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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Docs urge big changes to health records program

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

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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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 |

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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Developing a Specialty-Specific Action Plan for ICD-10

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

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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US Immigration Dept. Sees Advantages of New EHR Infrastructure |

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

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

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

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

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

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

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

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

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CMS Extends Hospital 2014 Meaningful Use Reporting Deadline |

CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | | EHR and Health IT Consulting |

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

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

ICD-10 transition delay one more year

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

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

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

The bending but not breaking of meaningful use

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

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

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

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

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

Heading to a showdown

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

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

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

Expect more to come.

Squeaky wheel gets the grease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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MA Gives Details on EHR Proficiency Requirement for Licensure |

MA Gives Details on EHR Proficiency Requirement for Licensure | | EHR and Health IT Consulting |
Massachusetts will allow physicians to demonstrate EHR proficiency in multiple ways to retain their medical licenses.

Physicians in Massachusetts will be able to choose from several options to demonstrate their EHR proficiency in order to renew their licenses in 2015, according to final regulations provided by the state’s Board of Registration.  The controversial provision that initially required providers to attest to meaningful use in order to retain their ability to practice medicine has been modified to allow for flexibility and certain exemptions.

The rule prompted outrage and disappointment among Massachusetts providers, and the Massachusetts Medical Society (MMS) has lobbied heavily against the restrictive requirements of the original language.  Opponents of the EHR proficiency provision decried the mandate as an unwanted intrusion into the practice of medicine.

“Collectively, these requirements increase administrative demands, add costs to the practice of medicine, and to the health care system as a whole,” said former Massachusetts Medical Society President Ronald Dunlap. “They will take time away from direct patient care and drive small to midsize practices to seek alignment with larger entities that have the capacity to fulfill the requirements, potentially causing further consolidations in the healthcare market.”

Starting on January 2, 2015, Massachusetts providers looking to renew their licenses will need to meet one of several methods of proving that they can adequately use an EHR system to provide quality care.  Participating as an eligible professional (EP) in the EHR Incentive Programs, or being employed by an eligible hospital (EH) that has attested to meaningful use, can both satisfy the provision.

But providers who are not eligible for meaningful use participation can still prove their competency by completing at least three hours of accredited CME courses on EHR use or becoming an authorized user of the Massachusetts Health Information Highway, which is the state’s designated health information exchange.

All physicians renewing their licenses before March 31, 2015 will be provided with a one-time waiver from the requirements, while physicians with renewal dates within 60 days of the end of March could submit their application early and qualify for the automatic exemption.  Additional exemptions are available for providers who are applying for limited licenses as an intern or medical resident, those who are applying for licenses but are not actively practicing medicine, or providers on active duty in the National Guard who are called up during a national emergency or crisis.  Physicians may also apply for a 90-day “undue hardship” exemption under certain circumstances.

“The Massachusetts Medical Society believes that electronic health records have enormous potential for patient care, and the Society’s extensive policy on EMRs declares support for them and a desire to work toward improving them,” said MMS President Richard Pieters, MD.  “We are grateful that the Board of Registration in Medicine has taken a reasonable approach on this issue, exhibiting utmost concerns for patient safety and access to care.”

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General Surgery News - Promise of EMR Systems Yet To Be Fulfilled for Many

General Surgery News - Promise of EMR Systems Yet To Be Fulfilled for Many | EHR and Health IT Consulting |

For more than a decade, electronic medical records (EMRs) have been called a critical step forward in modern medicine. The idea was that transitioning from paper to electronic records would increase efficiency, safety and savings in health care. The potential for EMRs to make patient records more accessible, reduce medical errors, allow medical institutions to communicate more seamlessly and save the health care industry billions of dollars each year was too tempting to pass up.

Despite this, the reality of EMRs seems not to have lived up to the hype. EMR systems have been costly to implement and are often laborious and confusing to learn. There is no universal system that all physicians can use; instead, medical professionals are faced with more than 100 systems, all competing for users and many of which cannot communicate with one another. But perhaps most notably, these systems do not appear to improve patient care, as promised, and in some cases may make care worse.

Nevertheless, the use of EMRs has ballooned in the past 10 years. In 2005, fewer than 25% of physicians’ offices and hospitals had adopted an EMR system, but today more than 80% use one. Despite the rapid spread, the central concerns about EMR systems remain the same: high cost, lack of standardization and interoperability, privacy issues and inferior patient care (Health Aff 2005;24:1103-1117).

But even before this spike in usage, many medical professionals were already well aware of the issues. In a 2004 report, researchers who had conducted 90 interviews with EMR managers and physicians found that “most physicians using EMRs spent more time per patient for a period of months or even years after EMR implementation. The increase resulted in longer workdays or fewer patients seen, or both, during that initial period …. Most respondents or their colleagues considered even highly regarded, industry-leading EMRs to be challenging to use because of the multiplicity of screens, options and navigational aids” (Health Aff 2004;23:116-126).

In a 2013 survey conducted by RAND Health, and sponsored by the American Medical Association, physicians echoed many of the same sentiments. In fact, physicians rated EMRs as a main reason for their job dissatisfaction. Summing up the results of the report, the RAND researchers wrote: “Despite recognizing the value of EHRs [electronic health records] in concept, many physicians are struggling to use their EHRs, which they describe as negatively impacting patient care in several important ways and undermining their professional satisfaction.”

