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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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5 Ways to Speed Up Healthcare Practice Office Management Using an EHR Solution

5 Ways to Speed Up Healthcare Practice Office Management Using an EHR Solution | EHR and Health IT Consulting | Scoop.it

If it hasn’t happened already, your practice will probably be adopting an EHR system soon, due to the mandated HITECH Act of 2009. While this may seem daunting and laborious now, we promise there are many benefits to integrating an EHR-PM system -- it will prove to be a great decision that will boost patient satisfaction and your practice’s overall efficiency and interoperability. Here are 5 ways it will do just that:


          1.  Automatic Appointment Reminders

Office managers have a lot to do, that’s obvious, so placing calls to confirm appointments sometimes falls by the wayside. This tends to result in missed appointments and scheduling errors. EHR systems are the solution to this problem: Practices are now able to send automatic phone calls and auto-messages to patients’ phones. Plus, EHR systems allow you to easily send a text to your patient, enabling you to connect with your patients where they are in 2016: on their cell phones.


          2.  One Screen to Rule Them All

Gone are the days when office managers and doctors were inundated with organizing and systematizing thousands of patients’ confidential records. Today, EHR systems allow for all of a patient’s historical medical records to be easily navigable from one screen. Worried about form field restrictions? No problem -- User-friendly EHRs offer progress notes and freehand fields throughout, so you will always have the most prudent information right at your fingertips.


           3.  Automatic Claim Management

If there’s one vexation we’ve heard from doctors over and over again, it’s the constant headaches and lost revenue associated with poor claim management. The reality is, insurance companies don’t always make it easy to settle their claims. An integrated EHR system will speed up this process by leveraging Revenue Cycle Management to automatically scrub claims clean, so there’s less chasing down records and insurance policies for doctors and staff.


          4.  Integrated Clearinghouses

Once these claims are scrubbed clean, 99% of them can then be submitted to clearinghouses. Some EHR software comes standard with a fully integrated clearinghouse, making the claims process easier and faster than it’s ever been. According to the Centers for Medicare and Medicaid Services, 30% of claims are denied/ignored on the first submission to insurers and 60% of those are never resubmitted. An EHR system is a solution to this problem. The right one can increase your practice’s revenue, decrease time spent on resubmissions and save you countless headaches!


           5.  Patient Portal

The best EHR systems save office managers time by enabling patients to pay bills and securely communicate with their doctors from the comfort of their own homes, on the train or even from the waiting room. These cloud-based features will directly affect the patient-doctor relationship, resulting in more organized communication, higher retention rates, and happier patients! Thanks to this intuitive patient portal, patients will love the new accessibility of their doctors.

 

Of course, not every integrated EHR-PM system supports all of these features because not all EHR software is created equal. Practice EHR is perfectly priced and cost-efficient for practices of 1-3 doctors. It’s built by doctors for doctors, which makes it uniquely positioned to address all of the doctors and office manager’s day-to-day concerns.

 

Technical Dr. Inc.'s insight:
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20 Questions to Ask an EHR Vendor Before Making the Switch

20 Questions to Ask an EHR Vendor Before Making the Switch | EHR and Health IT Consulting | Scoop.it

Choosing the right electronic health record (EHR) for your medical practice is a big decision. There are so many software's on the market today and it can be difficult for medical practices to find one that’s the best fit for their practice.

 

In order to make the best decision, it’s important to ask the right questions and have an honest conversation with the vendor about their software. Where do you start? The following is a list of 20 questions medical practices should ask before making the switch. This list is a compilation of the most commonly asked questions we hear from our prospective customers.

 

Ask the following questions and add a few of your own based on the needs of your practice. Asking the right questions and digging deep will help you find not only an EHR vendor but a partner who’s also committed to helping your practice be successful.

Learn about the company.

1. How many other practices use your software that our similar to my practice size and specialty?

2. Aside from EHR/PM, what other products and services can you offer my practice?

3. How do you keep my data secure?

4. Who owns the data in the system?

5. What sets you apart from other vendors?

 

Get to know the software.

6. Do you have an integrated practice management system? 

7. What clearinghouse do you use?

8. What types of devices can I use with your software?

9. Is your software cloud-based?

10. Is your system easy to use?

11. Is your software ONC 2015 Edition certified?

12. What reports are available in your EHR?

13. How will this software help improve patient flow and operations in my practice?

14. Are there any extra costs related to the software?

 

Ask questions about training, implementation, and support.

15. How long is the implementation process?

16. How is my data migrated into the EHR?

17. How does training work?

18. How responsive are your product development team and customer support team?

19. What are your support hours?

20. Are there costs related to set up, training, implementation or support?

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Practice EHR Success Story: Britt Larka, D.P.M

Practice EHR Success Story: Britt Larka, D.P.M | EHR and Health IT Consulting | Scoop.it

Situation

 

As a solo podiatrist, Britt Larka, D.P.M struggled to find an electronic health record (EHR) system designed to meet the needs of her Houston-based practice. In an effort to find the right system for her practice, Dr. Larka implemented multiple EHR's, continually facing the same three challenges. With each new system, Dr. Larka experienced financial, workflow and operational challenges.

  • Financial - Implementation, training, etc., on top of system pricing, became a financial burden
  • Workflow - The EHR's were not made for a practice of her size and difficult to navigate
  • Operational - The EHR's were cumbersome,  negatively impacting patient care, day-to-day operations, and efficiency

Unsure where to turn next, Dr. Larka received a recommendation from her long-time billing services provider,  leading her to Practice EHR - an EHR with built-in specialty-specific content and a simple workflow designed for small practices. 

 

Results

  • Seamless implementation.  Implementing Practice EHR was a smooth process for Dr. Larka and her office staff. For all new clients, Practice EHR offers data migration, integration, training and customer support at no additional cost, easing the financial burden and the learning curve that small practices typically experience with an EHR implementation.

 

  • Improved efficiency of documentationAfter implementing Practice EHR, Dr. Larka and her team quickly appreciated the system’s easy-to-use and intuitive workflow. Practice EHR's ease of use enabled her team to work more efficiently. In addition, with built-in podiatry templates and clinical content, Dr. Larka could easily log patient care, allowing her to spend more face time with patients. 

 

  • Improved efficiency of billingDr. Larka’s staff improved practice management and efficiency with the help of Practice EHR’s electronic claim submission feature. With Practice, EHR encounters get sent electronically to billing providers from within our system, increasing efficiency for the staff and helping physicians get paid faster.


About Practice EHR

Practice EHR is a cloud-based and specialty-specific electronic health record (EHR) and practice management (PM) solution designed exclusively for small practices. We realize that a one-size-fits-all EHR isn’t right for all care settings, that’s why we designed Practice EHR to meet the needs of small practices and their specialty. Simplifying the entire documentation and billing process, Practice EHR helps more than 1,000 physicians in 23 different specialties deliver care while running a more profitable and efficient practice. Interested in learning more about Practice EHR? Request a Demo by clicking below and a member of our team will contact you.

Technical Dr. Inc.'s insight:
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5 Secret Ways for Physicians to Use Your EHR More Efficiently

5 Secret Ways for Physicians to Use Your EHR More Efficiently | EHR and Health IT Consulting | Scoop.it

Implementing an Electronic Health Records system does not in and of itself guarantee a boost in productivity or revenue. However, it would be reasonable to assume that these will happen as a result of putting in the effort to learn how to best use an EHR. We would like to reveal 5 secret ways you can use an electronic health record system (EHR) to boost the output of your practice.

Secret Ways for Physicians to Use Your EHR More Efficiently

Use Medical Voice Assistant

If you are sick and tired of the effort required to complete the documentation aspect of your EHR, then it might be time to start using an intelligent medical-based voice assistant to do it for you. There are many AI-based medical dictation and clinical documentation software options out there that seamlessly integrate with and enable your voice commands to operate your electronic health record software. That said, talkEHR is the only electronic health record software available on the market that comes with an interactive voice assistant named Alison. This next generation technology empowers you to naturally interact with your EHR. You can use voice commands to enable features instantly, and it can also type for you.

 

Shortcuts Save Time

Just like you would save your favorite websites on a browser like IE or Chrome, we recommend that you think through the most useful features of your electronic health records software and then assign them shortcut keys so you can reach them with a single click. Generally speaking, there are a variety of other customization and shortcut options available with regard to setting up your dashboard or tabs as well. Investing the time upfront to customize such elements will ultimately save you time in the long run, thereby making it more manageable to run your practice.

 

Consider Useful Add-ons

Contact your EHR vendor to find out which add-ons are available. For instance, “Smart Pen” is an input device add-on that you use like an ordinary pen to put data into your EHR. These kinds of add-ons will improve the workflow of your practice and are worth your time and investment.

 

Explore your EHR

Electronic health record software is a complex system that is equipped with a range of features that you may or may not be aware of. Many features are built to reduce the hassle of practice management, but as is usually the case with new tools, you need to first know about them before you can explore them. So, we would suggest you fully explore your EHR and make note of the best ones available. You can also schedule a technical meeting with your vendor’s support team to fully understand the capacity of your electronic health record software.

 

Stay Updated

EHR suppliers frequently update the advanced features and bug fixes. We suggest that you ensure your practice is fully aware of this fact and stays updated with all the ongoing improvements that vendor makes to the system. This way, you can utilize your electronic health record software in the best possible way. Using your EHR more efficiently will save time so your practice can see and treat more patients, thereby increasing revenue. And don’t forget, if you have suggestions for your vendor, don’t hesitate to offer them feedback so they can improve their system to meet your expectations and needs.

Technical Dr. Inc.'s insight:
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inquiry@technicaldr.com or 877-910-0004
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How to Choose the Right EHR Vendor for your Practice

How to Choose the Right EHR Vendor for your Practice | EHR and Health IT Consulting | Scoop.it

Electronic Health Records (EHR) Software has gained considerable attention from practices worldwide due to its innumerable advantages. EHR’s are built to provide an organized, accurate, and cost-effective documentation process. Using one saves time and reduces paper work drastically, thereby enhancing productivity. But, finding the EHR system that best suits your practice and also installing it correctly are two major challenges that you are likely to face before reaping the real benefits of an EHR. So, before you go further with your EHR planning, let’s first have a look at some important pointers to keep in mind while looking for the best EHR vendor.

