EHR and Health IT Consulting
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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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Most doctors with EHRs still not taking advantage of their benefits

Most doctors with EHRs still not taking advantage of their benefits | EHR and Health IT Consulting | Scoop.it

Interoperability of medical records across physician offices remained elusive in 2015, according to the latest data reported out by the Centers for Disease Control.

About 8 in 10 U.S. physicians had an electronic health records system in 2015. One-third of these doctors electronically sent, received, integrated or searched for patient health information — indicating that most physicians still aren’t using EHRs to their fullest extent. These findings come from the NCHS Data Brief from the CDC, State Variation in Electronic Sharing of Information in Physician Offices: United States, 2015.. Only 9 percent of physicians took advantage of all four functions.

 

Full use of EHRs varies by state:

  • The percent of doctors who electronically sent patient health information to other providers ranged from a high of 56.3 percent in Arizona to a low of 19.4 percent in Idaho.
  • The percent of doctors who electronically received patient health data from other providers ranged from a high of 65.5 percent in Wisconsin to a low of 23.6 percent in Louisiana and Mississippi.
  • The percent of doctors who electronically integrated patient health information from other providers ranged from a high in 49.3 percent in Delaware to a low of 18.4 percet in Alaska.
  • The proportion of doctors who electronically searched for patient information from other providers ranged from a high or 61.2 percent in Oregon to a low of 15.1 percent in Washington, DC (the District of Columbia).

These data come from the 2015 National Electronic Health Records Survey which polled a national sample of nonfederal office-based patient care physicians between August and December 2015.

 

Health Populi’s Hot Points:  Most U.S. physicians have purchased, installed and are using electronic health records systems, driven primarily by financial incentives they’ve derived from the HITECH Act — part of the Stimulus Bill (more formally, the American Recovery and Reinvestment Act of 2009). Why was this part of the Stimulus package? The policy thinking was that health care costs in America were a key driver of the long-term deficit and so the U.S. health system had invest in the means to measure health spending and outcomes and then manage what we measure.

Without interoperability — that is, the ability to move data where it needs to go throughout the continuum of care and shared across providers who all serve the patient — we can’t fully measure, and thus manage, costs and quality for that N of 1 patient.

U.S. taxpayers have made the investment into EHRs for their doctors. But we’ve still miles to go before we see and benefit from the ROI from fully interoperable digital health records systems. There are promising technologies and standards beginning to be adopted by pioneering informaticists and healthcare systems — FHIR standards for innovating within the EHR environment, and APIs bringing patient-generated data to their personal health records. May 2017 be a new year for health data liquidity and sense-making out of EHRs

Technical Dr. Inc.'s insight:
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What Is Driving Claims in Healthcare about EHR Usability?

What Is Driving Claims in Healthcare about EHR Usability? | EHR and Health IT Consulting | Scoop.it

Over the past several months, healthcare association and industry reports have highlighted the importance of EHR usability to the success of healthcare organizations and providers providing efficient, effective, and safe patient care.

In 2014, the American Medical Association (AMA) released a new framework comprising a multitude of priorities for creating more intuitive (i.e., usable) EHR technology. Shortly thereafter, Frost & Sullivan published a report detailing how limited EHR usability was impacting healthcare CIOs and their organizations. Other research even indicated that an emerging EHR monoculture — that is, the dominance of a single EHR technology — might benefit EHR usability, interoperability, and innovation.

A leading health IT subject-matter expert, however, contends that much of the criticism of a lack of EHR usability could be missing the point.

“I am always very cautious about the whole usability conversation,” says Micky Tripathi, PhD, MPP, President & CEO of the Massachusetts eHealth Collaborative. “When you look at the vendor market there are thousands of them and even hundreds of the certified EHR vendors, and there is nothing in meaningful use or any government regulation that force them to have their products architected or engineered in a particular way.”

Obviously, regulation requires that certified EHR technology can perform certain functions, but it does not prevent EHR developers from coming up with innovative ways of doing say.

“In a free market essentially with lots of technology options and no barriers to entry, how is it that no one is making usable products and that we could make general statements about every one of those vendors aren’t doing this or that?” he asks.