In the study, the authors interviewed 24 practices about EHRs, 22 of whom were currently using a system. On the plus side, about one-third of the physicians reported that the EHR improved their job satisfaction and 61% said it improved quality of care. These physicians noted that their EHR system enhanced their abilities to access patient data at work and at home, provided guideline-based care and tracked patients’ disease.

In contrast, many physicians also expressed concerns over their EHRs, with about 20% saying they would prefer to return to paper charts. The central issues boiled down to inferior patient interactions, an inability to exchange information between different systems and a labor-intensive and time-consuming learning curve and data entry.

“Just because something is more expensive doesn’t mean it’s better,” said Peter Kim, MD, associate professor of surgery, Albert Einstein College of Medicine of Yeshiva University, New York City, who was not involved in the study. “For instance, the EMR giant Epic received $302 million from New York City, in 2013, for use in about 11 New York City public hospitals. But even within the same system, not all Epic EMRs are alike. An EMR’s functionality depends on who is programming it as well as the local needs of the institution. The same system may end up working well in one hospital, but poorly in another.”

Although people often assume that technology will reduce errors, that also is not the case. “In our hospital, administrators try to make our EMR sound perfect, but in reality, we have encountered huge errors and have had no audits of the system,” said Guy Voeller, MD, FACS, professor of surgery at the University of Tennessee Health Science Center, Memphis.

Along these lines, Dr. Kim recalled an incident when a toxic drug dose was written for the wrong patient, which missed all of the EMR system’s checks and balances. “Although that error could have happened with the old system, it wasn’t prevented by the EMR as it should have been,” Dr. Kim said. “We still need that human element in care, where a person is checking and verifying orders.”

Regarding patient interactions, physicians in the RAND study who complained that EHRs interfered with in-person patient care found that they were forced either to divide their attention between the patient and the computer or to give patients their attention but then spend hours inputting data afterward.

“With EHRs, physicians and nurses are looking at a computer screen and have their backs to the patient,” said Dr. Voeller. “Physicians and nurses are forced to devote time to their computer, not their patient.”

Another report revealed similar results. A team at Medscape surveyed 18,575 physicians in 25 different specialties from April 9, 2014, to June 3, 2014, about their EMR use. Of those, 4%, or 743 participants, were general surgeons.

The report found that about one-third of respondents felt their EHR systems worsened clinical operations and patient services, although about the same percentage reported the opposite. In terms of patient interactions, 70% of respondents said their system decreased their face-to-face time with patients and 57% said it lessened their ability to see patients, while about one-third felt their system enhanced their ability to respond to patients and effectively manage treatment plans.

Patient privacy was another major worry for physicians, approximately half of whom expressed concern about losing patient information because of a technological malfunction or about their lack of control over who can access patient data. About 40% of participants were also concerned about HIPAA compliance and hackers getting to data.

Similarly, of physicians who opted not to purchase an EHR system, the top reason was that the technology would interfere with the doctor–patient relationship (40% of responses). The other most frequent complaints were that EHR systems are too expensive (37%), and that the incentives and penalties from the Centers for Medicare & Medicaid Services are not worth the hassle of adopting a system (32%). Other reasons were that EHRs hurt patient privacy (22%) and were too complicated to learn (16%).

The financial burden of EMRs appeared to be increasing as well. According to the Medscape survey, in 2014, 23% of respondents said their EHR system cost $50,000 or more per physician to purchase and install, whereas in 2012, only 7% of respondents said their EHR system cost that much. Another report that evaluated the cost of EHRs, using survey data from 49 community practices in a large EHR pilot project, found that “the average physician would lose $43,743 over five years; just 27% of practices would have achieved a positive return on investment; and only an additional 14% of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive” (Health Aff 2013;32:562-570).

Currently, Dr. Kim said, the federal government is forcing institutions to have an EMR system, which is driving many physicians out of business and into a hospital on a salary or into retirement.

“Besides the cost of implementation, evidence already is accumulating that doctors order more—not fewer—imaging studies when [an] EMR is used,” wrote David Cossman, MD, a vascular surgeon in Los Angeles, in a 2012 piece in General Surgery News (May 2012, page 1).

As for billing, Dr. Voeller noted, “the way we bill through EMRs lends itself to fraud because physicians can document more complex visits that come with a higher price tag and reimbursement.”

Amid the confusion and ambivalence, some surgeons are holding out hope that as companies iron out the kinks in the current systems, EMRs may eventually live up to the early hype. Others remain skeptical that there is a magic bullet that will vastly simplify and improve EMRs.

Reflecting on the current state of the technology, Dr. Cossman wrote: “The big problem is that HAL [the sinister computer in Stanley Kubrick’s film “2001: A Space Odyssey”] is once again stalking us with the sweet siren song of untold efficiencies, cost containment and protection from human fallibility if we only move over to the passenger seat and let it drive. Don’t believe a word of it. Medicine cannot be practiced on autopilot. We will crash and burn without the human touch at the controls.”

