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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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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Electronic Health Records Consulting 

Electronic Health Records Consulting  | EHR and Health IT Consulting | Scoop.it

For most health systems, investment in an electronic health record (EHR) is inevitable—and possibly one of the largest expenditures they will make. To achieve the clinical, financial, and operational return on investment, you need to be strategic in your selection, implementation, and utilization.

 

Why the EHR life cycle is just like raising a child 

 

No matter where you are in your journey, our services are designed to produce results that improve efficiency, effectiveness, and quality of health care for patients.

 

Our clinically-experienced IT consultants can support you through the entire EHR lifecycle, including:

 

  • Implementation strategy and planning: We guide clients through everything that goes on behind the scenes before the “go-live,” including a full assessment of current capabilities and workflows to determine what functionalities to look for in an EHR. From there, we lead the selection process for new EHR platforms by vetting qualified vendor options, identifying the initial vendor selection pool, orchestrating product demonstrations, and assisting in the negotiation process.

 

  • Go-live: To increase the usability of the EHR, we give clinicians the ability to learn about and personalize the technology before the go-live date, with items such as common procedures or prescriptions. Once we launch, we provide around-the-clock project management at every level and work to address any challenges that may come up during the process. 

 

  • Optimization: Whether after the “go-live” or as a standalone engagement, we work to develop strategies that optimize the EHR’s capabilities and produce results that drive value and profitability in the healthcare delivery model. We often optimize EHR platforms for:
    • HCC Capture
    • Medicare Annual Wellness Visit
    • Evidence-Based Guidance

 

  • Meaningful use attestation: Attesting meaningful use requires effort from many directions—from navigating regulatory changes to overcoming operational challenges. We take some of these tasks off clients’ plates by tracking federal updates, sending actionable alerts, and validating every aspect of the attestation plan. 

 

  • Life sciences support: To support customers and grow health system partnerships, life sciences firms are leveraging EHR strategies that align with industry trends and consumer priorities. Our experts help these firms determine high-yield, value-add strategy for implementing health IT resources into the EHR. 

 

And while we use these processes to guide our clients through the EHR lifecycle, we also support any IT platform using similar methodologies.

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Getting the Most Out of Your EHR - Healthcare IT Consulting

Getting the Most Out of Your EHR - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.

 

8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and training can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.

 

EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.

 

EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.

 

Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.

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Should You Test Your EHR Data Backup and Restore Process?

Should You Test Your EHR Data Backup and Restore Process? | EHR and Health IT Consulting | Scoop.it

It’s common knowledge that backing up data for your medical practice is critical forprotecting against devastating losses of patient data in the event of a natural disaster, system glitch, or hardware failure. But practices should go further than simply backing their data up; testing these backup and restoration processes is just as important for ensuring data safety as the initial backup itself.

 

Why Backups are Important

 

For practices that utilize EHRs, having backups is critical for a number of reasons. While the first scenario that many imagine is a catastrophic loss of data resulting from a server malfunction or local event, this is not the only reason to have a data backup.

Experts recommend backups to protect againstsecurity breaches or viruses, to provide continuity of care across multiple providers or in the event of an outage, andthe protection ofvaluable assets for research and analytics.

Medical practices should establish scheduled, automatic backups as well as perform manual backups after making any system changes.

 

Your Backup is Only as Good as its Restore

 

When preparing an EHR data backup procedure, it’s important to remember that the value of your backup is congruous to the quality of the restore. A backup is no good if the restore is incompatible with current hardware or software, which is just one example of what can go wrong.

 

Particularly for practices using an EHR vendor, it’s essential to confirm compatibility of the restore with current systems. This restore must also be promptly accessible, and establishing synchronization with an EHR vendor is importantfor this timeliness. Checking post-restore integrity as a routine part of testing can ensure that once your restore is complete, your data will be accessible and useable.

 

How Will You Know if Your Backup is Good?

 

One of the most effective ways to know if your backup is good is to run a test. The test should exercise the system using common work processes that access multiple types of data.  The worst case is when a practice believes they have beensuccessfully backing up their data, only to find out that the backups are incomplete.

 

Other restore fail scenarios include practices that have discovered that theyhave only been backing up their software (URL: http://www.americanehr.com/blog/2011/12/data-backup-information-protection/), not their data. This kind of loss can be devastating for patients and providers alike, and regularly running tests can protect against these situations.

