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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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Doctors Reject Electronic Health Record Mandate

Doctors Reject Electronic Health Record Mandate | EHR and Health IT Consulting | Scoop.it

In an effort to increase the use of electronic health records by doctors, hospitals, and other health care providers, Congress passed the Health Information Technology for Economic and Clinical Health Act, more often known as the HITECH Act, in 2009. The law provided both incentives and penalties to encourage widespread adoption, but so far many hospitals and doctors have failed to comply.

On December 17, 2014, the Centers for Medicare and Medicaid Services (CMS) announced 257,000 doctors had failed to achieve what it termed “meaningful use” of electronic health records, and would have payments for Medicare services reduced by 1 percent as of January 1, 2015.

According to the American Medical Association, that is more than half of all doctors covered under the HITECH act.

Dr. Joe Bentivegna of Rocky Hill, Connecticut says electronic health records are expensive and impractical.

“Doctors struggle because the user interfaces are slow and there are too many questions,” Bentivegna said. “It works poorly with ophthalmology, my profession.”

Incentives and Penalties

Early on the HITECH act provided taxpayer funds to medical providers to help pay for the adoption of electronic health records. Those incentives will remain through 2016, but penalties have also kicked in for those who haven’t satisfied the CMS meaningful use requirement. The 1 percent reduction in 2015 will rise to 5 percent over five years, taking a significant bite out of many doctors’ revenue.

Dr. Stephen Stack, president-elect of the American Medical Association, expressed dismay over the news 257,000 doctors would be penalized in 2015.

“The Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency,” Stack said in a statement. “Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients.”

Stack charged the meaningful use requirements “are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden.”

Increasing Government Control

Twila Brase, president of the Citizens’ Council for Health Freedom, sees the meaningful use requirements as a backdoor way for the government to play a heavier role in directly controlling medical care.

“So if you want to control the entire health care system, what do you need?” Brase asked rhetorically. “You need to know what the doctors are doing, you need to decide what you want them to be doing, and then you need a system to record how far they are removed from what you want them to be doing to that you can financially penalize them.”

Brase expressed concern the electronic health records created in compliance with the HITECH Act will be used to ration care, pointing to comments by controversial MIT economist Jonathan Gruber.

“Gruber says they only want people to get the right care for the right things,” Brase explained. “They’ll sometimes talk about ‘right place, right time, right patient, right care,’ as though we were all sort of widgets in the system. Their plan is to use all of our data to standardize the practice of medicine, to put those standardized treatment protocols on the electronic health system, and nothing else.”

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Decide Consulting's curator insight, February 4, 2015 7:46 PM

Should physicians be penalized for not satisfying meaningful use requirements? EHRs are meant to be customizable and helpful, but many doctors only see the burden.

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Questions to Ask Before Choosing an EHR

Like many managers or owners of a thriving medical practice, you have heard about the benefits of using electronic health records software and are interested in implementing an EHR in your organization. You can assume that many, if not all, of your nearby competitors are using EHR, and the more effective they are in using this software, the better they will be able to attract and keep patients.

Transitioning from the old methods of paper-based systems to the latest advances in medical software is bound to raise some questions among you and your staff. Therefore, it’s a good idea to do some research first before making the commitment and selecting your EHR. With that in mind, here are some questions to ask as you prepare to make your choice.

Is the Software Vendor Knowledgeable and Reliable?

It’s much better to go with a software vendor that has sufficient experience, knowledge, and a proven track record in developing mission-critical software like EHR. Find a firm that has been around for a while and that has excellent reviews from your peers, as well as your competitors.

A software developer for medical organizations must have a staff that keeps up with the changing nature of healthcare delivery, adjustments in industry standards, and governmental rules. This ensures that you will always have access to software this is compliant with the entities you do business with.

What Kind of Training is Available?

After assessing the skill level and knowledge of your medical organization, you will have a better idea of how much training you need. Make sure that your software provider will give your team the training and help it needs to quickly get up to speed with using EHR software.

How Does the Software Company Handle Upgrades?

Upgrades are a fact of life in any computer system. You’ll want to ask your vendor how it approaches upgrades. There will be upgrades to improve the quality of the software, to be sure, but there will also be required updates, such as the ones EHR software developers must finalize to meet the U.S. government’s required change from ICD-9 to version 10 of the International Classification of Diseases.

Does the Software Vendor Provide Good Customer Service?

The last thing you want when dealing with unfamiliar software is to contend with unanswered questions on how to use it. Check the level of customer service from your prospective provider. Otherwise, your staff may experience unexpected and unnecessary downtime, hampering office productivity and lowering your organization’s financial success.

Making the decision to move from a paper-based system for managing your medical organization will make a significant impact on your staff’s daily activities. Now that you know you want to implement an EHR, it’s crucial to resolve any unanswered questions before making your software selection.

Key Takeaway:

  • Medical practice owners and managers who are aware of electronic health record software will want to ask some questions before choosing their EHR.
  • Don’t rush into buying EHR software that you are unfamiliar with. Make sure you understand how it will integrate with your organization.
  • Check what kind of training your software provider offers to ensure your staff can quickly get up to speed with the EHR system.
  • Verify the skill level and knowledge of your software company to make sure it will be capable of handling upgrades, especially those mandated by governmental regulations.
  • Does the EHR vendor provide the type of customer service that you deem appropriate? You will want to go with a firm that has excellent communication skills and will respond in a timely manner.


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Docs urge big changes to health records program

Docs urge big changes to health records program | EHR and Health IT Consulting | Scoop.it

A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.

Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.


"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.

"Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers’ needs, patient safety, and product innovation," the letter stated.

The coalition called on regulators to decouple the certification of electronic health records from Meaningful Use, which imposes a timetable for EHR adoption and a series of penalties and incentives based on doctors' compliance.

The groups also asked the Office of the National Coordinator to reconsider alternative software testing methods and to incorporate stakeholder feedback on a variety of technical matters related to Meaningful Use.

The healthcare world has been struggling with the migration to digital records, arguing that the Meaningful Use standards are hampering their ability to deliver good care.

Advocates for Meaningful Use argue it is helping speed the transition to EHRs, which will ultimately boost care and prevent deadly medical errors.

The program has undergone several delays as doctors and hospitals fail to attest to its various stages.


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HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model

HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model | EHR and Health IT Consulting | Scoop.it

EMRAM is an eight-step process that allows healthcare provider organizations to analyze their level of EMR adoption, chart accomplishments, and benchmark progress against other healthcare organizations across the country. Each of the stages is measured by cumulative capabilities and all capabilities within each stage must be reached before progressing.

“We’re happy to be able to confirm eClinicalWorks as an EMRAM Certified Educator,” said Blain Newton, COO, HIMSS Analytics. “EMRAM allows organizations to align IT initiatives and overall business strategy, which is essential to shaping future direction and moving the industry forward.”

Vendors achieving HIMSS Analytics Certified Educator status must pass an annual certification exam and commit to an annual educator program. This ensures they stay current with trends within the model and are equipped with the necessary knowledge to help their clients advance through the various stages.


“A major goal is having our customers utilizing the EMR the most beneficial way possible for both providers and patients,” said Girish Navani, CEO and co-founder of eClinicalWorks. “This certification will benefit organizations looking to analyze their adoption of EMR technology. We welcome being part of the program.”


