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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Measure Your Medical Practice Staff Tech Skills

Measure Your Medical Practice Staff Tech Skills | EHR and Health IT Consulting |

Before you begin training staff to use a new EHR or practice management system, it's a good idea to assess their overall comfort level and experience with using technology. Staff members with low computer literacy should receive basic skills training so they can take full advantage of vendor training during implementation. Without that foundation, they may feel lost and never achieve true proficiency with the new system, experts say. Here is a basic skills assessment survey recommended by CMS. Employees are instructed to indicate how familiar they are with various tasks or skills on a scale from 1 (no experience) to 5 (very comfortable).

Desktop skills:

• Safely turn computer on and off

• Restart your computer if it becomes locked

• Open a program using the Start menu

• Name the basic computer system parts

• Explain the terms: icon, menu, window, click, select, drag

• Use scroll bars and move, resize, and close windows

• Use help screens in the software programs

• Navigate among folders, create, name, and delete folders

• Copy or move a file from one folder to another

• Cut or copy and paste text

Internet skills

• Use a Web browser

• Recognize a URL

• Explain the terms ISP, website, home page, search engine

• Type a URL in an open box

• Use back and forward buttons to move through Web pages

• Create a bookmark

• Locate and click on links

• Use a search engine

• Print a Web page

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How Primary Care Health IT Use Spurs Quality Improvements

How Primary Care Health IT Use Spurs Quality Improvements | EHR and Health IT Consulting |

Strengthening workflow, treatment, and billing processes in primary care is critical to healthcare reform initiatives taking place around the nation. EHR technologies and other health IT systems play significant roles in supporting quality improvements in primary care practices.

The Agency for Healthcare Research and Quality (AHRQ) released a white paperUsing Health Information Technology to Support Quality Improvement in Primary Care –that discusses some key best practices for supporting enhanced quality of care.

The report outlines various health IT tools that can lead to quality improvements in the primary care setting as well as ways to stimulate greater use of health IT among primary care physicians. The key health IT tools primary care physicians will need in their practice include EHR systems, registries, decision support systems, and health information exchange (HIE). Several case studies are also presented to illustrate ways that providers can incorporate health IT in quality improvements.

Over the last six years, the Health Information Technology for Economic and Clinical Health (HITECH) Act has pushed forward the adoption of EHRs, e-prescribing systems, and other health IT tools.

Through the Medicare and Medicaid EHR Incentive Programs, the majority of healthcare providers have adopted health IT systems and are working toward quality improvement within their practice. The Patient Protection and Affordable Care Act also spurred healthcare reforms such as the integration of Accountable Care Organizations (ACOs).

AHRQ spoke with a panel of eight health IT experts to establish ways of incorporating health IT tools and advancing the development of quality improvements in the primary care setting. The organization also spoke with clinicians from an independent primary care practice, a large academic primary care facility, and a health information exchange that supports primary care establishments.

The researchers from AHRQ uncovered four factors that lead to the effective use of health IT tools in pursuit of improving the quality of primary care. These four factors are:

  1. A practice culture committed to health IT
  2. High-functioning health IT tools capable of tracking
  3. Knowledgeable staff with experience in health IT and quality improvement
  4. Workflows and practice processes that incorporate health IT

Both financial incentives and training assistance from health IT experts are key to garnering these four factors for a primary care practice. The Centers for Medicare & Medicaid Services (CMS) has already been utilizing this finding by offering meaningful use incentives and ICD-10 testing to ensure providers are on track with federal health initiatives.

One example of how health IT can be used for quality improvements in the primary care setting comes from Foresight Family Physicians, which has been operating for 25 years in western Colorado. The facility began transitioning to electronic records starting in 2004 and adopted a full-scale EHR system in 2007.

“Foresight currently uses health IT for quality improvement in several interrelated ways. First, the practice has a standing QI team, which includes four people who meet every two weeks for 1.5 hours,” the AHRQ report states. “To identify gaps in care and needed preventive health screening, the front office staff runs approximately 15 daily registry reports for all patients with appointments that day. This process generates reminders for patients who require screenings for depression, are due for a colonoscopy or mammography, have a body mass index over 30, and other concerns.”

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Why Should Your Practice Have a Cloud-Based EHR? - HITECH AnswersHITECH Answers

Why Should Your Practice Have a Cloud-Based EHR? - HITECH AnswersHITECH Answers | EHR and Health IT Consulting |

If you’re still debating whether to go with a web-based EHR or a server-based EHR, you should know why a growing number of practices are choosing to go with a cloud EMR.

How does a web-based EMR differ from the older technology of a client server-based EHR system?