 

Scheduling Your Backups

 

Aside from testing the functionality of backups,strategically determining the times that these systems will run will prevent interference with staff or clinic activities. Frequency also depends on how much data the practice can afford to lose. If a backup runs weekly, this means that a worst-case scenario could result in the loss of six days’ worth of data.

 

Depending on practice volume, agenda, and other factors, setting goals and quantifiable standards for backups ensures alignment with best practices.

 

Conclusion

 

Protection against disaster-borne data loss, along with the convenience of external management,has led many practices to choose third parties or their EHR vendor to administrate backups.  Don’t rely on external entities to validate your backups.  Internally test and verify your systems restore process too.

 

At ZH Healthcare, our BlueEHS services offer complete peace of mind with multiple layers of protection, including automated backups and “snapshot” components which can be used to restore your systems quickly. In addition, we offer on-demand download access from the cloud, and in-house data storage. 

 

 

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The Critical Importance of Comprehensive EHR Survey Data 

The Critical Importance of Comprehensive EHR Survey Data  | EHR and Health IT Consulting | Scoop.it

In order to respond to the question of survey populations, I would like to provide a summary of the survey oversight and governance process as well as a more detailed explanation of the methodology that American EHR uses to conduct EHR surveys.

 

  • American EHR Partners is a vendor neutral eHealth data organization that has been collecting information around EHR systems for over 5 years. Over 5,800 verified clinicians surveys have been completed since the launch of the site in 2010. All of the data collected is free for physicians and professional associations. American EHR Partners does not endorse any products or services. The program provides ratings on certified EHR systems. Ratings are based primarily on surveys of physicians conducted through their professional societies. Ratings are displayed on all EHR vendors regardless of their participation in the program.

 

  • Ratings are only displayed once a minimum number ‘n’ of survey responses have been received; the current minimum value is ten ratings. The rating scores are aggregated from the relevant questions asked on the physician user surveys, and these questions are available to the public. The ‘n’ is presented for all product ratings to assist the user when interpreting the rating data.

 

  • From time-to-time, American EHR Partners develops reports based upon the data collected.

 

  • American EHR Partners has a stringent governance process. Four advisory groups have been established to provide feedback on the American EHR Partners program. These are: Physician Advisory, Professional Society Advisory, EHR Vendors Advisory and a Healthcare Stakeholder advisory that includes national organizations not represented in the first three advisory groups.

 

  • All professional society participants, automatically have a seat on the society advisory group. The purpose of this advisory board is to guide American EHR from a specialty and subspecialty perspective and to provide guidance on education, collaborative initiatives and future development in relation to specialty and subspecialty physician groups.

 

Survey sample selection

 

When conducting a survey in conjunction with a professional society partner, for example the Physician Use of EHR Systems report, a randomized sample of members from each participating organization are surveyed. As the professional society partners are regularly surveying their members on a variety of topics, and in order to prevent over-surveying, each provides a random sample of members with active email addresses in order to conduct the American EHR survey. Each survey group receives an initial invitation to complete the survey as well as 1-2 reminders. Because the sample is selected randomly from the member database, we expect that some individuals will not be using EHRs. These individuals are excluded in the survey registration process. While it is desirable to be able to survey an entire professional organization’s membership, this is not possible due to the number of additional surveys that each organization conducts of their members as well as the issue of survey fatigue.

 

Prior to collection of data for the Physician Use of EHR Systems  report, an extensive review process was undertaken to update the American EHR survey in conjunction with the American Medical Association, American College of Physicians and the American Academy of Family Physicians. In particular, American EHR worked with AMA Market Research staff to formulate new questions designed to examine the economic impact of EHR use and the role of scribes. In order to keep the overall length of the survey at its current level, AMA and American  EHR agreed to eliminate questions that were not effective and/or addressed in other parts of the American EHR  survey.

 

When the 155 question survey is conducted, all physicians are verified either directly in conjunction with their professional society through a verified sample, against the AMA Physician Masterfile or in limited situations through a manual process.

Due to the comprehensive nature of the EHR survey, the survey takes approximately 20 minutes to complete. However, the detailed nature of the data collected also provides key insights into the adoption and use of EHR systems by clinicians in varying practice sizes and by specialty.