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Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com

Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10.  More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together.  But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process.  Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.

“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions.  The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.

Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them.  Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues.  They will address issues as they occur and learn as they go after implementation.  They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.

“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”

“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.”  Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.

“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.

“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.

Will EHR vendors and billing partners pick up the slack?  Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education.  The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists.  One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.

The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are.  CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing.  ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed.  Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so.  “Articles on ICD-10 are fear-based,” said a participant.  “I try not to go there.”

So where will they go?  To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions.  It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs.  ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.

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What Gets Measured Gets Managed - HITECH AnswersHITECH Answers

What Gets Measured Gets Managed - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I’ll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can’t deny that data doesn’t lie and when we measure data, we can manage it.

Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group’s practice manager was new to the organization and tasked with the responsibility of managing the eligible providers’ progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.

The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn’t sure if they could meet the patient engagement requirements and she didn’t know where they stood with the newly introduced objectives.

She asked for support through her network and found me.

Data > Information > Knowledge

I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)

 

I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).

They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.

We had 90 days to turn this around.

Team Work

Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.

Meaningful Use is a team sport, after all.

The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.

We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.

With each week’s reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.

Getting Creative with the Portal

In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.

Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and  gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.

They even told patients what to say:

Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]

This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.

The First Big Win

Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.

Their main focus on closing out the year was to keep up the good work.

Non-Percentage Based Objectives

Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.

Lessons Learned

1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.

2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.


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AMA Lists EHRs, Meaningful Use, ICD-10 as Top 2015 Challenges

AMA Lists EHRs, Meaningful Use, ICD-10 as Top 2015 Challenges | EHR and Health IT Consulting | Scoop.it

The New Year’s celebrations may be dying down this week as the healthcare industry gets back to work, but the American Medical Association (AMA) wants providers to keep a watchful eye on ten major challenges that they will face during the year ahead.  From ICD-10 to meaningful use to improving population health management and chronic disease care, the AMA list highlights some common complaints.

At the top of the list is a familiar refrain: the ongoing burden of regulatory initiatives such as meaningful use that have frustrated physicians for years.  The AMA has long advocated for changes to the program, and plans to “intensify” its efforts to push CMS towards greater flexibility for the program, especially after more than 50% of providers were notified that they will be receiving Medicare payment adjustments in 2015.

The overly-strict requirements of the EHR Incentive Programs “are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden,” AMA President Elect Steven J. Stack, MD said in a statement.

Coupled with meaningful use is the AMA’s other nemesis – ICD-10.   While the organization has tried everything from a Twitter rally to Congressional letters to industry appeals in order to continue delaying the code set indefinitely, the new list of challenges takes a bit of a different tack.  Instead of reiterating the AMA’s opposition to the codes, the list simply says that the AMA “has advocated for end-to-end testing, which will take place between January and March and should provide insight on potential disruptions from ICD-10 implementation, currently scheduled for Oct. 1.”

“Given the potential that policymakers may not approve further delays, ICD-10 resources can help physician practices ensure they are prepared for implementation of the new code set,” the section continues, which is some of the mildest language the AMA has used about the ICD-10 transition for some time.

Is there a little hint of resignation to defeat now that Congress itself has backed the 2015 implementation date, or will the AMA continue its lengthy fight until the very end?  The degree to which the AMA pushes resistance instead of readiness over the next few months may impact how many providers are prepared for the deadline and how many continue to pin their hopes on a postponement.

Other items on the list that will impact physicians in 2015 include the rampant abuse of prescription medications, the spread of diabetes and heart disease, and the need to adequately modernize medical education and the AMA’s Code of Medical Ethics.

The list also highlights the need to continue medical research and the sharing of clinical knowledge, to which end the AMA is launching JAMA Oncology, a new journal in its network of publications.  Physician satisfaction and the financial sustainability of medical practices is also on the AMA’s mind as it beta tests professional tools to help physicians chart a profitable course for the future.

To round out the top ten issues for the healthcare industry in the coming year, the AMA includes the need for reform to the Medicare physician payment system after the latest temporary Congressional SGR fix in April, the need to ensure adequate provider networks for patient care, and upcoming judicial rulings on healthcare-related issues such as liability, patient privacy, and the regulation of practices by state licensure boards.


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FDA Expands EHR Data Analytics with Active Surveillance System

FDA Expands EHR Data Analytics with Active Surveillance System | EHR and Health IT Consulting | Scoop.it

The Food and Drug Administration’s Sentinel Initiative, one of the first active surveillance infrastructures focused on identifying patient safety issues related to pharmaceuticals and other medical products, will expand past its pilot phase this year, announced Janet Woodcock, MD, Director of the Center for Drug Evaluation and Research in a blog post.  As a planned continuation of the Mini-Sentinel project, the full-scale system will allow the FDA to leverage advanced EHR data analytics by scanning millions of files for adverse events linked to drugs that fall under the Administration’s purview.

“Over the past five years, the Mini-Sentinel pilot program has established secure access to the electronic healthcare data of more than 178 million patients across the country, enabling researchers to evaluate a great deal of valuable safety information,” Woodcock writes. “While protecting the identity of individual patients we can get valuable information from Mini-Sentinel that helps us better understand potential safety issues, and share with you information on how to use medicines safely. We have used Mini-Sentinel to explore many safety issues, helping FDA enhance our safety surveillance capabilities, and giving us valuable input in decision-making on drugs and vaccines.”

The Sentinel Initiative differs from previous drug safety monitoring efforts in that it allows FDA researchers to actively dive into EHR data and insurance claims to analyze potential adverse events and establish links to specific pharmaceutical products.  This allows the FDA to work more quickly to identify problems than if they continued to rely on voluntary reporting alone.  Mini-Sentinel has previously confirmed the safety of two vaccines intended to protect infants against rotavirus after the voluntary recall of a third product that raised the risk of intussusception in patients who received the immunization.

The expansion of the project will build upon successful use cases from Mini-Sentinel, Woodcock says.  The FDA will refine its EHR data analytics methodologies as it continues to grow into what the Administration hopes will be a national resource at the center of an industry-wide collaboration between researchers, pharmaceutical developers, and other healthcare stakeholders.

The success of this vision relies on cooperation from academic and research partners, all of whom will need to further develop industry data standards for the system to function effectively.  “This work will allow computer systems to better ‘talk’ to each other and, ultimately will lead to better treatment decisions as clinicians will have a more complete picture of their patients’ medical histories, including visits with other providers,” Woodcock wrote in a previous blog post touting the success of the pilot system.  “Defining standards for capturing data from clinical trials, and using standard terms for items such as ‘adverse events’ or ‘treatments’ will allow researchers to combine data from different clinical studies to learn more.”

“From the outset, the goals of the Sentinel Initiative have been large and of ground-breaking scale,” she concludes. “We knew it would be years in the making, but Mini-Sentinel’s successful completion marks important progress. We look forward to continuing and expanding our active surveillance capabilities as we now transition to the full-scale Sentinel program.”


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EHRs: It's time to start from scratch

EHRs: It's time to start from scratch | EHR and Health IT Consulting | Scoop.it

A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing.