A better explanation, claims Tripathi, is the fundamental concept of economics — supply and demand. “Technology is always going to reflect the underlying businesses. Maybe I’m too much on the free market side, but the supply side is going to reflect what the demand side is asking for,” he says.


In the context of healthcare, Tripathi calls to mind two forces at work in driving EHR design and usability to this point. The first centers on purchasing power, which in healthcare has historically been controlled by large institutions.

“One might be that users of the systems for a long time were large enterprises rather than small enterprises,” he explains. “That tends to dictate how software was being designed because it was the large enterprises primarily providing feedback — an institutional mode focused on routinized practices.”


Likely more important than the first is the immaturity of much of the EHR market. “There is a whole bunch of new vendors not tied to any of that legacy stuff. For me more than anything else, it is still early in our market cycle — that there is not enough market and user feedback yet to make the products better,” adds Tripathi.

And considering how long end-user feedback takes to become incorporate in new software, EHR adopters are more than likely playing a waiting game.

“If you don’t like your software either you can work with your vendor or it’s going to be a ten-year process to get that feedback back into the market,” Tripathi explains. “The only way to make EHR products more usable is to have more users using them. No one can architect a perfect system particularly for something as complex as this.”

What’s next in EHR design and usability

If current EHR technology is not meeting the needs of healthcare organizations and providers, then what does the future of EHR design and usability hold? According to Tripathi, three emergent trends are starting to gather momentum.

Given the growth of value-based care, EHR expansion to include population health and care management is the first:

We are already starting to see care management and population health types of applications that are considered bolt-ons to existing EHR systems if developed by a new or third-party vendor. Increasingly, you have Epic, Cerner, eClinicalWorks, and other vendors reaching up-market essentially to build their own kind of those abilities and functions and integrate them back into the standalone EHR experience so that users have one continuous experience even though it is spanning the spectrum of care.

Another entails a new but familiar approach at aggregating and displaying patient health data. “I imagine we would start to see is more of a Facebook-like experience to the extent that we will have different contributors to the patient record, including the patient ultimately, that will be seen more as an ongoing stream of those contributions that are both narrative and have the ability to be structured,” claims Tripathi.

The last and most promising is similarly a capability already in use in other information technologies, using metadata and tagging elements.

“Lastly, we’re starting to see some products that have more of that fluid experience similar to using a browser but also supporting more of a user-generated structure of data,” says Tripathi. “Rather than all your data being LOINC, coded, or pulled down from drop-down menus, you’re able to go through and tag different parts of the note that you define as a user. You can then perform searches, aggregations, or slicing and dicing — all of that — based on those tags.”


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83% of Physicians Are Resistant to Use EHRs for Clinical Communications

83% of Physicians Are Resistant to Use EHRs for Clinical Communications | EHR and Health IT Consulting | Scoop.it

83 percent of physicians expressed frustration using EHRs to support clinical communications due to poor EHR interoperability, limited EHR messaging capabilities and poor usability that makes it difficult to find relevant clinical data, according to a recent study by Spyglass Consulting Group. The report entitled Point of Care Communications for Physicians 2014 based on 100 doctors working in hospital‐based and ambulatory environments nationwide reveals physicians are universally (96 percent) using smartphones as their primary device to support clinical communications.
Physicians Face Obstacles to Support Collaborative Care

Despite the universal smartphone adoption, the report finds 70 percent of physicians believe hospital IT organizations are making inadequate investments to address physician mobile computing and communication requirements at point of care due to limited planned investments, poor mobile EHR tools, and inadequate mobile user support. Majority of physicians interviewed report that they lacked the financial incentives, tools, and processes to support collaborative team‐based care. According to the Ponemon Institute, inefficient communications during critical clinical workflows costs the average U.S. hospital approximately $1.75 million annually.
Former CMIO Shares His Experiences

Steven Davidson, MD, MBA former CMIO at Maimonides Medical Center, Brooklyn, NY whose last project at Maimonides improving physician communication comments, “As we were developing our plans for improving communication among clinicians, we discovered that few hospitals were investing in communication‐driven workflow support, perhaps because meaningful use and HIPAA are consuming all the resources. Still, it seems many IT leaders hope the EHR‐‐a tool poorly suited to the task‐‐will suffice. In reality, overwhelmed nurses and doctors struggle accomplishing necessary communication through the EHR; instead implementing workarounds on their own devices.”