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Debating Viability of Universal Electronic Health Record |

Debating Viability of Universal Electronic Health Record | | EHR and Health IT Consulting |
How possible or impossible is the idea of having a universal electronic health record in the US? Our readers highlight the health IT obstacles in the way.

In concept, a universal electronic health record would eliminate many of the obstacles in the patient’s path along the care continuum. Such an idea, however, is not reality.

In searching for a solution to fragmented healthcare, the authors of a recent Harvard Business Review article pointed to the lack of a universal EHR as one factor in the way of integrated healthcare in the United States.

“The lack of a single health record for each patient that clinicians from all specialties can access in both inpatient and outpatient settings is an obstacle to integrating care. In addition, patient privacy protections inhibit the sharing of health information, creating both perceived and real hurdles,” wrote Institute for Healthcare Improvement and Weill Cornell Medical College’s Kedar S. Mate, MD, and the Permanente Federation’s Amy L. Compton-Phillips, MD.

The following question about universal EHRs was put to our audience: How possible or impossible is the idea of having a universal electronic health record in the US?

Three of our readers offered their insight into answering that question and their feedback providers more detail about the factors contributing to fragmented health data, highlighting how health data and privacy make the concept of a universal EHR highly unlikely.

The first set of comments comes from the head of a health IT privacy and security consultancy who recalls the work of the Nationwide Health Information Network and its inability to resolve interoperability after ten years of work:

I don’t think we’ll see anything like a universal EHR for the US for some time if ever. You have a significant number of vendors out there who would oppose this and may even call it a monopoly unless it was run by the government. At this time I really don’t think an EHR run by the government would be very popular with the voters in this country.

What I would settle for is true interoperability which we are a ways from. About 10 years ago ONC sponsored the Health Information Security and Privacy Implementation Collaborative which lasted for about three years. That was at the same time a fair amount of money and effort was being spent on building NHIN. It’s 10 years later and we still haven’t seen much progress on that front.

These comments were echoed by another health IT privacy and security consultant who highlighted the potential of local health information exchanges to make up for the lack of a national HIE infrastructure:

NHIN was about the only program I’d get behind, but it languished due to bureaucratic obesity. Too many consultants hired solely to work that project. Regional HIEs connected together would work, but the privacy implications in our government today worry me. Lots.

The last set of reader comments placed the concept of a universal EHR in the context of federal and state health IT regulations and policies (i.e., the requirements on covered entities and business associates under HIPAA) that continue to place limits on HIE, intentionally and unintentionally. These comments come from a regional health IT director with experience working with state HIEs:

Unfortunately some providers still see information as patient ownership. But the consumer will go to the provider that takes their insurance. Sharing that information between providers isn’t just required under MU it’s the morally right thing. I’ve seen and helped build numerous regional HIE and the amount of resistance regarding what to share and how much to share drives me crazy.

As for privacy, it’s bad enough that the consumer doesn’t fully understand HIPAA but providers still struggle with interpretation of the regulations. That struggle will continue as long as the OCR and HHS struggle with the “gray areas” left to the interpretation of the CE and BA.

Improved technical security is just a small part of the solution. The key was, is and always will be the policies, procedures and administrative piece of HIPAA. I’d venture to say most breaches in the past and most to come will be the result of provider employees failing to follow their training or choosing to intentionally ignore the patient right to medical and financial privacy.

Integrated is the focus of most current attempts at healthcare reform, but up to this point regulation and infrastructure have yet been able to work well together. As the comments from our readers clearly suggest, the resolution to interoperability is unlikely to come from those incapable of seeing the barriers in its path.

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Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR

Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR | EHR and Health IT Consulting |

I think we could broaden the question even more and ask if any EHR vendor has really fostered healthcare innovation. I’m sorry to say that I can’t think of any real major innovation from any of the top hospital EHR companies. They all seem very incremental in their process and focused on replicating previous processes in the digital world.

Considering the balance sheets of these companies, that seems to have been a really smart business decision. However, I think it’s missing out on the real opportunity of what technology can do to help healthcare.

I’ve said before that I think that the current EHR crop was possibly the baseline that would be needed to really innovate healthcare. I hope that’s right. Although, I’m scared that these closed EHR systems are going to try and lock in the status quo as opposed to enabling the future healthcare innovation.

Of course, I’ll also round out this conversation with a mention of meaningful use. The past 3-5 years meaningful use has defined the development roadmap for EHR companies. Show me the last press release from an EHR company about some innovation they achieved. Unfortunately, I haven’t found any and that’s because all of the press releases have been about EHR certification and meaningful use. Meaningful use has sucked the innovation opportunity out of EHR software. We’ll see if that changes in a post-meaningful use era.

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People Aren't Perfect and EHRs Can't Change That | Physicians Practice

People Aren't Perfect and EHRs Can't Change That | Physicians Practice | EHR and Health IT Consulting |
George W. Bush got one thing right and one thing wrong. He was right when he announced that he was "The Decider." He was wrong when he chose where he would get the information on which to base his decisions. He understood that he could never know everything about everything, therefore it didn't really matter if he knew nothing about anything, as long as he could apply his instincts for deciding to knowledge that was supplied and explained by others.

Keep that in mind while we think about healthcare practitioners. Being human, there are two things about which you can be sure:

1. People can't perform an operation flawlessly, in precisely the same way time after time after time; and

2. People can't keep track of (remember) all of the things that hallucinating managers and regulators think that they should.