A cloud EMR is different (and better, in our opinion) due to the following factors:

Your software is always up to date
With a web-based EMR, the software is always up to date, usually at no additional charge. No more expensive upgrades causing delays; just open the SaaS-based software and you have the latest version.

Rest easy on HIPAA data requirements
Data security is much easier to manage with a web-based system. Cloud EHR vendors can provide much more security for your data than you can internally with office servers. As reported by the Business Insurance site, “Data breaches seem to be everywhere these days except the one place everyone fears—the cloud.” That could be because cloud EMRs offer financial-level security for your data.

Accessibility—work from anywhere
One of the things many users love about the cloud is the ability to work from anywhere—whether it’s e-prescribing from a smartphone or checking a patient record from the beach while on vacation. We don’t recommend you work on your vacation, but we understand the realities of medical practice.

Cloud-based EHR systems allow continued functioning during and immediately after disasters
Hospitals and physicians discovered the benefits of cloud-based data first after Hurricane Katrina and again after Super Storm Sandy; with a web-based system, you can practice (and bill) from anywhere.

Reduced expense for both software and hardware
A cloud-based system is more cost-effective, particularly for small to medium sized practices, since there are no large hardware expenditures and the software expense is a consistent, low subscription rate. You won’t have to plan for large hardware and software expenditures.

Better IT support
Damn it, Jim, you’re a doctor—not an IT person. And you will probably not be able to hire IT support of the same caliber as the staff of a web-based EHR vendor. Why not make use of their resources and eliminate your headaches?

You can use a cloud-based EHR on a mobile device such as an iPad or other tablet
A survey of physicians by web-based EHR review group Software Advice showed that 39% of physicians want to use their EHR on a tablet such as iPad, and in another survey, a majority of patient respondents indicated that they find use of an EHR on a tablet in the exam room to be “not at all bothersome.”

Satisfaction levels are higher among mobile EHR users
A recent survey by tablet-based EHR review group Software Advice found that providers using a mobile EHR expressed twice the satisfaction levels of those using EHRs via non-mobile systems. And as mentioned above, an effective mobile EHR needs to be cloud-based.

It’s particularly important to note that cloud-based systems are nearly always more secure than any system you could set up in your office. For most practices, data security and HIPAA best practices are not their area of expertise—excellent patient care is. But for cloud EMR systems, those areas are key to our success. We are better at it because we must be in order to continue in business. And as mentioned above, the proof is in the lack of data breaches among cloud-based companies.

One proof of the idea that a cloud-based EHR is the best choice is the fact that most EHRs that were originally server-based have since developed cloud-based offerings as well. If server-based technology is state of the art, why are those vendors switching platforms?

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Harnessing the Power of Big Data with Digital Health Partnerships -

Harnessing the Power of Big Data with Digital Health Partnerships - | EHR and Health IT Consulting |

In today’s digital world, electronic patient data is growing exponentially and moving faster than healthcare organizations can imagine. At the same time, clinicians suffer from information overload, and high-volume and increasingly complex clinical patient loads, alongside dwindling time and resources.

Now more than ever, the pressure is building to harness the power of big data and digital technologies to help clinicians make faster, patient-centric decisions that increase quality of care and enhance health outcomes all while decreasing costs.

Sounds great, right? Especially to the critical care domain where data is extraordinarily dense, time is our greatest opponent, and fiscal concerns represent an annual cost to the U.S. economy in excess of $260 billion and approximately 40 percent of total inpatient costs.

But what if health care analytics and clinical decision support (CDS) could combine to deliver rapid bedside diagnostics or upstream health detection capabilities? That is to say, a tool that provides first responders, clinicians, hospital staff, home care providers, and patients with clinically relevant, patient-centric information, intelligently filtered and presented at appropriate times to transform care delivery.

Historically, CDS applications have operated as components of comprehensive electronic health record (EHR) systems—in other words, retrospective data repositories or order entry systems with limited data streams that are, at best, semi-real time.

However, the next generation of CDS tools seeks to incorporate advanced data processing systems capable of discovering and harnessing actionable insights from all varieties of medical data, and leveraging these insights for diagnostic, predictive and prescriptive capabilities.

In a nutshell, this next gen CDS tool will aggregate disparate patient health information—static and real-time—across care delivery touchpoints for analysis and optimization, enabling clinicians to make faster decisions and implement personalized, patient-centric treatment options at the point of care, whether that is the home, ambulance, hospital or battlefield.