Next Generation Communications

The report states that hospital IT has an imperative need to evaluate mobile devices and unified communications solutions to support collaborative team-based care and address regulatory requirements introduced by the Affordable Care Act including readmissions penalties, patient centered care models, and pay for performance. Spyglass notes that the next generation communications solutions must be secure, easy-to-use, and tightly integrated with the EHR to provide adequate clinical context to successfully close the communications loop with colleagues and team members.

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Epic Systems Wins Big in “Best of KLAS” EHR Rankings

Epic Systems Wins Big in “Best of KLAS” EHR Rankings | EHR and Health IT Consulting | Scoop.it

Epic Systems Wins Big in “Best of KLAS” EHR Rankings

A number of Epic Systems products have achieved top marks in the annual Best of KLAS health IT and EHR rankings, including best overall physician practice vendor and best overall software suite in addition to other awards for acute care, ambulatory care, health information exchange (HIE) and patient portals.  The recognition signals a return to dominance for the health IT giant, which temporarily lost its top title to athenahealth in 2013.

“We are honored to be able to continue to work with talented healthcare providers to create the annual Best in KLAS report. Their feedback is beneficial as vendors strive for excellence,” said Adam Gale, CEO and president of KLAS Research in a news release announcing another winner, Phytel, which was named the top population heath management vendor. “We also look forward to expanding our global research initiative to evaluate additional products/services that impact both provider and vendor success.”

Other familiar names featured frequently in the latest report, including Impact Advisors, winner of the overall IT services firm category, Cerner Corporation for best small ambulatory EHR, and athenahealth for small and mid-sized practice management.  Epic, however, snagged the ribbon for large ambulatory practice management.

Accenture Health may be getting a few more phone calls in the next few months after being named best ICD-10 consulting firm, while Optum’s computer assisted coding (CAC) expertise won the category for the in-demand technology.  For clinical documentation improvement (CDI), another critical ICD-10 competency, KLAS awarded first prize to Navigant.

Overall, Epic received eleven recognitions from the independent research company, which indicates how deeply and widely the company has been able to integrate itself into the healthcare industry’s IT needs.  In contrast, Cerner received three nods and athenahealth bagged two, while McKesson and MEDITECH had one apiece.  Last year, athenahealth had five honors to its name, with Chairman and CEO Jonathan Bush claiming that his company’s victory over Epic for ultimate prize was a triumph of “nimble, innovative models” over the “old guard of HIT leaders.”

Putting aside Epic’s runaway dominance – and athenahealth’s slip from the spotlight this year – Bush may have been correct in saying that new contenders are challenging the big names that seemed so solidified in the early days of the EHR Incentive Programs.  The large number and diversity of winners shows that the marketplace continues to be fragmented, giving new companies a chance to offer the intuitive, user-friendly, feature-rich EHRs that healthcare organizations are clambering for.

With EHR replacement still a very strong force in the marketplace, vendors have a strong incentive to claw their way past their competitors onto EHR ranking lists that give them visibility and credibility in an environment of weary mistrust.

“We are all part of a community of care,” Gale said of the 2013 winners list. “From the vendors that provide services and advance healthcare technology, to KLAS, who produces insights on vendor performance, to the providers who administer care, our joint efforts can make a difference in the lives of the patients.”

“To the healthcare providers, your effort to be heard and counted is critical. It is your voice, amplified by KLAS, that can drive improvements to healthcare technology and services. To the healthcare vendors who diligently seek to align with provider needs, we thank you for your unwavering determination to deliver excellence with passion. We commend your efforts to truly be Best in KLAS.”


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Questions to Ask Before Choosing an EHR

Like many managers or owners of a thriving medical practice, you have heard about the benefits of using electronic health records software and are interested in implementing an EHR in your organization. You can assume that many, if not all, of your nearby competitors are using EHR, and the more effective they are in using this software, the better they will be able to attract and keep patients.

Transitioning from the old methods of paper-based systems to the latest advances in medical software is bound to raise some questions among you and your staff. Therefore, it’s a good idea to do some research first before making the commitment and selecting your EHR. With that in mind, here are some questions to ask as you prepare to make your choice.

