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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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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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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