 

There are so many EHR vendors waiting for a chance to gain your business. They all offer attractive service packages and discounts to make their product seem the most attractive. But, they can’t all be the best in actuality, so it’s important that you consider some critical questions. These questions will equip you with sufficient information about the vendor and will help you make an informed decision. Below are the primary items we’d recommend you think through before going forward:

Tips for Choosing the Right EHR Vendors for your Practice

  • Compatibility and Reliability

If you are used to evaluating vendors on a regular basis, then you would be aware of the requisites of the vendor selection process. But for those not accustomed to this, the first step is to determine that the EHR system in question is compatible with your company’s infrastructure. For that, a trusted and reliable vendor should be chosen who has a solid history, including an impeccable service record. Customer reviews say a lot about a product or a service and are worth looking into.

  • Meaningful Use (MU) Criteria

There are certain criteria that’ll help you shortlist a vendor. The EHR incentive program has set the meaningful use criteria specifically for the EHR systems, so look to this as a priority. It is a common feature found in EHR systems, but the latest one is the MU3 category.  We would recommend that you make sure your new one has this.

  • Aligned Core Values

You want an EHR system made specifically for the management of healthcare-related information and organized for proper documentation. But, it should also align with the needs and values of your practice (a.k.a. customization options). The vendor should be willing to design a unique service package that suits your core operations, too.

  • Impressive User Experience

Although this is not the number one priority list, it’s still important to keep in mind when picking the right EHR system. A system with a confusing workflow that isn’t intuitive won’t work. Ignoring this would be a mistake. Make sure you and some team members of your practice try it first to confirm whether it’s the right fit from a usability perspective.

 

These are some of the key characteristics to think through. Before stepping into the market, do some homework and shortlist all the potential EHR vendors that seem to carry potential. Then, conduct some research on each one of them to narrow down your list. These steps will save you time while guaranteeing, to a great extent, the trustworthiness of your vendor and effectiveness of your decision.

Technical Dr. Inc.'s insight:
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inquiry@technicaldr.com or 877-910-0004
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4 Key Considerations for Analysts When Implementing an EHR 

4 Key Considerations for Analysts When Implementing an EHR  | EHR and Health IT Consulting | Scoop.it

Implementing a new EHR system requires a great deal of collaboration between clinical and technical teams. Analyzing the legacy system and operational workflows, then successfully recreating—or better yet, improving—this experience in a new EHR takes finesse.

 

The foundation of every successful EHR and other large-scale implementation is a team of analysts who are knowledgeable, engaged and passionate about their work. From groundwork and discovery to build, acceptance testing and go-live support, analysts do it all. Here are four key considerations for analysts to keep in mind to help ensure their projects go well and they continue to thrive in their roles.

 

1 – Start with the end goal in mind.

When gathering requirements, project teams will often start by walking through every workflow in the legacy system with end users. This can be a long process, and can lead to a lot of information gathering that is ultimately unnecessary. A better approach is to start at the end and work backwards. Ask users why they complete these workflows and what the expected outcome is. This will help get to the root of the requirements, and allow analysts to immediately begin thinking in terms of the new EHR.

 

Here are several questions analysts can ask when gathering requirements:

  • What is the end goal or objective?
  • Why have you traditionally done it this way?
  • What would improve the process?
  • What is the clinical rationale for this workflow?

 

By starting at the end and asking users why they do what they do and what outcome they are hoping to achieve, analysts can more effectively and efficiently build a system that meets the needs of users.

 

2 – Be aware of the functional limitations of legacy systems.

A key point that is sometimes overlooked is that EHR workflows are often defined by—and limited by—the functionality of the EHR itself. Users will default to what they are familiar with, so if a certain workflow is used frequently in the legacy system, they will assume it is required in the new one. Some workflows may not be needed, however, because the new EHR is designed to achieve the objective in a different, more efficient way. If analysts do not understand this, they risk building in features that are counterproductive, or not needed at all in the new system.

 

For example, in her current workflow, a clinic manager needs to generate and print a report of all the assessments completed in the office each day. During requirements gathering, she may feel this is an important step to replicate in the new EHR. As it turns out, this workflow is a result of poor auditing functionality in the legacy system – to keep proper records, the clinic manager is required to generate and print these reports. Improved auditing functionality in the new EHR eliminates the need for the daily assessment report and makes this workflow unnecessary.

 

3 – Communication is key.

One of the most important things an analyst can do is to effectively translate the clinical and business needs of end users into technical requirements for the new EHR system. They must also communicate future-state workflows in a way end users can understand and relate to. Communicating effectively is vital to project success.

 

EHR transitions are often intimidating and frightening for users who have established a comfort level with the legacy system, and likely had little input in the decision to change platforms. Analysts can begin to alleviate concerns and increase user adoption by putting together a few “quick wins.” A quick win is when an analyst identifies a piece of functionality that is very important to users, but is also easy to build and demonstrate in the new EHR. Quick wins communicate to users the team is not only listening to their needs, but can also deliver solutions quickly and effectively. This also increases confidence, workgroup participation, and communication response time with users and stakeholders, all of which contribute to project success.

 

4 – Strike a balance between functionality and maintainability.

Enterprise EHR systems are complex and, depending on the size and diversity of the user base, may require a team of several hundred application analysts to maintain. In addition, it’s important to remember that every clinical user in a health system is depending on the EHR to complete their documentation and deliver the highest quality of care to patients. Because of this, it is important to strike a balance between functionality and maintainability.

 

If the project team attempts to build in every piece of functionality requested by end users, including things that are nice to have but not critical for the system to function, the EHR will become unwieldy and difficult to maintain. Future updates by the EHR vendor will likely break any customizations, cause unnecessary downtime, and push the volume of help desk requests beyond what the business can support.

 

In contrast, if the project team oversimplifies and standardizes too much, they risk building a system that does not meet the core requirements of end users. When users can’t leverage the system the way they need, they find “creative” approaches that don’t always work, or simply don’t document everything needed. This can lead to a host of problems such as violating operational policy, regulatory reporting issues, loss of revenue due to incorrect documentation, HIPAA violations and, ultimately, lower quality of care for patients. A well-balanced system will keep the support team busy but not overwhelmed, include all required functionality as well as some quality of life features and allow clinicians to be at their best with patients.

 

In summary, by keeping workflow objectives in mind, understanding legacy system limitations, communicating effectively and balancing functionality and maintainability, analysts demonstrate the value of their critical role in EHR implementation success.

Technical Dr. Inc.'s insight:
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Stanford Launches App That Connects to Epic EHR & Healthkit

Stanford Launches App That Connects to Epic EHR & Healthkit | EHR and Health IT Consulting | Scoop.it

tanford Health Care today announced its new iOS 8 MyHealth mobile health app for patients. Developed in-house by Stanford Health Care (SHC) engineers, MyHealth connects directly with Epic’s EHR, Apple’s HealthKit and cloud services for consumer health data monitoring.

The SHC MyHealth mobile app is designed to make it quick and simple for patients to manage their care right from their iPhones, including:

• Make appointments

• Get test results – your lab results are automatically made available in the palm of your hand

 

Communicate with your care team through a secure messaging system where your information is always kept confidential

• Have a video visit with your doctor through the new ClickWell Care clinic which gives you the convenient option of a “virtual” appointment

 

• Manage your prescriptions and medications

• View your health summary

• Access and pay your bills

• Share your vitals with your doctor via HealthKit integration

Secure Messaging


With the new MyHealth app, patients can communicate directly with their care team through a confidential and secure messaging system. In addition, the app automatically syncs with wearable and wireless products, allowing patients to take vital signs at home or on the go. That data is automatically and securely added to the patient’s chart in Epic for their physician to review remotely.

“The SHC MyHealth app allows patients to connect their lives with their health care,” said Pravene Nath, MD, Chief Information Officer, Stanford Health Care. “By integrating with companies like Withings, our physicians have access to meaningful patient data right in Epic, without having to ask the patient come in for an appointment. We believe this is the future of how care will be delivered for many types of chronic conditions.”

 

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Pro-Active EHR Optimization is a Necessity

Pro-Active EHR Optimization is a Necessity | EHR and Health IT Consulting | Scoop.it

Everyone knows that routine maintenance is required to keep a home, car, or even a person in good shape and performing well. The same is true in regards to our electronic health records (EHR). To meet the requirements and capitalize on the benefits of meaningful use, the US market has seen an unprecedented amount of EHR implementations. However, many organizations aren’t seeing the expected benefits. Factors such as rushed, system-focused implementations, lack of standardization or focus on workflows, end-user and physician dissatisfaction, high ticket, and request volumes, and/or sub-optimal training are major drivers for optimization needs. Routine maintenance and pro-active EHR optimization are a constant and ongoing necessity and should be treated that way from a planning, budgeting and prioritization perspective. Here are some key areas to consider in a post-EHR go live world.

 

Thorough Assessment, Prioritization, and Management of Current Issues and Complaints

 

Most organizations use a ticketing system to log EHR issues. Following an EHR activation, ticket volumes often increase to the point where an organization cannot manage the volume and cannot differentiate priority issues from common, organizational issues. This is exacerbated by the constant “pull” of resources that are now needed for other organizational objectives and projects.

The truth is, your EHR “project” doesn’t go away when the system goes live. Rather, a program management organization, complete with an integrated Governance structure, must remain to manage upgrades, maintenance, and optimization. A great first step is understanding issues and prioritizing ongoing efforts for your teams and your organization. A thorough review, cleanup, validation, and categorization of all issues should be conducted. This requires the establishment and ongoing execution of a ticket intake and review process that identifies the priority and necessity, understands the source of the problem (e.g., user proficiency, workflow inefficiency, build defects) and reconciles that against the objectives of the organization. It is critical to include operational and clinical leaders in this process and often requires time for interviewing and even shadowing clinical and operational users to fully understand and accurately document issues.

 

Categorizing, Prioritizing, Integrating and Approving Effort

Most issues can be categorized into four areas:

 

Break/Fix
Break/fix are issues with the software functionality that need to be fixed by either the IT analysts or vendor.