Is the Software Vendor Knowledgeable and Reliable?

It’s much better to go with a software vendor that has sufficient experience, knowledge, and a proven track record in developing mission-critical software like EHR. Find a firm that has been around for a while and that has excellent reviews from your peers, as well as your competitors.

A software developer for medical organizations must have a staff that keeps up with the changing nature of healthcare delivery, adjustments in industry standards, and governmental rules. This ensures that you will always have access to software this is compliant with the entities you do business with.

What Kind of Training is Available?

After assessing the skill level and knowledge of your medical organization, you will have a better idea of how much training you need. Make sure that your software provider will give your team the training and help it needs to quickly get up to speed with using EHR software.

How Does the Software Company Handle Upgrades?

Upgrades are a fact of life in any computer system. You’ll want to ask your vendor how it approaches upgrades. There will be upgrades to improve the quality of the software, to be sure, but there will also be required updates, such as the ones EHR software developers must finalize to meet the U.S. government’s required change from ICD-9 to version 10 of the International Classification of Diseases.

Does the Software Vendor Provide Good Customer Service?

The last thing you want when dealing with unfamiliar software is to contend with unanswered questions on how to use it. Check the level of customer service from your prospective provider. Otherwise, your staff may experience unexpected and unnecessary downtime, hampering office productivity and lowering your organization’s financial success.

Making the decision to move from a paper-based system for managing your medical organization will make a significant impact on your staff’s daily activities. Now that you know you want to implement an EHR, it’s crucial to resolve any unanswered questions before making your software selection.

Key Takeaway:

  • Medical practice owners and managers who are aware of electronic health record software will want to ask some questions before choosing their EHR.
  • Don’t rush into buying EHR software that you are unfamiliar with. Make sure you understand how it will integrate with your organization.
  • Check what kind of training your software provider offers to ensure your staff can quickly get up to speed with the EHR system.
  • Verify the skill level and knowledge of your software company to make sure it will be capable of handling upgrades, especially those mandated by governmental regulations.
  • Does the EHR vendor provide the type of customer service that you deem appropriate? You will want to go with a firm that has excellent communication skills and will respond in a timely manner.


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Survey: Physicians See Benefits, Drawbacks in EHR System Switches

Survey: Physicians See Benefits, Drawbacks in EHR System Switches | EHR and Health IT Consulting | Scoop.it

Changing electronic health record systems could improve EHR functionality and help physicians meet meaningful use requirements, but physicians might be unhappy with the switch, according to a survey published in the journal Family Practice Management, FierceEMR reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Durben Hirsch, FierceEMR, 1/20).

For the survey, researchers polled 305 family physicians who had switched EHR systems in 2010 or later. The survey was conducted between July 2014 and September 2014 (Edsall/Adler, Family Practice Management, January/February 2015).

Survey Findings

The survey found that the most common reasons for changing EHR systems were:

  • Needing additional functionality;
  • Wanting to meet meaningful use requirements;
  • Desire to increase usability; and
  • Requiring improved training and support.

Researchers also found that 59% of respondents agreed or strongly agreed that their new system had better functionality, and 57% said that the change helped them to meet meaningful use requirements.

However, just 43% of respondents indicated they were happy with the switch to a different EHR system. Respondents who were part of the decision to change EHR systems were happier with the change than those who were not part of the decision-making process.

Overall, 81% said the time investment in changing EHR systems was challenging, with issues such as:

  • Productivity loss;
  • Data loss; and
  • Data migration problems.
Comments

Researchers said that physicians need to carry out a careful evaluation of their current EHR system prior to making a change. They also said that making alterations in physician workflow could result in better outcomes.

They noted that switching EHR systems might be necessary to improve functionality or achieve meaningful use but added that "if you just want to change because you don't like using your current EHR or consider it a drag on your productivity, the grass may not be greener on the other side"


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Reigniting ICD-10 Momentum in Your Organization

Reigniting ICD-10 Momentum in Your Organization | EHR and Health IT Consulting | Scoop.it

Now that Congress has rejected requests to delay ICD-10, it’s time to get on the bandwagon or risk significant financial implications. ICD-10 touches virtually every aspect of your organization’s processes and systems, and failure to prepare and comply with the mandate will have a significant impact on your reimbursements.