 

We stand steadfastly behind the methodology, process, collection of data as well as the interpretation of the results as presented in our most recent report. In particular, we believe that the ability to survey physicians in conjunction with their professional organizations provides the most relevant and representative information on actual experiences in the use of EHRs.

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Health Alerts App Brings Public Health Notifications to Your Mobile Device. 

Health Alerts App Brings Public Health Notifications to Your Mobile Device.  | EHR and Health IT Consulting | Scoop.it

I’m now excited to announce that AmericanEHR has recently released a mobile app called Health Alerts. The AmericanEHR Health Alerts app brings you timely information on outbreaks and incidents on public health emergency topics, including: diseases, infections, natural disasters, drug recalls, travel medicine, and more. This information is pulled directly from live feeds provided by the world’s most trusted sources for public health information, including:

 

  • Centers for Disease Control and Prevention (CDC)
  • World Health Organization (WHO)
  • US Food and Drug Administration (FDA)
  • International Society for Infectious Diseases (ISID)
  • US Department of Agriculture (USDA)
  • US Department of Health and Human Services (HHS)
  • International Society of Travel Medicine (ISTM)
  • European Centre for Disease Prevention and Control (ECDC)
  • Public Health Agency of Canada (PHAC)
  • And many more…

 

It is projected that a coordinated outbreak prevention strategy can help save tens of thousands of lives annually. The U.S. Centers for Disease Control and Prevention reported that by preventing infections from antibiotic-resistant germs through more efficient coordination among healthcare facilities and public health departments, as much as 80 percent of infections could be prevented in the next five years.

 

AmericanEHR’s Health Alerts app can not only slash the spread of these types of diseases and infections, but it provides clinicians, the public, health agencies and healthcare facilities with real time alerts and updates to stop outbreaks in their tracks. Being aware of the latest health bulletins and the symptoms to keep a watchful eye open for means lower healthcare costs, and faster, more accurate responses to health threats as they materialize.

 

The AmericanEHR Health Alerts app is free to use with an AmericanEHR account. The app is available for iOS (Apple) devices such as iPhone, iPad, and iPad Mini. It’s currently in limited release to select clinicians and patients as we gather feedback from the medical community.

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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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Moving into post-EHR era

Moving into post-EHR era | EHR and Health IT Consulting | Scoop.it

Consultants weigh in on what hospitals should expect from them as healthcare moves beyond digitization and into the age of consumerism.

 

Healthcare information technology is evolving in many ways, and quickly so. That means health IT consulting has to change with the times, to evolve alongside the technology consultants help healthcare provider organizations, master.

 

Consultants from top firms across the health IT consulting spectrum have various ideas about what firms must do next to successfully aid provider organizations with technology. Call them next-generation health IT consulting goals.

 

For example, health IT consultants must move beyond prediction, said Jeff Geppert, a senior research leader at Battelle, an independent research, consulting and development organization that applies science, technology, and engineering to challenges in various industries, including healthcare.

 

“The current narrative on health IT consulting services is becoming commonplace,” he said. “The focus is on data science and applications that leverage large and connected datasets, powered by predictive analytics and artificial intelligence/machine learning running in the cloud.”

 

However, there is nothing very transformative about prediction, he cautioned.

 

“It is by necessity short-term and event-driven,” he said. “Healthcare provider organization CIOs should be looking for health IT consultants with a compelling long-term and goal-driven vision, and a plan to work with them to bring that vision about.”

 

"The focus [of health IT consulting] will shift to extracting more value from investments and identifying which new investments are necessary to drive competitive advantage for the system."

“Health IT consulting today seems like the auto industry a hundred years ago with multiple companies competing to build the most technologically advanced car,” he said. “Somewhere out there is the Henry Ford of health IT who will build something inexpensive, standardized, aligned with the needs of people, and scalable from individuals to the federal government.”

 

Healthcare provider organization CIOs should be looking to partner with health IT consultants with demonstrated longevity across multiple industries, he added.

 

John Curin, vice president of innovation at Burwood Group, a healthcare consulting firm that focuses on direct acute care, physician workflow and health IT, said he sees healthcare CIOs watching consulting services expanding beyond the EHR.

 

“The vast majority of the health IT consulting space has been overwhelmingly EHR-centric up to this point,” he contended. “Today, EHR and revenue cycle systems migration is largely complete or well-understood. The focus will shift to extracting more value from those investments and identifying which new investments are necessary to drive competitive advantage for the system.”