They have multitudes of unnecessary meaningful use buttons that must be clicked because the government says so. They have data formats that are incompatible with other EHR systems. Doctors fumble around trying to enter orders using electronic physician order entry (POE). There is terrible user support. And so on. At the end of the day there is decreased productivity, doctors are unhappy, and patients are unhappy. Big brother in the form of the hospital and the state have more big data to look at, but certainly there doesn’t seem to be many benefits to patient care. The major benefit is to the companies that make these proprietary closed-source EHR systems. They get obscenely rich.

But surely there can be benefits to EHR systems? What about the ease of access to the patient’s chart? No more waiting for the chart to come up from medical records. In fact, no more medical records department at all! Aren’t we saving health care dollars by cutting out those jobs, as well as medical transcriptionist jobs and unit secretary jobs. Surely paper charts were worse?

Doctors should not turn away from information technology. After all, we use all sorts of sophisticated computer technology every day, from the internals of the ultrasound machine to the software running an MRI scanner, to the recording system used in electrophysiology procedures. There is a role for technology in our record keeping as well.

The problems with current EHR systems are manifold. They are hack jobs, with nightmarish interfaces that obviously were never user tested. They are overly ambitious, trying to do all things and thus doing nothing well. They are ridiculous. I mean, having doctors enter orders directly into a computer — seriously? EHR companies have no incentive to improve their user interfaces, because government mandates require that they are used no matter how awful they are. Those who don’t adopt these systems are penalized by loss of Medicare dollars.

I think it is an interesting thought experiment to consider how EHR systems would have been designed if they had been allowed to evolve naturally, without the frenzied poorly thought out incentives that exist in the real world. Imagine a world where physicians, the primary users of these systems, drove development and adoption of these systems. Imagine that there were no mandates or penalties from the government to adopt these systems. If a system was developed that improved physician workflow, it would be adopted. Nothing that slowed productivity, as the current EHR systems do, would ever be bought by a practice if the physicians made the call. Imagine EHR companies visiting practices, analyzing workflows, seeing areas that could be improved by computers, and recognizing areas that wouldn’t, at least with current technology. Imagine EHR companies testing their user interfaces using doctors from a spectrum of computer experience, as major software companies like Apple and Google do. Imagine them competing with each other not on how many modules they can provide, but on how few keystrokes or mouse clicks their system used to do the same work as another system. Imagine no government mandates for meaningful use, no dummy buttons that say “click me” but otherwise do nothing.

Think about how you would design a system. Certainly it is useful to have old records available online and we would want to keep that. The problem is how to get them there. Having physicians enter data is probably the least efficient way. Dictation and handwriting are still the fastest data entry methods. If Dragon is good enough (I’m not convinced it is) use it, or keep your transcriptionists around. They are very nice people who need jobs anyway. If handwriting recognition is good enough (I don’t think it is yet) use that, otherwise just store the written notes as pictures and be satisfied. In the ideal world, rather than force physicians to become typists and data entry specialists, we would wait until computer artificial intelligence was developed enough to allow the physicians to continue to do things the old way, with the computer processing the doctors’ notes transparently. If the technology isn’t there yet, develop it, but don’t push it on us prematurely.

Medical records primarily should exist to document important information about patients. It should not be primarily a means to ensure maximum billing of patients. If we eliminate that aspect, EHRs become much simpler. I would envision a small tablet that the MD carries everywhere with him or her. Keep the old workflow. Pull up patient records on the tablet. Write notes on the tablet in handwriting or dictate into it. The tablet transcribes the input and files it appropriately.

Need to give patient orders? Select from some templates or write them in. If the software is not good enough to transcribe written orders on a tablet, hire some unit secretaries to do this like they used to. Let them learn the intricacies of computerized order entry, and let the doctor deal with the intricacies of making diagnoses, doing procedures, and looking patients in the eye and grasping their hands when they are ailing — things that doctors do best. Minimize the interactions with the computer and maximize the interactions with the patients.

A good EHR system can simplify drug reconciliation, pull in drug data from patient pharmacies, and automatically identify patients who are being “overprescribed” pain meds. The system can look up recent relevant medical articles, can show appropriate medical guidelines, and can provide sophisticated medical calculators. There are so many good things computers can do for medicine. They’ve gotten an awfully bad rap from the current iteration of EHR systems. I think the technology exists or can exist to do all these good things, but there is no incentive if we remain satisfied with the status quo. The current systems don’t do any of these things. They just get in the way.

If we lived in an ideal world it would be time to chuck the lot and start over.


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EHR Incentive Program Status Report October 2014 - HITECH AnswersHITECH Answers

EHR Incentive Program Status Report October 2014 - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

As of October 2014, more than 418,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  In May 2013, CMS announced that more than half of all eligible health care providers had been paid under the Medicare and Medicaid EHR Incentive Programs. In August of 2014, HHS reported more physicians and hospitals are using EHRs than before. And in December of 2014, an ONC data brief released stated financial incentives and ability to exchange clinical information found to be top reasons for EHR adoption.

The Centers for Medicare & Medicaid Services (CMS) has released the most recent numbers for the EHR Incentive programs. Here are some Program-to-date highlights from this latest CMS report – October.

  • Active registrations of those completed totaled 505,641 breaking down with 335,964 Medicare EPs, 164,912 Medicaid EPs, and 4,765 hospitals.
  • 50 States and 5 territories have open Medicaid registration. For links to states’ Medicaid EHR Incentive Program websites, see your State EHR Incentive Program Milestones and Web Resources guide.
  • A total of 418,752 unique providers have been paid with breakdown of 268,010 Medicare EPs, 132,412 Medicaid EPs, 4,695 eligible hospitals, and 13,635 Medicare Advantage Organizations for EPs.
  • 39,271 EPs have received a HPSA bonus payment for program years 2011 and 2012.
  • 3,514 hospitals have received payments under both Medicare and Medicaid (of those, 727 were CAHs).
  • A total of $25,774,554,152 has been paid out in the program to date.
  • Medicare EPs have been paid $6,525,991,926 with the majority of those, Doctors of Medicine or Osteopathy receiving $5,880,245,369.
  • Medicaid EPs have been paid $3,360,689,785 with the majority of those, Physicians receiving $2,358,438,340.
  • Eligible hospitals have been paid $15,481,118,733 with Medicare only $597,234,756, Medicaid only $366,549,394, and Medicare/Medicaid $14,517,334,584.
  • Medicare Advantage Organizations For Eligible Professionals have been paid $406,753,707.
  • Medicaid EHR Incentive payments began in January 2011 and Medicare EHR Incentive payments began in May 2011.
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EHR Requires You to Reconsider Your Workflow

EHR Requires You to Reconsider Your Workflow | EHR and Health IT Consulting | Scoop.it

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.


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What are the Benefits of EHR

What are the Benefits of EHR | EHR and Health IT Consulting | Scoop.it

Electronic Health Records (EHR) is one such constituent of information technology in the healthcare sector that has been researched extensively in the recent times post the Health Information Technology for Economic and Clinical Health (HITECH) Act.

With an ability to streamline medical records and initiate integrated healthcare, EHRs can transform the way in which care is given. With an increased access to patient’s medical history, EHR is the future of healthcare. Once implemented the benefits of EHR outweigh the cost incurred in its application.

