proper use of such apps — needs to be worked out.

“It is intuitive to people, the idea of a prescription,” said Lee H. Perlman, managing director of Happtique, a subsidiary of the business arm of the Greater New York Hospital Association.

 

Happtique is creating a system to allow doctors to prescribe apps, and Mr. Perlman suggested that a change in the way people think about medicine might be required: “We’re basically saying that pills can also be information, that pills can also be connectivity.”

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4 reasons voice recognition and mobile devices are meant to be together | EHR Watch

4 reasons voice recognition and mobile devices are meant to be together | EHR Watch | EHR and Health IT Consulting | Scoop.it

Remember doctors walking down halls, talking into tape recorders like Agent Dale Cooper from Twin Peaks? Now they're holding conversations with their mobile devices, taking a page from David Bowman and Frank Poole's interactions with HAL 9000 in 2001: A Space Odyssey.

Ubiquitous mobile devices such as iPhones and Androids offer both opportunities and challenges for physicians. Critical EHR data is accessible almost anywhere and near instantly, and patient notes can be recalled with a few taps on a screen. But minimized screen real estate is at a premium: What data should be shown? And that's to say nothing of the challenges of entering the data: Typing full notes on a mobile phone can be a carpal-tunnel inducing strain.

 

Nuance Healthcare's Jonathon Dreyer thinks these strengths could be improved – and the weaknesses could be eradicated – with strong integration of voice recognition, cloud-based applications and natural- or clinical language understanding technology. He says these tools create "better access for the physician," who can have an interactive dialogue with his or her device to access and create medical records on the fly.

 

Dreyer offers four reasons voice recognition and mobile devices were meant to be together.

 

1. Speech to text. "There's no question that these mobile devices are great for consumption of information, but when it comes to generation ... they fall flat," says Dreyer, who says he's noticed more and more people attaching external keyboards to their mobile phones, effectively turning them in to mini laptops. That's contrary to the point of a mobile device, he argues, and "even with a keyboard I can't imagine a physician entering data that way."

Speech-to-text services for mobile devices resolve that shortfall. As a majority of doctors are comfortable around dictation already, this enables them to allow patient notes or clinical information directly in to their device, on the fly. Dictating to a service that can automatically convert a doctor's speech to text lets them deliver notes in a conversational style. This is good for several reasons: It frees them up from typing on a small keypad and it means that they may include things they'd forget to type.

 

2. Custom commands and navigation. "You've got so much information in an EMR, especially within the confines of a four inch screen, it becomes really difficult to present that information," says Dreyer. While software vendors are getting better at choosing what data to display and when, he envisions a better approach. Voice recognition lets physicians "have a free form and flowing conversation" with their devices, "like they were actually talking to a person at their side."

Dreyer references a study that found 81 percent of doctors own a smartphone and that a majority of them use their devices to access reference materials at point of care. "A physician can simply say, 'Show me my patients for the day,' or, 'Show me Mary Smith's info,'" and have that information brought up as he or she is walking in to the room to see the patient, says Dreyer. That level of flexibility can make a physician's workflow much more efficient and can allow them to devote more time to patient care and less to retrieving and looking through records.

 

3. Clinical language understanding. Natural or clinical language understanding is a process that can pull relevant medical information out of a narrative conversation and convert it in to actionable data that a computer can act upon. A physician "can take speech recognized text, run it through a CLU engine that extracts clinical data and pull structured information out of a patient narrative," says Dreyer. This allows a physician to concentrate more on getting an accurate narrative from the patient, as opposed to asking routine questions. Having a CLU to sort all of the data "allows physicians to document the patient's whole story," says Dreyer. Capturing the entire narrative means the resulting care will be better. "You don't want to force patient narratives in to a template."

 

4. Future developments. What if a doctor saw a patient and dictated the notes, mentioning the patient showed signs of a certain ailment and that they were prescribing a certain medication, and had a speech recognition and CLU system that was able to send a prescription order to a pharmacy – all in real time? "That scenario is totally feasible," says Dreyer. "For as much as there is unknown [in medicine], there is a lot of known." With actions and protocols centered around so many day-to-day routines, integrating voice recognition and CLU systems with a physician's commands could simplify and streamline workflows

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New analysis of docs on Twitter shows that they are active and connected users

New analysis of docs on Twitter shows that they are active and connected users | EHR and Health IT Consulting | Scoop.it

The use of social media has exploded in the last couple of years, and doctors are also jumping on board.