 

System Enhancement
Enhancement issues pertain to desired functionality that is either not yet developed by the vendor or not yet implemented by the IT department.


Workflow
Workflow issues arise when a process or procedure is inefficient.

 

Training
Training issues occur when the system is functioning as designed but the end user is unaware of how to use it properly. Training may also be needed to teach advanced functionality.


After categorization, issues should be prioritized. The prioritization process should be carried out through the Program Management and Governance structure and is typically not simply an “IT” process. Understanding the issues and requests, prioritizing them against the organizational objectives and then including them in the ongoing capital and operating plans allows adequate focus, funding, and validation for the work. This may be simple and quick – break/fix items, refresher training, etc. However, the focus may be more complex and cross multiple areas of the organization – new system functionality, upgrades, workflow redesign, etc. The latter often requires the organization to move back into “project mode” with a detailed timeline, project plan and in some cases, capital funding.

 

Optimization Implementation and Ongoing Maintenance

Now that a structure is in place, resources are adequately funded and work is prioritized, the organization can move forward knowing that the EHR can be properly maintained, but also leveraged for its true functionality. There will be many moving parts that may involve system configuration, system upgrades, workflow redesign, and end user training. Having a dedicated optimization team and project manager that interacts and coordinates with the key operational and clinical leaders is key to ensuring success, but also aides in optimizing an EHR solution that supports the organization’s objectives as well as the patient experience.

 

Optimum Healthcare IT provides optimization services that are customized to meet our client’s needs whether a full assessment and plan are needed or just hands on resources. An example of our streamlined methodology is shown below:

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Epic Launches Sonnet with Rhyme and Reason

Epic Launches Sonnet with Rhyme and Reason | EHR and Health IT Consulting | Scoop.it

The long-anticipated launch of Epic’s new scaled-down Electronic Health Record (EHR), known as Sonnet, took place in March at HIMSS18 with tremendous excitement. Sonnet is intended for smaller to mid-sized hospitals, critical access hospitals, post-acute care facilities, long-term care facilities, and physician practices, who either do not require all of the functionality of a full version EHR or don’t have the budget or the resources needed to implement the full version of Epic. Through the use of Sonnet, these smaller systems will have access to a scaled-down version of Epic which falls at a more competitive price point and with a significantly quicker implementation timeline.  “It’s still the same Epic, it has a fully integrated inpatient-outpatient, rev cycle, and patient portal,” Adam Whitlatch, Epic’s research and development team lead, told Healthcare Dive in February. Additionally, Sonnet will allow smaller hospitals a clear and attainable add-on/upgrade path with the ability to adopt different features of Epic as they expand.

 

It’s an exciting move for Epic on the heels of Epic CEO Judy Faulkner’s call for a shift in collective thought when she announced she would now refer to the EHR as CHR.  To Judy, and I believe many of us, the letter change represents the bigger picture. “Healthcare is now focusing on keeping people well rather than reacting to illness. We are now focusing on factors outside the traditional walls,” Faulkner told Healthcare IT News.  In the future, the CHR will include more types of data, such as social determinants, sleeping patterns, diet, access to fresh foods, exercise, and whether they are lonely or depressed because all of those factors can have an enormous impact on an individual’s health.

 

Epic continues to increase its footprint with the addition of Sonnet; aiming to capture a market segment which KLAS research identified in 2016 as the most significant buyers of EHRs in the U.S. accounting for nearly 80% of all sales. This portion of the market has historically been dominated by Athena Health, e-Clinical works, NextGen and the like.

 

It will be interesting to watch how Sonnet is received in the market and if Epic can successfully move into the community hospital space. It can be argued that Epic is the undisputed leader in the healthcare IT market with Cerner a close second as it pertains to healthcare organizations over 300 beds. The ultimate question is if a scaled-down Epic EHR can garner the same level of success in this space? If Epic can balance the functionality needs to support the complexity of healthcare, while maintaining a light-version of Epic that is easy to maintain and satisfactory to providers, then they will be successful.

 

Still, with an implementation of this size, there is a lot of complexity. As with all implementations, it is vital to have a structured plan in place that includes how to most efficiently manage the retirement of legacy systems, an effective communication and change management strategy, resource allocation, and the proper training of your current staff. Getting it right the first time is the differentiator of a successful install.  Engaging with the right advisory partner can be the key to managing costs. The right partner can aide in making decisions regarding how to best approach an installation from a best practices/”lessons learned” perspective. Often, a new install is the largest investment many hospitals of this size will make in a fiscal year. Doing it right can have great reward, but missing the mark, can have costly implications.

 

As a community hospital, if the implementation of your EHR isn’t correct, the future care of your patients and the financial stability of your organization could be in jeopardy. Optimum Healthcare IT has the people, the expertise, and the experience to ensure that your EHR is implemented correctly and smoothly.

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Alen Smith's comment, October 26, 2018 7:49 AM
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Sharing What You Know for EHR Consultants

Sharing What You Know for EHR Consultants | EHR and Health IT Consulting | Scoop.it

In the world of Healthcare IT consulting, it is important to share what you know. HIT Consultants work long hours to get the job not only done but won.  They know how to put their thinking to work.  These rock stars stay focused longer than others to push the success needle forward for their clients.  But, before their work is done, there is one more win that can add tremendous value – knowledge sharing.  It’s the next best step that can lift the lid of consulting services to higher levels.  Here’s how.

 

Four questions that EHR Consultants can ask themselves:

 

What do I know?
There are a plethora of skills that consultants bring to the table that range from core functional skills to having a good knack for people, talent development, and team building.  A general thought among consultants is that their knowledge is common knowledge.  Everybody knows this, right?  Think again. What’s common to them may not be so common to their peers or their clients.  Plus, their experience and knowledge may have paved a different road from other consultants so knowledge sharing is a definite gain.

 

Who can benefit from my knowledge?
Without question, consultants add value to the clients by knowledge sharing.  They can also add value to their peers by passing on their proven record of how to’s, quick wins, best practice solutions and lessons learned.  Their peers can share their added value with their clients.

 

What do I need to know?
It’s always a good rule of thumb to place ourselves between teaching and learning.  And even the most knowledgeable consultant can benefit from learning. In addition to sharing your knowledge, ask your peers what they have learned.  A proactive approach to knowledge sharing will ensure success for everyone.

 

Who do I need to know?
Get to know peer consultants who know more and whose experience has exceeded yours.  It’s great to be able to have this person handy for quick huddles to field any questions you have.

Creating intentional opportunities for high performers to collaborate is a big deal.  It gives consultants with all levels of skills and experiences a forum and space to both learn and share the sharpest innovative tools in the market with their clients.  Everybody wins.

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Medical Billing and Coding Trends for 2018

Medical Billing and Coding Trends for 2018 | EHR and Health IT Consulting | Scoop.it

According to the New York Times, disease-classification systems originated in 17th-century London to help doctors prevent the bubonic plague from spreading to populations that didn’t speak English.

 

French physician and statistician Jacques Bertillon (the 1890s) introduced the first medical coding system when he developed the Bertillon Classification of Causes of Death. In the 20th century, the codes encompassed not only causes of death but also the incidence of diseases.

 

These days, medical coding translates the content of a patient’s health records into a universal standard medical code so it can be billed properly. Let’s take a closer look at the landscape to see how things stand, and identify the medical billing and coding trends you should look for in 2018.

 

The medical billing and coding landscape

 

Between 2015 and 2020, Deloitte predicts worldwide spending on health care will increase anywhere from 2.4 to 7.5%. Despite this extra spending, many healthcare delivery organizations are facing increased operational costs, which are eating into their returns.

 

One source of increased operational costs is the ever-expanding complexity of medical billing. The same Times piece cites in-office earwax removal and vaccinations as examples; there exist unique codes for the method used as well as each injection. On top of that, not every payer uses the same coding system.

 

Administrative costs account for a full quarter of U.S. hospital spending; for comparison, those costs sit at 16% and 12% in England and Canada, respectively.

 

While medical billing and coding are ever-changing, there is the general movement toward efficiency. Here are three medical billing and coding trends you should be watching in the coming year; they’ll only get more important as 2018 gets underway

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Three trends to look for in 2018

 

1. Computer Assisted Coding (CAC)

 

  • Uses natural language processing (NLP) to read and interpret text-based clinical documentation from patient charts.
  • Identifies potentially relevant ICD-10-CM diagnoses, ICD-10-PCS and CPT procedures, and present on admission (POA) indicators to provide suggested codes and corresponding documentation for coders or CDI specialists to review and approve.

 

CAC software is proliferating, particularly for coding inpatient claims. According to a report available through Research and Markets, the global market for computer-assisted coding software is projected to reach $4.75 billion by 2022.

 

According to CareCloud, coding specialists are afraid that the CAC built into EHRs could replace their jobs within a decade. This concern, however, is likely overblown. CAC is a huge help to human coders. According to one study, CAC increased coder productivity by over 20% and reduced coding time by 22% relative to their peers who didn’t use CAC, all without reducing accuracy.

 

2. EHR alignment


Poor record keeping—from not capturing the chart data you need to code correctly to capturing the data but making it hard for a coder to find later—can lead to a variety of problems for reimbursement. Already, most providers spend too much time searching for the right diagnostic codes for their patients rather than looking at and listening to them.

 

If your EHR and medical billing software are integrated, especially if your medical billing offers CAC, the process can go much faster. For example, your software can offer coding suggestions at the point of documentation, making codes more accurate from the get-go.

 

When your EHR has integrated CAC, it can automatically populate patient demographic data into a bill instead of wasting time by requiring staff to re-enter it and introducing the opportunity for errors. Fewer errors increase your first-pass claim acceptance rate, can improve data abstraction, and offer more robust reporting than standalone EHR and billing and coding software.

 

This reporting can include a robust set of financial data, such as units billed per visit, days sales outstanding (DSO) to accounts receivable, net revenue per visit (NRV), staff productivity, referral numbers, appointment cancels, and no-shows.