When completely functional to the extent that the information present can be exchanged with doctors, there are innumerable benefits of EHR which include.
  • EHR Can store comprehensive health information from lab results to radiology tests, medicines, and even allergies.
  • EHR not only stores information but also computes it with the inclusion of Electronic clinical decision support alerts, which aid in monitoring drug interaction checks and thereby reduces medication errors and improves the overall quality of healthcare.
  • EHR with their enhanced ability to store and analyse data prompt healthcare providers with preventive measures for the patient at the point of care thus enhancing clinical decision making.
  • Through EHR The health history can be shared with other health care providers in nursing homes, hospitals, across state and even across country at any given time.
  • Electronic Health Records (EHR) can be accessed on any gadgets such as laptops, tablets, phones.
  • It improves the efficiency of the care givers who can quickly refer to the health history of the patients via EHR and track the treatment progress with greater ease.
  • It enables quick access to the medical records of the patient.
  • It aids in lowering the health cost by preventing redundant medical tests.
  • EHR reduces paperwork and saves time and space required to store or search for any medical history.
  • It improves clinical decision making by integrating patient information from various sources and making it available to the physicians thus encouraging integrated healthcare.
  • It ensures safety of the patient and promotes productivity of the health care staff by reducing medical errors that arise due to missing information, a common occurrence with manual charts.
  • EHR encourages proper documentation with legal and accurate billing.
  • It promotes e prescribing thereby reducing any reading errors by the pharmacist and in turn ensures patients safety.

Therefore in a nutshell Electronic Health records (EHR) with its many benefits are definitely the future of healthcare. It is convenient, reliable and also saves cost in the long run. An exhaustive use of this system will certainly improve the quality of health care eventually.


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I bought a online service for my family and parents to use/share between us so we can help each other at any time if there is an emergency.

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What happens to medical notes today's EMRs

What happens to medical notes today's EMRs | EHR and Health IT Consulting | Scoop.it

I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks are considered by physicians to be living in an alternate reality where a mobile phone app could fix all that is wrong with the health care system.


Being on the dinosaur side, I thought I’d try a quick experiment/analogy to demonstrate that EMR dissatisfaction is not a mere cost artifact. To show what happens when a digital intermediary runs medical information through a translator, I selected a random paragraph about the epidemiology of aphasias from an article in Medscape. I copied and pasted it into Google translator and then ran it backwards and forwards a few times in different languages. In the end, the original paragraph (exhibit A) became the second paragraph (exhibit B):

Exhibit A:

“Not enough data are available to evaluate differences in the incidence and clinical features of aphasia in men and women. Some studies suggest a lower incidence of aphasia in women because they may have more bilaterality of language function. Differences may also exist in aphasia type, with more women than men developing Wernicke aphasia.”

Exhibit B:

“Prevalence and characteristics of men and women are expected to afasia is not enough information available. If afasia some studies, women work more, not less, because they show that the spoken language. There may be differences in the type of OST, women and men to develop more of a vernikke afasia, more.”

Although the B paragraph bears some resemblance to A, it is nearly impossible to determine its original meaning. This is similar to what happens to medical notes in most current EMRs (except the paragraph would be broken up with lab values and vital signs from the past week or two). If your job were to read hundreds of pages of B-type paragraphs all day, what do you think would happen? Would you enthusiastically adopt this new technology? Or would you give up reading the notes completely? Would you need to spend hours of your day finding “work-arounds” to correct the paragraphs?

And what would you say if the government mandated that you use this new technology or face decreased reimbursement for treating patients? What if you needed to demonstrate meaningful use or dependency and integration of the translator into your daily workflow in order to keep your business afloat? What if the scope of the technology were continually expanded to include more and more written information so that everything from lab orders to medication lists to hospital discharges, nursing summaries, and physical therapy notes, etc. were legally required to go through the translator first? And if you pointed out that this was not improving communication but rather introducing new errors, harming patients, and stealing countless hours from direct clinical care, you would be called “change resistant” or “lazy.”

And what if 68,000 new medical codes were added to the translator, so that you couldn’t advance from paragraph to paragraph without selecting the correct code for a disease (such as gout) without reviewing 150 sub-type versions of the code. And then what if you were denied payment for treating a patient with gout because you did not select the correct code within the 150 subtypes? And then multiply that problem by every condition of every patient you ever see.

Clearly, the cost of the EMR is the main reason why physicians are not willing to adopt them without complaint. Good riddance to the 50 percent of doctors who say they’re going to quit, retire, or reduce their work hours within the next three years. Without physicians to slow down the process of EMR adoption, we could really solve this health care crisis. Just add on a few mobile health apps and presto:  We will finally have the quality, affordable, health care that Americans deserve.


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Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com

Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Developments during the last week of January will have a serious effect on the progress of meaningful use, interoperability, and health reform in the coming year.

Perhaps the most important development for health IT was a reduction in meaningful use reporting requirements in 2015. After months of feedback criticizing the meaningful use requiring for reporting in 2015, the Centers for Medicare & Medicaid Services (CMS) finally decided to opt for a 90-day reporting period rather than one requiring a full year’s worth of EHR data.

In a CMS blog post, Patrick Conway, MD, the Deputy Administrator for Innovation & Quality and CMO, highlighted three meaningful use requirements the federal agency is considering for an upcoming proposed rule.

The first would require eligible hospitals like eligible professionals to report based on the calendar year, which would give these organizations time to implement 2014 Edition certified EHR technology (CEHRT). The second would change “other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” Lastly and most importantly, CMS is considering reducing the meaningful use reporting requirement from 365 days to 90 days.

As Conway noted, this proposed rule is separate from the one for Stage 3 Meaningful Use expected next month. However, the spirit of the two proposals is to reduce burdens on providers while promoting expanded use of CEHRT.

Most recently, the Office of the National Coordinator for Health Information Technology provided its earliest plans for enabling nationwide interoperability. The first draft version of the interoperability is the first iteration of the federal agency’s long-term plans for enabling a health IT ecosystem and infrastructure with the ability to exchange patient health data efficiently and securely.

“To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.

The lengthy draft comprises both long- and near-term goals for promoting standards-based exchange among healthcare organizations and providers. The document is current open to public comment through the beginning of April.

At a higher level, the Department of Health & Human Services (HHS) laid out its plans for shifting healthcare dramatically from volume- to value-based care. Secretary Sylvia M. Burwell has committed Medicare to making half of the program’s reimbursements based on value by 2018. Over the next two years, the department is aiming to shift 30 percent of fee-for-service payments into quality-based reimbursement paid through accountable care organizations (ACOs) or bundled payments.

The challenge for the department and the Medicare program is significant considering that accountable care comprises an estimated 20 percent of total Medicare payments. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement,” Burwell said.

While all these changes took place within HHS, President Barack Obama and members of Congress began revealing their plans for supporting personalized medicine. The President’s Precision Medicine Initiative is already on the table and offers $215 million to support the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and ONC. Meanwhile, the House Committee on Energy & Commerce is moving forward with the discussion phase of its 21st Century Cures initiative which aims at speeding along patient-centered regulation and supporting medical researchers, clinical data sharing, clinical research, and product regulation.