 

In an effort to understand how physicians are using social media, WCG, an independent strategic communications firm, created a database of nearly 1,400 doctors on Twitter and linked their profiles to the National Provide Identifier, a unique 10-digit identification number that the Centers for Medicare & Medicaid issues to providers in the U.S.

 

After tracking more than 400,000 tweets over a five-month period this year, the creators of the database came away with a few conclusions. According to a post written on the website of one such physician tweeterand blogger, the findings were:

 

1. These are active users. They tweet over 2x per day on average.
2. Twitter is a part of their work-day. More than 50% of tweets are sent between 9am and 5pm (in the physician’s local time zone).
3. They have an audience. 2/3 have at least 150 followers (the median is 306).
4. They connect to each other. More than 1/3 of the doctors are followed by at least 20 other doctors in the database.


The most-followed physician by those in the database was none other thanKevin Pho(the same physician on whose blog, this entry was posted); followed by nearly half of the doctors studied.
The characteristics of the database are not unlike the overall specialty mix and geographic location of the overall physician population in the U.S.

 

The database creators also wanted to find out what the doctors talk about and decided to analyze a sample of tweets related to diabetes, breast cancer and prostate cancer. A whopping 83 percent of the specialties mentioned the term “diabetes” in tweets.

 

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How social data could help expose drug side effects, personalize prescriptions

How social data could help expose drug side effects, personalize prescriptions | EHR and Health IT Consulting | Scoop.it
Social data pulled from online health forums and the comments section of blogs is helping patients learn about side effects to various drugs and could ultimately help them figure out the medications that suit them best.

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Pariscribe bets on Microsoft Surface for mobile EMR

Pariscribe bets on Microsoft Surface for mobile EMR | EHR and Health IT Consulting | Scoop.it

At $499 per download, the most expensive piece of software in the new online Microsoft Windows Store for the forthcoming Windows 8 operating system is a mobile electronic medical record from Pariscribe, a Toronto-based health IT vendor. It also is the first EMR built for the Microsoft Surface line of tabletsthat will hit the market when Windows 8 is released Oct. 26.

 

Pariscribe introduced the product, called EMR Surface, last month, in anticipation of the latest version of Windows, which Microsoft is positioning as a more business-oriented operating system than the two platforms that hold almost a duopoly on the mobile market, Apple iOS and Android. “We feel Microsoft Surface and Windows 8 will dominate, at least in the office environment,” Pariscribe President and CEO Manny Abraham said

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The Health IT Duo – Patient Portal and Cloud EHR

The Health IT Duo – Patient Portal and Cloud EHR | EHR and Health IT Consulting | Scoop.it
While we were not finished thanking internet to abridge the communication gaps, the introduction of social media further elongated the process. From layman to healthcare professionals, almost everyone has a social media ...
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Clinical Workflow Analysis: The Value of Task-Level Detail

Clinical Workflow Analysis: The Value of Task-Level Detail | EHR and Health IT Consulting | Scoop.it

EHR selection and implementation, usability, and software design all share a common set of goals, the most important of which are ensuring that users are productive and that patients receive quality care. Workflow analysis as an adjunct to system selection and implementation is old news (1). Perhaps, the recent ground swell of interest in usability and, by extension software design, points to another potentially useful application of workflow data. Obviously, software design and usability affect implementation and productivity. Why not, then, use the knowledge captured during workflow analysis across all four areas?

 

Properly conducted, workflow analysis reveals important information about what occurs in an organization. Analyzing key processes and determining the tasks involved in completing them helps organizations to eliminate redundancies and identify activities requiring further optimization (1). Conceivably, workflow data taken from a representative cross-section of similar organizations could prove to be useful for software designers. For example, having workflow data from 500 primary care internal medicine practices should provide invaluable information to software designers concerning clinician work habits and information needs that could be mapped directly to EHR software features, functions, and workflows. It seems reasonable to assume that this type of information would be helpful for other healthcare initiatives such as meaningful use and patient safety as well.


