EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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EHRs and Legal Liability

In today's digital age, the use of electronic health records (EHR) only continues to increase, as does the legal questions and issues surrounding their use.

Via nrip
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Benefits of Online Medical Records Outweigh the Risks

Benefits of Online Medical Records Outweigh the Risks | EHR and Health IT Consulting |
Just as it's now easy to visit an ATM from just about any bank in almost any country and access funds stored at your local bank, it ought to be possible for any medical provider -- with your permission -- to access your medical records from anywhere.


A couple of years ago I arrived at my hotel in Berlin after a 12 hour flight and noticed that I had forgotten to pack medication I was taking at the time. Of course, I had no idea the actual name of the medication, let alone the exact dosage. And when I discovered it was missing, it was the middle of the night in California, so I couldn't call my clinic or pharmacy.


But it wasn't a problem. I logged on to the Palo Alto Medical Foundation's My Health Online website, found the prescription information and -- with the hotel's assistance -- arranged an immediate phone consultation with a local doctor, who prescribed replacement pills. The only reason I needed to speak to a doctor was because the German pharmacy wouldn't fill a foreign prescription. Had I been in the United States, I could have skipped the phone call and used the site to request that the prescription be sent to a local pharmacy.


That service, which is now also available via a smartphone app, has made me a smarter health care consumer. Thanks to the site and app I can now access all of my medical records, including most test results, notes from physician visits, preventive services and more. I can also use the service to request appointments and exchange messages with clinic doctors. It even lets you graph vital signs and numeric test results to see how you're doing over time.

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EHR Implementation — Big Bang or Staged? What You Should Know.

EHR Implementation — Big Bang or Staged? What You Should Know. | EHR and Health IT Consulting |

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.

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Using A Standard EHR Approach

Using A Standard EHR Approach | EHR and Health IT Consulting |

An academic medical center builds a toolkit to streamline go-lives at its 59 clinics.


Because Oregon Health and Science University has 59 clinics, two hospitals and 800 salaried faculty physicians, implementing an enterprisewide electronic health records system was a daunting task. To greatly simplify implementation at the clinics, the academic medical center developed a standardized, 10-week approach, using a team of clinical experts to guide each implementation.


After launching the EHR at about five clinics late in 2005, the organization used the regimented approach to roll it out to all the other outpatient sites by last March. Now it’s turning its efforts to implementing the software, from Epic Systems Corp., Verona, Wis., at its hospitals.

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5 experts on today's top EHR usability issues | Government Health IT

5 experts on today's top EHR usability issues | Government Health IT | EHR and Health IT Consulting |

We talked with diverse industry insiders for their take on what is critical to user-centric design and what the usability factors might mean to healthcare and to the healthcare IT market. Here is a sampling of some of the topics on their minds.


Data entry. The biggest complaint is data entry, says JiaJie Zhang, director of the ONC’s SHARP project, charged with finding ways to make EHRs easier to use. “Nobody wants to become a data-entry clerk,” Zhang says. “Their job is to take care of patients, and data entry so far is not optimized. It involves many, many issues here. It is basically the repetition. If you enter this one here, you have to enter it again in a different place. It should be automatic.”

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Meaningful Use is Up to You: 4 Key Points From Dr. Farzad Mostashari

Meaningful Use is Up to You: 4 Key Points From Dr. Farzad Mostashari | EHR and Health IT Consulting |
Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, realizes implementing and utilizing electronic health records for meaningful use may be easier said than done. However, he is optimistic about the changing ecosystem of healthcare and the role meaningful use will play.


"I know it may be easier said than done, but I also know that many [hospitals and providers] are doing it. I have confidence that by working together we will be able to do what we couldn't have done on our own — reach a brighter future for medicine," said Dr. Mostashari during the CMIO Leadership Forum: Transforming Healthcare Through Evidence-Based Medicine held Oct. 4-5 in Chicago.


Dr. Mostashari did not deny that it is a hectic time in the healthcare industry. He cited the quick change of pace and uncertainty with hospital consolidation as reasons the environment around meaningful use is challenging. However, he argued that these reasons are also what makes meaningful use important. "Medical information and health information technology are at the fulcrum of the industry's transformation," said Dr. Mostashari.

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The Ups and Downs of Electronic Medical Records

The Ups and Downs of Electronic Medical Records | EHR and Health IT Consulting |
Electronic record systems can make health care more efficient and less expensive, but their potential for mistakes and confusion can be frustrating, costly and even dangerous.
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EMR – The Certification Game

EMR – The Certification Game | EHR and Health IT Consulting |

The introduction of government’s incentive program brought with it the most talked about topics today, which is the concept of Electronic Medical Records (EMR) certification. As part of the healthcare industry, from hospitals to solo healthcare providers, everyone is well aware of the fact that the government’s financial incentives are to be allocated to providers who make the meaningful use of certified EMRs.