If your organization has lost momentum or has not started the ICD-10 journey, hiring internal resources or working with external experts will be necessary to meet the deadline. Below is a cheat sheet – based on best practices and industry guidelines – of essential questions to ask leadership and next steps:

  • Is ICD-10 a priority for your leadership team?
    Evaluate organizational awareness of ICD-10 and confirm leadership is in place to drive the transition. Successful ICD-10 planning involves defining project leadership, executive sponsorship, and reporting structures. Given the far-reaching organizational impacts of ICD-10, without defined roles and responsibilities, a critical remediation area may be missed. Identify stakeholder accountability for ICD-10 compliance and designate project managers to lead revenue cycle, coding and clinical documentation improvement (CDI), and IT system initiatives. Develop a project communication plan that sets expectations about what should be communicated to whom, the reason for the communication, frequency, and method.
  • Are your systems ready and have you evaluated the impact of ICD-10 to all system workflows?
    Assess operational readiness by taking an enterprise-wide systems and process inventory to identify where codes are used. Utilize assigned project managers to uncover all systems and processes where ICD-9 codes are sent, received, or stored. Conduct workflow analyses to ensure understanding of how systems and processes are impacted. This exercise can provide immediate benefit to an organization as workflows operating inefficiently are identified. Develop a prioritized project plan and remediation timeline for each impacted area. For example, technology and workflows need to be optimized within patient access to assure compliant orders for dates of service on or after October 1, 2015. Conduct regular reporting on initiatives and ensure stakeholders are being held accountable for designated tasks.
  • Does your staff have appropriate organizational awareness and knowledge of ICD-10?
    Understand what roles individuals play within your organization with respect to ICD-9 code usage, and employ a role-based training initiative. While coders, CDI specialists, and providers will need the majority of training, areas, such as patient access, ancillary departments, business offices, and IT should not be overlooked. Also, keep in mind the impact on your quality team. Patient populations monitored by core measures, as well as other quality metrics are determined by ICD-9 codes. When selecting a training vendor, confirm the vendor offers courses tailored by job function and provides the necessary courses for coders and specialty-specific training for providers. Track and communicate training progress and ensure training compliance is an organizational priority. As part of your strategy, attempt to incorporate training with other planned education to reduce workflow disruption.
  • Are you establishing ongoing experience with the new code set?
    Act fast to incorporate dual coding initiatives. Based on experiences with ICD-10 in other countries, research suggests that allowing coders to simultaneously code in ICD-9 and ICD-10 allows them to achieve proficiency and decrease productivity loss. Dual coding has been shown to significantly reduce the anticipated 40 to 60 percent inpatient and estimated 20 percent outpatient productivity loss. The first step is to create a project plan that identifies coders, checks systems, and determines expected coding system upgrades. Next, create a strategy for managing dual coded data to be analyzed. A coding roundtable of key stakeholders from an organization’s coding team should be developed to create accountability and drive documentation improvements during the dual coding process. As part of the learning process, coder education should initially emphasize documentation requirements for coding the most common conditions within the organization and those with the highest allowed amounts. A minimum of six months of practice is recommended.
  • Are you conducting internal and external testing of systems for ICD-10 compliance?
    Define testing goals and document a plan to test each impacted system internally and conduct external testing to the greatest extent possible. Appropriately testing impacted applications is a complex and time-consuming process and should not be seen as a last step. Many variables — including competing organizational priorities and resource availability — as well as clearinghouse, payer, and third-party tester schedules, can influence the testing timeline. Designate a well-defined team to undertake, define, and monitor the testing readiness plan for your impacted systems and software. Each impacted system should be reviewed for the type of testing that is needed. Billing systems are the most complex and must be ready to send ICD-10 coded bills to payers or payment will be denied. Testing of billing systems should include all of the workflows where codes live, (e.g., claim edits that currently contain ICD-9 codes). Use your high volume and high value codes for testing, and determine the ICD-10 workflow for each impacted application. Then, complete individual testing of applications by running the applications through the identified workflows. Once that process is complete, begin integrated testing through following the process for codes to flow to downstream applications and out to the payer. If you haven’t been selected for payer testing, then work with your clearinghouse to test claims externally through them.
  • Is your CDI program optimized and ready for ICD-10?
    Emphasize clinical documentation process improvements to realize bottom-line gains now while preparing for ICD-10. While most healthcare systems have a CDI program, many are not achieving the desired results in appropriately coding conditions to the highest level of specificity. For example, if the organization is not able to code the specific type of congestive heart failure in ICD-9, the problem will only worsen in ICD-10 with requirements for greater specificity to attain complications and co-morbidities (CCs) and major complications and co-morbidities (MCCs) for many DRGs. While revamping a CDI program is a separate goal, perfecting ICD-9 queries and introducing ICD-10 queries early will help prepare an organization for ensuring compliance with the increased specificity ICD-10 demands.
  • Have you planned for predicted delays in cash flow?
    Create a contingency plan to mitigate potential productivity and revenue losses. Hope for the best, but prepare for the worst. Based on Canada’s ICD-10 experience, coding productivity may drop by 50 percent immediately following implementation. Performance improvements may take at least 90 days to be realized. If claims are suspended, rejected, or delayed following ICD-10 implementation, have a plan available in advance to quickly respond to different scenarios. Alternatively, some providers and payers have drafted stopgap provisions in their contracts to maintain a consistent cash flow and “true up” every three months.