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Big data is coming, but when will it be really useful?

Big data is coming, but when will it be really useful? | EHR and Health IT Consulting | Scoop.it

One of the many promises of EHRs is that, in fairly short order, they’re going to make an ever-growing amount of data available in the quest for better population health management.

But how realistic is that promise?

 

As this academic sees it, “there is sometimes unbridled enthusiasm that the data captured in clinical systems, perhaps combined with research data such as gene sequencing, will effortlessly provide us knowledge of what works in healthcare and how new treatments can be developed. . . . I honestly share in this enthusiasm, but I also realize that it needs to be tempered, or at least given a dose of reality. In particular, we must remember that our great data analytics and algorithms will only get us so far. If we have poor underlying data, the analyses may end up misleading us. We must be careful for problems of data incompleteness and incorrectness.”

 

From there he goes on to cite a number of reasons for poor data capture. “Probably the main one,” he says, “is that those who enter data, i.e., physicians and other clinicians, are usually doing so for reasons other than data analysis.”

 

Adding to the list, he says, “I also know of many clinicians whose enthusiasm for entering correct and complete data is tempered by their view of the entry of it as a data black hole. That is, they enter data in but never derive out its benefits. . . . (A) common complaint I hear from clinicians is that data capture priorities are more driven by the hospital or clinic trying to maximize their reimbursement than to aid clinicians in providing better patient care.”


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Why Your Doctor Doesn’t Want You Using iPhone And iPad Health Apps | Cult of Mac

Why Your Doctor Doesn’t Want You Using iPhone And iPad Health Apps | Cult of Mac | EHR and Health IT Consulting | Scoop.it

Doctors may be fans of the iPad as a clinical tool, but they’re not certain that Apple’s iPad, the 5000+ health and medical apps in the App Store, or other mobile technologies are safe and effective health tools for patients. That’s the gist of a report by PwC Global Healthcare. The report was based on surveys of physicians, healthcare management professionals and payers, and mobile technology users in ten countries around the world.

 

According to the report, just under two-thirds (64%) of healthcare providers acknowledged that mobile technologies offer potential benefits for patients, but feel that mobile health (also known as mhealth) is virgin and untested territory. As a result, the majority of doctors (73%) don’t suggest iOS or mobile health apps to their patients and some (13%) even discourage patients from using them.

 

The reasons for not encouraging mobile health apps cover a variety of territory.

 

There’s the perception of cost, complexity, and scope of change associated with implementing mobile health solutions and an associated lack of technology systems in many healthcare environments. For example, the survey identified that only 40% of private practices and 63% of public sector offices and hospitals worldwide have wireless connectivity.

 

Concerns about how patients would use mobile health apps was a common reason for discouraging their use. That breaks down into a handful of issues, including patient compliance with health tools, the ability to ensure their proper use, and a concern that patients would become too independent and avoid regular office visits. That last concern appears to be a very valid point since 59% of mobile health users said iOS apps and other mobile technologies have replaced some visits to doctors or nurses.

 

Beyond patient use of health apps, concern about industry regulations was the biggest drawback to deploying mobile health solutions followed be the sense that healthcare, as an industry, has a particularly conservative culture. Those are areas that PwC’s Global Healthcare’s Christopher Wasden identified as different between as different between industrialized and developing countries.

 

The adoption of mobile health in emerging markets versus developed markets is a paradox. In developed markets, mHealth is perceived as disrupting the status quo, whereas in emerging countries it is seen as creating a new market, full of opportunity and growth potential. In younger, developing economies, healthcare is less constrained by healthcare infrastructure and entrenched interests. Consumers are more likely to use mobile devices and mHealth applications, and more payers are willing to cover the cost of mHealth services.

 

Other interesting points from the study include the following:

 

Health administrators and payers are more encouraging of mobile health solutions – 40% approve of such technologies compared to just 25% of doctors.


Two thirds of people who use health and fitness apps discontinue their use after six months (or earlier).