It's just the way human brains are constructed. It may not be what anyone wants to hear, but it's a fact and no amount of wishing will alter the facts.

So, the worst thing that an EHR can do is to add to the number of procedures that people must perform flawlessly and the number of things that they must remember to do. Being the worst thing possible, that is, of course, exactly what most of them do do (and why some think that they are do-do).

Computer systems will never make good deciders and people will never make good robots.

For an EHR to be useful, it should focus on documenting events, keeping track of work in progress, and alerting people in useful ways when new information becomes available that might require a decision. Then it should present that new information, in context, so that people can make the best decision possible.

When the available information is skewed, biased, incomplete, or just plain wrong, bad decisions will be the result. When information that could be available is not available, the decisions that get made will be a total crap shoot.
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ONC Should Decertify Products that Block EHR Interoperability |

ONC Should Decertify Products that Block EHR Interoperability | | EHR and Health IT Consulting |
Congress attempts to further EHR interoperability by asking the ONC to decertify EHRs that don’t meet data sharing standards.

Congress has instructed the ONC to “take steps” to decertify EHR products that actively block the sharing of information or the interoperability of health IT systems in the 2015 omnibus appropriations bill.  The $1.1 trillion spending bill, which has a number of health IT implications, asks the Office of the National Coordinator to ensure the integrity and value of the Certified EHR Technology (CEHRT) program to healthcare providers and to the taxpayers whose dollars are invested in the EHR Incentive Programs.

The language in the bill firmly directs the ONC to meet Congressional expectations about the future of interoperability in the healthcare industry.

“The Office of the National Coordinator for Information Technology (ONC) is urged to use its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers,” Congress says.

“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”

This is not the first time that questions have arisen about the seeming laxity of some provisions of the EHR certification requirements.  Earlier this summer, the Health IT Now Coalition posed the same query to the ONC: if federal and industry roadmaps focus so sharply on the need for widely-adopted data standards, health information exchange, and the fluid transfer of data across the healthcare continuum, why are providers still being encouraged to purchase EHR software that doesn’t allow them to achieve these goals?

“Taxpayers have paid $24 billion over three years to subsidize systems that block health information in a program Congress created to share health information,” said Joel White, Executive Director of Health IT Now, at the time.  “We call on HHS and Congress to use their authority to investigate business practices that inhibit or prohibit data sharing in federal incentive programs. We also call on HHS to work to decertify systems that require additional modules, expenses, and customization to share data.”

While the omnibus bill may have done little to satisfy critics on either side of the aisle, the Congressional injunction to speed interoperability by withdrawing certifications from EHRs based on closed, proprietary technologies may go a long way towards cheering up health IT pundits over the holiday season – even if it brings no small amount of anxiety to the healthcare providers who have already invested heavily in EHR technology that may come on the certification chopping block.

If a number of products are decertified, will the ONC provide any type of compensation for healthcare organizations that will be required to purchase new technologies in order to continue to meet meaningful use criteria?  Will those organizations be eligible for extensions or exemptions as they try to adopt new software and reengineer their processes accordingly?  How will significant changes to the certification process affect the timelines for Stage 3 of the EHR Incentive Programs?

Congress has asked the ONC to produce a report on the interoperability landscape, the challenges to industry-wide data exchange, and its plans to retool the certification process, in which some of those answers may be revealed.  “The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee,” the omnibus says, and must be delivered no later than 12 months from now.

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As Adoption Slows, the Market Must Embrace EHR Interoperability |

As Adoption Slows, the Market Must Embrace EHR Interoperability | | EHR and Health IT Consulting |

While medicine is a field focused on helping and healing, at the core of every major industry lies a cold, hard truth: money must be made in sufficient quantities to develop new products, satisfy investors, and employ staff. For many years, EHR vendors have worked to satisfy both sides of the equation, delivering health IT that improves care quality while carving out profits in a market that saw sudden, explosive growth after the EHR Incentive Programs debuted in 2009.

But as EHR adoption and purchasing has started to slow due to the impending saturation of the first-time buyer’s market, vendors are becoming slightly more creative in the way they keep their coffers full, and that often comes at the expense of cash-strapped healthcare providers who are now tied into using EHRs to meet federal expectations. Even though interoperability is becoming an increasingly important part of the EHR landscape, there is an inherent tension in the industry between the adoption of interoperable data standards that promote sharing and the vendors who wish to ensure the loyalty – and continued payments – of their customers.

As the health IT ecosystem matures and providers begin to leverage their data assets in different ways through the growth of analytics and ancillary systems, some EHR vendors have decided to make the storage, transmission, and use patient data into an asset of their own. While the question of data ownership is not a new one, the focus on industry-wide EHR interoperability thanks to efforts from the ONC and other organizations is placing renewed scrutiny on how vendors keep healthcare providers on a short leash by using fees and pricing scales to tie up patient data in inventive and potentially counterproductive ways.

“The vendors are very aware of the way the fees and complexity affect this move towards EHR interoperability,” says Justin Lanning, Senior Vice President and Managing Director of Analytics at Xerox Healthcare Provider Services, and there are few restrictions on the federal side related to how vendors can structure their fees, upgrades, and caveats.

