EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Can True EHR Customization Help Physician Practices Survive?

Can True EHR Customization Help Physician Practices Survive? | EHR and Health IT Consulting | Scoop.it
In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.

It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.

Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today’s world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.

This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from “corporatized” healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.

Capable and cost-effective?

So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government’s evolving mandates that regulate healthcare record-keeping.

In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.

And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way, and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence ‘Rusty’ Hofmann in The Huffington Post, describes it, EHRs are like Model T Ford: Any Color You Want As Long As It’s Black.” The majority of these solutions hitting the market today just don’t cut the mustard when it comes to really addressing the needs of our country’s doctors and healthcare practices.

Furthermore, while the creators of many of these packaged EHR solutions claim to be “customizable,” they are actually merely “configurable.” Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.

These solutions also require heavy reliance on a computer screen, which often hinders a doctor’s ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.

Diversity and true EHR customization rule

So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.

In short, it is crucial that developers of these software tools accommodate doctors’ needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.

This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.


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Lessons learned from an award-winning EHR system replacement | Healthcare IT News

Lessons learned from an award-winning EHR system replacement | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

In 2012, ARcare undertook a fast-paced transition to a next-generation electronic health record system. Less than two years later, ARcare was nationally recognized, receiving HIMSS Analytics' Stage 7 Ambulatory Award, the highest HIMSS honor for EHR adoption.


ARcare, a private, non-profit corporation providing primary care in rural Arkansas and Kentucky through a network of clinics, pharmacies and wellness centers, is the first Federally Qualified Health Center – and was one of only two ambulatory practices not connected with a hospital – to receive a Stage 7 ambulatory award.

On the way to a successful implementation, ARcare learned a great deal about the relationship between ongoing physician involvement and final clinical training – information that may help our peers who are moving forward with similarly ambitious systems replacements.

Managing change during the transition

ARcare’s system replacement involved moving from comparatively basic EHR use to a more comprehensive system with clinical event functionality that would enable us to better manage patient conditions across multiple care venues. A primary goal was to have the system drive orders and events rather than merely document clinical activity.

Migrating to next-generation technology across an enterprise requires significant IT resources, training, management support and workflow changes. Our strategy was to tie these elements together with a carefully constructed change-management plan, in which a highly experienced, multi-disciplinary team with C-level support facilitated all aspects of system adoption. The change-management team was tasked with creating a continuum of sustained change with a primary focus on improved patient care, stripping away governance of information silos. In this spirit of change management, each identified issue was relevant to the team – rather than individual roles – without regard to reporting structures.

The importance of keeping physicians in the change-management loop

Although ARcare achieved significant success in the arena of change management from an IT perspective, and within an aggressive timeframe, we also found in hindsight that keeping physicians in the loop throughout the transition can simplify clinical training during the final stages of implementation.

While ARcare actively sought input and buy-in from physicians on the front end of the transition, our sensitivity to the demands on physicians’ available time led us to remove most of them from the actual transition process, preserving involvement to a select few clinical staff members as physician representatives. While physicians remained involved to provide input to the new standardized workflows required by the new system, most of them had minimal exposure to the new system prior to clinical training.


The scheduled training sessions involved the clinical staff who were part of the change-management team performing training duty: nurse practitioners training other nurse practitioners and physicians training other physicians. We had anticipated this to be one of the easier tasks of implementation, and hadn’t fully accounted for the learning needs of clinical staff.

Although our physician leadership group requested they be the trainers, it soon became apparent that many healthcare professionals are simply uncomfortable voicing the need for additional help, especially to their peers. We also learned that having select clinical staff involved in the overall process didn’t necessarily translate directly to building teaching skills; the ability to understand complex technology and to teach its use are quite different. We decided to revisit training with the assistance of our own KMS – knowledge management systems – education team.

Getting clinical training back on track

Together with the KMS education team and led by four top instructors, we created a new, three-day program that integrated training for physicians, nurses and physician assistants.

Working in small groups, clinical staff participated in the training program, which was rolled out across facilities in series. Feedback gathered at the end of each training session helped to improve each subsequent session. Satisfaction increased quickly and steadily, and ARcare has continued to provide training updates on a regular basis to ensure continued optimal performance.

Well worth the effort

Five months after going live with our new system, ARcare became the first ambulatory practice that was not part of a hospital to achieve Stage 6 on the HIMSS Analytics EMR Adoption Model. One year later, we became the first FQHC to achieve the highest level of EHR usage, Stage 7.