 

3. Blockchain
In 2016 ONC called for white papers on how the blockchain can improve healthcare. Researchers submitted more than 70 papers, and ONC awarded 15 papers covering everything from precision medicine clinical trials and research to a decentralized blockchain-based record management prototype for EHRs.

 

“Blockchain is booming in clinical trials right now; it is a big favorite of the pharmaceutical sector,” Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, said. Palombini predicts that blockchain has an especially intriguing promise in EHRs.

 

In early 2017. EHR Intelligence’s Kate Monica wrote: “Blockchain is becoming increasingly common as a way to improve the standardization and security of health data.”

 

In September, HealthcareITNews published “Why blockchain could transform the very nature of EHRs.” And Bruce Broussard, CEO of Humana, described blockchain as the next big healthcare technology innovation.

 

There are three primary reasons EHRs should consider adopting blockchain data storage:

 

  • It can offer better privacy protections
  • It can make information exchange easier and more efficient
  • It can increase patient control over their data

 

With blockchain, it could be as simple as a patient giving their doctor a token to access their records. “Using blockchain technology to reconfigure EHRs makes sense,” Elizabeth G. Litten, partner and HIPAA privacy and security officer at Fox Rothschild, recently wrote.

 

Dave Watson, a chief operating officer at SSI Group (an RCM and analytics company), sees tremendous potential for the blockchain to improve revenue cycle management and claims processing.

 

By recording tests, results, medical billing, and payments in an immutable ledger, the blockchain could reduce fraud and even save money by decreasing the time and labor currently used to track that information through various systems.

 

On Medium, strategy, design, and development consultancy Sidebench wrote that the three areas where the blockchain could impact healthcare with the clearest path forward to providing significant ROI through cost savings are developing better health exchanges, protecting patients and practitioners through supply chain accountability, and reducing fraud in billing and claims.

 

Palombini’s “Holy Grail” is when patients own and control their own complete health histories, from the hospital, stays to outpatient visits to data from wearables. A blockchain is a tool that could help get us there. But it’s not the only way.

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EHR Market Needs Competition & Innovation

EHR Market Needs Competition & Innovation | EHR and Health IT Consulting | Scoop.it

I spend a fair amount of my days engaged in conversations with family physicians and policymakers on how to improve our nation's health care system. These conversations and the feedback they generate are the engines that drive the AAFP's advocacy. There are dozens of pertinent issues impacting family physicians and their patients, but there are two themes that emerge in every conversation. The first is the disdain family physicians, really all physicians, have for electronic health records. The second is how the EHR industry, to date, has failed in its core mission.

 

On Jan. 20, 2004, President Bush made the following statement as part of his State of the Union Address: "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care."

 

On April 26, 2004, the Bush Administration formally launched the Promoting Innovation and Competitiveness campaign(georgewbush-whitehouse.archives.gov), which was aimed at accomplishing the goals outlined in his SOTU address. The campaign made several observations and had several goals, but I would like to highlight three:

 

A patient's vital medical information is scattered across medical records kept by many different caregivers in many different locations – and all of the patient's medical information is often unavailable at the time of care.


Innovations in electronic health records and the secure exchange of medical information will help transform health care in America -- improving health care quality, preventing medical errors, reducing health care costs, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care.
Within the next 10 years, electronic health records will ensure that complete healthcare information is available for most Americans at the time and place of care, no matter where it originates.
Within the next 10 years?

 

Guess what? Time's up, and none of this happened. It is reasonably safe to say that in the 14 years since President Bush issued his call to action, the promise of EHRs has failed epically to meet the expectations outlined in the SOTU speech -- avoid dangerous medical mistakes, reduce costs and improve care. Some would argue that we have digressed in each of these areas.

 

I struggle to find an articulate and elegant way to describe what is so frustrating about electronic health records, but I think I have found a way to do so succinctly -- they suck. They suck as products, and they suck the life out of everyone that uses them.

 

Ponder this, since President Bush issued his 2004 challenge, the following innovations hit the market -- Facebook (2004), Reddit (2005), Twitter (2006), iPhone (2007), Airbnb (2008), Thumbtack (2008), Rent the Runway (2009), Uber (2009), Instagram (2010), Pinterest (2010), Snapchat (2011), Alexa (2014), Bumble (2014), and dozens of others targeted at specific industries or activities. Each of these platforms changed an industry or changed the way we communicate and share information with each other. They have made positive contributions to our economy and our lives.

 

It is a shame that the efficiencies realized from these platforms have not translated to health care via EHRs. Instead of streamlining the healthcare industry, EHRs have created a plethora of cottage industries and consultants; required physicians to incorporate "workaround;" and, most sadly, the EHR has contributed significantly to the onset of an actual epidemic -- physician burnout.

 

A few weeks ago, I was in San Francisco and had the opportunity to meet Andrew Hines(canvasmedical.com), an engineer who has spent his professional career working in and around the technology industry, including work for a major EHR company. During our conversation, he said something that really stuck with me, both for the boldness of the statement and the fact that, deep down, I think we all know it may be true. He said, "I used to think we could improve the electronic health record from within, but now I realize the only way to truly improve electronic health records is to start over."

 

A Harvard professor known for his work in disruptive innovation, describes this as sustaining versus disruptive innovation. Incumbents focus on incremental improvements in their products whereas new entrants succeed with disruptive innovations. The problem with healthcare and EHRs specifically, is that incumbents have all the market power.

 

Steven Waldren, M.D., director of the AAFP Alliance for eHealth Innovation, summed it up as follows: "The reason EHRs suck is not due to a lack of innovation in technology but rather in a lack of innovation in health care. It seems that the health care industrial-complex, unlike other industries, is insulated from such innovative challenges from new players."

 

Waldren summarized his thoughts in a simple statement, "Without competition, we will not see the technology innovations in health care we have seen in other industries."

 

There are no easy solutions in health care, and improving EHRs is no different. However, we desperately need innovation and meaningful competition in the health information technology and EHR space. The following are three objectives the AAFP is pursuing to increase competition and spur innovation:

 

Make it easier for new companies to enter the health IT marketplace -- The AAFP continues to work on expanding interoperability to allow appropriate access to data stored in EHRs, in a timely manner. The AAFP is aggressively advocating for policies that force EHR vendors and other health IT products to be interoperable based on a defined set of standards. We also believe that all data in the EHR should be available for use by third-party vendors, of course with appropriate privacy.


Make it easier for innovators to design smarter health IT products -- One of the differences between health care and the general IT space is the complexity and fuzziness of the semantics of clinical data. The AAFP is committed to working with others to model clinical data in standard ways that allow developers to make health IT systems that can reason about clinical data and therefore help automate tasks physicians must perform.
Eliminate or reduce administrative requirements placed on health IT products -- The poor usability of EHRs is often due to external requirements established by regulators and payers, such as clinical documentation, which does not add clinical value. The AAFP is actively promoting policies that eliminate or, narrow, those requirements. We believe a reduction in administrative burden will help physicians, and also allow health IT developers to focus on features and functions that add clinical value.
Closing Thought


As you can tell, I am frustrated with the performance of current EHRs and the negative impact they are having on our health care system and each of you personally. The dominant companies in the market have produced products that have largely failed at the core goals established in the early 2000s. As I have noted, technology in every other industry tends to result in rapid improvements to function and efficiencies. Health care simply hasn't seen the same improvements, and the companies that make these products have seen windfalls in the billions, yet their products continue to underperform and fail to meet expectations of patients, physicians, and policymakers.

 

I remain a strong supporter of the broad use of EHRs in our health care system. The EHR still stands to improve the aggregation and distribution of medical information, which would improve our health care system. Without a doubt, the ability to access and transmit medical information among care sites and physicians would improve care and result in efficiencies for patients and the system overall.

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From EHR to Paper to EHR .. to Paper??

From EHR to Paper to EHR .. to Paper?? | EHR and Health IT Consulting | Scoop.it

I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know.

When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like a LAB, ER, and X-RAY.

 

Patients always assume that medical records transfer seamlessly between practices. They don’t, even between clinics that use the same EMR vendor. The stack of papers gets scanned in, as images or PDFs, but they don’t appear in the searchable, tabular or report-compatible form. Often, they don’t each get labeled, but are clumped together under headings like “Radiology 2010-2017”.

 

In one of the clinics I work in, a Registered Nurse enters patients’ medical history in the EMR before each new patient’s first appointment. In the other, it is my job. In both cases, only a fraction of he information is usually carried over from one EMR to the other, and the patient’s life story risks getting diluted, even distorted.

 

It doesn’t take much imagination to understand why things work this way:

 

Once upon a time, the Rulers of a great country handed out money to all the medicine men so they could start using computers to document what they did (and what they charged for, which was the real reason the Rulers handed out money the way they did).

 

This was a gift, not only to the medicine men but also to a lot of computer companies, who quickly geared up and made EMRs that the medicine men needed to buy before the deadline the Rulers had imposed.

 

Soon the medicine men gave all their newfound money to the computer makers. One of the things they thought they remembered hearing about was “interoperability”, but the computer makers were no fools. By making it just about impossible to transfer data between EMRs, the computer companies figured they could keep their respective customer's hostage because no matter how much they hated the slapped-together systems, it would be too costly to start over with another system.

 

Eventually, each vendor secretly hoped they would end up with the most users and thereby becoming the industry standard when the medicine men and the Rulers caught on to the lack of interoperability.

 

That, I explain to those of my patients who were around for it, is like the early days of VCRs – Betamax or VHS – more than 100 times over or, think about it, 100 times worse.

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3 Reasons Physician Practices Need a Cloud-Based EHR

3 Reasons Physician Practices Need a Cloud-Based EHR | EHR and Health IT Consulting | Scoop.it

Cloud-based EHRs are becoming a key requirement for medical practices looking for a new electronic health record (EHR) system. According to a Black Book survey, nearly 85 percent of physicians shopping for a new EHR required mobile access from their new system.

Why have cloud-based EHRs become increasingly popular? Many small to medium size medical practices who’ve transitioned to this type of software are realizing the benefits. Let’s look at three reasons web-based EHR systems are a great solution for physician practices.