“Sometimes hospitals, even the bigger ones, have to pay thousands of dollars for data sharing capabilities to be turned on or supported.  That can be a significant challenge for some organizations.  I believe it is key for us to assure that the systems already purchased and invested in provide interoperability as part of the system, and not at extra extraneous fees or complexity.”

“Everybody can go get certified, [through the ONC] and they can get certified by module,” Lanning explains. “But the certification process isn’t robust enough. It just doesn’t require enough to get recertification. And then once you get that certification, there’s no part of it that says you have to sell your modules individually. If a vendor collects a certain amount of data, and I show that they can integrate functions just fine with their own CQM module, they can get through certification.”

“But then the vendor can go to a hospital and say, ‘Here’s your EHR and it’s extra for the CQM module. It’s all certified.’ And the hospital says, ‘Well, I don’t want to use your CQM module. I want you to exchange data with this other CQM vendor.’ The vendor will come back and say, ‘We can’t do that unless you buy our CQM module first and they we will exchange data with the other CQM vendor.’ That doesn’t make any sense at all, but since there are no restrictions preventing this behavior that’s how they bundle their capabilities. So we’ve got to work that out.”

Despite a continued interest in EHR replacements that is driving a significant portion of sales as organizations seek to install software that will help them through Stage 2 of meaningful use, EHR vendors that grew rapidly over the past five years need to maintain a certain level of income from their customers if they are to stay afloat.

“With the billions of dollars we have invested privately and as a government with taxpayer dollars to improve the electronic foundation of our healthcare management systems, most of the US market has already made their choice on their long-term EHR partner,” says Lanning. “We likely won’t be seeing big shifts of US based hospitals changing their EHR systems over the coming years. Rather, we are entering a time in the US market of focusing on improving and integrating our existing systems. As we are seeing with many of the public and private EHR companies, a lot of their big growth opportunity will come internationally when it comes to new system sales.”

Some vendors are seeing the business potential in interoperability by joining organizations like the CommonWell Alliance, which is turning data sharing into a saleable service, or working together on the Argonaut Project in response to recent recommendations to the ONC. Surescripts is another health IT vendor that is seeking ways to pry a profit from encouraging health information exchange, and a number of HIE organizations on the local or state level are also striving for similar results.

The ONC and Federal Trade Commission (FTC) recently stated their belief that competition among EHR vendors will eventually lead to interoperability instead of the opposite, as the free market tips the vendor community into giving providers what they want: the ability to seamlessly and affordably exchange vital health information with partners across the care continuum.

“I do feel we need to shift, at this point, from thinking vendors growth will come from charging and often over-charging for many different areas of system functionality and integration that should simply be a part of these expensive systems,” Lanning said. “Some vendors feel that by making it harder to integrate with other vendors, health systems will choose to spend their money on all of the other little things they need to with the same vendor. But health systems are beginning to demand the integration for the flexibility they desire, and we must respond as a market.”

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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 |

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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Bright Futures VisitPlanner iPhone and iPad medical app review

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

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

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

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

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

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

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

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

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

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OMB Reviewing Proposed Stage 3 Meaningful Use Requirements |

OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | | EHR and Health IT Consulting |

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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EHR Requires You to Reconsider Your Workflow

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

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

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

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

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

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

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

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What are the Benefits of EHR

What are the Benefits of EHR | EHR and Health IT Consulting |

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

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

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

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

Lesa Moore's curator insight, January 3, 2015 11:36 AM

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

Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR

Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR | EHR and Health IT Consulting |

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.

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Does your EHR meet your organization's unique needs? | Healthcare IT News

Does your EHR meet your organization's unique needs? | Healthcare IT News | EHR and Health IT Consulting |

Different healthcare specialties have different electronic health record (EHR) requirements as there is significant variation in care processes, clinical content and decision support across care settings. For example, a primary care facility’s EHR “must-haves” are dramatically different from those of outpatient surgery center. While the primary care provider sees many patients for a variety of reasons, the surgery center delivers more focused, predictable and short-term care with unique workflow requirements. In the same vein, an ophthalmology practice requires technology to capture data from a number of instruments—often more than many other specialties. Likewise, a dermatology provider often completes numerous procedures in one visit, and an inpatient behavioral health setting with group counseling demands yet another approach to capturing and collecting patient care information.

Despite their diverse EHR needs, there is a commonality among these and other medical specialties: each requires a robust EHR that enables providers to easily gather data, completely and accurately document care, smoothly share information and facilitate good communication to achieve the best patient outcomes. To select the right EHR, specialty practices must fully appreciate how the technology addresses their particular needs and requirements.

Five considerations for selecting a specialty-focused EHR

Verifying that an EHR has the features clinicians need to provide care and manage patients is critical to its success. The following five considerations can guide a practice when evaluating an EHR to ensure the technology meets the organization’s clinical and business specifications, strengthening care delivery while safeguarding the practice’s future.

1.    The right content. The first step—and probably the most important—is to look at the depth and breadth of content the solution provides and make sure it fully aligns with the specialty’s requirements. This becomes more complex for a subspecialty. For example, an EHR with strong cardiology features may not meet the distinct needs of a pediatric cardiologist. In these cases, it is also important to select an EHR that can be supplemented with additional subspecialty information to better meet their needs.