Roughly half the population expect mobile health options will improve the convenience (46%), cost (52%) and quality (48%) of healthcare.


Nearly half of those surveyed expect mobile apps will change the way they manage chronic conditions (48%), medications (48%) and overall health (49%).


60% of consumers believe doctors are not as interested in mobile health options as patients and technology companies.

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Mobile apps, medical records fuel healthcare's digital transformation - FierceHealthIT

Mobile apps, medical records fuel healthcare's digital transformation - FierceHealthIT | EHR and Health IT Consulting | Scoop.it

It's always interesting when the popular press tackles topics that healthcare industry leaders have been talking about for ages. It brings a different perspective and a fresh voice that's sometimes lacking in board room discussions, conference lectures and trade publication articles.

 

In a recent series titled "The Digital Doctor," the New York Times offers a glimpse into what the average consumer sees when he or she stands at the intersection of healthcare and technology: how health IT is changing medicine and doctor-patient relationships from the patient's point of view.

 

The series touches on a number of hot health IT topics--from how younger physicians are embracing technology to how older doctors are trying to catch up to how texting and social media can help pediatricians communicate with teens to the balance between the benefits and the dangers of electronic health records.
In this special report, FierceHealthIT takes a deeper look at some of the subjects in the series. On the following pages, you'll find highlights from and links to the Times' articles as well as links to additional news and information from our own coverage of the topics from the past year.


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9 ways social media is impacting the business of healthcare | Healthcare Finance News

According to a recent report by the Health Research Institute at PwC US, nine distinct uses of social media are helping companies to have an impact on the healthcare business, and to take a more active and engaged role in managing individuals' health.

 

"Organizations should coordinate internally to effectively integrate information from the social media space and connect with their customers in more meaningful ways that provide value and increase trust," the report read. "Insights from social media also offer instant feedback on products or services, along with new ideas for innovation. Organizations that can incorporate this information into their operations will be better positioned to meet the needs of today’s consumers."

 

The report outlined nine additional ways social media is impacting the business side of healthcare.

 

1. Communication is shifting to public, more open forums. Which means less money spent on mailings, websites, and other marketing initiatives. According to the report, four characteristics of social media have altered the nature of interactions among people and organizations: user-generated content, community, rapid distribution, and open, two-way dialogue. "In the past, a company would connect with its customers via mail or a website, but today's dialogue has shifted to open, public forums that reach many more individuals," read the report. "Early adopters of social media in the health sector are not waiting for customers to come to them." Ed Bennett, who oversees social media efforts at the University of Maryland Medical Center, agreed. "If you want to connect with people and be part of their community, you need to go where the community is," he said. "You need to be connecting before you are actually needed."

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How can social media impact treatment, research?

How can social media impact treatment, research? | EHR and Health IT Consulting | Scoop.it
BOSTON--Roger Chafe, PhD, director of pediatric research at the Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada, discussed the intersection of social media and more traditional media at the Medicine 2.0 Congress, and how both are impacting treatments and research.

 

For example, despite little clinical evidence or support for venoplasty to treat the symptoms of multiple sclerosis (MS), published information about a small trial of 65 patients in 2008 led to significant public debate about the treatment. Thousands of MS patients expressed their dismay on Facebook that the MS Society of Canada was moving too slowly on clinical trials for the potential treatment. Within days, the society reversed its position and requested research proposals.

 

In another example, Canadian wife and mother Jill Anzarut was diagnosed with HER-2 positive breast cancer with a tumor less than .5cm in size. She was denied coverage for Herceptin because her tumor was too small--Ontario guidelines indicated Herceptin for tumors 1cm or larger in size. Anzarut set up a Twitter account which generated numerous news articles about her plight. Eventually, a clinical trial for Herceptins effect on smaller tumors was set up.

 

Social media allows patients a greater platform for challenging treatment coverage decisions and research priorities, Chafe said.