 

Further, consultants will offer services to help healthcare providers transition – the shift will be toward internally developed interdisciplinary strategies with a focus on systemwide financial and clinical outcomes improvement, Currin said.

 

“For example, to make IT more successful, CIOs will stop reacting to external plans and timelines, such as regulatory compliance introduced by meaningful use or vendor roadmaps based on product lifecycle and implementation schedules,” he said. “Instead, they will start building frameworks to drive better financial and clinical performance.”

"The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage"

On another note, consumerism is significantly affecting healthcare today, forcing healthcare provider organizations to meet changing patient expectations. Along with receiving the best medical care available, today’s health care consumers also expect a first class experience across every touchpoint at an organization.

 

“With expectations becoming increasingly ‘consumerized,’ executives are realizing that their healthcare organization will be judged on how patients rate their overall experience,” said Rob Barras, executive leader, health solutions, at CTG Health Solutions, a clinical and financial IT consulting firm that serves healthcare provider, payer and life science organizations. “This means that meeting these demands needs to be front of mind for CIOs.”

 

This trend toward a consumerism approach will accelerate significantly, and health IT consultants will have to be on top of it to successfully assist healthcare provider organizations, Barras said. Soon, Amazon, Wal-Mart, CVS, and Apple will consider themselves care providers, he added. And while most traditional health systems are doing business as usual, smart CIOs will plan ahead to match the future expectations set by these retail giants in yet another industry, he said.

 

“Many of these major players believe there is an opportunity to capitalize on what they believe traditional providers have been slow to do – provide easy access and quality care at a reasonable and transparent price,” he said. “The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage, and for consulting firms to rush to assist with this stage in the planning process.”

 

And Barras said that moving forward, health IT consultants have to be getting healthcare provider organizations implementing the latest healthcare information technologies now, not later.

“For the past couple of years, many healthcare organizations have treated emerging technologies as somewhat of a luxury and not as something with immediate business value,” he said. “However, technologies have matured quickly and already are being implemented to meet business needs, meaning organizations without structured plans to roll out the latest in analytic, AI and IoT solutions are in danger of falling out of step with competitors.”

This means that health IT consultants must focus on becoming innovation hubs – as opposed to internal caretakers – of technology to provide true value to healthcare clients, Barras added.

 

“The right CIO can help change the mindset of an organization, but that change must be supported from the top down,” he advised. “A key to this is working with consulting partners who understand that using technology is a way to create a competitive advantage for the future. Providers should engage partners who can clearly articulate the value of their work and the vision.”

 

 

 
 
 
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5 Steps to EHR Data Conversion

5 Steps to EHR Data Conversion | EHR and Health IT Consulting | Scoop.it

EHR data conversion is the process of moving patient data from legacy EHR system to a new EHR system. While automated EHR data conversion seems like a complex affair, it doesn’t have to be. When an experienced vendor partners with strong internal leadership, the data conversion will follow a proven, 5-step process, and the data will undergo a failsafe ETL.

Why Change EHR?

Healthcare providers are expected to document patient encounters. Traditionally, this documentation has been completed on paper and stored in file cabinets. However, the last decade has seen significant growth in provider adoption of Electronic Health Records (EHRs). The combination of government incentives, advances in technology, and improved outcomes and operations have fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. EHRs improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

While EHR adoption has increased, so too has the need to change systems while maintaining the access to and integrity of patient health information. Healthcare administrators point to provider dissatisfaction and mergers and acquisitions as the primary contributors for changing EHR providers within their organization. In preparing for the implementation of a new EHR, healthcare organizations have been grappling with how to handle the data in the legacy systems.

What is EHR Data Conversion?

In response to this challenge, many healthcare organizations are turning to automated EHR data conversion to maintain data integrity. An automated ETL (Extract, Transform, Load) process avoids risks related to data manipulation, because not a single patient record is touched.

 

In an automated conversion, source values are extracted from both the legacy (source) system and new (target) system to create a conversion map. That map is entered into a conversion utility software. Data from the legacy system is run through the conversion utility and transformed to meet the needs of the new system. While it is being transformed, the conversion utility is monitoring for errors and estimated completion. After the data has met the standards, it is then loaded into the new system.