Benefits of a Cloud-Based EHR

  1. Cloud-based EHRs offer cost-savings and scalability. 

Unlike costly server-based systems, cloud-based EHRs are centrally hosted and do not require any hardware installation, maintenance or software licensing, making them much more affordable and easily scalable for practice growth.

Cloud-based EHRs are offered as software as a service (SaaS), meaning practices simply pay a monthly fee to use the software. Practices also don’t have the headache of worrying about updating the system, as updates are made automatically. Additionally, when a practice expands, new users, physicians or locations can easily be added.

  1. Cloud-based EHRs result in better accessibility and patient care.

Cloud-based EHRs are a win-win scenario for physicians and patients. With cloud-based systems, physicians always have important information at their fingertips, allowing them to provide better, more efficient care to their patient. Imagine a scenario where a physician is out of office but needs to follow up on an emergent case. With a web-based system, the physician could still log in to the EHR remotely and access the patient record as well as integrated clinical decision support. Having access to that pertinent information, at the right time makes it possible for the physician to provide better patient care.

Cloud-based systems also provide an opportunity for better patient interaction and engagement. Most cloud-based EHRs are accessible via an iPad, laptop or mobile device, meaning physicians are no longer tied down to a computer screen. Cloud-based systems allow for better mobility and patient interaction. For example, a physician can easily go from exam room to exam room with a handheld iPad and even engage the patient by showing them certain diagrams, charts or health information.

  1. Cloud-based EHRs improve communication.

Cloud-based EHRs provide greater flexibility than ever before. With cloud-based systems, small practices have secure access to their EHR whenever they want, from whatever device they want, as long as there’s internet access. The ability to access the system remotely, whenever necessary, allows for better communication and collaboration between physicians, staff, and patients. While patients won't have access to the EHR they do have 24/7 access to an online patient portal where they can send a secure message to the practice. Depending on the scenario, the practice can then log in to the EHR to follow up with the patient immediately or respond accordingly. The practice also has access to important patient information for scenarios that occur outside of office hours that will help them make more informed decisions for follow up procedures.

Cloud-based EHRs provide a lot of advantages for physician practices. Many who’ve already made the transition to a cloud-based EHR are experiencing the benefits.

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Practice EHR Success Story: Cooperative City Chiropractic

Practice EHR Success Story: Cooperative City Chiropractic | EHR and Health IT Consulting | Scoop.it

Transitioning to an electronic health record (EHR) can be a daunting task for any healthcare organization, especially for small practices. However, going electronic can also have numerous advantages.

 

Situation

 

Coop City Chiro, a five-physician chiropractic facility in Bronx, NY, manages 3,000 patient visits per month. With a growing patient load on top of the maintenance associated with existing medical records, Coop City Chiro needed a better way to manage their practice on the back end without disrupting patient care. In order to find the right EHR for them, Coop City Chiro started their search with the following needs in mind:

 

  • Find an EHR that organizes and optimizes patient documentation.
  • Implement an EHR without causing distractions or unnecessary obstacles for their patients and staff.
  • Train staff and doctors on an EHR without disrupting their busy schedules.
  • Adopt an EHR that fits their practice’s budget and capacity.

 

The chiropractic facility chose to implement Practice EHR, an EHR system priced for small practices and built specifically for each specialty.

 

Results

  • Live within minutes. Coop City Chiro implemented Practice EHR within minutes and without any disruption to patients or staff because the EHR is so easy-to-use.

 

  • Improved efficiency of documentation and billingCoop City Chiro noticed an immediate improvement in practice management and overall efficiency because they could easily log patient care and bill for all their patients in one single platform.

 

  • 50,000 in cost-savingsAfter implementing Practice EHR, Coop City Chiro reported $50,000 in cost-saving by going electronic and eliminating postage, ink, toner, envelopes, paper, etc.

 

 

 

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4 Tips for Making the Most of an EHR Demo

4 Tips for Making the Most of an EHR Demo | EHR and Health IT Consulting | Scoop.it

Selecting the best electronic health record (EHR) for your medical practice can be an overwhelming process. With so many healthcare technologies on the market today, how can you confidently choose the right solution for your practice?

Similar to many other advisors, we believe the product demonstration (demo) is a critical tool in the selection process. In order to make an informed decision and find the right EHR for your medical practice, it’s helpful to see and experience the software first hand.

An EHR demo is a helpful evaluation tool. There’s lots to cover—and uncover—so come prepared with questions. Here’s four tips for making the most of your next demo:

  1. Have a good understanding of how the EHR aligns with your practice’s needs.

    Before the demo, establish a list of your must-have features and requirements and evaluate how the EHR matches up. In general, a good EHR should provide features that support better practice operations and simplify daily tasks. Is it user friendly? Is it designed for your specialty? Does it include features that will help your practice operate more efficiently? Ask specific questions about how features work and how they’ll make your work life easier; uncover whether or not the EHR is designed to support you day-to-day and for the long term while also helping you achieve government requirements.
  2. Know pricing and exactly what’s included.

    There’s a variety of price points and pricing structures for EHRs. Most likely you will find general pricing information on the company website, but the demo is a good time to confirm any additional costs. Not all vendors are transparent about fees, so it’s important to get specific about what’s included in the price and what’s not. Upcharges vary from vendor to vendor but are commonly related to specific feature functionality, set up, data migration, implementation, training, support or system maintenance.
  3. Understand the process for implementation, training and support.

    Understanding processes for implementation, training and support and setting expectations early, prepare you for a smooth transition. In addition to knowing if the vendor charges for startup costs and support, ask the vendor the standard length of time for implementation and training and what means of support are available. Practices looking to implement quickly should consider cloud-based EHRs systems that eliminate having to invest in hardware and complete cumbersome training.
  4. Confirm the EHR is certified.

    To receive incentive payments under the ongoing EHR adoption program, eligible providers are required to use certified EHR technology. Ask vendors about their certification and how the software supports meeting government-sponsored program requirements. Most EHRs will have certification information available on their website (like we have done here) or you can also visit the ONC website for the Certified Health IT Product List (CHPL).

EHRs are necessary for better practice management, care delivery and patient outcomes, but not all EHRs are created equal. Asking the right questions during a demo will help you make informed decisions and find an EHR that’s right for your medical practice. 

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5 Essential Benefits of Using Artificial Intelligence (AI) Technology in EHR's

5 Essential Benefits of Using Artificial Intelligence (AI) Technology in EHR's | EHR and Health IT Consulting | Scoop.it

Machine learning is a promising domain that has positively impacted many industries and now healthcare is witnessing its powerful emergence. The progress of Artificial Intelligence-based technology, along with other advances in EHRs is bringing a new wave of interest in how this latest technology is going to change the shape of health and healthcare. EHR platforms are at the forefront of using artificial intelligence within the healthcare arena. This is because of the widespread use of EHR software and the capability of EHR software to categorically store real-time patient data. These data sets can be used by artificial intelligence to make predictions and suggestions for the future.

 

This fast-growing digitalization has created major opportunities for the use of artificial intelligence. Industry experts and innovators see the potential and continue to gradually improve AI-based features within updated EHR systems. The widespread use of this digital health data advances health outcomes and there is no doubt it will eventually reshape the healthcare industry. Let’s have a look at some more unique benefits.

Benefits of Using AI Technology in EHR Software

  1. Better Diagnosis & Treatment

Newly developed AI diagnostic systems can help providers diagnose and treat different diseases. This advanced system uses the historical data and patient symptoms to predict future illness. EHRs are more intelligent now and can suggest the high paying CPT codes for the identified disease so providers can maximize their earning potential as well. In the future, this AI-based diagnostics system could possibly even lead to self-diagnosis tools and treatment facilities for common diseases.

  1. Reduces Human Error

talkEHR is a good example of a self-learning electronic health record system that comes with an integrated medical voice assistant named “Allison”. This intelligent voice assistant lets you talk with your EHR, and performs the requested functions you tell her to. This saves charting time and reduces human errors. Also, the longer you use the system, the more this self-learning software is able to provide you with an improved, personalized experience.

  1. Cost-Efficient

Artificial intelligence based EHR software automate the normal workflow of medical practices and, to some extent, eliminate the need for additional support staff. Auto reminder calls, appointment scheduling, and other task automations are improving the workflow of medical practices, as well as reducing overhead expenses.

  1. Better Medical Imaging Analysis

Artificial intelligence-assisted medical imaging analysis is much better than a manual one. It analyzes and compares the cell structures and also tissue segmentation to identify disease and suggest treatment.    

  1. Improves Productivity

AI-based EHRs improve the productivity of medical practices as they significantly reduce the administrative complexity, clinical waste, malpractice likelihood, and help to save the staff time they would otherwise spend on repetitive tasks.

Healthcare facilities are making necessary investments in AI-based EHR development, and over time, the AI algorithms will continue to improve and fully transform the healthcare industry. How closely will this transformation resemble the vision of medical futurists? We look forward to seeing how it takes shape. Feel free to share your thoughts in the comment box below!

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EHR Optimization as a Bridge to Population Health Management 

EHR Optimization as a Bridge to Population Health Management  | EHR and Health IT Consulting | Scoop.it

In the quest to meet value-based care, population health and quality reporting goals, healthcare leaders face an array of avenues and tactics. While the strategies differ, one constant in virtually all efforts to bring structure to new care delivery models is the improved use of technology and systems, and the troves of data they store and transmit.

 

Analytics has a pivotal role in meeting healthcare’s triple aim of reducing the per capita cost of care, improving patient experience (including quality and satisfaction) and improving population health. Without the support of the clinicians using these technologies and the information they hold, however, it is difficult to succeed. This has prompted some healthcare organizations to champion a quadruple aim that also seeks to improve the work life of healthcare providers.

 

To develop and execute on a quadruple – or even triple aim – healthcare leadership teams must answer the question:

 

How can our organization capture the information needed to deliver effective, data-driven care in a manner that benefits patient outcomes and compliments provider workflows?

 

Through a disciplined EHR optimization methodology, a structured plan, and input from providers and clinicians on goals and practical ways to meet those goals, it is possible to adopt a data-capture care strategy that minimizes impact on provider workflow while maximizing return on reimbursement.

