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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Addressing Health Data Sharing Risks

Addressing Health Data Sharing Risks | EHR and Health IT Consulting | Scoop.it

As healthcare organizations step up their efforts this year to exchange more patient data with others to help improve care, it's urgent that they address the "significant risks" involved, says Erik Devine, chief security officer at 370-bed Riverside Medical Center in Kankakee, Ill.

The Office of the National Coordinator for Health IT, the unit of the Department of Health and Human Services that oversees policy and standards for the HITECH Act electronic health record financial incentive program, later this month expects to release a final draft of a "10-year roadmap" that includes an emphasis on the interoperability of EHR systems, paving the way for nationwide secure health data exchange. This comes as Congress is demanding more scrutiny of EHRs that "block" interoperable health information exchange, impeding efforts to improve access to data to boost care quality.


An important question that healthcare organizations need to ask as health information exchange gains momentum, Devine says in an interview with Information Security Media Group, is "Are we prepared to manage all the information that's flowing in and out of the system?"

To help defend against the increased risk of breaches during health information exchange, Devine says it's vital that healthcare providers use "very strong encryption methods for data in transit and at rest."

Plus, data needs to be inaccessible to anyone who doesn't need to access it "at every level, from the provider, to the healthcare information exchange steward, to the data that's sitting on the servers in the data center at your hospital. That is key for HIE to be successful," Devine stresses.

Healthcare organizations need to step up their defenses as they ramp up information exchange locally, regionally and nationally because "it's not going to be rocket science for [bad actors] to take this data," Devine says. "They're going to find vulnerabilities in these systems, they are going to find vulnerabilities in process or workflow, including a simple social engineering attack."

In the interview, Devine also discusses:

  • Advanced persistent threats facing healthcare, as well as the threats posed by employees and business associates;
  • The challenges involved with securing applications;
  • Riverside's top information security priorities and projects for 2015;
  • How his new position teaching computer science at a local university will potentially help him tap new talent and ideas for his organization.


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Scanning Medical Records and Keeping Your Practice Digital - HITECH AnswersHITECH Answers

Scanning Medical Records and Keeping Your Practice Digital - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

In my previous scanning post we discussed the important role scanning documents plays in a successful EHR implementation. Moving from paper to electronic medical records takes a plan to know what you want to migrate from your files to your computer. But what about after your implementation and now in your daily workflow? Does scanning have a new role? Practices and hospitals alike find that while going digital helps to lessen the paper flow it still doesn’t eliminate it. There will always be something that might be acquired on paper. And when that happens, it is important to scan the document and be sure it gets included in a patients record.

Having scanning stations that are available and easily accessible for use will help integrate scanning needs into your workflow. If the scanner is off in a workroom or administrative office, it is more likely the task will be overlooked or put off in a to-do pile. Consider more than one scanner depending on your physical layout and system workstations.  Here are some areas where you might continue to see documents for patients in paper form and should be included in a patient’s electronic record. Where is this paper being collected and how can it get scanned into your system most efficiently?

  • New patient admissions and history forms
  • Capture ID and insurance card images
  • Referrals sent from other physicians
  • Medical Orders
  • Patient submitted history records
  • Patient submitted lab or procedure results
  • Consent forms
  • Payer EOBs or denial and resubmit documentation

Practices should also remember their overall business and consider digitizing all areas not just patient records. Human Resources is a big paper department with employee records and files. There are a lot of forms that start on paper for the simple fact of collecting signatures. Are you still keeping all this information in file cabinets? Consider digital employee files and scan the documents for electronic retrieval and storage.

Is your practice still using paper log sheets for medication dispensing and inventory reconciliation? Are you still using a paper sign-in sheet for patients when they arrive? Are you still receiving paper faxes for business or patients? Evaluate all the paper processes and consider a solution to convert to electronic or continue and store by scanning the documents. Benefits to electronic documents range from ease of ability to retrieve and share to simply eliminating the physical storage needs of paper documents.



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

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

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

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

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


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


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Stage 3 Meaningful Use proposals at White House for final review

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

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

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

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

“We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients. Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements,” CMS states in a rule summary on the OMB site.