Before getting inundated in the complexities, it is important to understand what exactly certified EMRs are and what the science behind certification is. A certified EMR is the one that meets the, minimum, set of standards and requirements set by the regulatory authorities. In other words, it could also be said that a certified EMR is the one that fulfils the criterion for meeting the meaningful use objectives.

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EMR Monitoring Tool Catches Sepsis Cases Earlier

EMR Monitoring Tool Catches Sepsis Cases Earlier | EHR and Health IT Consulting |

Sepsis--a medical condition in which the body has a severe inflammatory response to bacteria or other microbes --costs the US approximately $14.6 billion a year, according to the Centers for Disease Control and Prevention. Several initiatives put in place at the University of Kansas Hospital are making a dent in those numbers, resulting in a savings of $18,000 per patient, or $18 million a year.

The university hopes to take this success one step further with the use of CareVeillance, a first-of-its-kind sepsis identification tool that replicates patient information from an electronic medical record (EMR) and monitors patients in real time for the complication.

Bryan Eckert, senior principal at CSC Health Delivery Group, said in an interview with InformationWeek Healthcare that the CareVeillance system includes customer-designed workflows and algorithms to provide this situational awareness, and it automates risk scoring while finding early warning signals often buried in the EMR.

"At a high level, we use industry-standard means of replicating patient information from an EMR: it doesn't matter whose it is," Eckert said. "We're grabbing information at the interface level ... we're grabbing it at two tiers."

Via nrip
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The Data Entry Paradox

Everyone, including this blog writer, has been touting the virtues of the vast troves of data already or soon to be available in the electronic health record (EHR), which will usher in the learning healthcare system. 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 The data is unstructured? No problem, just apply natural language processing


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.


There are all sorts of reasons for inadequate data in EHR systems. Probably the main one is that those who enter data, i.e., physicians and other clinicians, are usually doing so for reasons other than data analysis. I have often said that clinical documentation can be what stands between a busy clinician and going home for dinner, i.e., he or she has to finish charting before ending the work day.

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Personalized Medicine vs. ObamaCare

Personalized medicine is the future. It is where the science is going. It is where the technology is going. It is where doctors and patients will want to go.  Yet unfortunately for many of us, this is not where the Obama administration wants to go.


First, the good news. Biosensors that can be worn on clothing or jewelry, or held against the skin by a Band-Aid-like patch, or inserted beneath the skin are capable of monitoring a whole host of chronic diseases. Among the technologies that have been, or soon will be, developed are devices that can continuously monitor the blood glucose levels in diabetics; the rate of breathing, blood oxygen saturation, etc., of asthmatics; and the heart rate and other parameters of patients with heart disease. There are even heart attack and stroke attack detectors. In some cases, personalized devices can activate therapies. A wearable, automatic insulin pump can be coupled with a blood glucose measuring device to create a virtual artificial pancreas. (See this fascinating summary.)


The science of genetics is also about to explode. There are as many as 1,300 genetic tests currently available that relate to about 2,500 medical conditions. Gene tests can predict your probability of getting particular types of cancer, whether you will respond to routine chemotherapy or whether there is a special therapy that only works on people with your particular physiology. The days when experts argued over whether men should get a prostate cancer test could be long gone.  A simple test can tell if you have a high probability of contracting the disease, or a low one.

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Tracking your body with technology

Tracking your body with technology | EHR and Health IT Consulting |

Devotion to self-tracking has a name -- "Quantified Self" -- which is a website established by Wired co-founder Kevin Kelly and Gary Wolf, Wired contributing editor. Wolf's own website, Aether, says more than 12,000 people worldwide are members of Quantified Self Meetups.


Inside Larry Smarr's refrigerator this week was a stool sample that he planned to ship to a laboratory, which will send back a report of information about what's going on inside Smarr.

This monthly test is not part of his doctor's orders, nor is the plethora of mobile technologies that Smarr uses to track what's going on inside his body. But Smarr believes everyone should take charge of monitoring their own health, given how little time people tend to spend actually talking to their doctors.

Smarr may be an extreme example, but many people are turning to available technologies to gain knowledge about their bodies that they can use to optimize their health, beyond what information annual doctor's visits might bring.