 

Optimization in Action
Consider how EHR Optimization can aid population health management efforts.

 

Many healthcare organizations are analyzing patient data to identify high-risk and/or high-utilization patient populations that could pose savings opportunities if their care interventions are migrated from high-cost emergency department and inpatient settings to preventive and primary care, but how many are truly looking up-stream at how the configuration and use of the EHR impacts their success?

 

When developing and deploying an organization’s population health goals and identifying target patient populations, consider how your organization can engage and support your clinicians in this evolution. What clinical workflow supportive functionality is available in your EHR to aid and prompt care team members to ask the right patients the right questions, proactively screen, and implement low-cost interventions to quickly put population health management into action? How can these opportunities be implemented without disruption of patient care flow?

 

Here are specific strategies for building an EHR Optimization plan targeted toward enabling population health while supporting your providers:

 

  • Engage your clinicians early on. Including your providers and allowing them to tell you how they work and what will work for them to support your effort makes a successful initiative.
  • Integrate with established workflows when possible. Data entered correctly into your EHR supports your analytics needs. You will depend upon your providers to capture this for you.
  • Prioritize your target patient populations. Which initiatives will yield the highest return? Start with a single impactful goal and fine tune processes, measurement and engagement around it.
  • Ensure consistency in design. Provide consistency in data standards and naming conventions. This can go a long way to eliminate redundancy in documentation for clinicians. This is particularly important when planning to expand your program

 

EHRs and supporting technologies are an incredible data source and the key to value-based care and population health management success. EHR implementation and optimization strategies that keep the quadruple-aim top-of-mind can support organizational initiatives while enhancing, or at very least not burdening, clinical workflows of your EHR users. Engaging your end users in the process inspires a collaborative, supportive environment while encouraging a successful outcome to organizational directives.

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Making the Case for Patient-Generated EHR Data - Healthcare IT Consulting

Making the Case for Patient-Generated EHR Data - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

The proliferation of wearable and mobile health devices from Fitbit, Apple Health, Google Fit, Nokia Health/Withings and others is bringing patient-generated data into the digital health fold. Health-savvy patients amassing this information are increasingly looking for ways to share the data with their providers.

 

Epic is one Electronic Health Record (EHR) vendor looking to bridge the gap between patients’ device app data and the patient health record. Patients can integrate data tracked on Apple iPhone devices into Epic’s MyChart patient portal; with an active MyChart account, patients can sync data such as weight, steps, pulse, blood pressure, and more back to the EHR for providers to review.

 

For example, let’s say I am a patient with hypertension and I’m on a new medication. I’m interested in monitoring how that medication impacts my health over the next month. Epic’s Apple integration enables me to track my vital signs daily for a month and share that information with my provider without the requirement of an in-office visit or sending the information via fax or postal mail. The data captured via my smartphone will already be with my provider by the time I have my next follow-up visit.

 

The Benefits of a Patient-Generated Data Strategy

Technology that supports bringing patient-sourced data into healthcare assessments poses benefits to both providers and patients. Providers can more easily track and monitor patients between visits. This offers clinicians a fuller picture of a patient’s health beyond lab results, problem lists, allergies, and medications. Patient lifestyle data beyond the walls of institutionalized care can reveal where patients are doing well and where there is room for improvement.

 

Patient involvement in personal health monitoring between visits promotes patient accountability in reaching health goals. If I’m an overweight patient with a weight reduction goal, for example, my doctor can recommend I use a Fitbit that allows me to track step data. I can routinely review that data and provide feedback to my provider with real-time updates on whether I’m reaching my daily goals or not.

 

Wearables and personal tracking devices drive patient accountability with empirical data that is captured automatically. Patients become more active participants in their health and in the creation of their health record.

 

Both patients and providers benefit from improved access to quantifiable health information. Shared visibility into patient health trends over time improves patient access and engagement, mitigates trust issues, and strengthens the patient/provider relationship.

 

Considerations When Integrating Patient-Generated Data

hile the integration of patient-sourced data into EHRs poses clear patient engagement and accountability wins, implementing this exchange of information does come with unique challenges. Here are a few key considerations healthcare organizations need to address along their journey.

 

Patient awareness. Promoting the availability of device data integration is key to usage. To build awareness some healthcare organizations may set up “health bars” in waiting rooms or lobbies to offer patients a tangible experience of offerings. These health bars typically feature devices like iPads, iPhones, and Fitbits with information on the various integration points available to patients.

 

Patient technical aptitude. Another hurdle healthcare organizations may face when rolling out device data integration is patient technical aptitude. Support teams dedicated to helping less tech-savvy patients successfully sync devices can help drive adoption.

 

Provider adoption. Driving provider awareness and adoption of device data integration is another challenge healthcare organizations may need to tackle. Clinicians need to be aware of the offering, how to make it available to their patients, and how to use the information when received. Educating providers on the how, what and why through tip sheets, medical staff meetings, and other venues is essential.

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AI Platform with Epic EHR to Support Clinical Workflows

AI Platform with Epic EHR to Support Clinical Workflows | EHR and Health IT Consulting | Scoop.it

M*Modal integration with Epic EHR supports virtual assistants and nursing applications for an advanced workflow in Epic

 

M*Modal, a provider of clinical documentation and Speech Understanding solutions, announced that it is integrating its artificial intelligence (AI) powered platform with the Epic EHR to support clinical workflows. Creating time to care through smarter, more unified workflows, M*Modal® speech and AI enabled solutions are designed to significantly improve the productivity of the entire care team while driving quality-centric outcomes.

 

Leveraging M*Modal’s long history of delivering industry-leading, cloud-based conversational solutions integrated with the Epic EHR, M*Modal further simplifies documentation tasks for clinicians with fully speech-driven workflows. The two companies have worked together over the years to enhance the user experience of joint clients by improving physician adoption and satisfaction, as well as the overall quality of clinical documentation with AI-powered solutions such as Computer-Assisted Physician Documentation (CAPD).

 

M*Modal is currently working on the following integrations to enhance the clinical documentation experience:

 

· M*Modal integration with Rover: Using embedded M*Modal technology, nurses will conversationally engage with flowsheets as the AI-powered system automatically finds the right row to record patient information such as vitals. Taking the nursing workflow to the next level, Epic’s task management module is designed to enable nurses to conversationally create task reminders that help streamline the workday and reduce care gaps.

 

· M*Modal integration with Haiku Voice Assistant: Furthering the experience of clinicians using the Haiku mobile app with embedded M*Modal Speech Understanding, clinicians can use the EHR’s Voice Assistant with M*Modal AI technology to also speech enable physician tasks such as querying the patient record, performing scheduling functions, placing orders, and more.

 

· M*Modal integration with Hyperspace Voice Assistant: In this next-generation EHR workflow, clinicians can benefit from a fully speech-driven and interactive experience (powered by M*Modal technology and hundreds of speech commands) to document the entire patient encounter and navigate the EHR. Bringing the Voice Assistant to Hyperspace creates an entirely new way of interacting with the EHR, which enables physicians to spend more and better time with patients.

 

· M*Modal integration with NoteReader CDI: Already installed at several healthcare facilities, NoteReader CDI can utilize embedded M*Modal market-leading CAPD technology to proactively deliver quality-focused insights to physicians at the point of care. Additionally, it uses the M*Modal CAPD infrastructure and robust reporting capabilities to monitor and improve physician engagement with the system.

 

“We are delivering on the critical necessity for bringing clinician-assistive technologies to market to improve efficiency and ease of documentation for multiple caregivers while also providing proactive insights on patient care in real time,” said Michael Finke, President of M*Modal.

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Don't Overlook EHR Communication

Don't Overlook EHR Communication | EHR and Health IT Consulting | Scoop.it

Through all of the planning and preparation that goes into an Electronic Health Record (EHR) implementation, EHR communication is often overlooked and undervalued. With everyone focused on delivering the system, building applications, testing hardware and validating workflows, end user preparedness, outside of training, can be overlooked.

 

Sure, they’re going to be trained on the system, but it’s important to remain engaged with end users in the months and weeks leading to go-live, but also beyond go-live. In many aspects, post-live communication is more vital to day-to-day operations throughout the organization.

 

In this post, we’ll discuss the primary types of communication that must be considered, carefully planned for and thoughtfully executed to serve end users best as they prepare for and live in the new world of the EHR.

 

Types of EHR Communication

 

Internal Marketing, pre- go-live
Transitioning to an EHR is daunting for everyone. It’s exciting and new, but it is scary. It’s a daunting task for leadership and project teams, but for end users, this new technology will completely disrupt their professional lives – especially those that have never used the technology.


The merits of the new system, how it will help them in the long run, and how it will benefit patients must all be sold to end users who, in most cases, have always worked a certain way – without technology. The system must be sold to them because there will be resistance, some kicking and screaming, all the way through go-live.


Change Communications
Don’t listen to anyone that tells you that you’ll be able to relax once the system goes live. If anything, the importance of clear, concise communication escalates exponentially after go-live.


Technology, by its nature, evolves. And electronic health records are not exempt. One of the primary features of the technological age we live in is that the systems we use can, and will, be updated.
When changes are made to the system, there must be a coordinated Change Management procedure featuring robust communication to all impacted employees.


System Updates/Downtime Messaging
EHR’s and the infrastructure they run on are fallible. No matter how well the system is designed and built, there will be issues and downtimes that negatively impact end users, and if not planned for accordingly, patients.


System Update (SU) and Downtime procedures must be carefully developed and communicated throughout the organization to ensure that employees know the protocols that are in place in the event of a system outage.


Additionally, communications processes and protocols must be installed throughout the organization to ensure that vital information can be delivered to end users crisis situations – and that end users can communicate what’s happening on the ground with leadership and IT.


Ultimately the goal here is to ensure that clinicians can continue to care for their patients in the event of a system outage and proper communication is key.


Targeted Messaging
This comes down to a simple realization – clinicians are extremely busy people that don’t have time to wade through waves of content to find what pertains to them.
Messaging designed with a specific user group in mind that includes a concise, actionable message works best. Think providers or nurses.