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EHR Implementation — Big Bang or Staged? What You Should Know. | EHR Blog | AmericanEHR Partners

EHR Implementation — Big Bang or Staged? What You Should Know. | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

Big Bang describes an implementation where a practice begins using all of the functions at the same time. A staged implementation refers to a practice that gradually starts using a defined subset of EHR functionality before implementing more functionality; this process is then repeated until all of the functions of the EHR system are implemented. The advantages of each approach have been endlessly debated amongst health IT wonks. My view is that the best approach falls somewhere in the middle and may differ for each practice. Before going into the pros and cons of each approach, it is important to elaborate on some of factors that may limit the options your practice considers.

Unfortunately, many EHR vendors are currently suffering from severe resource constraints and may not be able to facilitate staged implementations, especially in smaller practices. If they are able to support staged implementations, the cost for this type of implementation may be higher, as their on-site training staff may be less efficiently deployed. Many EHR vendors are increasingly relying on interactive online training models that allow practices to train on their own schedule. This approach requires less one-on-one interaction, reducing the demand on trainers and how much vendors charge for training. Practices can also reduce the need for vendor training by utilizing a super-user model where a few clinicians and staff receive extensive training on the use of the system and then help train the rest of the practice.

 

Big Bang:

Advantages

 

Theoretically faster as all of the functionality is available at go live.
Onsite training can be completed in a single block of time, reducing the costs of training.
The drop in productivity experienced after all EHR implementations can be shorter, even though it may be more substantial. This is because staff are not continually trying to learn new technologies.
Disruptions caused by the unnatural segmentation of tasks, e.g. the documentation of a patient encounter on paper and then electronically prescribing a medication, are avoided.

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mHealth apps may make chronic disease management easier

mHealth apps may make chronic disease management easier | EHR and Health IT Consulting | Scoop.it
Mobile health (mHealth) applications (apps) for smart phones and tablet computers are proliferating rapidly, ranging in complexity from products as simple as patient scheduling and point-of-care electronic physician note apps to sophisticated remote patient monitoring devices.

 

“The whole world of mobile health is really expanding very dramatically,” Richard J. Katz, MD, director of the Division of Cardiology at George Washington University Hospital in Washington, DC, told Clinical Advisor.

Smart phone apps are incredibly promising for the field of chronic disease management due to their pervasiveness and increasing attention by designers to things such as user experience and ease-of-use, according to Julie Kientz, PhD, director of the Computing for Healthy Living and Learning Lab at the University of Washington in Seattle.

 

“More and more frequently, medical professionals and technology researchers are teaming up to deliver best practices from researchers in a mobile format that can be there whenever the patient needs it and serves as a convenient system for tracking data and receiving reminders for medications,” Kientz said in an interview.

 

There are many apps available in iTunes and the Android marketplace for clinical disease management, as well as patient self-management, for conditions including asthma, diabetes, heart disease, cancer, and even autism and insomnia.

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Will meaningful use help prevent prescription drug abuse? | EHRintelligence.com

Will meaningful use help prevent prescription drug abuse? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Growing national concerns over the rise of prescription drug abuse could lead to future meaningful use requirements the Electronic Health Records Incentive Programs, according one of the Office of the National Coordinator for Health Information Technology (ONC) Federal Advisory Committees (FACs). As its name suggests, the Meaningful Use Workgroup helps the Health IT Policy Committee by defining determine the meaningful use of electronic health records by eligible professionals (EPs) and hospitals (EHs) in future stages of the Centers for Medicare & Medicaid Services (CMS) incentive programs.

 

During yesterday afternoon’s meeting, the group considered the addition of potential objectives to Stage 3 Meaningful Use order to support the national effort to reduce prescription drug abuse through health IT. In particular, the Meaningful Use Workgroup discussed the value of a state-level program for monitoring prescription drug use, the Prescription Drug Monitoring Program (PDMP).


According to a report from the Centers for Disease Control and Prevention (CDC), drug poisoning has surpassed motor vehicle accidents over the last twenty years as the leading cause of death from injuries. In 2008, poisoning led to 41,000 deaths, with 89% resulting from drug poisoning.

 

In response to drug-related fatalities, many state lawmakers have embraced the concept of prescription monitoring programs (PMPs) as a means of combating prescription drug abuse as of October 2012. The Alliance of Prescription Monitoring Programs defines PMPs as


an effective tool for improving patient safety and curtailing the abuse and diversion of prescription drugs by enabling a state to monitor the prescribing and dispensing of controlled substances. By accessing this information before they prescribe or dispense, a practitioner can provide better patient care and help protect their practice.