All in all, the last week of the first month of 2015 may go down in history at a pivotal moment in the real transformation of healthcare in the United States.


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Survey: Physicians See Benefits, Drawbacks in EHR System Switches

Survey: Physicians See Benefits, Drawbacks in EHR System Switches | EHR and Health IT Consulting | Scoop.it

Changing electronic health record systems could improve EHR functionality and help physicians meet meaningful use requirements, but physicians might be unhappy with the switch, according to a survey published in the journal Family Practice Management, FierceEMR reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Durben Hirsch, FierceEMR, 1/20).

For the survey, researchers polled 305 family physicians who had switched EHR systems in 2010 or later. The survey was conducted between July 2014 and September 2014 (Edsall/Adler, Family Practice Management, January/February 2015).

Survey Findings

The survey found that the most common reasons for changing EHR systems were:

  • Needing additional functionality;
  • Wanting to meet meaningful use requirements;
  • Desire to increase usability; and
  • Requiring improved training and support.

Researchers also found that 59% of respondents agreed or strongly agreed that their new system had better functionality, and 57% said that the change helped them to meet meaningful use requirements.

However, just 43% of respondents indicated they were happy with the switch to a different EHR system. Respondents who were part of the decision to change EHR systems were happier with the change than those who were not part of the decision-making process.

Overall, 81% said the time investment in changing EHR systems was challenging, with issues such as:

  • Productivity loss;
  • Data loss; and
  • Data migration problems.
Comments

Researchers said that physicians need to carry out a careful evaluation of their current EHR system prior to making a change. They also said that making alterations in physician workflow could result in better outcomes.

They noted that switching EHR systems might be necessary to improve functionality or achieve meaningful use but added that "if you just want to change because you don't like using your current EHR or consider it a drag on your productivity, the grass may not be greener on the other side"


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Reigniting ICD-10 Momentum in Your Organization

Reigniting ICD-10 Momentum in Your Organization | EHR and Health IT Consulting | Scoop.it

Now that Congress has rejected requests to delay ICD-10, it’s time to get on the bandwagon or risk significant financial implications. ICD-10 touches virtually every aspect of your organization’s processes and systems, and failure to prepare and comply with the mandate will have a significant impact on your reimbursements.

If your organization has lost momentum or has not started the ICD-10 journey, hiring internal resources or working with external experts will be necessary to meet the deadline. Below is a cheat sheet – based on best practices and industry guidelines – of essential questions to ask leadership and next steps:

  • Is ICD-10 a priority for your leadership team?
    Evaluate organizational awareness of ICD-10 and confirm leadership is in place to drive the transition. Successful ICD-10 planning involves defining project leadership, executive sponsorship, and reporting structures. Given the far-reaching organizational impacts of ICD-10, without defined roles and responsibilities, a critical remediation area may be missed. Identify stakeholder accountability for ICD-10 compliance and designate project managers to lead revenue cycle, coding and clinical documentation improvement (CDI), and IT system initiatives. Develop a project communication plan that sets expectations about what should be communicated to whom, the reason for the communication, frequency, and method.
  • Are your systems ready and have you evaluated the impact of ICD-10 to all system workflows?
    Assess operational readiness by taking an enterprise-wide systems and process inventory to identify where codes are used. Utilize assigned project managers to uncover all systems and processes where ICD-9 codes are sent, received, or stored. Conduct workflow analyses to ensure understanding of how systems and processes are impacted. This exercise can provide immediate benefit to an organization as workflows operating inefficiently are identified. Develop a prioritized project plan and remediation timeline for each impacted area. For example, technology and workflows need to be optimized within patient access to assure compliant orders for dates of service on or after October 1, 2015. Conduct regular reporting on initiatives and ensure stakeholders are being held accountable for designated tasks.
  • Does your staff have appropriate organizational awareness and knowledge of ICD-10?
    Understand what roles individuals play within your organization with respect to ICD-9 code usage, and employ a role-based training initiative. While coders, CDI specialists, and providers will need the majority of training, areas, such as patient access, ancillary departments, business offices, and IT should not be overlooked. Also, keep in mind the impact on your quality team. Patient populations monitored by core measures, as well as other quality metrics are determined by ICD-9 codes. When selecting a training vendor, confirm the vendor offers courses tailored by job function and provides the necessary courses for coders and specialty-specific training for providers. Track and communicate training progress and ensure training compliance is an organizational priority. As part of your strategy, attempt to incorporate training with other planned education to reduce workflow disruption.
  • Are you establishing ongoing experience with the new code set?
    Act fast to incorporate dual coding initiatives. Based on experiences with ICD-10 in other countries, research suggests that allowing coders to simultaneously code in ICD-9 and ICD-10 allows them to achieve proficiency and decrease productivity loss. Dual coding has been shown to significantly reduce the anticipated 40 to 60 percent inpatient and estimated 20 percent outpatient productivity loss. The first step is to create a project plan that identifies coders, checks systems, and determines expected coding system upgrades. Next, create a strategy for managing dual coded data to be analyzed. A coding roundtable of key stakeholders from an organization’s coding team should be developed to create accountability and drive documentation improvements during the dual coding process. As part of the learning process, coder education should initially emphasize documentation requirements for coding the most common conditions within the organization and those with the highest allowed amounts. A minimum of six months of practice is recommended.
  • Are you conducting internal and external testing of systems for ICD-10 compliance?
    Define testing goals and document a plan to test each impacted system internally and conduct external testing to the greatest extent possible. Appropriately testing impacted applications is a complex and time-consuming process and should not be seen as a last step. Many variables — including competing organizational priorities and resource availability — as well as clearinghouse, payer, and third-party tester schedules, can influence the testing timeline. Designate a well-defined team to undertake, define, and monitor the testing readiness plan for your impacted systems and software. Each impacted system should be reviewed for the type of testing that is needed. Billing systems are the most complex and must be ready to send ICD-10 coded bills to payers or payment will be denied. Testing of billing systems should include all of the workflows where codes live, (e.g., claim edits that currently contain ICD-9 codes). Use your high volume and high value codes for testing, and determine the ICD-10 workflow for each impacted application. Then, complete individual testing of applications by running the applications through the identified workflows. Once that process is complete, begin integrated testing through following the process for codes to flow to downstream applications and out to the payer. If you haven’t been selected for payer testing, then work with your clearinghouse to test claims externally through them.
  • Is your CDI program optimized and ready for ICD-10?
    Emphasize clinical documentation process improvements to realize bottom-line gains now while preparing for ICD-10. While most healthcare systems have a CDI program, many are not achieving the desired results in appropriately coding conditions to the highest level of specificity. For example, if the organization is not able to code the specific type of congestive heart failure in ICD-9, the problem will only worsen in ICD-10 with requirements for greater specificity to attain complications and co-morbidities (CCs) and major complications and co-morbidities (MCCs) for many DRGs. While revamping a CDI program is a separate goal, perfecting ICD-9 queries and introducing ICD-10 queries early will help prepare an organization for ensuring compliance with the increased specificity ICD-10 demands.
  • Have you planned for predicted delays in cash flow?
    Create a contingency plan to mitigate potential productivity and revenue losses. Hope for the best, but prepare for the worst. Based on Canada’s ICD-10 experience, coding productivity may drop by 50 percent immediately following implementation. Performance improvements may take at least 90 days to be realized. If claims are suspended, rejected, or delayed following ICD-10 implementation, have a plan available in advance to quickly respond to different scenarios. Alternatively, some providers and payers have drafted stopgap provisions in their contracts to maintain a consistent cash flow and “true up” every three months.

