EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Avoiding Legal Troubles Stemming from EHR Liabilities

Avoiding Legal Troubles Stemming from EHR Liabilities | EHR and Health IT Consulting | Scoop.it

I'm a big supporter of the EHR and its promise to make documenting patient care more accurate, easier, and clear. I also have a healthy respect for the dangers of the EHR — and see new dangers pop up constantly.

With all good technological tools, there are hazards that need to be recognized. The EHR can pose a liability for providers and institutions, and the legal profession is beginning to exploit this weakness in malpractice actions against providers and institutions.


Modern EHRs have a significant learning curve, and require a complete change in the process of documenting patient care. Many functions are a double-edged sword; including record cloning, automated dictation, medication dose checking, documentation templates, automatic record population, etc. The functionality of the EHR can make the job of providers much easier in generating a record, but this same functionality can introduce bad data, wrong dosages, and other errors that can harm patients.


The bottom line is that providers are ultimately responsible for what is charted in the EHR. Here are just a few examples of these new liabilities and how to avoid them.


• Scribes. Much of the charting that is done on the front end of a hospital admission is performed by the nursing and ancillary staff, or in the ER, scribes. This is very helpful in a busy inpatient and/or outpatient department, and speeds patient care and documentation. However, unless the provider verifies the accuracy and completeness of the record, significant errors can made.


• Cut and paste. The "cut and paste" function is one that is familiar to anyone using a computer in the modern age. This can interject errors, and propagate them when one does not exercise due diligence in making sure that the final record reflects the actual encounter. There are tools available which make searching for repetitive text in a record very easy. Obvious propagation of narratives and erroneous data, over and over again, is hard to defend in a court of law, and demonstrates that care was not taken. It also introduces doubt into all areas of the records being scrutinized.


• Note cloning. "Cloning" is another issue that works much like cutting and pasting. Cloning is the practice of copying an entire previous record into a new, editable record. The hazard here is obvious, and similar to the previously discussed practice of cut and paste. It goes without saying the more information and data that you "clone," the greater the risk you are going to miss something, and propagate erroneous data.


• Use of templates and macros. Macros for things such as review of systems and physical examination can really make you look bad when another provider or lawyer is reviewing your record. It is easy to miss that you called a positive physical finding negative, if you don't carefully review the record prior to finalizing it.


• Pull-down menus. Finally, clickable pre-populated components and pull-down menus can be hazardous in that it is sometimes easier to choose the wrong thing than it is to use "free text" to customize the finding or information.


On the bright side, templates for procedures help providers quickly and accurately document informed consent, indications for the procedure, the actual procedure, and the post procedure care by giving the provider a concise and complete format for documentation. The other benefit of the EHR from the provider standpoint is allowing the provider to make a more complete record in support of the level of care that is being billed.


I have to admit that in the past, I have used all the functionality of the EHR, and have made mistakes in my documentation. After studying these issues, and becoming aware of the hazards to patient safety and care, I'm much more sophisticated in my use of the functionality of the EHR. I still use macros and auto-text, but my use of cut and paste is limited to including diagnostic test reports that don't auto-populate. I never use cloning even though the functionality is still allowed in our EHR.


One of the big changes for me has been the deployment of enterprise level dictation in our EHR. Now, even though I can type 60 WPMs, I can much more rapidly and accurately dictate a unique HPI, PE, and plan, and better ensure that the record is accurate.


Take the time to understand EHR technology, and avoid the pitfalls that can be expected to increase your liability in the delivery of patient care.


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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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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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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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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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Stage 3 Meaningful Use proposals at White House for final review

Stage 3 Meaningful Use proposals at White House for final review | EHR and Health IT Consulting | Scoop.it

Why do these things always seem to happen late on Friday afternoons? At least this time it’s not right before a holiday. Actually, with a bit more inspection, I see that it did happen right before a holiday.

HIMSS is reporting today that the White House’s Office of Management and Budget is “in its final stages of review” of the proposed rules for Stage 3 of the Meaningful Use EHR incentive program. OMB always goes over proposed and final regulations to measure the fiscal — and, presumably, political — impact before allowing executive-branch agencies to make public releases.

A peek at OMB’s reginfo.gov site indicates that the MU Stage 3 proposal from CMS and related ONC plan for certification of EHRs are indeed at OMB for final review.

“We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] 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,” CMS states in a rule summary on the OMB site.

A placeholder date (“02/00/2015 “) on the same page suggests that the proposal will be published in February. However, a placeholder date on the page for the forthcoming ONC certification standards indicates that the plan was supposed to come out in November.

And the date the two notices appeared on the reginfo.gov? Dec. 31, when pretty much everyone was already checked out for the extended New Year’s weekend.

Stage 3 is scheduled to start no earlier than Oct. 1, 2016, for hospitals and Jan. 1, 2017, for individual providers.


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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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Developing a Specialty-Specific Action Plan for ICD-10

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

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

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

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

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

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

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


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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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2015 Hospital Healthcare IT Predictions | Hospital EMR and EHR

2015 Hospital Healthcare IT Predictions | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

At the start of 2015, I thought I’d put down some predictions on what will happen in the world of healthcare IT and EHR. These won’t be crazy predictions, since I don’t think anything crazy is going to happen in healthcare in 2015. We’ll see some clarity with a few programs and we’ll some some incremental change in things that matter to hospitals.