This audience also benefits from a well-known or trusted sender. They don’t pay attention to mass emails from generic inboxes. Their bosses, Chief Medical Officers, Chief Nursing Officers, or a department head usually garner the most respect, and the most attention, in clinical circles.


Patient Communication
This change is disruptive for patients as well, especially during go-live. Taking the time to thoughtfully communicate the change to patients will help ease the transition for them as well.
They’ll have questions. Why is my doctor on that computer so much? Is my medical information online? Is it secure?
Without going into the minutia around the EHR, device integration, real-time data, secure servers, firewalls, data centers, etc. – take the time to explain the change to patients, at least at a high level. They will appreciate it.


myChart & Meaningful Use
On the surface, Meaningful Use and MyChart communication don’t immediately come to mind when thinking of the EHR communications plan. They should, though. Soon after go-live, the focus shifts to stabilization and optimization, which includes myChart and Meaningful Use.


While they’re paired together here because they’re add-ons that don’t necessarily fall under the initial communications scope, these two are very different and need their own comprehensive communications plans and delivery methods as the content, audience, and implications are drastically different.


While not explicitly responsible for building or activating the EHR system that will revolutionize your organization, it’s important to have a person or team dedicated to communicating with your end users – at all stages of the system’s life cycle. Uninformed end users are disgruntled end users, and it pays to have communications people that have experience with IT and EHR delivery as it is a world unto itself.

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Pediatric EHRs Must be Treated Differently

Pediatric EHRs Must be Treated Differently | EHR and Health IT Consulting | Scoop.it

When it comes to healthcare, there are many different types of facilities and settings. There are acute care hospitals, specialty care hospitals, nursing homes, long-term care facilities, ambulatory care centers, surgical centers, outpatient clients, physicians’ offices, rehabilitation centers, pediatric care hospitals, and many more. What all of these different care settings have in common is that they most certainly benefit from some form of electronic health record (EHR) software, each with their own specific needs. What they do not have in common, is the type of patients or type of care they provide. Pediatric patients and healthcare facilities require the right approach to install their Pediatric EHR.

 

An acute care hospital’s primary task is to provide short-term care for people with varying degrees of health issues. These usually stem from injury, disease, or genetics. They are open 24/7/365 and bring together physicians from varied specialties, a skilled nursing staff, technicians, and specialized equipment. Most hospitals offer a wide range of services including emergency room, labor and birth, scheduled surgeries, and lab work. Acute care hospitals utilize standard EHR software where each department has a specific module with tailored functionality to meet their needs.

 

The difference between the standard acute care hospital and pediatric care hospitals is, of course, the patients. Though it may seem obvious, teams in pediatric facilities must recognize that infants, children and those with special needs are not merely small adults and they cannot be treated as such. Caregivers must pay additional attention to how they interact with pediatric patients and their families. Bedside manner, psycho-social considerations, and family dynamics have to be considered during the course of care.  In many respects, the Pediatric EHR must be treated the same.

 

Pediatric facilities have unique requirements that dictate many aspects of their EHR software adoption.  Hardware and device placement have unique needs to facilitate documentation where the patient is – many times patients aren’t located in their bed or assigned room.  Specific attention and adherence to isolation requirements are vital. Also, close attention should be given to screen visibility to include parents or other approved family members engaged in care planning, patient teaching, and patient education.  Consideration is also given to the multi-disciplinary care team engaged with a pediatric patient – case management, social work, therapies, child life services, etc.

 

Hospitalizations are essential for both adults and children. How a healthcare organization chooses to treat them is even more critical. Pediatric organizations require special machines, special tests, special nurses, special doctors, and more importantly SPECIALIZED Pediatric EHR software systems. While the primary objective for healthcare organizations is to provide high-quality patient care, they must also make money.  Reimbursement rates continue to decrease which calls for consistent best practices for both hospitalized adults and child to ultimately reduce the length of stays.  Effective and efficient use of the EHR coupled with the power of the data it provides is crucial to patient satisfaction and improved care.  Additionally, healthcare organizations can save money and improve patient care by partnering with healthcare IT consulting companies who have the knowledge and methodologies to ensure that when an EHR is implemented, no matter the setting or patient type, it will be done correctly.

 

Whether it is a standard acute care hospital or a specialized pediatric hospital, Optimum’s expert resources recognize these needs and facilitate incorporation of the “triangle of care” – meaning patient, family and caregiver/device.  In the majority of our activations, we have provided expert support for pediatric inpatient settings, PICU settings, Leve 2, 3 and 4 NICU’s, Pediatric Trauma and Emergency Room settings while implementing their Pediatric EHR.

 

While preparation is undoubtedly a key ingredient for success, all the planning in the world can yield minimal results if you don’t have the right people in place to execute the plan. In addition to the years of experience Optimum brings to the table, we also specialize in allocating the right resources – the right people – for your project at the right time. Optimum Healthcare IT uses its SkillMarket portal to not only manage your go-live resources, but to optimize resources based on your needs, their skillset, and geo-location.

 

Our commitment to your needs ensures that your implementation will be successful throughout your planning, go-live, stabilization, and optimization. And once you make it through the arduous task of implementing an electronic health record, the challenge then becomes sustaining it and meaningfully using it. Optimum Healthcare IT has the best team in the business.

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Healthcare providers to control all clinical content of the patient record

Healthcare providers to control all clinical content of the patient record | EHR and Health IT Consulting | Scoop.it

Turn health data into actionable, cost-saving strategies

oday’s healthcare challenges are no mystery. Hospitals and health systems are navigating the transition to value-based care while continuing to rely on traditional fee-for-service reimbursement models. Uncertainty about the future of health care in the United States is making this shift even more complex as organizations seek a path forward that conquers both known (and unknown) challenges ahead.

 

The standard advice heard across the industry is to “leverage data,” but how does a health system do this? Every healthcare delivery network in the country is rich with data, but how can this resource be applied for each of your care settings, clinicians and provider groups, payers and reimbursement models, and shifting populations?

 

Ensuring high quality patient care and outcomes while balancing financial realities in an evolving market requires a robust data analytics solution—one that can handle the breadth and complexity of health care today without an army of data analysts to make it work.


The 3M Performance Matrix Platform is a data analytics and performance management solution that combines 3M Health Information Systems’ decades of coding and risk-adjustment experience with the data processing power of Verily, an Alphabet company. The platform simultaneously analyzes performance in managing populations throughout your network across all visits, episodes of care and disease cohorts to:

 

  • Automatically identify the root causes of quality issues and excess costs to strengthen performance
  • Prioritize system-wide problem areas using advanced intelligent data processing power
    Work with experienced professionals to drive sustainable behavior change and process improvement

With Verily’s big data computing power, the Performance Matrix platform applies 3M’s risk adjustment methodologies and performance measures to all available data. It then mines this enriched data to identify and prioritize key problem areas. Rather than deploying teams of data analysts, the technology does the work for you.

 

Using Verily’s analytics engine and 3M’s real-world, proven methodologies, the platform helps improve performance by focusing on areas and interdependencies of preventable clinical and financial issues that stem from:

  • Under- and over-utilization of services or care settings
  • Avoidable care, such as readmissions and complications
  • Unnecessary costs
  • Post-acute services

 

3M Performance Matrix analyzes aggregated data against dozens of performance measures to identify and describe the most impactful problem areas. This combination of problem prioritization and analysis helps you focus on what can be fixed, and done differently, going forward. 3M Health Information Systems

Hyland Healthcare’s enterprise imaging

Hyland Healthcare’s suite of enterprise imaging solutions allow healthcare providers to control all clinical image content—including images from specialty departments. When integrated with a clinical imaging system or EHR, clinicians and staff can view medical images in the context of the patient record from within those familiar systems.

 

Eliminating departmental imaging silos improves clinical workflows, strengthens security of protected health information (PHI), enhances disaster recovery, and eases the burden of building and supporting multiple clinical imaging interfaces to the EHR. The following are core components of Hyland Healthcare’s enterprise imaging portfolio.

Acuo VNA

The Acuo Vendor Neutral Archive (VNA) provides standards-based enterprise access to medical images regardless of viewing application, offering independence from proprietary archives, and streamlining clinical workflows.

 

The solution leverages technologies to support the management and sharing of medical images across the enterprise and beyond, allowing providers to assemble a comprehensive image-enabled patient record.

 

With on-site, cloud, and hybrid deployment options, Acuo VNA supports business continuity and disaster recovery strategies while providing a platform for clinical content integration, interoperability, and exchange.

NilRead

NilRead, a multi-specialty, zero-footprint enterprise viewer, provides a universal vendor-independent platform for accessing a full range of DICOM and non-DICOM image data. Integrating seamlessly with most EHR, PACS, or VNA, NilRead identifies and ingests images from virtually any departmental archiving solution—whether dermatology JPEGs, data-intensive virtual pathology slides, or radiology DICOM files.

 

This scalable solution is based on a zero footprint, web-based architecture, meaning only a browser is needed to launch the application. There is no software or plug-ins and images never reside on the workstation. NilRead runs on any web-enabled mobile device, tablet, or PC, providing clinicians with constant access to medical images and remarkable tools to enable collaboration across the enterprise.

PACSgear

PACSgear solutions complete the enterprise imaging framework by allowing providers to capture a variety of documents, film, photos, video, and other media and integrate them with any EHR, VNA, or PACS. Hyland Healthcare’s ModLink software uses DICOM Structured Report or HL7 measurement data from ultrasound, DEXA, and CT devices to auto-populate reports in voice recognition systems. Meanwhile, ImageLink worklist solution manages HL7 to DICOM MWL mappings, facilitating Integrating the Healthcare Enterprise (IHE) workflow for interoperability with existing PACS.

PACSgear connectivity offerings:

PACS Scan, PACS Scan Mobile, PACS Scan Film, PACS Scan Web, EHR Gateway, ModLink, Media Writer, Gear View QC, MDR Video – Touch, ScopeCap, DICOM Box, and Image Link.
Hyland Healthcare

Alliance Community Hospital first MEDITECH customer to deploy CommonWell Services

MEDITECH, an Enterprise Health Record (EHR) vendor and Contributor Member of CommonWell Health Alliance, has deployed CommonWell interoperability services at Alliance Community Hospital (ACH). The capabilities will enable ACH, a non-profit hospital serving the residents of Alliance, OH, to exchange patient information seamlessly for improved patient care and quality outcomes.