2.    Configuration flexibility. When specialty practices can easily configure their EHR to reflect workflow nuances, they can optimize data capture, streamline care and improve outcomes. The EHR should allow physicians to easily configure their own templates, yet provide consistency to maintain a high standard of care. For instance, an OBGYN facility needs EHR flexibility for visits ranging from prenatal care and reproductive endocrinology to annual wellness exams. Physicians should be able to customize these forms to match workflow, yet maintain alignment with ACOG (American Congress of Obstetricians and Gynecologists) standards.

3.    Smooth integration with current technology. Specialty practices often have more diagnostic equipment feeding data into the EHR than primary care practices. For example, an ophthalmology group may have as many as 12 different devices capturing and sending data to the EHR. Because of this, a practice should closely review how well a potential solution interfaces with the practice’s current technology, particularly focusing on how the EHR incorporates the disparate data into workflow. Specialties linked to a hospital or health system should also assess how seamlessly the proposed EHR share key information with the larger organization. Ideally this is bi-directional!

4.    Facilitates the patient experience. Patients can be nervous when they see a specialist, and this can be exacerbated if the physician is more focused on navigating technology rather than talking with the patient. By choosing software that enables patients, medical assistants, nurses and others to capture as much data as possible in the EHR before the doctor enters the room, a practice can allow the physician to focus on the patient’s particular care needs instead of looking at a computer screen to input routine data. Remember, a good EHR gives physicians the right information at the right time to come to the right conclusion while they are in front of the patient. In other words, it keeps the patient at the center of the experience.

5.    Strong, Forward-thinking vendor. Not all vendors are equal, and spending time comparing the various options is a valuable exercise. As part of the vetting process, practices should gauge a vendor’s commitment to their specific clinical specialty and learn about plans for future technology development. In addition, consider the vendor’s organizational and financial strength to sustain the cost of supporting the specialty into the future and keeping up with regulatory compliance.

Although specialty practices have historically avoided jumping feet first into EHR technology, this is no longer an option for organizations that want to sustain and build referral volumes. In fact, by selecting and implementing a tool that consistently captures and shares specialty-focused data, providers can position themselves as the expert of choice for both peers and patients.

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Ingredients to a Successful ICD-10 Implementation - HITECH AnswersHITECH Answers

Ingredients to a Successful ICD-10 Implementation - HITECH AnswersHITECH Answers | EHR and Health IT Consulting |

Have you ever thought about just how many moving parts there are in an ICD-10 implementation? The whole process can seem overwhelming to a practice and as a Practice Management/EHR vendor who needs to understand all of these different pieces, we’ve found that the best way to approach this is by breaking down the implementation into three main ingredients: People, Processes & Technology. So what do these mean, what’s your role and how do you formulate a plan for ICD-10 success?

People – Because a successful ICD-10 implementation affects all departments in your practice, awareness, preparation, testing and training should already be well underway. Medical coders and physicians aren’t the only people who require high ICD-10 competency. The key to preparing your entire staff for ICD-10 readiness is identifying what training is required by role, who conducts the training, budgeting for training costs and downtime, timing and finally, ensuring staff is adequately prepared and capable. ICD-10 readiness should include regular communications with management, IT staff and clinical staff about new procedures and new or updated software such as Practice Management and EHR systems. Staff also needs to be able to handle new requirements and forms, such as paper superbills, as part of the new billing, claims and documentation procedures.

Processes – The impact of ICD-10 on practices can vary depending on specialty, patient mix, top diagnoses and payer mix. Solo and other small practices will typically have greater risk and deeper impacts due to fewer resources and available funds. Moving to ICD-10 will require tremendous effort and process coordination of nearly every workflow. Processes to manage 120,000 new codes in a way that allows simple, accurate look-up and application of codes requires collaboration across the practice – including your IT systems and people. Productivity standards may have to be redefined, requiring additional coding staff, existing staff may need to be retrained, and providers may need to change how they document with more detailed diagnosis information.

Technology – This is the backbone of a successful ICD-10 implementation and gives your practice, people and processes a foundation to guide your operations and improve coordination of benefits and care. When properly configured to an ICD-10 environment, technology can help ensure critical processes are performed – such as documentation, coding, billing and bi-directional data transmission – all while ensuring third-party integrations can do the same. As the ICD-10 crossover date approaches, the risk of having non-compliant IT systems grows exponentially. By paying close attention to your existing IT environment and examining it against changes required to accommodate new data, new workflows and potentially new people prior to implementation, you can greatly increase your ICD-10 readiness.

As you can see, we all have a responsibility to understand the ingredients that make up an ICD-10 implementation, which will increase our knowledge in these areas and in turn, reduce risk. Look for opportunities for training, industry webinars and vendor testing. Some vendors are even offering ICD-10 Risk Assessments to assist practices in understanding the impact of ICD-10 and providing recommended actions based on the assessment results. All of these opportunities will support the success of the People in your practice performing Processes that are supported by your Technology. When these three ingredients are understood, planned for and in sync, we’ll be able to achieve ICD-10 success together!