While changing processes, systems, technologies, and staff resources to accommodate the shift from ICD-9’s 17,000 to ICD-10’s 140,000 codes may seem overwhelming, there is still time to meet the requirements by taking a prioritized and focused approach.  Having the right mix of expertise and staffing is necessary to meet the upcoming deadline.  Contingency plans will also help mitigate losses following ICD-10 implementation. Beyond getting paid, ICD-10 also promises to improve clinical outcomes by increasing the specificity and accuracy of clinical documentation to guide patient care decision-making. It’s an investment that is worth the effort.


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Amazing Charts Releases 2015 Predictions for Medicine and Technology

Amazing Charts Releases 2015 Predictions for Medicine and Technology | EHR and Health IT Consulting | Scoop.it

Amazing Charts, a leading developer of Electronic Health Record (EHR) systems for physician practices, today issued its healthcare predictions for 2015.

1.      Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end Concierge Medicine, and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.

2.      Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.

3.      EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.

4.      Wearable Health Devices Empower Patients: Led by FitBit, the market for mobile health monitoring devices saw explosive growth in 2014. Now Apple is entering the scene, and 2015 promises to see even more apps and devices introduced to consumers. How the government regulates these devices may depend on how they are marketed. For example, a glucometer could be unregulated if the intent is for a user to monitor blood sugar levels for better nutrition. If the same glucometer is marketed for monitoring diabetics, however, it may be more strictly regulated as a medical device.

5.      EHR Interoperability Still Around the Corner: While all EHRs will not be able to seamlessly communicate in 2015, the core infrastructure for increased data liquidity will largely be in place. The data standards of the CCDA and its predecessor, the CCD, are increasingly used by EHR vendors. In addition, Meaningful Use Stage 2 mandates that patients can receive a digital summary of their own records on demand. These positive steps forward will combine in 2015 to get us closer to the promise of data interoperability.

6.      EHR Switching Accelerates: Many practices selected an EHR system lured by the promise of Meaningful Use incentives and now find themselves dissatisfied with their decision, primarily because the solution is not user friendly and slows them down. Despite barriers to switching systems, we will witness a mass conversion of solutions toward EHRs that better meet providers’ expectations and requirements.

7.      The Doctor Will NOT Be In: In 2015 and beyond we will see reimbursements drive the “virtual” appointment, whereby health plans will reimburse clinicians for online patient visits. Patients and their providers will connect over virtual platforms for scheduling, reviewing test results, writing prescriptions, etc. As they do, more and more insurers will follow suit as technology advances and claims its place in the doctor’s office.


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Many Say Meaningful Use Stage 2 Is Disastrous, but the Data Say Otherwise

Many Say Meaningful Use Stage 2 Is Disastrous, but the Data Say Otherwise | EHR and Health IT Consulting | Scoop.it

The industry news is full of disparaging talk about the health of the EHR Incentive Programs (i.e., meaningful use), particularly the low number of Stage 2 attestations. While some statistics show that only 35% of the nation’s hospitals have met Stage 2 meaningful use requirements, further analysis reveals a different story.