ICD-10 – I predict that ICD-10 will again be delayed with the next SGR fix. I don’t have any inside information on this. I just still believe that nothing’s different in 2015 that wasn’t true in 2014 (maybe AHIMA’s lobbying harder for no delay). I think another delay will put all of ICD-10 in question. Let’s hope whatever the decision is on ICD-10, it happens sooner than later. The ICD-10 uncertainty is worse than either outcome.

Meaningful Use – MU stage 2 will change from 365 days to 90 days. It will probably take until summer for it to actually happen which will put more people in a lurch since they’ll have even less time to plan for the 90 days than if they just made the change now. MU stage 2 numbers will be seen as great by those who love meaningful use and terrible by those who think it’s far reaching. The switch to 90 days means enough hospitals will hop on board that meaningful use will continue forward until it runs out of money.

EHR Penalties – Doctors will be blind sided by all the penalties that are coming with meaningful use, PQRS, and value based reimnbursement, even though it’s been very clear that these penalties are coming. Doctors will pan it off on “I can’t keep up with all the complex legislation.” and “I knew the penalties were coming, but I din’t think they’d be that big.” Watch for some movement to try and get some relief from these penalties for doctors. However, it won’t be enough for the doctors who want to start a perpetual SGR fix like delay of the EHR penalties. Many practices will have to shut down because of poor business management.

Direct to Consumer Medicine – Doctors will start to move towards a number of direct to consumer medicine options such as telemedicine and concierge medicine. These doctors will love their new found freedom from insurance reimbursement and the ongoing hamster on a treadmill churn of patients through their office. How far this will go, I’m not sure, but it will create a gap between these doctors who love this “new” form of medicine and those who feel their stuck on the treadmill.

Interoperability – 2015 still won’t see widespread healthcare interoperability, but it will help to lay a clear framework of where healthcare interoperability needs to go. A couple large EHR vendors will embrace this framework as an attempt to differentiate themselves from their competitors.

There you go. A few 2015 predictions. What do you think of these predictions? Any others you’d like to make? I feel like my predictions feel a little bit dire. A few show signs of promise, but I think that 2015 will largely be a transitory period as we try to figure out how to get the most value out of EHR.

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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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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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Can True EHR Customization Help Physician Practices Survive?

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

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

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

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

Capable and cost-effective?

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

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

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

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

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

Diversity and true EHR customization rule

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

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

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


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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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The Benefits of Electronic Health Records

The Benefits of Electronic Health Records | EHR and Health IT Consulting | Scoop.it

What are the benefits of electronic health records? Human Resource files? Invoices?

Implementing an electronic records system has the potential to provide extraordinary benefits for clinics, healthcare organizations, and physicians. By facilitating workflows and improving the overall quality of patient care and safety, electronic documents are able to provide a wealth of measurable benefits – including some impressive financial savings.

Financial Benefits of Electronic Health Records (EHRs)

A study, published by The American Journal of Medicine, has shed some light on the financial costs and benefits associated with an electronic health records system. This particular study looked to find quantifiable cost savings directly influenced by electronic records – and what they found was astounding.

The estimated net benefit from implementing an electronic health record system in a primary care setting over a 5 year period? $86,400 per provider.

Researchers even accounted for the inevitable productivity loss during the implementation of an EHR system. In this particular study, researchers found that even if a healthcare organization sustained a prolonged 10% productivity loss for 12 months…there was still a 5 year net benefit of $57,500 per provider.

According to this study, the primary benefits/savings accrued came from:

  • Savings in drug expenditures
  • Improved utilization of radiology tests
  • Better capture of charges
  • Decreased billing errors

However – this study did not include other cost saving factors, such as:

  • Decreased malpractice premium costs
  • Storage costs
  • Supply costs
  • Generic drug substitutions
  • Increased productivity
  • Decreased staff requirements
  • Increased reimbursement from more accurate patient evaluations
  • Decreased claims denials from inadequate documentation

Not only does this study illustrate the ROI of electronic records – it illustrates that these financial savings are just the tip of the “benefits” iceberg.

Without a doubt, the implementation of an electronic record system in a healthcare setting can result in a positive return on investment. However, healthcare organizations should also be looking to expand their electronic document systems to include more than just medical records. Consider the financial benefits to be had enhancing other paper-intensive processes, such as the management of HR files or the indexing of invoices.

Electronic documents have proven their value as medical records – so why not share the savings with every department?


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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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What Happens When An EHR Vendor is Acquired?

What Happens When An EHR Vendor is Acquired? | EHR and Health IT Consulting | Scoop.it

With meaningful use money running out, and as the EHR industry matures, we’re going to see more and more consolidation in the EHR market. Many EHR vendors are going to start running out of money. Other larger EHR vendors are going to want to try and buy up market share. In some ways this has already begun. See Greenway being purchased by Vitera Healthcare Solutions and Cerner acquiring Siemens to name some of the larger ones that have happened recently. Although, anyone that’s been a user of Bond EHR (people still miss that EHR software), Allscripts MyWay, Misys, etc etc etc knows the challenges of when your EHR vendor gets acquired.