The overall experience helped the organization recognize and develop an appreciation for the fact that change can and should be a positive experience. ARcare has developed a level of confidence across the organization where employees are less reluctant or fearful of change, and where learning from failure produced valuable outcome – not just in successful training, but in the successful adoption of a new Greenway Health EHR that brought with it substantial benefits, including:

  • Improved patient management with better information access for providers and clinical event management that drives events and orders, computerized provider order entry and closed-loop medication administration, and other advanced functions that improve patient care
  • The ability to exchange data directly with the state health department
  • Streamlined access to patient records across the network of primary care clinics, dental clinics, pharmacies and wellness centers

During the transition to the new system, ARcare successfully converted more than 17.2 million records, including clinical notes, images and test results. Now, when ARcare identifies and secures a new clinic site, the new site can be completely operational from an IT perspective in 30 days or less thanks to advanced system capabilities for scalability and extremely fast implementations. As of today, the system provides paperless charting and order entry for 37 ARcare clinics.

In all, it’s been a very satisfying transition in which the gains were well worth the pain – pain that can be avoided by following the lessons learned in ARcare’s approach and re-working of clinical training. In short: It’s all about identifying an effective training team.



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How Large-Scale EHR Adoption Is Transforming the Pharmacy | EHRintelligence.com

How Large-Scale EHR Adoption Is Transforming the Pharmacy | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
With the addition of onsite clinics and EHR technology to support practitioners, pharmacies are fast becoming producers of large amounts of health data and innovators in using this information to guide consumers toward positive health outcomes.
“We have a phenomenal platform to improve health and delivery value to the marketplace,” Walgreens CMO and Group Vice President Harry Leider, MD, MBA, tells EHRIntelligence.com. “The big idea is using our physical and digital footprint to support patients to get well, stay well, or to help manage chronic illness.”
This ecosystem of opportunity is the subject of Leider’s keynote during next week’s mHealth Summit in Washington, DC. It represents the culmination of his organization’s efforts to implement a health IT infrastructure capable of capturing large stores of health data.
“We’re now accumulating large amounts of data every month from consumers who are logging their steps, weight, and things such as blood pressure or glucose — either automatically through devices or manually,” he reveals. “In return, our consumers receive reward points for these activities. We’re on the cusp of proving the effectiveness this program, called Balance Rewards for health choices, to improve health outcomes.”
Driving this increase in health data is large-scale EHR adoption across the company’s many retail locations which were originally using an in-house EHR technology better suited to the needs of pharmacists than clinicians:
Our IT system was homegrown, Intercom Plus, and designed and enhanced over many years to support the prescription fulfillment process, but it really wasn’t configured to capture robust clinical information. The EHR that we’re now using in our pharmacies enables our pharmacists to record data about the important services they are providing: like blood pressure tests and immunizations. They can capture much more clinical information that is of value to clinicians in the community or to our own pharmacists and nurse practitioners. This also enables us to do more outcomes studies to evaluate the the effectiveness and value of our clinical programs.
Concomitant with this widespread EHR adoption is the need for health information exchange (HIE) health information with other clinician EHR users outside of the Walgreens ecosystem and the challenge of interoperability.
The decision to add a clinical arm to its traditionally pharmacy-only setup appears novel, but according to Leider it actually recalls a time when pharmacists played a more direct role in the lives of individuals.
“In the late nineteenth and early twentieth centuries, your pharmacist was oftentimes more critical than your doctor, unless you needed surgery, because they he or she could make a tincture of something to suppress a cough or compound a prescription to provide a salve for a rash,” he explains. “Surveys demonstrate that this trusted relationship between patients and pharmacists continues to this day and is very strong.”
In many ways, recent decision-making at Walgreens indicates a plan to emulate that former setup which can now be enhanced with new and emerging technologies and approaches to care delivery.
Technology is definitely enabling Walgreens to share data across the healthcare continuum,” Leider maintains. “In many of our stores, we’ve moved pharmacists from out behind the counter, making them more accessible, and providing them with tools and supports to counsel patients not only about medications, and medication adherence, but also about healthy behaviors such as smoking cessation.”



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Developing a Specialty-Specific Action Plan for ICD-10

Developing a Specialty-Specific Action Plan for ICD-10 | EHR and Health IT Consulting | Scoop.it

As the calendar turns over to the beginning of a new year, the healthcare industry begins yet another countdown towards an autumn implementation date for ICD-10.  With just under ten months left until the most recent deadline of October 1, 2015 – and that date likely to stick thanks to Congressional support and a growing chorus of healthcare stakeholders endorsing the switch – healthcare providers may not have the luxury of banking on an additional delay.  Organizations can make the most of their remaining time by using CMS resources to develop a specialty-specific action plan that will carry them through their ICD-10 prep for the rest of the year.