All states with the exception of Missouri have enacted PMP legislation. Whereas Guam has successfully enacted legislation, the District of Columbia is the only territory not having passed legislation. (As of October 2012, this legislation was pending.) Of the states and territories with legislation, nine have yet to begin PMP operations.

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EHRs: Fewer errors and better care are the end game, not increased fraud

EHRs: Fewer errors and better care are the end game, not increased fraud | EHR and Health IT Consulting | Scoop.it

In an industry notoriously slow to adopt new technologies, the EHR game has been a long one.

 

Don’t give up on the technology, stay focused on the end game.

 

It’s a fact that the potential of EHR technology is set to accomplish the mantra, the mission of every hospital I know: better patient care. While the technology, its implementation, and adoption is still quite nascent, the data and information available to doctors will ultimately save lives. It will help identify patient complications before they happen; decrease the number of hospital re-admissions; reduce patient safety events; compile data to change and improve treatment for chronic disease, and so much more.

 

And while much of the communication around EHRs has been about how digital records will improve workflow for providers, there are also undeniable benefits for healthcare consumers. The end game for EHRs looks like this from a patient perspective.

 

Quality and consistency from provider to provider


According to a recent report from the Institute of Medicine, 20 percent of patients reported that their test results or medical records weren’t transferred to another medical institution in time for an appointment, and 25 percent said their doctor had to re-order tests to have the correct information for diagnosis. [1] With EHRs, that will change. As you move from primary care physician to specialist to emergency care and so on, you no longer have to repeatedly fill out forms, have duplicate exams, lab tests, or even explain your symptoms to multiple care providers ’ your health history, medication history, lab results, family and social history and vital statistics all move with you once your provider joins a Health Information Exchange.


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The Perils and the Potential of EMR: The Good, The Bad and The Ugly

The Perils and the Potential of EMR: The Good, The Bad and The Ugly | EHR and Health IT Consulting | Scoop.it

As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping.  The medical record is vital to the care of the patient.  It tells the story of each patient’s journey through the medical system.  The idea of centralizing all pertinent medical information is, in theory, a step in the right direction.  In utopia, there would be one medical record for each and every patient that could be accessed by any healthcare provider on the planet at a moments notice.  However, in practice, this is a monumental task.  Earlier this week, the New York Times published a special section on The Digital Physician.  As part of the feature, the current state of the Electronic Medical Record (EMR) was examined.

 

The Federal government has mandated the implementation of EMR in order for providers to be paid at the highest allowable rates and receive certain incentive pay for complying with EMR. Terms such as “meaningful use” have been coined by legislators in Washington, DC.  Certainly, a great deal of money has been spent by both the US government as well as individual providers to develop EMR and implement electronic records by predetermined government deadlines.  EMR has the potential to provide increased patient safety and significant cost savings if developed properly.  However, current EMR systems are not really ready for “prime time”  There is no real data out there that has demonstrated improved outcomes with EMR use–it is interesting that Medicare refuses to reimburse for unproven therapies but the Federal government will mandate EMR implementation without long term outcomes data.  Only recently are studies emerging to give us some idea of the impact of EMR on patient outcomes.  I think that there is a great deal of work to be done in order for EMR to have the desired impacts on safety, communication and healthcare cost containment.

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Three Key Plays to Make EHRs More Useable

Three Key Plays to Make EHRs More Useable | EHR and Health IT Consulting | Scoop.it

What makes an EHR more usable? The answer is a team consisting of patients, physicians, and vendors.

 

Play 1: Physicians need to engage patients and the vendor.
Physicians and clinicians are the primary users of an EHR. As users they need to open a channel to their EHR vendor and offer insights and suggestions on how to make their interaction with the technology smooth, beneficial, convenient, accurate, and useful. It will take some time to communicate these elements, but it is the only way to move more quickly up the usability curve. It will be time well-spent.