The process of an automated EHR data conversion may seem like a complicated and difficult undertaking. It doesn’t have to be when it is handled by an experienced vendor working with strong internal leadershipundergoing a recognized data conversion process.

5 Steps to EHR Data Conversion

1. Discovery

During the discovery phase of the process, the healthcare organization team will play a large role. An EHR vendor will ask internal IT staff to extract all data from the current system. Working together with an internal designated leader, IT staff, and Physicians Advisory Committee (PAC), the data conversion vendor will work to identify how much data is available, what data needs to be converted, and the accuracy of the legacy data.

2. Scope Definition

The scope definition phase of the process is the point at which both parties come to an agreement on which portions of the data need to be converted, the method of the conversion, and the prioritization of the data. During this time, the two teams should schedule time to review the records, format them to meet the new formatting requirements, and set the processes to updated record fields not available in the conversion.

3. Testing

Once the scope has been fully defined, and the formatting requirements are completely understood, the primary responsibility of the conversion then shifts to the vendor. Based on the input gathered during the scope definition step, the data architects working for the vendor will map the data fields and formatting from the old system to equivalent data fields and formatting in the new systems. After the map has been created, the data architects upload the test conversion data to a testing site.

4. Validation

This step is a shared responsibility between the healthcare organization and EHR data conversion vendor. Once the data has been loaded to the test site, the data architects validate the data. Then the healthcare organization leaders review the content, validate the records, and sign off on the final data set. This step may require several cycles. However, it is imperative for the success of the conversion.

5. Migration

Once the data has been validated, the vendor will executive the final migration. While the data is migrating, the vendor’s conversion utility should be monitoring total errors, parsing errors, mapping misses, percent complete, date/time to finish, and success rate. When all the data is converted and migrated to the new system, the healthcare organization will go live!

Throughout the EHR data conversion process, healthcare organizations are tasked with making important, and often tough, decisions about how to handle data, the methods of conversion, and data prioritization. It is important that healthcare organizations plan ahead, schedule the necessary time, and work closely with EHR data conversion vendors who are well versed in the each step of the process.

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How To Measure What We Cannot See In Healthcare

How To Measure What We Cannot See In Healthcare | EHR and Health IT Consulting | Scoop.it

These days it seems that everyone in healthcare is buzzing about big data and analytics, and no wonder. Transforming, if not reimagining, healthcare is going to take everything we’ve got. Achieving the triple aim of higher quality, better access and lower cost of care cannot be done without being able to measure what we do. As the old adage says, “if you can’t measure it, you can’t improve it”. To that I might add, “if you can’t see it, you can’t improve it”.

 

Anyone who has walked the halls of a hospital or clinic knows there is no shortage of data. We just aren’t very good at knowing exactly how to get our arms around it. Data is only meaningful if it is organized in ways that we can truly comprehend what it is telling us. Today, the smart money is on technologies that help us visualize and therefore understand data without the need of a PhD in advanced analytics.

 

One such tool is something we call Power Map for Excel. This 3D visualization add-in is now a centerpiece (along with Power View, Power Query, and Power Pivot,) within the business intelligence capabilities ofMicrosoft Power BI in Excel.

 

Information workers with their data in Excel have realized the potential of Power Map to identify insights in geospatial and time-based data that traditional 2D charts cannot communicate. For instance, digital marketers can better target and time their campaigns while environmentally-conscious companies can fine-tune energy-saving programs across peak usage times. These are just a few of the examples of how location-based data is coming alive for customers using Power Map and distancing them from their competitors who are still staring blankly at a flat table, chart, or map.

 

Please take a look at the video below. Then ask yourself, what if instead of mapping U.S. Power Production we were looking at:

 

  • Syndromic surveillance of the geospatial distribution and severity of an infectious disease

 

  • A real-time map of a hospital system’s nosocomial infection rate

 

  • A representation of the incidence of chronic disease plotted against the geographic distribution of toxins in air, soil and water

 

  • A facilities, capabilities and occupancy map of a region’s readiness for accountable care
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American EHR Call For Submissions.

American EHR Call For Submissions. | EHR and Health IT Consulting | Scoop.it

Do you have a story to tell or experiences using health information technology? How would you like to share those experiences with American EHR’s 26,000+ members who represent all 52 states and territories and 152 medical specialties?

 

Whether positive or negative, shared experiences surrounding the usage of EHR’s or other technologies such as mobile apps or web-based tools are extremely valuable to clinicians, ancillary caregivers, and staff who work in clinical patient settings.