While changing processes, systems, technologies, and staff resources to accommodate the shift from ICD-9’s 17,000 to ICD-10’s 140,000 codes may seem overwhelming, there is still time to meet the requirements by taking a prioritized and focused approach.  Having the right mix of expertise and staffing is necessary to meet the upcoming deadline.  Contingency plans will also help mitigate losses following ICD-10 implementation. Beyond getting paid, ICD-10 also promises to improve clinical outcomes by increasing the specificity and accuracy of clinical documentation to guide patient care decision-making. It’s an investment that is worth the effort.


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Patient portals and EMRs: Each requires a different skillset

Patient portals and EMRs: Each requires a different skillset | EHR and Health IT Consulting | Scoop.it

Most readers know that an EMR (electronic medical record) is the back-end software that runs a health care organization. EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, and view clinical information.


I’ve written at length about the differences between B2B software and B2C software and how B2B software is generally not very good (particularly from a usability perspective). And it’s not very good simply because it can get away with not being very good. B2B companies often just need a good salesperson that can lock-in long-term contracts to be successful. Once the software is purchased, it’s not easy for users to switch.

B2C companies, on the other hand, need an incredible product to be successful. If your user experience isn’t flawless, you cannot survive in the B2C space. The switching costs for consumers are near zero — the user experience must be incredible. Product is much more important than distribution. B2C user satisfaction scores are significantly higher than B2C scores.

Applying this to health care, if you’re a hospital and your EMR is hard to use, your employees will still use it because they have to — they can’t easily switch to a competitor.

But if your patient portal is bad you will lose patients instantly. It’s too easy for patients to switch to something else.

The Healthcare Information and Management Systems Society (HIMSS) published a good report talking about patient portals.  They noted that despite the difficulty of building a wonderful online consumer experience and the totally different skill set required to execute on it, 80 percent of hospitals surveyed chose their patient portal vendor simply because it was the same vendor that provides their EMR (the top three portals were made by Epic, Cerner and McKesson). All of these vendors have been building B2B enterprise software systems for more than 30 years. They’re all wonderful companies. But they have no idea how to build a patient facing product. Their management, engineering talent, sales force, culture and DNA is all about B2B. They have almost no chance of building a world class consumer product. That’s not a knock on these companies; it’s just reality. You can’t be good at both.

As we transition to a world where the patient is in the driver’s seat, exposing patients to old-fashioned enterprise software code and interfaces is not a good idea. Hospitals shouldn’t let a piece of software touch their customers unless it’s been vetted and tested fully, and it’s clear that patients love it. If you check out the satisfaction scores for most patient portal apps, you’ll find that most patients despise them (one of them I looked at last week had 2,000 reviews in the iOS app store and more than 1,500 of them were only 1 star).

Patients are becoming consumers. They want slick, easy, mobile, beautiful, simple and seamless web experiences. If the software that touches patients doesn’t give them that they’re going to go somewhere that does.

Now, in defense of these hospitals let it be known that there aren’t a lot of great consumer-focused software companies building-out patient portals. So in the short term, they might have no choice. But I’d encourage CIOs that are making patient portal investments to consider the consumer and to cautiously enter into flexible and short term contracts with these patient portal vendors.

You should be careful about buying groceries from the company that fixes your car. And you should be careful about buying consumer-facing software from the company that built your EMR.


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EHR Technology Patent Lawsuit Deemed Abstract, Ineligible | EHRintelligence.com

EHR Technology Patent Lawsuit Deemed Abstract, Ineligible | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

MyMedicalRecords has failed in an EHR technology patent lawsuit brought against numerous competitors, according to an Electronic Frontier Foundation report.

The court’s ruling applies to a consolidation of cases with MyMedicalRecords as the plaintiff and the following as defendants:

  • Walgreen Co.
  • Quest Diagnostics, Inc.
  • WebMD Health Corp; WebMD Health Services Group Inc.,
  • Jardogs, LLC; Allscripts Healthcare Solutions, Inc.

United States District Judge Otis D. Wright, II, concludes that the MyMedicalRecords ’466 in patent ineligible on the grounds that it pertains to “long-known abstract idea.”

Following the application of a test from a related patent case (Mayo Collaborative Servs. v. Prometheus Labs., Inc.), Wright takes particular umbrage with the eighth claim of the MyMedicalRecords complaint because it lacks “inventive concepts”:

Claim 8 recites a method for providing a user with the ability to access and collect personal health records in a secure and private manner by: (1) associating access information with the user to access a server storing files; (2) providing a user interface; (3) receiving files at the server from a health care provider; (4) receiving requests through the user interface; (5) sending files; and (6) independently maintaining files on the server.  All six of these concepts are routine, conventional functions of a computer and server and therefore broadly and generically claim the use of a computer and Internet to perform the abstract purpose of the asserted claims.

According to Wright, the remaining claims similarly fail in adding anything of significance to the abstract idea of securing and sharing information.

Ultimately, the US District Court of the Central District of California sided with the defendants and their granted their motion judgment “without leave to amend.” For its part, MyMedicalRecords is still boasting a large patent portfolio that remains unaffected by the court order.

“MyMedicalRecords, Inc. will continue to pursue opportunities to monetize its 13 U.S. patents with more than 300 existing claims where appropriate in the burgeoning health information technology marketplace,” the company said in a public statement following the ruling.

As Adi Kamdar of EFF reports, the litigation being pursued by MyMedicalRecords works against meaningful use requirements that demand eligible providers perform each one of the activities listed by Wright.

“It falls in the category of threats from patent holders who decide to go after companies for abiding by new rules or regulations—doing so, they allege, infringes one or more of their patents,” he writes.

Without EHR technology certified to support, these providers would have limited options for selection EHR and health IT systems. For those opposed to “patent trolling,” the case of MyMedicalRecords raises questions about the patent application and acceptance process.


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IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?



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Bright Futures VisitPlanner iPhone and iPad medical app review

Bright Futures VisitPlanner iPhone and iPad medical app review | EHR and Health IT Consulting | Scoop.it

“Bright Futures” is a national children’s health promotion initiative that has been adopted by the American Academy of Pediatrics for well-child care and is used in most pediatric practices.

These guidelines include recommendations in 26 categories covering 32 recommended well-child visits from newborns to 21 year-olds, and keeping track of recommendations at each visit is a challenge. Making these recommendations more accessible is the challenge the Bright Futures VisitPlanner app from the AAP attempts to address.

The home screen opens to the “Doctor’s Dashboard,” which may be a bit off-putting to non-physician primary care providers.


Users can choose “visits” or “patients.” Choosing visits brings up the “Visit Plan Builder,” where users can select one of the 32 recommended visits or create their own custom visit. The planner can be connected to a specific child or used generically. Users can input recommended immunizations scheduled (if connected to a specific patient) or view generic schedules under the “immunizations” tab. Under the “Anticipatory Guidance” tab, users can input some or all specific recommended anticipatory guidance questions for the patient’s age.