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EHR/EMR Workflow System Usability–Roots in Aviation Human Factors

EHR/EMR Workflow System Usability–Roots in Aviation Human Factors | EHR and Health IT Consulting |

You may have noticed aviation-inspired terms, illustrations, and ideas on the High-Usability EncounterPRO EMR Workflow System:

  • A pilot helped to design EncounterPRO’s user interface (UI).
  • EMR UI design is mimicking evolution from traditional cockpits to today’s glass cockpits.
  • The phrase EMR “rollout” derives historically from “rolling out” a new aircraft from its hanger for its first public viewing.
  • EncounterPRO’s Office View is like a radar view from an aircraft control tower, from where staff can see where everyone is and how long they’ve been waiting.
  • The illustration at the top of each fat footer sitemap is an aviation concourse.
  • Aviation human factors is an important subdiscipline within Industrial Engineering (which has many other useful applications within pediatric and primary care “production systems”).
  • Then, of course, there is that cool helmet with an EncounterPRO screen projected on its wrap-around visor.

What if I told you that EHR/EMR workflow systems:

  • Reduce workload and difficulty of carrying out the phases of a patient encounter.
  • Relieve physicians of having to perform repetitive sequences that are unrewarding and for which human beings in their inconsistency can be at their best or their worst.
  • Endow physicians with the gratifying part of their jobs: decision making.

It would be true, but I would be paraphrasing page 176 of the Handbook of Aviation Human Factors in which it says that designers of cockpit automation hope to:

  • Reduce workload and difficulty of carrying out the phases of the flight.
  • Relieve pilots of having to perform repetitive sequences that are unrewarding and for which human beings in their inconsistency can be at their best or their worst.
  • Endow pilots with the gratifying part of their jobs: decision making.

I’ve seen many EMRs over the years, some designed by physicians, some designed by programmers, and many  designed by both. However, a physician, a programmer, *and* a pilot designed EncounterPRO—and it shows.

Aviation human factors techniques and ideas about individual and team performance have been used to improve patient safety (for example), but less so for sheer high-performance effective and efficient EMR data and order entry.  Since World War II, the aviation industry has spent millions (perhaps billions) of dollars on aviation human factors research on the design of high-usability, high-performance robust avionics and cockpit management systems. Many aspects of traditional EMR design contradict  this accumulated knowledge and experience.

As a result, an EMR Workflow System looks and works differently from any other EMR of which I am aware. While I wouldn’t want to fly a plane using EncounterPRO as cockpit management software, of the hundreds of EMRs out there it would the most suited to the task. In fact, after one presentation, representatives from an aviation software company approached us to ask if we would consider adapting EncounterPRO to serve as a cockpit management program. Given EncounterPRO’s roots we were flattered and intrigued, even if we eventually decided to continue to concentrate solely on ambulatory EMR workflow automation.

My own MS in Industrial Engineering at the University of Illinois, Champaign-Urbana involved a year in both the aviation human factors and health systems engineering programs. (This was by accident. There was a research assistantship available to work on an aviation human factors research project.) Aviation and aerospace medicine intrigued me for a while, but I decided that health care workflow was an even more target rich environment. Ironically, several years later I wrote natural language processing grammars for the Pilot’s Associate project (where I faced the truth of a popular linguistic proverb: All grammars leak.)

I had the enjoyable experience of hanging out with a sizable community of aviation human factors graduate students (both from IE and from other graduate departments such as psychology). That’s where I learned about the Fitts and Hicks laws that I discussed in the Cognitive Psychology of Pediatric EMR Usability and Workflow. I also bumped into an idea that has stuck with me since.

For each of the effects of the normal aging process–

  • vision decline,
  • hearing loss,
  • motor skill diminishment, and
  • cognitive decline

–there are a set of design principles and assistive technologies that address environmental challenges causing similar decreases in skilled performance.

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The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting |
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data. One way to bridge this gap is through standardized role-based education.

Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort. Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT. As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.
Fiona Ehret-Kayser's curator insight, December 23, 2014 3:28 PM

This is a really interesting take on the use of data in a patient's records. I wonder if ...?!

Four Ways Your EHR Can Improve Patient Engagement | Physicians Practice

Four Ways Your EHR Can Improve Patient Engagement | Physicians Practice | EHR and Health IT Consulting |
EHRs are often blamed for a decline in patient interaction, as some physicians are forced to spend more time looking at their screens and less time making eye contact with their patients. However, if leveraged properly, EHRs can actually allow for more effective interactions with patients during visits. The result will be a more collaborative form of care.

Here are four specific ways that physicians can use EHRs to enhance patient engagement:

1. Take advantage of your patient portal.

The patient portal can play a big role in increasing patient engagement since it is a secure repository and communication tool for a practice. It is a tool that both physicians and patients can actively use for sending/receiving reminders for preventative or follow-up care, sending patient education materials, receiving patient questions and requests, scheduling/changing appointments, and more.

A patient portal can be extremely beneficial to patients because it allows them to actively manage their care and can also help solve their common pain points. For example, getting lab results has traditionally been a tedious process, but the ability to access results on-demand through a portal can be a huge time saver for patients.

2. Leverage solutions that extend your EHR capabilities.

There are various forms of technology that can help physicians achieve a higher level of patient engagement, working in conjunction with your EHR, such as interfaces connecting to other products or solutions.