Bear in mind, this description simplifies what is a highly sophisticated and complex health IT tool to a functional concept. Key challenges for implementation include the ability to:

  • Collect and aggregate health data, including that from monitors, throughout the patient care continuum into a single portfolio
  • Normalize, pre-process and de-identify data for analysis—not all data is created equal and not all data is useful in its raw form
  • Capture data at the point of care, stream for real-time computational analysis and combine with retrospective data
  • Present actionable insights in a format that end-users can easily consume for enhanced decision-making in the clinical workflow or home life-flow

Ultimately, such a solution could have the power to save a life, elevate care delivery, reduce length of stay, improve quality of life or predict and avoid a critical health event altogether.

To many, this sounds almost like science fiction, but probable with the help of a small village—or in our case, a team of digital health partners comprised of world-class researchers like those at the University of Michigan, advanced analytic technology products, wearable and anti-wearable sensors, and mobile and connected health solutions.

Healthcare has lagged behind the retail and financial sectors in the use of big data and digital technologies but the gap is closing and closing fast. The risks are high, but manageable through the teaming of digital health partners, and worthy of such a high-impact payoff. Data is king and the more hard evidence we have the better decisions we can make as clinicians, patients, families, providers, payers and industry alike.

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drchrono preps EHR, PHR for Apple Watch

drchrono preps EHR, PHR for Apple Watch | EHR and Health IT Consulting |

The first developer to make an EHR exclusively for the iPad is now aiming to be the first choice for physicians and patients looking to make the most of their new Apple Watches.

When the Apple Watch first becomes available from select retailers April 24,  Mountain View, Calif.-based ambulatory EHR developer drchrono will be ready – just as is it was five years ago, when a newfangled contraption called the iPad first hit stores.

At HIMSS15 in Chicago this past week, Daniel Kivatinos, drchrono's co-founder and chief operating officer, demonstrated new software for the Apple Watch that had been in the works for months – since Apple first put out the software development kit for the device.

"The moment they release the SDK, we can build a simulator app, even though we don't actually have the physical hardware," said Kivatinos. "We did the same thing with the iPad: When we heard about the iPad in 2010, we downloaded the SDK prior to the actual hardware being released.

"The moment the physical hardware came out for the iPad, we released the app in the app store," he added. "Same situation here: The moment the physical hardware comes out, our app will be available."

Kivatinos says drchono plans to be among the first to offer an integrated EHR as soon as Apple Watch becomes available. He's excited about the device's potential to transform the office experience for doc early adopters, offering a new twist on real-time communication between physicians and their patients.

"We've thought about this a lot: What is our company, what do we do?" said Kivatinos. "Over the past several years we've realized we're creating wearable health records for doctors and patients."

With close to 70,000 physicians and more than 4 million patients registered on the drchrono platform, he said, both groups are poised to enjoy the benefits of this unique way of interaction.

"This is a completely new experience," he said. "For the first time, doctors are going to have information given to them with their hands free: A doctor could be administering a shot, picking up a child, moving an elderly person – looking at the information while doing whatever it is they need to do."

Likewise, said Kivatinos, patients should be drawn to experiencing their personal health records through a device on their wrists, using drchrono's app to schedule appointments, get medication reminders and manage their chronic diseases: "Apple creates a very nice experience for patients. It's not just about usability, it's about enjoyment."

The app will enable docs to view a patient information at a glance, respond to messages via quick text and see eRx refill requests – offering a wearable extension of the drchrono iPhone and iPad apps, according to drchrono.

"Doctors are incredibly busy; drchrono on Apple Watch gives them insights about their practice and patients just by checking their wrist," said CEO Michael Nusimow in a press statement. "Its simply amazing to have a hands-free way to gather quick insights about a patient."

Plenty of other vendors have already readied software for the Apple Watch's release, of course, and many of them were showcasing it at HIMSS15. Epic, Cerner, athenahealth, Vocera, Mayo Clinic and more all announced apps – or plans for apps – at the show.

Kivatinos said he's confident drchrono's early leadership among curious early adopters of Apple technology will keep them well-positioned among physician practices.

"If you look at the early days in 2010, we put our (iPad) app out the first week and had thousands and thousands of docs download it," he said. "It took some of our competitors years to get to that point."

Physicians "want innovation, but they want it to work," said Kivatinos. "We had one doctor who bought a $100,000 EHR, and came to us a week later and said, 'This doesn't work. What do you guys have?' He literally just junked it. If it doesn't work, they're just going to walk away."

The critical questions? "Is it usable, is it designed well, can I just put information into it and walk away quickly? Can I just do my rounds? I don't want this thing in my way."

The company touts different "modes" for the Apple Watch app, depending who's using it and how. "Glance" offers a quick view, giving docs a snapshot of their patient schedule for the day. "Short Look Notifications" can display brief messages generated from the EHR app. "Long Look Notifications" offer a doctor a view of the app itself.