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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


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How Innovative EHR Use Supports Care Quality Improvements | EHRintelligence.com

How Innovative EHR Use Supports Care Quality Improvements | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Care quality improvements through innovative EHR use are front and center at University of Missouri (MU) Health Care. Over the past few years, the organization has climbed the rankings awarded by the University HealthSystem Consortium (UHC) and now is one of a dozen academic medical centers to receive a Quality Leadership Award in 2014.

According to the head of the organization, MU Health Care owes much of its progress to its work through Tiger Institute for Health Innovation, a private/public partnership between the University of Missouri and Cerner Corporation.

“So much of the EMR is documentation, patient safety, etc., so our ranking and technology use are closely related and correlated,” MU Health Care CEO & COO Mitch Wasden, EdD, tells EHRIntelligence.com. “Three years ago we were 56 out of 141 academic medical centers, last year we were 27th, and this year were 9th.”

Several years ago, MU Health Care took a risk, albeit a calculated one (given the nature of the Tiger Institute), in choosing to outsource their health IT services to Cerner, but it has quickly paid dividends.

“As a vendor, they know the development pipeline — they know what products they’re making that are going to dovetail nicely with other products — so when we talk about what we want to do strategically with IT, they know exactly what the timelines are and how it can happen,” Wasden explains. “In my prior life, I have been in organizations that had their own IT shops. I also have been in organizations that did outsource IT and it was a disaster.”

A major benefit of the partnership is the ability of MU Health Care to shift its workload from supporting EHR and health IT systems to developing innovative ideas for improving the use of these technologies.

“When you bring up ideas with Cerner, they’re thinking about the value to all their clients. They see it more as an opportunity, a living lab, they can glean ideas from. From an innovation standpoint, I have seen that the uptake on ideas is much quicker,” Wasden says.

As a result of this freedom to innovative, MU Health Care has created the Plan, Do, Study, Act (PDSA) Model that challenges members of the organization to come up with quality improvement initiatives as a means of addressing each of those categories that gained the recognition of the likes of UHC.

As Wasden reveals, each of the 5,500 employees at MU Health Care are required to participate in two quality improvement projects annually — a bottom-up approach. “Healthcare is changing so fast that we need people on the frontlines thinking about how to change workflows because senior management is not close enough to it. We’re not going to have all the answers,” he adds.

To support the program, MU Health Care set out to create a database uniquely designed to log and track the progress of these quality improvement projects over a period of three years. The first two years aimed to support the logging of these projects and their completion. The third year brought with it a dozen or more metrics for quantifying the effectiveness of all this work.

“We don’t want to just have activity; we want to have results. That’s our development plan so that we can start quantifying in total what the impact is,” Wasden maintains.

Next wave of care quality improvements

Moving forward, Wasden sees innovation focuses on three closely related areas all centered on patient engagement. For his part, Wasden has been an outspoken advocate of the patient portal as key player in aggregating patient health information. It is no surprise then that MU Health Care is putting all of its eggs in that basket.

“We have been pretty aggressive about patient portal. In the future it’s about migrating it to be more of a mobile platform. Today, we’re one of a few organizations where you can go on to hundreds of doctors’ schedules and book your appointment without any permission from the clinic,” Wasden reveals.

MU Health Care is preparing to expand those scheduling options to include electronic visits, either real-time videoconferencing with clinicians or asynchronous texting visits. Currently, the $40 service is in its pilot stage in three offices.

The next thing we’re going to allow you to do is book electronic visits — video or asynchronous texting visits — for $40. We’ve built it and are actually piloting it in three doctors’ offices.

Additionally, making the patient portal more robust will soon include giving patients access to registry data in order to view the status of their medical conditions. But the most significant addition to the patient portal is likely to be the use of a patient-facing dashboard for patients to see procedures based on their age, sex, and medical condition that they should complete in a given time period.

“In healthcare based on your age, sex, and medical condition, there are probably five or six things every year you should have done, but you’re just not tracking it,” Wasden explains. “We’re taking your age, sex, and medical condition and pushing to the portal the things you need to have done this year and click here to schedule. Now we’re showing to the patient the value of integrated medical care.”

Integration is the impetus behind the expansion of the patient portal at MU Health Care, a solution to fragmentation in care delivery. The organization is banking on getting patients signed up for and using the patient portal and aggregating disparate health data in one place. “When you look at this age of biometric data, we really think that your portal is going to become the aggregator,” says Wasden.


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