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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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Report: Epic, Cerner Leading “Next Wave” EMR Vendors

Report: Epic, Cerner Leading “Next Wave” EMR Vendors | EHR and Health IT Consulting | Scoop.it

Nearly half of large hospitals surveyed will be making a new electronic medical record (EMR) purchase by 2016, according to a recent report from the Orem, Utah-based KLAS research. Of those planning on making a change, Verona, Wisc.-based Epic and Kansas City-based Cerner are the leading contenders among EMR vendors.

KLAS interviewed 277 providers from large hospitals (200+ beds), which gave feedback on what vendors they are considering, why they are considering them, and what their timelines look like for making these purchases. The survey was good news for Epic and Cerner. Forty-six percent of those respondents who mentioned Epic and 23 percent who mentioned Cerner were leaning towards choosing them for their second EMR purchase. Next was McKesson and Meditech, with 19 percent each. At the low end of the totem poll was Siemens at 9 percent and Allscripts with 4 percent.

Furthermore, 79 percent who mentioned Allscripts said they were steering clear of the company and 82 percent said the same of Siemens. Siemens, McKesson, and Allscripts were the most likely EMR systems to be replaced by the providers. Not a single person with Epic plans on replacing that system.

“Where the last round of EMR purchases was fueled by meaningful use requirements and enticing reimbursements, this next round is being fueled by concerns about outdated technology and health system consolidation,” report author Colin Buckley. “This shift in focus will play a major factor in which EMRs are being considered.”

Integration is a huge reason why Epic and Cerner are doing well. KLAS says Epic is seen as safe due to “total integration” and reliable delivery. Cerner, too, is a market leader due to integration and expansive functionality. The only caveat to Cerner’s success is its revenue cycle stability. On the other end, Allscripts lack of integration has turned away buyers. Although, current customers are encouraged by the company’s change in management (Paul Black became CEO in late 2012) and acquisitions of Jardogs and dbMotion.


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Why Don’t 35% of Patients Know that Patient Portals Exist? | EHRintelligence.com

Why Don’t 35% of Patients Know that Patient Portals Exist? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Patient portals are becoming important tools for engagement and population health, but patients are largely unaware of the technology.

While patients are generally enthusiastic about viewing their EHR data and engaging with their providers online, a concerning number of patients are unaware of the possibilities of using a patient portal, finds a new survey from Xerox.  Among the 64 percent of patients who are not portal users, 35 percent did not know a portal was available to them, and 31 percent stated that their providers had never mentioned the technology to them.  Despite the widespread lack of knowledge, 57 percent of non-users said they would be more engaged and more proactive in their own healthcare if they had access to their data online.

“With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals,” said Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox. “Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way.”

The survey indicates a generation gap when it comes to how patients use online tools.  While baby boomers are more likely to view patient portals as a utilitarian feature by making appointments online (70 percent), refilling prescriptions (58 percent), and communicating through emails with their physicians (60 percent), millennials view portals as an informational hub.  Younger patients want to see personalized information (44 percent), tailored care plans, details about related services from their providers (44 percent), and industry news that might relate to their issues and concerns (23 percent).

Perhaps surprisingly, baby boomers, aged 55 to 64, were among the most frequent users of patient portals.  Eighty-three percent of this age group indicated that they already do or would be very interested in communicating with their healthcare providers through a portal.  Millennials were more likely to want mobile access to online tools, with 43 percent stating their preference for smartphone and tablet interfaces.

Providers can help to shape patient engagement – and help themselves to meet the 5 percent patient engagement threshold included in Stage 2 meaningful use – by taking the time to educate patients about their options and opportunities.  Reinforcing the idea of signing up for a patient portal account at multiple points along the patients’ journey through the office, from check-in to follow-up, can help to secure a patient’s interest.  And physicians themselves should take the lead, St. Claire asserts.

“Physicians just aren’t having that dialogue,” she said to HealthITAnalytics.  “When we look at some of the best practices out there, we see that having that conversation multiple times along the patient’s path through the office is most effective.  And we think having that conversation directly with their physician is going to be most important.  People really want to hear it from their physician, because they’re that trusted source.  Even as medicine is changing, having that talk with the physician is probably going to have the most impact.”



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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 | Scoop.it
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.

Conclusion
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.
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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 ...?

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

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

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

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

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

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

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

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

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


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CMS Provides Details about ICD-10 End-to-End Testing Weeks | EHRintelligence.com

CMS Provides Details about ICD-10 End-to-End Testing Weeks | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

With the deadline for physicians, providers, suppliers, clearinghouses, and billing agencies to apply to take part in the next wave of ICD-10 end-to-end testing, the Centers for Medicare & Medicaid Services (CMS) is providing a closer look at these ICD-10 preparation activities.

The application deadline for volunteer testers to participate in ICD-10 end-to-end testing between April 26 and May 1 is scheduled for January 9. Those who are already slated to participate in ICD-10 end-to-end testing next month do not need to re-apply.

“Approximately 850 volunteer submitters will be selected to participate in the April end-to-end testing,” the federal agency announced earlier this week. “This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers.”

After April’s testing week, physicians, providers, suppliers, clearinghouses, and billing agencies will have one final end-to-end testing week to be a part of between July 20 and 24.

In a list of frequently asked questions (FAQs) released alongside this call for ICD-10 end-to-end testing volunteer applications, CMS details components of the testing activities ranging from differences between types of testing as well as the data used during the testing process.  Here’s a sampling:

How is ICD-10 end-to-end testing different from acknowledgement testing?

The goal of acknowledgement testing is for testers to submit claims with ICD-10 codes to the Medicare Fee-For-Service claims systems and receive acknowledgements to confirm that their claims were accepted or rejected.

End-to-end testing takes that a step further, processing claims through all Medicare system edits to produce and return an accurate Electronic Remittance Advice (ERA). While acknowledgement testing is open to all electronic submitters, end-to-end testing is limited to a smaller sample of submitters who volunteer and are selected for testing.

Is it safe to submit test claims with Protected Health Information (PHI)?

The test claims you submit are accepted into the system using the same secure method used for production claims on a daily basis. They will be processed by the same MACs who process production claims, and all the same security protocols will be followed. Therefore, using real data for this test does not cause any additional risk of release of PHI.

Last month, American Health Information Management Association (AHIMA) and eHealth Initiative found that some healthcare providers still lacked ICD-10 testing plans as well as assessments of the impact ICD-10 implementation would have on their facilities. According to their findings, ten percent of organizations did not have a plan in place for conducting end-to-end testing, with 17% having no clear understanding of when their organization will be ready to begin ICD-10 testing processes.

The AHIMA-eHealth Initiative survey gives credence to claims from Workgroup for Electronic Data Interchange (WEDI) that the most recent ICD-10 delay will cause many providers to postpone their ICD-10 testing activities until 2015 with potentially costly effects.

“Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production. We urge the industry to accelerate implementation efforts in order to avoid disruption on Oct. 1, 2015,” WEDI Chairman and ICD-10 Workgroup Co-chair, said in September.

Physicians, providers, suppliers, clearinghouses, and billing agencies applying to be part of April’s testing week will receive word from their Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractors in late January.



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