Kivatinos says he's "100 percent" certain the Apple Watch is going to catch on in a big way among consumers – and his customers.

I wonder aloud whether the embrace might be more tepid – something akin to a new form factor such as Google Glass, which found limited acceptance among the general public, but is still enjoying innovative clinical use cases.

Kivatinos says he's convinced it's an Apple to oranges comparison. Glass, with its temple tapping and head nodding, necessitated a new and sometimes questionable type of social etiquette, he said. The "experience was a little different: harder to set things up and install," he said – to say nothing of the cost.

"I bought a Google Glass. It cost $2,000 with prescription lenses," he said. "$2,000 and $350 is a drastic difference. Price point is so critical."

Whether it's docs looking for easy access to vital signs, staff messaging, e-prescriptions and labs; or patients looking for an attractive and convenient interaction to manage their meds or schedule appointments, he's convinced the Apple Watch will find favor among folks and physicians alike.

"The interest is amazingly high," he said.

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Keeping Up With Technology: A Must for Medical Practices

Keeping Up With Technology: A Must for Medical Practices | EHR and Health IT Consulting |

Still carrying around that BlackBerry you've had for the last five years? Still using Microsoft 2003 on that XP machine of yours? Still think the "cloud" is a fad? You might be doing yourself and your business a disservice if you answered "yes" to one or more of those questions.

Keeping up with the ever-changing world of technology is tough. Change can be hard. It's much easier to keep the status quo and ignore all the technological advances happening around you. The problem is, if you don't adapt and keep up with technology, you'll miss out on all the advancements and benefits it has to offer.

That trusty BlackBerry took too long to embrace touch-screen technology and missed out on creating a robust app store. The result is you can't check into your American Airlines flight on your phone, you can't use Hailo to get a cab, you can't access your Google Drive documents, and you can forget about looking up restaurant reviews on Yelp. Basically, even though switching to an Android or iOS device may be inconvenient in the short-run, the long-term benefits are well worth it. You'll have to learn how to use a new tool but that took has far more uses.

Technology in the workplace can mean the difference between a successful business and a failing business. Capable hardware and efficient software will keep your office running in tip-top condition and will allow your employees to focus on their jobs instead of troubleshooting their computers.

Look into Web-based programs that can be accessed remotely and that have export features that allow you to easily extract the data you need. Productivity suites like Google Documents are free and offer a comparable experience to the costly Microsoft Office standard (Google documents are compatible with MS Word). If you have to use Microsoft Office, don't skip on more than one major update. The difference between Word 2007 and Word 2010 is probably greater than you think.

The anxiety in introducing new technology to your office staff lies in the assumption that each employee has a different adoption threshold; some will "get it" and others will struggle. That's not as big of a hurdle as it's been in the past, as technology has become more uniform. Most people have a smartphone of some design, and many have households with smart TVs, multiple computers, and other universal technologies. Like all things, it may take a day or two for your staff to become comfortable with the new work flow, but your bottom line...and talent pool...will appreciate it.

In summary, don't be afraid to try new technology. If there's a hot new device or productivity program, there's probably a reason for it being so popular. Don't turn your practice into a technological ghost-town. Think about what your competition is doing.

In regards to technology, it’s good to be a leader and it’s also good to be a follower ... just make sure you’re one of them versus neither of them.

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Drchrono uses Apple Touch ID to let doctors into electronic health record

Drchrono uses Apple Touch ID to let doctors into electronic health record | EHR and Health IT Consulting |

Apple opened up the Touch ID fingerprint reader to third-party developers when it released iOS 8, and some in the health care world are beginning to take advantage of it.

Drchrono, which makes an electronic health record optimized for use on iPads, has now used that capability to authenticate doctors into the patient record — and to keep unauthorized users out.

This may be part of a wider push by Apple to get iPhone 6s and iPads into the tech arsenals of enterprises like large medical groups and hospitals. The new iPad Air 2 and the iPad Mini 3 now come with Touch ID, as do the iPhone 5s, iPhone 6, and iPhone 6 Plus.

Where the medical record is concerned, the Touch ID button could be hugely effective in providing secure yet easy access. For care providers using drchrono, three taps will get them into the medical record. They rest their finger on Touch ID to get into the iPad, tap the drchrono EHR app, and then, when the app is open, they hit Touch ID once more to get into the EHR. They no longer have to enter a passcode.

“The amazing thing about Touch ID is that people sometimes forget password and PIN codes,” Drchrono COO and cofounder Daniel Kivatinos wrote on the company’s blog. “This changes the game even more … touch technology in health care.”

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