 

MEDITECH is the first EHR vendor in CommonWell to deploy the Argonaut Project’s FHIR specifications to customers for the purpose of document exchange, providing near real-time access to a participating patient’s data. Embedded directly into the MEDITECH EHR, these CommonWell services include patient enrollment capabilities and C-CDA exchange, opening the door for more comprehensive sharing of discrete segments of data in the future, such as medication and allergy data.

 

Today, more than 9,300 provider sites are Live on CommonWell services across the nation, and more than 30 million individuals are enrolled..

 

Accelerate and improve patient care anytime, anywhere with secure mobile app AlertView

AlertView, the mobile application developed by Novarad Healthcare Enterprise Imaging, was created to accelerate healthcare by notifying physicians via text message that reports and findings are ready for review.

 

AlertView makes healthcare more efficient by eliminating unnecessary delays in the review of imaging reports. The AlertView app instantly sends a text message to referring physicians, radiologists, or cardiologists alerting them that a report is ready for review. No matter where they are, they can review with one click on the text message, and have this instantly shared with other medical care professionals. This type of mobile communication and collaboration improves patient outcomes while minimizing disruptions for primary care physicians and hospital staff.

 

The app’s features include secure login with TouchID, a dynamic patient list to enable quick searches, extensive filtering including modality and time filters, a convenient basic report view along with an in-depth full report view, display of all key images in the study, and enhanced data security through deep linking

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Are Medical Practices Taking Advantage of Cloud-Based EHR?  

Are Medical Practices Taking Advantage of Cloud-Based EHR?   | EHR and Health IT Consulting | Scoop.it

In today’s medical field, technology is a big player. With regulations dictating that even independent practices attempt to make the jump to a dedicated EMR/EHR. An EMR/EHR, or electronic medical record/electronic health record interface, provides physicians and patients a way to connect to promote efficient healthcare delivery and organizational profitability. Today, we will look at how smaller healthcare providers are utilizing EMR/EHR solutions that are hosted in the cloud, bucking the trend of hosting their patient information locally.

 

EMR/EHR


For the modern healthcare provider, the EMR/EHR is a major piece of software. The EMR/EHR is an interface that physicians, healthcare providers, and insurers use to update the information on each patient. As the patient has access to their own EMR/EHR file as well, it makes it a very useful guide for all parties involved to manage an individual patient’s care.

 

Major Considerations
With the massive cost of health care, it isn’t much of a stretch to say that there are some very serious considerations that have to be made to the way that doctors and health organizations utilize cloud-hosted technologies. Many providers, however, are reluctant to do just that as there are serious questions about the viability of cloud computing for regulation-covered information such as electronic protected health information (ePHI). One such consideration is the massive incentives offered to organizations who implement “meaningful use” EMR/EHR technology. In order to meet the “meaningful use” criteria, however, many separate variables have to be met, including:

  • Engaging patients in their own care
  • Improving quality, efficiency, safety, and reducing health disparities
  • Improving care coordination
  • Improving public health and health education
  • Meet HIPAA regulations for the privacy of health records

 

So while many of these variables seem to be common sense, there are additional costs that go along with this kind of comprehensive use of EMR/EHR functionality, which, for smaller medical practices, can be enough of an impetus to not meet those qualifications. Cost usually supersedes most other qualifications, even in a high-stakes, results-based business model like healthcare. That means that even though utilizing cloud technology will cut costs, there is no guarantee that a practice will meet the necessary criteria for “meaningful use”.

 

That said, cloud computing has more resources available to maintain data security than ever before, and organizations can still move to an EMR/EHR solution that will benefit their users, and their staff. If you are looking for a solution to help your medical practice cut costs, get dynamic web-based functionality, or get your technology in a position to meet industry regulations, contact the experts

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Fix the EHR!

Fix the EHR! | EHR and Health IT Consulting | Scoop.it

After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.

 

Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing.

 

Mashing up all these functions — charting, clinical ordering, billing/compliance and quality improvement — inside the EHR has been a disaster for the clinical user, in large part because the billing/compliance function has dominated. The pressure from angry physician users has produced a medieval solution: Hospital and clinics have hired tens of thousands of scribes literally to follow clinicians around and record their notes and orders into the EHR. Only in health care, it seems, could we find a way to “automate” that ended up adding staff and costs!

 

As bad as the regulatory and documentation requirements are, they are not the largest problem. The electronic system's hospitals have adopted at huge expense are fronted by user interfaces out of the mid-1990s: Windows 95-style screens and drop-down menus, data input by typing and navigation by point and click. These antiquated user interfaces are astonishingly difficult to navigate. Clinical information vital for care decisions is sometimes entombed dozens of clicks beneath the user-facing pages of the patient’s chart.

 

Paint a picture of the patient. For EHRs to become truly useful tools and liberate clinicians from the busywork, a revolution in usability is required. Care of the patient must become the EHR’s central function. At its center should be a portrait of the patient’s medical situation at the moment, including the diagnosis, major clinical risks and trajectory, and the specific problems the clinical team must resolve. This “uber-assessment” should be written in plain English and have a discrete character limit like those imposed by Twitter, forcing clinicians to tighten their assessment.

 

The patient portrait should be updated frequently, such as at a change in clinical shifts. Decision rules determining precisely who has responsibility for painting this portrait will be essential. In the inpatient setting, the main author may be a hospitalist, primary surgeon, or senior resident. In the outpatient setting, it’s likely to be the primary care physician or non-physician provider. While one individual should take the lead, this assessment should be curated collaboratively, a la Wikipedia.

 

This clinical portrait must become the rallying point of the team caring for the patient. To accomplish this, the EHR needs to become “groupware” for the clinical team, enabling continuous communication among team members. The patient portrait should function as the “wall” on which team members add their own observations of changes in the patient’s condition, actions they have taken, and questions they are trying to address. This group effort should convey an accurate picture (portrait plus updates) for new clinicians starting their shifts or joining the team as consultants.

 

The tests, medications or procedures ordered, and test results and monitoring system readings should all be added (automatically) to the patient’s chart. But here, too, a major redesign is needed. In reimagining the patient’s chart, we need to modify today’s importing function, which encourages users indiscriminately to overwhelm the clinical narrative with mountains of extraneous data. The minute-by-minute team comments on the wall should erase within a day or two, like images in SnapChat, and not enter and complicate the permanent record.

 

Typing and point and click must go. Voice and gesture-based interfaces must replace the unsanitary and clunky keyboard and mouse as the method of building and be interacting with the record. Both documenting the clinical encounter and ordering should be done by voice command, confirmed by screen touch. Orders should display both the major risks and cost of the tests or procedures ordered before the order can be confirmed. Several companies, including Google and Microsoft, are already piloting “digital” scribes that convert the core conversation between doctor and patient into a digital clinical note.

 

Moreover, interactive data visualization must replace the time-wasting click storm presently required to unearth patient data. Results of voice searches of the patient’s record should be available for display in the nursing station and the physicians’ ready room. It should also be presentable to patients on interactive whiteboards in patient rooms. Physicians should be able to say things like: “Show me Jeff’s glucose and creatinine values graphed back to the beginning of this hospital stay” or “Show me all of Bob’s abdominal CT scans performed pre- and postoperatively.” The physician should also be able to prescribe by voice command everything from a new medication to a programmed reminder to be delivered to the patient’s iPhone at regular intervals.

 

Population health data and research findings should also be available by voice command. For example, a doctor should be able to say: “Show me all the published data on the side-effect risks associated with use of pembrolizumab in lung cancer patients, ranked from highest to lowest,” or “Show me the prevalence of postoperative complications by type of complication in the past thousand patients who have had knee replacements in our health system, stratified by patient age.”

 

AI must make the clinical system smarter. EHRs already have rudimentary artificial intelligence (AI) systems to help with billing, coding, and regulatory compliance. But the primitive state of AI in EHRs is a major barrier to effective care. Clinical record systems must become a lot smarter if clinical care is to predominate, in particular by reducing needless and duplicative documentation requirements. Revisiting Medicare payment policy, beginning with the absurdly detailed data requirements for Evaluation and Management visits (E&M), would be a great place to start.

 

The patient’s role should also be enhanced by the EHR and associated tools. Patients should be able to enter their history, medications, and family history remotely, reducing demands on the care team and its supporting cast. Patient data should also flow automatically from clinical laboratories, as well as data from instrumentation attached to the patient, directly to the record, without the need for human data entry.

 

Of course, a new clinical workflow will be needed to curate all of this patient-generated data and respond accordingly. It cannot be permitted to clutter the wall or be “mainlined” to the primary clinical team; rather, it must be prioritized according to patient risk/benefit and delivered via a workflow designed expressly for this purpose. AI algorithms must also be used to scrape from the EHR the information needed to assign acuity scores and suggest diagnoses that accurately reflect the patient’s current state.

 

Given how today’s clinical alert systems inundate frontline caregivers, it is unsurprising that most alerts are ignored. It is crucial that the EHR be able to prioritize alerts that address only immediate threats to the patient’s health in real time. Health care can learn a lot from the sensible rigor and discipline of the alert process in the airline cockpit. Clinical alerts should be presented in an easy-to-read, hard-to-ignore color-coded format. Similarly, hard stops — system-driven halts in medication or other therapies — must be intelligent; that is, they must be related to the present reality of the patient’s condition and limited to clinical actions that truly threaten the health or life of the patient.

 

From prisoners to advocates. The failure of EHRs thus far to achieve the goals of improving healthcare productivity, outcomes, and clinician satisfaction is the result both of immature technology and the failure of their architects to fully respect the complexity of converting the massive health care system from one way of doing work to another. Today, one can see a path to turning the EHR into a well-designed and useful partner to clinicians and patients in the care process. To do this, we must use AI, vastly improved data visualization, and modern interface design to improve usability. When this has been accomplished, we believe that clinicians will be converted from surly prisoners of poorly realized technology to advocates of the systems themselves and enthusiastic leaders of efforts to further improve them.

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