John SquireJohn Squire For example, using speech recognition software can increase the speed and accuracy with which patient records are created. As a result, physicians have more time to interact with patients in the exam room during visits. According to a 2014 Medscape EHR report, 70 percent of respondents said their EHR "decreases their face-to-face time with patients." Leveraging speech recognition software can allow physicians to directly combat this common barrier.

Laboratory, radiology, and medical device interfaces can also help support patient engagement — these interfaces allow physicians to automate their work flow, and import results into patient portals for patients to access at their leisure. Additionally, there are features built into many EHRs that physicians can leverage to encourage patients to be more proactive in their healthcare, such as reminders, clinical decision support alerts, a report writer, etc.

3. Empower patients through visual display data.

Another common pain point for patients is the amount of time physicians spend typing, touching, and looking at the computer screen during visits. One easy way to remove the barrier of the computer screen is by involving the patient through visual display of their data in the exam room. Visual integration connects patients with the process without them feeling overwhelmed.

Internist James Legan does exactly this in his practice by projecting Amazing Charts EHR from his laptop onto flat screen TVs in his exam rooms, inviting patients to view their medical charts, prescriptions, lab reports, radiology images, and more. "Most of my patients really enjoy seeing their BMI graphs, medical history, radiology images, and other medical information. It gets them more engaged with their own health," explained Legan.

Legan's approach is just one way to use visual integration of data to encourage patients to participate in shared decision making. Other solutions can be as simple as physicians sitting next to patients and sharing their screen.

4. Use the EHR for shared decision making and education.

Shared decision making involves physicians and patients determining the best care options together, rather than the clinician making care decisions for the patient. This modern approach of delivering care can play an integral role in patient engagement since it empowers patients to choose care based on their unique values and perspectives.

EHRs allow physicians to easily share their role in the shared decision-making process with patients by demonstrating the use of clinical decision support tools. EHRs can also make it easy for patients to review education materials along with their clinician, giving them a better understanding of their conditions and providing deeper insight into their clinician's recommendations than previously available. Many EHRs have a collection of educational materials physicians can access at a moment's notice and share with patients via patient portal or through printouts sent home with the patient.

Patients can play a role in optimizing their outcomes through activities such as identifying individual values, motivations, and health management skills prior to their next visit, reviewing literature provided via the EHR, and using the patient portal to communicate between visits.
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Effects of Interoperability on Health Data Privacy Policies |

Effects of Interoperability on Health Data Privacy Policies | | EHR and Health IT Consulting |

Interoperability enables healthcare providers to make the most well-informed decisions for individual patients, but it introduces the potential for sensitive patient health data to become compromised if the technologies exchanging information or the pipeline between these systems are unsecured.

“In terms of what I think some of those challenges are, it’s no big secret; we’re working on interoperability,” Lucia Savage, the new Chief Privacy Officer for the Office of the National Coordinator for Health Information Technology, recently told

“Of course there are the topics that have been well-discussed in the press, like data lock and all that stuff that have to with people’s proprietary systems,” she continued. “But what’s really more essential in the privacy and security realm is making sure people understand how are current legal and regulatory environment actually help support interoperability — right now, at this very moment in time.”

New models for care delivery (e.g., accountable care organizations) emphasize the need for interoperable EHR and health IT systems, added Savage. Interoperability, however, is limited to certain geographies and contexts. In short, there is tremendous room for improvement.

“For example, insurance companies contract with large systems to the ACOs. For that to succeed, just like the Medicare ACOs, data has to flow between the two parties,” Savage explained. “That data is flowing right now in some ways, and in some ways it could flow better and could make better use of the delivery system was built with the meaningful use incentive.”

According to the ONC’s Chief Privacy Officer, a lack of health information exchange (HIE) as a result of limited interoperability comes as a surprise to patients who “thought their doctors were doing this already.” And what is essential is that the healthcare organizations and providers, both private and public, make use of new forms of exchanging information while adhering to the privacy and security rules laid out by HIPAA.

“The HIPAA environment we have is perfectly designed for that. It’s media-neutral, meaning 20 years ago when faxes were new, that’s how the information started to move. Now the information is moving through other media but the rule hasn’t changed. We’re going to capitalize on that,” she maintained.

The next step involves the building of trust among providers and patients, which will come with time and use:

When we introduce a pretty significant technological innovation it takes optimally to breed trust. If through interoperability it facilitates physicians engaging their patients through electronic health record systems and the portal, and giving patients access, giving dialogue with patients about their data that they collect and share about themselves, then patients confidence in the system will grow because they’re using it too.

For the ONC, the path forward requires the federal agency to gather information and listen carefully to the insights of subject-matter experts so that the “potential benefits and the possible risks” of a fully interoperable, HIE-enabled healthcare environment are understood and incorporated into emerging and evolving regulation and oversight.

“Most of the people in the know understand well how HIPAA works for these big data analytics, but there’s new sources of data, whether its wearables or patient generated data or the way people want to take a healthcare transactional data and add data from public records systems to it for analytics purposes,” Savage said.

Not only is interoperability a challenge from the technology side of healthcare, but it also presents new challenges to health IT security and privacy.

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