Users can also input, under the “notes” tab, information on guidance given, immunizations, and patient info. Selecting “patients” enables users to add new patients with demographic data, photos, records of illnesses, and birth information. The records of illnesses do not come pre-programmed with any list of conditions or ICD-9 codes, so requires all free text. Also, the birth information is limited to time and anthropometric data, without fields for newborn screens (e.g., the congenital heart screen, hearing screen, metabolic screens) or even free text information. Once the build is complete, users can view the “visit plan” which includes recommended screening and physical exam maneuvers under the “perform” tab, immunizations, the selected anticipatory guidance questions, and any inputted notes. Once the visit is selected, users have to return to the visit screen to edit the visit, while users in the “in visit” mode can check off immunizations or anticipatory guidance questions as completed. The header is helpfully different — blue in the “visit plan builder” mode and green in the “in visit” mode.


The visit summaries can be emailed or AirPrinted once completed, with the app warning about the data security of email — although there is no mention of data security elsewhere on the app.


The app also includes PDFs of the “Bright Future” Previsit questionnaires and parent handouts for each recommended well-child visit, although they are only in English and not available in Spanish. Starting in adolescence with the 11 year-old visit, the app includes separate parent and patient handouts. There is a section for “Tools and Resources”, which has useful information, although mostly via embedded web links to the AAP’s Bright Futures website.


There are also BSA and BMI calculators, a PDF of the summary “Bright Futures” schedule, and a useful PDF on “Coding for Pediatric Preventive Care”. None of the PDFs can be opened in any other PDF app. Lastly, the app includes a section on “Doctor’s Contacts” where users can input other providers and their contact information and link those providers to specific patients.


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OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com

OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services is one step closer to issuing a notice of proposed rulemaking (NRPM) for the next stage of meaningful use requirements for the Medicare EHR Incentive Program.

The Office of Management and Budget (OMB) is currently reviewing the proposed rule for Stage 3 Meaningful Use that is expected to be published in February.

Few details about the requirements for Stage 3 appear in the rule submitted to the OMB by the Department of Health & Human Services as part of the Unified Agenda — that is, with the exception of the following:

In this proposed rule, CMS will implement Stage 3, another stage of the Medicare and Medicaid EHR Incentive Program as required by ARRA. We are proposing the Stage 3 criteria that EP’s, eligible hospitals, and CAHs must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients.  Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.

The rule before the OMG also indicates that CMS will coordinate with the Office of the National Coordinator for Health Information Technology to ensure that EHR certification criteria and certified EHR technology will be in place when Stage 3 goes into effect no earlier than 2017.

During a Health IT Policy Committee meeting in March, the group voted to approve 19 objectives recommended by the Meaningful Use Workgroup. Those recommendations fall into four categories of care improvements:

Improving Quality of Care and Safety
1. Clinical decision support
2. Order tracking
3. Demographics/patient information
4. Care planning — advance directive
5. Electronic notes
6. Hospital labs
7. Unique device identifiers

Engaging Patients and Families in their Care
8. View, download, transmit
9. Patient generated health data
10. Secure messaging
11. Visit Summary/clinical summary
12. Patient education

Improving Care Coordination
13. Summary of care at transitions
14. Notifications
15. Medication reconciliation

Improving Population and Public Health
16. Immunization history
17. Registries
18. Electronic lab reporting
19. Syndromic surveillance

Before any of the proposed rule’s requirements for Stage 3 Meaningful Use are enacted, the NPRM must made available for public comment which has the potential to influence the requirements of the final rule. Given the resistance CMS has faced as a result of Stage 2 Meaningful Use, the federal agency is likely to receive requests for greater flexibility and timing from healthcare organizations and industry groups.


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Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com

Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
The adjustments involved in successful meaningful use attestation still get a thumbs-down from pessimistic physicians.

Physicians are still not sold on the idea of changing their daily workflows to meet the requirements of meaningful use, finds a new study in BMC Medical Informatics and Decision Making.  In a survey of 400 providers at 47 ambulatory practices, the researchers found a general unwillingness among all types of physicians to adapt to the needs of Stage 1 meaningful use (MU), and a general lack of confidence in their organization’s ability to rise to the challenges presented by EHR implementation.

The study cites the importance of effective change management strategies as a foundation for preparing healthcare providers for the impact of EHR implementation and meaningful use attestation.  “In busy practice settings, such change efforts are often difficult to implement effectively. In fact, experts have suggested that without sufficient readiness for change, change efforts are more likely to lead to unrealized benefits or fail altogether,” the authors write.  “With billions of dollars invested in MU and the countless hours spent by providers and clinical staff on MU implementation nationally, unrealized benefits from the program would carry significant financial and opportunity costs for health care systems.”

Resistance to the changes involved in meaningful use is nothing new in the healthcare industry.  The study adds to the anecdotal notion that physicians are particularly unwilling to embrace workflow changes due to new technologies and requirements.  While approximately 83% of nurses and advanced practice providers (APPs) indicated a willingness to change their workflow in response to meaningful use, just 57.9% of physicians reported the same.  Nearly 45% of nurses and APPs believed their organization would be able to address any problems that arose during meaningful use attestation, but only 28.4% of physicians were optimistic about overcoming issues.

Specialists were nearly three times more likely than primary care providers to believe that meaningful use would divert significant attention away from the practice of patient care.  Twelve percent of specialists thought their interactions will patients would suffer, compared to 4.4% of other providers.  However, specialists were no more likely than other providers to believe their organizations were unready to tackle meaningful use.

“These results suggest that leaders of health care organizations should pay attention to the perceptions that providers and clinical staff have about MU appropriateness and management support for MU,” the study concludes. “Change management efforts could focus on improving these perceptions if need be as it is feasible that doing so could improve willingness to change practices for MU.”

The authors suggest that organizational leaders invest in education for their staff about the benefits and opportunities involved in meaningful use.  Creating opportunities to provide guidance, demonstrations, and training for EHR proficiency and documentation measures required for attestation may help to ease trepidation among providers, while indicating a strong sense of support along with a clear implementation framework may help to make meaningful use attestation a more successful prospect.


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US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com

US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
A centralized EHR infrastructure is promoting care quality improvements in the US Immigration and Customs Enforcement department.

The US Immigration and Customs Enforcement (ICE) system is celebrating the completion its EHR infrastructure implementation, which transformed the agency’s paper-based healthcare system into a centralized, web-based system that allows health information exchange to improve care coordination while cutting costs.  For its quick and successful implementation, the team charged with developing the EHR infrastructure has received a 2014 Director’s Award for meritorious service for outstanding performance and inspiring accomplishments advancing the mission of ICE.

As with other governmental healthcare systems, the ICE Health Service Corps (IHSC) must track and coordinate care for persons that may travel between facilities or have a history of care at private providers.  IHSC, which operates under the Department of Homeland Security, provides care to around 15,000 ICE detainees at more than 20 facilities, the department’s website says.  Patients in the system also receive care from external providers when necessary, which requires the 900-strong IHSC staff to exchange health data electronically in order to ensure continuity.

