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

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

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

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


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


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


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


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


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


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


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


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


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


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


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


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FDA Expands EHR Data Analytics with Active Surveillance System

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

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

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

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

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

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

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


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Drchrono uses Apple Touch ID to let doctors into electronic health record

Drchrono uses Apple Touch ID to let doctors into electronic health record | EHR and Health IT Consulting | Scoop.it

Apple opened up the Touch ID fingerprint reader to third-party developers when it released iOS 8, and some in the health care world are beginning to take advantage of it.

Drchrono, which makes an electronic health record optimized for use on iPads, has now used that capability to authenticate doctors into the patient record — and to keep unauthorized users out.

This may be part of a wider push by Apple to get iPhone 6s and iPads into the tech arsenals of enterprises like large medical groups and hospitals. The new iPad Air 2 and the iPad Mini 3 now come with Touch ID, as do the iPhone 5s, iPhone 6, and iPhone 6 Plus.

Where the medical record is concerned, the Touch ID button could be hugely effective in providing secure yet easy access. For care providers using drchrono, three taps will get them into the medical record. They rest their finger on Touch ID to get into the iPad, tap the drchrono EHR app, and then, when the app is open, they hit Touch ID once more to get into the EHR. They no longer have to enter a passcode.

“The amazing thing about Touch ID is that people sometimes forget password and PIN codes,” Drchrono COO and cofounder Daniel Kivatinos wrote on the company’s blog. “This changes the game even more … touch technology in health care.”


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Change is Coming: What to Expect in Health IT in 2015 -

Change is Coming: What to Expect in Health IT in 2015 - | EHR and Health IT Consulting | Scoop.it

In 2015, healthcare information technology will continue to drive towards solutions that respond to the industry challenges of providing increased quality of care at a lower cost in a changing regulatory environment. Providers must respond to declining reimbursement models, quality demands of consumers and payers, along with increasing EHR mandates. Payers are striving to align care and cost incentives across both providers and consumers. Consumers are being asked to bear more of the cost of care and in the process are becoming more price sensitive, quality aware, and more personally responsible for their own care.

In support of these goals, the macro-level trends will be on continuing the significant support for Electronic Health Record systems, providing actionable analytics, and improving the infrastructure. For health IT in 2015, these macro-trends will result in a healthcare industry focus on the following areas:

  1. EHR On-going Upgrades, Enhancements and Support: These costs have become so high and ubiquitous that are not often regarded as trend, but it is a trend that will continue
  2. Meaningful Use: Responding to the next level of Meaningful Use requirements and the ability to better respond to Meaningful Use Audits will also be required
  3. ICD 10 Compliance: Compliance with ICD 10 can be expected to finally arrive in 2015, and   investments will be needed to updating the update systems and develop more specific reporting that ICD 10 will allow
  4. Data Interoperability: Increasing the ability to collect consistent, timely, meaningful and trusted data across diverse sources (e.g., clinical data systems, claims data, operational data) will increase the ability to provide improved quality and lower costs, and the increased data interoperability will be leveraged in systems used by providers, payers and consumers alike.
  5. Clinical Decision Support: Providers (and Payers) will be driving improvements in evidence-based care, predictive outcomes and risk management
  6. Operational Decision Support: Operational decision support will be required to provide better insights into care delivery processes, into the total cost of care at a patient and procedure level, into operational costs and into consumer factors affecting the cost of care
  7. Security: An on-going threat across all industries, maintaining security of Personal Health Information will require increased vigilance. As health information and operational systems become more interconnected the security challenges and risks become exponentially greater.
  8. Cloud: Data center management need not be a core competency in healthcare. More and more organizations will realize others can better manage their data and systems at a lower cost, and integration between on-premise and cloud-based systems will become more common.
  9. Patient Portals / Engagement / Mobile User Devices: Payers, providers and consumers have incentives and interests to leverage technologies that will help to better manage consumer health (e.g., chronic conditions, post-acute care, overall wellness, etc.) and associated costs.  Personal health monitoring devices are becoming more sophisticated and consumers are largely willing to share this data with their provider.
  10. Tele-health: Tele-health has the ability to provide more immediate care, especially for those in rural areas and where cost pressures have decreased the availability of more local providers.  Tele-health will be see increasing use for non-acute and follow-up appointments.

The one constant in the healthcare industry for the foreseeable future will be change. Supporting that change will be ever more sophisticated technologies that will completely change the provisioning of healthcare as we know it today. The trends above will be realized in different ways and times by different organizations, but all healthcare organizations will need to adapt in order to survive into even the near future.



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The Benefits of Electronic Health Records

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

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

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

Financial Benefits of Electronic Health Records (EHRs)

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com

EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
EHR quality reporting led to $4.9 million in ACA awards to 332 health centers.

The Department of Health & Human Services (HHS) has rewarded the quality improvement efforts of health centers with $36.3 million in Affordable Care Act (ACA) funding.

“This funding rewards health centers that have a proven track record in clinical quality improvement, which translates to better patient care, and it allows them to expand and improve their systems and infrastructure to bring the highest quality primary care services to the communities they serve,” HHS Secretary Sylvia M. Burwell said in an official statement.

The rewards spans four distinct kinds of quality improvement achievements.

The first award went to 361 health centers and totaled $11.2 million for health center quality leaders, those clinical settings scoring in the top 30 percent of all health centers based on best overall clinical outcomes.

The second award of $2.5 million rewarded 57 national quality leaders for surpassing national clinical standards for chronic disease, preventive care, and perinatal/prenatal care.

Clinical quality improvers — demonstrated at least a 10-percent improvement in clinical quality measures between 2012 and 2013 — were recipients of largest sum of awards, $17.7 million. The award goes to 1,058 health centers.

The last category of awards recognized 332 EHR reporters which received $4.9 million for reporting clinical quality measures (CQMs) for their entire patient population.

According to the Health Resources and Services Administration (HRSA), ACA-established Health Center Program comprises close to 1,300 health centers operating in more than 9,200 delivery sites in all 50 states, the District of Columbia, and US territories and treating approximately 21.7 million patients.

The ACA earmarked $11 billion to be disbursed over a five-year period to support the creation, expansion, and operation of health centers.

In the past year alone, 43 Health Center Controlled Networks received $21 million in rewards specifically for EHR adoption and meaningful use with requirements to “include at least 10 Health Center Program grantees and overall will provide support to more 700 health centers nationwide.”

In a recent brief, the Office of the National Coordinator for Health Information Technology (ONC) demonstrated that incentive dollars and looming financial penalties are driving EHR adoption and meaningful use.

The chance to benefit from tens of thousands of dollars from the EHR Incentive Programs was cited as a major influence for 62% of physician providers participating in the 2013 National Ambulatory Medical Care Survey Physician Workflow Survey. Another major factor were the ONC-funded regional extension centers whose availability during Stage 1 Meaningful Use and beyond influenced 35 percent of respondents to adopt a certified EHR technology and demonstrate meaningful use as part of the EHR Incentive Programs.

The major takeaway from the HHS and ONC announcements is the integral role health IT-related funding in the form of incentives or awards plays in transforming the care delivery and coordination through the innovative use of technology.



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