"I am trying to respect my doctor by doing my part of the homework," said Smarr, 63, of La Jolla, California. Smarr is the director of the California Institute for Telecommunications and Information Technology, a research center at the University of California's San Diego and Irvine campuses.


As of Thursday, there were 873 people registered for the Quantified Self message boards, where people discuss the latest apps and research. The website has a list of hundreds of apps and tools available for tracking different aspects of your life, from mood to diet to sleep. The movement hosted the conference Quantified Self 2012 last weekend, with Smarr as a guest speaker.

Via nrip
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Security audits necessary to land EHR incentives -

To qualify for the federal Electronic Health Records Incentive Program, providers must perform security risk audits when they install their systems or make changes to their office policies and procedures. Providers then are required to fix any weaknesses the audits reveal.

The Health Insurance Portability and Accountability Act of 1996 safeguards patients’ medical information. One HIPAA breach, such as a lost patient record, can cost a physician $50,000. Penalties can climb to $1.5 million.

Providers can ask their IT employees or contractors to do a risk analysis. Physicians can do the analysis themselves using guidelines available on the Internet.

“As a practical matter, providers are not security experts, and getting some sort of outside help would be recommended,” saidTom Reavis, communications manager for Arizona Health-e Connection, a nonprofit that helps doctors convert to electronic systems.

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Q&A: Preparing for ICD-10, competing HIT initiatives

Q&A: Preparing for ICD-10, competing HIT initiatives | EHR and Health IT Consulting |

Because of recent rulings by the Centers for Medicare & Medicaid Services (CMS) on second phase of the EHR Incentive Programs and the compliance date for ICD-10, 2014 is likely to become a busy year for providers, hospitals, and health systems..


In and of themselves, the demonstration of meaningful use of electronic health records (EHRs) and the transition to the International Classification of Diseases, 10th Revision (ICD-10) are serous undertakings. Because of recent rulings by the Centers for Medicare & Medicaid Services (CMS) on second phase of the EHR Incentive Programs and the compliance date for ICD-10, 2014 is likely to become a busy year for providers, hospitals, and health systems affected by both programs as they attempt to assign resources to competing priorities and deadlines. It would appear that CMS has set in motion a perfect storm that could cripple healthcare staff and exhaust their resources.

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Cloud-based EHR considerations for small providers

Cloud-based EHR considerations for small providers | EHR and Health IT Consulting |

Small practices, more so than most healthcare providers, are constantly looking at the bottom line. So when it comes to EHR adoption, thinking about cloud-based EHR is a natural progression. While cloud-based EHR does have its advantages over client-server EHR, there are items that smaller providers need to take into account before going all-in on cloud.



Because cloud-based EHR software is run through the Web, you won’t have to worry about server, hardware and software installation. This may mean a quicker return on investment (ROI) than if you were bringing in a big, server-based system. And for small offices with limited space, installing all that hardware may not be the best use of your surroundings. But don’t let the ease of implementation be the definitive reason you use cloud-based EHR. Quality, security and cost of the software should be the three main areas of focus when selecting EHR software



Security is a big concern among physicians when it comes to EHR – but it shouldn’t be as worrisome as some perceive it to be. According to, Web-based EHR systems achieve HIPAA compliance through data centers with bank-level security and high-level encryption methods that render data unreadable even in the event of a data breach. Furthermore, client-server systems are often left unencrypted and only as secure as the room where they are stored. The key here is having an encrypted high-speed Internet connection, which provides your practice with access to data and applications without having to manage software changes or invest in server hardware. And if you’re comfortable with personal Gmail or online banking accounts, both of which are cloud-based, you shouldn’t have too much concern with cloud EHR when it comes to security.

Scalability and accessibility

The ability to be agile and grow out or scale back an EHR system is a necessary requirement for small providers, because it’s hard to future predict staff or financial changes. You can’t increase the capacity of a client-server system without paying through the nose, while expanding your cloud EHR software’s capabilities shouldn’t be too cumbersome.


Short term vs. long-term savings

Some client-server systems can cost $40,00-$60,000 to bring in and then you need to consider licensing fees, maintenance costs, updates and patches. Implementing cloud-based EHR is much less, as you pay a monthly fee, called software as a service (SaaS), which can cost about $10,000-$13,000 up front and then about $500 per month in service fees. And you get automatic updates, instead of having to pay separate fees with a server-based EHR.

While using Web-based software may make an instant impact on your bottom line right now, how confident are you in this company’s longevity? It’s great if you’re paying a certain amount per month for services and getting everything you need from the software, but what happens if the company goes bottom-up down the line? For small practices, this is an area in which they need to remain cautious during the decision process.