 

Whether you’re a primary care clinician, a practice administrator, or a technology expert, please take a few moments to share your experiences and insights.

 

What are we looking for?

 

500–700 word articles on topics such as the following:

  • Interopability
  • Connected Health
  • E-Prescribing
  • Data exchange (or the lack thereof)
  • Clinical decision support
  • Clinical mobile apps
  • Tips on time-saving
  • Areas in which technology use is challenging
  • Interacting with patients using portals or personal health records
  • MACRA and Meaningful Use

 

All submissions are reviewed by our editorial team prior to publication, and must be educational in nature. Open to clinicians, practice managers, consultants, CIO’s, or other health IT professionals.

 

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A Successful Approach to EHR Data Conversion - Healthcare Technology Consulting, EHR Implementation & Vendor Selection

A Successful Approach to EHR Data Conversion  - Healthcare Technology Consulting, EHR Implementation & Vendor Selection | EHR and Health IT Consulting | Scoop.it

As the field of healthcare IT continues to grow, there is an increasing demand for healthcare organizations to implement electronic health records (EHR). In order to ensure a successful transition into a new EHR, organizations must include the process of data conversion into their implementation plan. EHR data conversion, so

 

metimes referred to as data migration, is the process of taking data from an old health record system and transferring it into a new system. This process may occur between paper-ba

sed health records and an EHR as well as between an old EHR and a new EHR. At Afia, we have worked with multiple companies to assist with numerous data conversions. Though all conversion processes are not created equal, we have developed a three-step approach to help make the complexities easier to manage.

First Step: Establish the Scope of Data

This step is crucial and must occur at the forefront of the data conversion process. Initially, organizations must select what specific data they want converted. Organizations may decide to covert as little information as possible or they may want the scope to be more overarching and exhaustive. If there is data deemed useless in the legacy system, it is important to take note of this since some organizations may decide to not transfer such data over to the new system. It is also important to determine what level of data cleanliness the organization is comfortable with. Deciding on the level of cleanliness for data saves organizations time from fixing parts of data that don’t necessarily have to be fixed and can dramatically reduce the amount of time it takes for a successful conversion. Additionally, some parts of converting the data will have to be done manually. It’s important to outline in detail what the automated pieces of the conversion process cannot handle. Inevitably, there will be a handful of things that need to be hand entered for one reason or another. The manual conversion pieces can often get lost during the rush to get the other data converted, but without careful planning you can easily find yourself without critical information in the new system. Defining the scope at the beginning of this process prevents organizations from having to redo work and saves organizations precious time and money. It can be a painful process to get everything organized properly, but it can easily derail your entire system launch without proper planning.

Second Step: Map Out the Conversion

This requires organizations to determine where data from the legacy system will be inserted in the new system to ensure that data is properly transferred between the two systems. This part of the process focuses on making sure that the new system houses data in a way that is easy to find and interpret by healthcare personnel. Often, this requires database professionals to manipulate tables to ensure that data is transferred in the correct manner.

Third Step: Extract the Data

The last step of our approach is to extract the data from the legacy system and place it into the new system. At this point, the computer will inform organizations when data is incorrect which will require database professionals to manipulate tables to accommodate such findings or to manually change the data to ensure it is placed in the new system correctly. This is where the level of cleanliness is relevant. The level of cleanliness that the organization decides upon will influence how many extractions are required. Typically, multiple extractions are needed to ensure data is clean enough for an organization’s liking. The number of extractions will also determine the time, money, and number of people dedicated to data conversion project.

HIPAA Requirements

Lastly, it is important to keep in mind that all HIPAA requirements apply whenever discussing protected health information (PHI). Since PHI is the main source of discussion during a data conversion, it is of utmost importance that all individuals participating in the data conversion are aware of how to avoid HIPAA breaches. The most important aspect of abiding by HIPAA requirements is to ensure that the data conversion is occurring in a secure place where vendors and organizations can sort through errors and communicate about specific client information. Through experience and creative thinking, Afia has created a reliable approach to data conversion that helps to navigate through an unpredictable process. We offer data conversion services for all parts of the process and can oversee organizations through the entire process. Afia also offers our Cloud Services where organizations have the option to host their PHI with us in our secure server space to avoid HIPAA breaches.

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