“The very nature of detainee health care requires sending medical information across different locations,” said Capt. Deanna Gephart, deputy assistant director of Operations for IHSC in a press release.  “Now that we have the capability to share data electronically, the detainee health care system is much more efficient, which translates into increased quality health care provided to detainees.”

“I couldn’t be more proud of the effort of the team who dedicated their time and effort to modernizing this system,” added Jon Krohmer, assistant director of IHSC. “In less than 15 months, they successfully acquired, installed, configured, trained and deployed the system to all 22 IHSC-staffed facilities.  In the process, ICE has realized a $2 million annual cost avoidance.”

The EHR will allow ICE to better complete public records requests, including the release of data under the Freedom of Information Act, Congressional inquiries, and routine audits.  ICE also believes the new system will contribute to a reduction in the risk of medical errors, improved standardization of care, and the ability to better measure and achieve high performance on quality metrics.

Gephart previously noted that the department’s health information management system lacked sufficient interoperability “ICE has a frequent need to send medical information across different locations, which is cumbersome when each site has its own system,” she said in September.  In 2012, ICE completed 220,000 intake screenings and 104,000 physical exams while conducting more than 13,000 emergency room or off-site referrals, highlighting the need for robust care coordination throughout the busy system.

The successful EHR implementation comes amidst massive modernization efforts by the Department of Veterans Affairs and Department of Defense (DOD), both of which operate on an even larger scale.  Interoperability and care coordination cross multiple facilities are equally critical to these projects, and are some of the major criteria for the vendor selection process as the DOD seeks to leave its legacy systems behind in favor of a newly centralized infrastructure.


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CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com

CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

While this week marks the end of one and beginning of another year, those in the healthcare industry should take note of all that transpired in the previous year to avoid similar setbacks in 2015. This is especially true for matters scheduled to have been addressed over the last 12 months.

ICD-10 delays, meaningful use changes, health IT vendor competition, and EHR implementation gaffes. Based on the interest of our readers, those were the most popular topics of 2014 on EHRIntelligence.com.

ICD-10 transition delay one more year

More than any other topic on our news site, ICD-10 garners the greatest amount of our readership’s attention and given its high stakes, it makes sense. This past October was supposed to usher in a new era of clinical coding — the move from ICD-9 to ICD-10 — and put the United States on par with other leading nations in terms of healthcare documentation.

The Congressional debate over the sustainable growth rate (SGR), however, swiftly dashed those visions. Close to one week after expectations began to build that Congress would vote on an SGR patch that included a one-year ICD-10 compliance delay, the Senate voted in favor of the bill. While the rest of the nation took this as business as usual on the Hill, the healthcare industry scrambled to put new plans together for postponing their 2014 ICD-10 implementation activities.

What the delay meant to providers depended on where they practices. Larger healthcare organizations reported high levels of ICD-10 readiness while some smaller physician groups and practices were completely unsure where they stood. No matter their view of the most recent ICD-10 delay, most are committed to removing ICD-10 implementation pain points to be ICD-10 ready by Oct. 1, 2015.

The bending but not breaking of meaningful use

This past year began with eligible professionals and hospitals working to achieve Stage 2 Meaningful Use, but that is hard to do when certified EHR technology is unavailable.

Early hints of changes to meaningful use reporting in 2014 emerged as early as February when the Centers for Medicare & Medicaid Services (CMS) introduce a new meaningful use hardship exception dealing with a lack of available CEHRT.

In September, the federal agency finalized a rule intended to give providers greater flexibility in meeting meaningful use requirements in 2014 — known as the flexibility rule. However, this did not turn out to be CMS’s final move.

The flexibility rule was followed by the reopening of the meaningful use hardship exception application submission period for both EPs and EHs and the extension of the 2014 meaningful use attestation period for EHs and critical access hospitals through the end of the year.

Despite their intentions, neither has put to rest repeated calls for 2015 meaningful use reporting requirement changes by industry stakeholders.

Heading to a showdown

Prognosticators in health information technology (IT) have foreseen consolidation in the marketplace over the next few years. But it is unlikely that they saw things playing out as they did in 2014.

Cerner’s acquisition of Siemens Health Siemens over the summer is an example of how quickly and dramatically the market can change. Most viewed the maneuver as a power play by the Kansas City-based health IT company to contend with Epic Systems and its market share among health systems and hospitals.

While the growth of both Cerner and Epic continues to loom large over the industry, they still have to contend with numerous other players in the ambulatory care space, especially given Epic’s recent loss to athenahealth as the top overall software vendor over the past year.

Expect more to come.

Squeaky wheel gets the grease

When EHR implementations go well, those involved in the process are more than willing to share details of their experiences. When they don’t, it is like pulling teeth.

Poorly managed EHR implementations can prove costly. The University of Arizona Health Network saw red of a different variety as a result of its Epic EHR adoption. Whidbey General Hospital felt the financial effects of a software glitch in its MEDITECH EHR that crippled its billing system and left it short on cash. Meanwhile, a Cerner EHR implementation gone awry led to the dismissal of Athens Regional Medical Center’s CEO.

If 2014 was a busy year, then 2015 is only likely to be busier. Stay with us as we continue our coverage of meaningful use, EHR and ICD-10 implementation, and anything else health IT-related that comes our way.



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Is Your EMR Hooked Up To The World? | Hospital EMR and EHR

Is Your EMR Hooked Up To The World? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

A few months ago, I was having a conversation with a vendor executive about the challenges EMR companies face.  He said that in his mind, the big differentiator won’t be interfaces or even key features, but the extent to which the vendor has hooked up with key outside services.

According to this man — whose story, to be honest, I haven’t been able to verify — it can three months or more to link up with big laboratory providers like LabCorp or Quest.  Partnering with payors is another nightmare, even for vendors that run a practice management system already handling billing issues. And what about synching up with radiology information systems

Now, don’t get me wrong:  Service providers are getting wise to this problem. LabCorp, for example, now boasts about its EDI interface and touts its connections with 300+ EMR, practice management and laboratory information service vendors. It also offers eLabCorp, a Web-based solution for test ordering and test result retrieval.

Private software vendors are also in the mix. For example, I stumbled across one vendor offering bundles that connecting physicians, payors and radiology information systems.

But most of the interface development seems to be ad-hoc, with the costs borne by the healthcare provider rather than the EMR vendor.  And it’s a costly problem.

As things stand, after all, creating flexible, functional interfaces between EMRs and key service providers is still largely a job for specialized experts, and they don’t come cheap.  (As readers know, it’s not that your crack IT team can’t build the interfaces on its own, but where will staffers find the time?)

However, my guess is that as IT users get their bearings, they’ll demand a better range of connected partners from EMR vendors.  Rating how connected vendors are to labs, payors and other transaction partners is likely to rise close to the top of RFPs and internal checklists.

Ultimately, even high-end EMR systems will begin to look similar as the hospital industry standardizes on Meaningful Use-driven features and functions. (You’d think a multi-million dollar system would have a unique footprint, but let’s face it, anything can get commoditized.)

Soon, to get hospital business, they’ll have to offer options which directly improve operations or generate profits. And it’s not a moment too soon.

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