Via nrip
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Why the next wave of health IT innovation will build on EMRs, cater to physican happiness

Why the next wave of health IT innovation will build on EMRs, cater to physican happiness | EHR and Health IT Consulting |

There’s no shortage of primary physicians, but rather a shortage of primary physicians who are able to use their time efficiently in today’s healthcare environment.


That’s why the industry is moving away from the first version of the EMR, according to Dr. Lyle Berkowitz, the associate chief medical officer of innovation at Northwestern Memorial Hospital and Medical Director of IT & Innovation at for Northwest Memorial Physicians Group in Chicago.


The inaugural EMRs are basically computerized versions of paper records that weren’t necessarily designed with usability in mind, he noted. So rather than saving time and making administrative processes easier, they’re in some cases adding to doctors’ workloads.

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Providers Seek Consulting Firms For Smaller EHR Projects

Providers Seek Consulting Firms For Smaller EHR Projects | EHR and Health IT Consulting |
With EHR installation a done deal, many health providers look to consulting firms for smaller Meaningful Use projects, KLAS study shows.


Healthcare organizations seeking to meet Meaningful Use Stage 1 requirements are much less inclined to hire consulting firms to fully install an electronic health record (EHR) and more likely to turn to these firms to help with smaller projects that enhance the features and functionality of their EHRs, a new KLAS report reveals.

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IT Staff Shortages May Short Circuit Meaningful Use

Health IT staff retention is a growing concern for healthcare CIOs, even as they have trouble filling existing openings, reports College of Healthcare Information Management Executives poll.
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The EHR As an Object Worthy of Study

The EHR As an Object Worthy of Study | EHR and Health IT Consulting |

It isn’t often that I come across an article that truly resonates with me, but Next-Generation Phenotyping of Electronic Health Records, by Hripcsak and Albers, did just that. While the authors’ main focus is EHR data quality, they make this intriguing observation/suggestion:


It will require study of the EHR as if it were a natural object worthy of study in itself (emphasis mine), and it may be helpful to employ the general paradigm of physics, which involves modeling and aggregation. It will be helpful to pull in expertise and algorithms from many fields, including non-linear time series analysis from physics, new directions in causality from philosophy, psychology, economics, of course our usual collaborators in computer science and statistics, and even new models of research that engage the public.


I absolutely agree–it is time to start treating EHR systems as more than front ends to data stores. Considering the role that EHR systems are expected to play in improving healthcare quality and safety while lowering or stabilizing costs, the design of clinical systems is rarely discussed in the literature. As I have mentioned in previous posts, most EHR-related standards address the content and features EHR systems should have, but specifically disclaim any concern about how systems should be built. It’s almost as if the prevailing attitude is that EHR design and architecture are straightforward and require little real intellectual input. This raises another issue that I think deserves discussion—the intellectual work of software development.


Via nrip
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Health IT is an essential element to transform the Nation’s healthcare system

Health IT is an essential element to transform the Nation’s healthcare system | EHR and Health IT Consulting |

Recently, four members of Congress sent a letter to HHS Secretary Sebelius asking her to suspend payments for the EHR Incentive Payments authorized in the American Recovery & Reinvestment Act of 2009.  The Members make reference to recent reports reveal[ing] that the EHR program may be leading to higher Medicare spending and greater inefficiencies while doing little, if anything, to improve health outcomes.


HIMSS opposes halting the Meaningful Use EHR Incentive Program.  Health IT is an essential, foundational element of any meaningful transformation of the Nation’s healthcare delivery system. HIMSS Analytics data provides clear indication that government incentives are working; take a look at the chart above.

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The Seven Habits of Highly Effective Health Care CIOs


Habit 1: Be Proactive-- Take initiative in life by realizing that your decisions are the primary determining factor for effectiveness in your life.


Habit 2: Begin with the End in Mind -- Self-discover and clarify your deeply important character values and life goals.


Habit 3: Put First Things First -- Prioritize, plan and execute your work based on importance rather than urgency.


Habit 4: Think Win-Win -- Genuinely strive for mutually beneficial solutions or agreements in your relationships.


Habit 5: Seek First to Understand, Then To Be Understood -- Use empathic listening to be genuinely influenced by people, which compels them to reciprocate the listening and take an open mind to being influenced by you.


Habit 6: Synergize -- Combine the strengths of people through positive teamwork, so as to achieve goals no one person could have done alone.


Habit 7: Sharpen the Saw -- Renew your resources, energy and health to create a sustainable, effective lifestyle.