The Centers for Medicare and Medicaid Services has provided a number of transition resources to providers who may not be sure what is required for the ICD-10 switch or how to achieve transition benchmarks.  Among these Road to 10 tools is an interactive timeline feature which allows providers to select their practice type, size, progress, and business partners to formulate a personalized plan.

The action plan tool provides common specialties with tailored information, including the clinical documentation changes necessary for the most common ICD-10 codes and sample clinical scenarios for practice.  For cardiologists, for example, the literature reminds practitioners that a myocardial infarction is only considered acute for a period of four weeks after the incident in ICD-10 compared to 8 weeks in ICD-9.  Orthopedists are prompted to remember the specificity requires to accurately code a bone fracture, including the type of fracture, localization, healing status, displacement, and complications, while obstetricians will need to distinguish between pre-existing conditions and pregnancy-related issues when documenting complications.

For the 27% of providers who have not planned to start their ICD-10 testing as of November, and especially the 30% who admitted that a lack of understanding had them stalled, the Road to 10 timeline provides detailed steps to achieve internal and external testing of systems.  From identifying sample cases for testing to coordinating with external business partners and fixing any problems that arise from the process, the resource allows providers to review checklists and suggestions that will set them on their way towards a successful testing period.

CMS suggests that healthcare providers have their internal testing already completed by this point in the process, and is currently seeking volunteers for their end-to-end testing week scheduled for the end of April.  According to the timeline, the external testing process is likely to extend through July as organizations coordinate with their payers and clearinghouses, but the number of providers that are significantly behind these recommended timeframes means that many in the healthcare industry are likely to experience a sharp crunch up against the October deadline.

Providers that are struggling with the sheer volume of tasks associated with the ICD-10 switch may benefit from using the Road to 10 toolset and exploring CMS resources on the transition to identify common pitfalls that may strike their specialty or size of practice.


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EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com

EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
EHR quality reporting led to $4.9 million in ACA awards to 332 health centers.

The Department of Health & Human Services (HHS) has rewarded the quality improvement efforts of health centers with $36.3 million in Affordable Care Act (ACA) funding.

“This funding rewards health centers that have a proven track record in clinical quality improvement, which translates to better patient care, and it allows them to expand and improve their systems and infrastructure to bring the highest quality primary care services to the communities they serve,” HHS Secretary Sylvia M. Burwell said in an official statement.

The rewards spans four distinct kinds of quality improvement achievements.

The first award went to 361 health centers and totaled $11.2 million for health center quality leaders, those clinical settings scoring in the top 30 percent of all health centers based on best overall clinical outcomes.

The second award of $2.5 million rewarded 57 national quality leaders for surpassing national clinical standards for chronic disease, preventive care, and perinatal/prenatal care.

Clinical quality improvers — demonstrated at least a 10-percent improvement in clinical quality measures between 2012 and 2013 — were recipients of largest sum of awards, $17.7 million. The award goes to 1,058 health centers.

The last category of awards recognized 332 EHR reporters which received $4.9 million for reporting clinical quality measures (CQMs) for their entire patient population.

According to the Health Resources and Services Administration (HRSA), ACA-established Health Center Program comprises close to 1,300 health centers operating in more than 9,200 delivery sites in all 50 states, the District of Columbia, and US territories and treating approximately 21.7 million patients.

The ACA earmarked $11 billion to be disbursed over a five-year period to support the creation, expansion, and operation of health centers.

In the past year alone, 43 Health Center Controlled Networks received $21 million in rewards specifically for EHR adoption and meaningful use with requirements to “include at least 10 Health Center Program grantees and overall will provide support to more 700 health centers nationwide.”

In a recent brief, the Office of the National Coordinator for Health Information Technology (ONC) demonstrated that incentive dollars and looming financial penalties are driving EHR adoption and meaningful use.

The chance to benefit from tens of thousands of dollars from the EHR Incentive Programs was cited as a major influence for 62% of physician providers participating in the 2013 National Ambulatory Medical Care Survey Physician Workflow Survey. Another major factor were the ONC-funded regional extension centers whose availability during Stage 1 Meaningful Use and beyond influenced 35 percent of respondents to adopt a certified EHR technology and demonstrate meaningful use as part of the EHR Incentive Programs.

The major takeaway from the HHS and ONC announcements is the integral role health IT-related funding in the form of incentives or awards plays in transforming the care delivery and coordination through the innovative use of technology.



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