 

In addition, ultimately, patients will have access to information contained within an electronic health record. A conversation needs to happen between physicians and patients about how they want to get their data and in what form. There have been several recent articles about how patients value having access to their notes in the EHR. Patients add an essential perspective to how an EHR should be used. It is a system to serve them and their care.

 

Play 2: Vendors need to engage physicians and patients in the usability of their applications.

 

The best healthcare vendors listen to their customers. It is more than listening though. It is acting on what is heard in a way that makes the product better, more usable, and more effective. EHR vendors can change the model by involving patients in this process as well. Even though physicians, clinicians, and administrative personnel are the primary users of an EHR, their solutions benefit patients, too. Information in an EHR will be viewed and carried forward by patients, so they can provide a valuable perspective on usability.

 

Play 3: Patients need to be open to giving feedback and insights on electronic health records.

 

The first step in this process may be for patients to ask for access or a copy of relevant data from their EHR. To gain credibility in the process, patients need to be conversant, meaning they need to have their data in whatever form their physicians will provide it.


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Meaningful use of EHR systems begins with meaningful training

Meaningful use of EHR systems begins with meaningful training | EHR and Health IT Consulting | Scoop.it

The adoption of certified electronic health record technology (CEHRT) requires time, money, and most importantly people. An ongoing debate among health information technology (IT) experts currently centers on the lack of available health IT professionals and training resources.

 

 The Health IT Workforce Development Subgroup identified a number of challenges that providers encounter on their way to become meaningful users in the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs.


Meaningful use requires the “meaningful training” of health IT professionals, but there’s still the problem of affording these resources. Considering that the regional extension centers (RECs) created by the Office of the National Coordinator for Health Information Technology are set to expire with the close of Stage 1 Meaningful Use, it’s imperative that providers have access to reliable and affordable resources for future phases of the EHR Incentive Programs.


The second challenge is time, namely being able to allow staff to attend health IT training. Currently, meaningful users find themselves in the first phase of meaningful use, but they will face new requirements and evolutions in health IT as the program moves forward.

 

To keep with innovation, providers must be able to receive training as new requirements emerge or have access to health IT professionals capable of supporting them. Not only must future stages of meaningful use update technology, but also they need to upgrade and advance the skills of health IT users.


The third challenge involves the health IT workforce itself. How will providers ensure that they have the qualified personnel on hand to keep them on the path to meaningful use? This leads to the matter of certification.

 

Degree and certificate programs should take into account the demands of the market and come to a consensus about what the requisite skills and qualifications are. And what counts as accredited training? Considering that providers are strapped for time, the increasing need for training in the workplace itself requires a rethinking of how these users receive credit for their work. The training environment is changing, necessitates that accrediting bodies reimagine constitutes an accredited activity.


While meaningful use places a significant emphasis on EHR technology, its mission is to change the way providers use health IT to improve the care of their patients and patient populations. To achieve this end, providers must adopt as well as adapt to new and emerging technologies, beginning with knowledge of and access to the right resources and best practices.


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EHR implementation: How common blunders can alienate your patients

EHR implementation: How common blunders can alienate your patients | EHR and Health IT Consulting | Scoop.it

Many practices are adopting an EHR for the first time, with various surveys finding 70% to 80% putting in systems, double the rate of three years ago. Almost every health IT implementation comes with hurdles and blunders. It can be frustrating when blunders affect the patient experience, but many are common and can be prevented by learning from the mistakes of other physicians.

 

When a practice has no system to see which patients are scheduled, or the waiting room is full of angry patients while their physician tries to get back online, or the physician logs in only to find a blank screen, “it can be kind of a chaotic day,” said Becky Little, director of clinical operations for Genesis Ob/Gyn. “Not having the network or data, you’re kind of flying by the seat of your pants in terms of who is coming in and for what.”

 

Many of the common blunders can be linked to how the technology is implemented and how it is used. “For the most part, the technology works,” said Amit Trivedi, health care programs manager for ICSA Labs, a technology testing and certification organization. “It’s getting people to work with the technology that is more difficult.

 

“One of the toughest things is that folks view EHR implementation as a technology project, and it is because you are making a sizable investment in hardware, software, licenses and all that stuff. But it’s easy to forget that ultimately it’s a people and process project, not as much technology.”


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