Also, make room to have a life. Even the CIO cannot always be "on." You must take vacations and get away from the technology-driven invasion of personal and family time. You may be surprised by how much your behavior influences your staff's.


When they see the CIO responding to emails at night, over weekends and on holidays, they learn this is what is expected. Try standardizing your schedule and avoid emailing your staff after 6 p.m., on weekends, or during vacations or holidays unless it is a true emergency -- then watch the stress level drop in your department.


Sharpening the saw also applies to your IT infrastructure. Many organizations continue to layer more and more complex applications onto their infrastructure without an adequate plan or resources to refresh or upgrade it -- to keep it "sharp."


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Collaborative video for healthcare the key for avoiding readmission fines

Collaborative video for healthcare the key for avoiding readmission fines | EHR and Health IT Consulting |

Many Americans believe that the Patient Protection and Affordable Care Act (PPACA), which was championed by President Obama, is simply intended to provide access to healthcare insurance for all Americans. However, there’s a lot more to the legislation, including new and innovative ways to drive down the overall cost of care and incentives to focus on keeping Americans healthy instead of simply treating them when they’re sick.


One of these initiatives intended to cut healthcare costs for the government went into affect this Monday. Now, if patients are readmitted to a hospital unnecessarily within 30 days of discharge, the hospital will face fines from the government.


The program initially focuses on three conditions that often result in readmission – pneumonia, heart disease and congestive heart failure. The penalty is also capped at 1 percent of the hospital’s Medicare payments for the first year. The penalties will rise progressively to 3 percent of Medicare payments over time and will eventually be expanded to include joint replacements, stenting, heart bypass and stroke treatment.

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A 12-step Program to Ensuring the Secure Data in Your EHR Stays That Way

A 12-step Program to Ensuring the Secure Data in Your EHR Stays That Way | EHR and Health IT Consulting |

1. Continue following the rules and regulations set forth by HIPAA. Do not leave printed patient health information where others have access to it. When scanning information into a patient’s EHR, destroy the paper copy when it is no longer needed. Unlike paper charts, it is easy to see a computer screen from across the room. Computer screens should not be visible from the waiting room, check-in area or any place an unauthorized person may be able to see a patient’s EHR. Install privacy filters on monitors to block anyone from viewing the computer from a side view.


2. Install antivirus, intrusion detection and firewall software.


3. Do not use social security numbers as a unique patient identifier. This is something I’d like to see adopted universally in healthcare. There’s no need for my SSN to be sitting on the top of my new patient forms for all the world to see.


4. Patients have the right to control who sees their information. Whether or not an EHR system is in place, do not share patients’ health information with anyone unless the patient has personally authorized it or such disclosure is authorized by law (e.g., mandated disease reporting). Ensure that employers,marketers and law enforcement or immigration officers do not have access to patient records. If your practice is part of a Health Information Exchange network, patients have the right to choose whether or not they will participate. Patients have the right to revoke their consent for sharing information.


5. Patients should understand their rights to consent, as listed in #4 above.


6. Always log out of the EHR system when leaving the computer. If EHRs are left open on the screen, other people can access and/or modify patient information. This activity will be logged as the user’s and he/she may be held accountable for any privacy violations.

For more about this subject, take a look at this insightful article by Dean Wiech of Tools4ever.


7. Keep all passwords safe and secret. Create a password carefully. Passwords should not be obvious, such as birthdays, pets’ names or favorite sports teams. Think of something that is easy for you to remember, but impossible for anyone else to guess. Never share passwords. If anyone asks a staff member for his/her password, the staff member should report that person immediately to the practice administrator. Passwords should not be posted or written down near the staff members’ desks. Change passwords every three months.


8. Ensure hardware is safe and secure. Portable computers are easy to steal. Computers, servers and other equipment that contain data should be locked in a secure place when not being used.


9. Be careful when accessing EHRs from outside of the office. When opening a patient’s EHR in public, make sure no one can see the computer screen. Only access EHRs from a secure Internet connection.


10. Train all staff members on data security policies and procedures. Make sure everyone in the practice understands and observes the policies and procedures for protecting patient health information.


11. Keep up with staffing changes. If an employee leaves the practice, change the user’s status to inactive. This means they can no longer sign in with their old password.


12. Review audit trails periodically. Reviewing audit trails can alert practices to potential system abuse or misuse. Some staff members forget to log out of their system, as well as access parts of the EHRs that are beyond their practice function. Audit trails can let practice administrators know when this occurs and take appropriate action.

Via nrip
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