While your EHR being acquired by another EHR vendor is almost never a good thing for your EHR software’s future, L Nelms visited this post on EMR and EHR News and offered an even worse story of an EHR being acquired and the fallout the doctors felt. I’ve removed the name of the vendors since the principle could apply to many vendors that get acquired.

After completing Stage one of Meaningful Use, I am now dropping out of the whole damn thing. This decision is based entirely on my continued dissatisfaction with the EMR program I chose. I started using EHR Vendor A in 2012. As many know, EHR Vendor A was subsequently bought by ABC corporation who refused to honor the original contract which promised no additional fees. ABC corporation, knowing that they had customers “right where they wanted them” — knowing that switching programs would incur tremendous costs and disruption to the practices’ work flow, immediately imposed a $250.00 monthly “support fee”, requiring automatic payments from the customers credit card. I do not know what constitutes “support” from this company, as I had problems with the program and attempted to contact them numerous times from Nov 19, 2014 to Dec 9, without a SINGLE reply in any form from them. On Jan 1, 2015, they increased this fee to $300.00.

They continue to inundate us with newsletters telling us how wonderful they are, including an alert urging us to “respond today” to arrange to get the new certified software installed. This was sent on Christmas Eve! They warned us repeatedly that we must be using the new software ON Jan 1,2015, in order to meet MU. What they didn’t mention until the day before the install, was that there is a “one-time installation fee of $99.00″ (charged immediately, of course, to you credit card).

I asked if I could do the install myself and was told “yes, but we’re not really charging for the install, we’re charging for the SQL server update (which actually can be done oneself ). But I was told I had to pay. And now, the new certified software, which is COMPLETELY different from the previous version, is a nightmare. It is agonizingly slow, painstakingly labor intensive, and heaven forbid I should require tech support who, on top of being nowhere to be found, are so disrespectful (the last one one I spoke to actually said — when I expressed my dissatisfaction with not being able to get my data when I terminate my contract — “well we didn’t force you to buy our program”

Which doesn’t explain why I feel so violated…..

I should clarify that my data from EHR Vendor A is “available”: after many cryptic replies from them over several days, I was finally told that I can access the data from the server, but then — and you all know the story– I must take out a second mortgage on my home to have the data converted to some semblance of a usable format. This may not be illegal (only because the the recklessness of the companies has not yet been regulated), but it is certainly of questionable ethicacy

I think this is a fear that many doctors have when selecting and purchasing their EHR software. It’s why many of them still choose to go with the big name EHR vendors. Stories like this one scare doctors away from a small EHR vendor with an uncertain future. Although, I’ve written previously about the uncertain future of large EHR vendors as well.

The EHR industry should do better than this. I hope this story is an aberration, but I’m afraid we’re going to see more and more stories like it as the EHR industry consolidates. There will still be many good EHR actors out there that are appalled by these stories like I am. Hopefully, more and more doctors will find those good actors who are sincere in their efforts to provide a quality product with a quality user experience for the doctor. They’re out there, but bad actors like what’s described above give the good apples a bad name.



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Time for Government to Step Out of the Way of EHR and Let the Market Takeover? | Hospital EMR and EHR

Time for Government to Step Out of the Way of EHR and Let the Market Takeover? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

The always interesting and insightful John Moore from Chilmark research has a post up that asks a very good question. The question is whether it’s time for the government to get out of the EHR regulation business and let the market forces back in so they can innovate. I love this section of the post which describes our current situation really well:

But as often happens with government initiatives, initial policy to foster adoption of a given technology can have unintended consequences no matter how well meaning the original intent may be.

During my stint at MIT my research focus was diffusion of technology into regulated markets. At the time I was looking at the environmental market and what both the Clean Air Act and Clean Water Act did to foster technology adoption. What my research found was that the policies instituted by these Acts led to rapid adoption of technology to meet specific guidelines and subsequently contributed to a cleaner environment. However, these policies also led to a complete stalling of innovation as the policies were too prescriptive. Innovation did not return to these markets until policies had changed allowing market forces to dictate compliance. In the case of the Clean Air Act, it was the creation of a market for trading of COx, SOx and NOx emissions.

We are beginning to see something similar play-out in the HIT market. Stage one got the adoption ball rolling for EHRs. Again, this is a great victory for federal policy and public health. But we are now at a point where federal policy needs to take a back seat to market forces. The market itself will separate the winners from the losers.

His points highlight another reason why I think that ONC should blow up meaningful use. In my plan, I basically see it as the government getting out of the EHR business. I do disagree with John Moore’s comments that the government should step away from interoperability. If they do, we just won’t have interoperability. I guess he’d make the argument that value based reimbursement will force it, but not in the same way that the rest of the EHR incentive money could force the issue.

I have learned that to really get out of this game or even do what I describe will take an act of congress. HHS can’t do this without their help. Although, they could get pretty close. Plus, maybe they could exert their influence to get congress to act, but I won’t be holding my breathe on that one.


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