Each month since July 2014, CMS and the Office of the National Coordinator for Health IT update the Health IT Policy Committee on the number of successful Stage 2 attestations. The following day, the same headlines appear with multiple industry analyses and strong reactions that take the low attestation volume as a sign of failing long-term meaningful use viability. These critics say that in November 2014, only 17% of the nation’s hospitals successfully demonstrated Stage 2, and most recently that in December 2014 that figure was 35%.

These numbers are being used to demonstrate how difficult it is for the majority of the hospitals to meet Stage 2 requirements and even to make the case that most will not be capable of attesting due to overly stringent requirements. While these numbers are not technically wrong, a closer look reveals a different picture. This is not an attempt to be provocative, but rather we want to provide additional detail to those figures because they do not tell the whole truth about how well hospitals have fared in Stage 2.

Stage 2 Attestation Numbers Send Mixed Messages
First, the numbers cited were correct when the number of Stage 2 attestations were compared with the entire population of U.S. eligible hospitals (EHs). Of course, based on such data, it looks as if only about a third of the hospitals have been able to meet Stage 2 requirements through the end of November 2014. Some have interpreted this number to mean that meaningful use Stage 2 is a disastrous program, but the industry should not use these numbers to judge the success of Stage 2, or in fact, hospitals’ ability to meet the requirements. Why?

The EHs participating in the EHR Incentive Program are required to progress through a set meaningful use timeline. This means every meaningful use participant is scheduled to start at Stage 1 and remain in each stage for two years before moving to the next stage, unless the policy allows otherwise. For example, the early adopters who began in 2011 were in Stage 1 for three years instead of two, as CMS moved the Stage 2 start year to 2014. Therefore, not every EH in the nation is scheduled to attest to Stage 2 in 2014. Even if they wanted to attest to Stage 2, they would not be able to do so.

Instead, the industry should look at how many EHs are scheduled to be in Stage 2 in 2014, rather than looking at all EHs. Per the CMS data:

  • 809 hospitals attested to Stage 1 Year 1 in 2011;
  • 1,754 hospitals attested in 2012;
  • 1,389 attested in 2013; and
  • 83 attested in 2014 by Sept. 30.

Thus, only 2,563 hospitals (i.e., those that started in 2011 or 2012, or 809 + 1754) were scheduled to demonstrate Stage 2 in 2014. Among these hospitals, 65.58% (1,681) of EHs successfully attested to Stage 2 by Dec. 1, 2014. It is this number that tells an accurate story of Stage 2’s viability so far.

Admittedly, CMS only includes Medicare-only or dually-eligible EHs in the database cited above, and CMS did not clearly indicate whether 1,681 include all types of EHs. However, the number of Medicaid-only EHs account for a small proportion here. Based on CMS’ October 2014 report, fewer than 100 Medicaid-only EHs should be in Stage 2 in 2014. Even if we added 100 to the calculation to account for Medicaid-only EHs, the percentage would still be at more than 63%.

Attestations Are on the Rise
In addition, the number of successful Stage 2 attestations has grown exponentially since CMS first announced that 10 hospitals attested to Stage 2 by July 1, 2014. We find many organizations wait until the final 30 days or even closer to the attestation deadline to attest, so it is no surprise to see such growth — especially in the last few months when the number doubled between Nov. 1, 2014, and Dec. 1, 2014.

Additionally, the majority of EHs had to wait until Oct. 1 if they chose the last fiscal quarter, as is likely the case for the majority of attestations. This approach was popular because it gave these organizations the first three quarters of the fiscal year to implement the 2014 Edition CEHRT and to make the required workflow adjustments. So the nearly-66% of successful Stage 2 EHs attestation will only rise from here, especially considering the fact that CMS has extended the hospital attestation deadline to Dec. 31.

Where Hospitals Stand at the End of 2014
The College of Healthcare Information Management Executives recently estimated that about one-third of the hospitals scheduled to attest to Stage 2 in 2014 will use the flexibility rule, which allows them to attest to Stage 1 requirements in 2014 if their certified EHR upgrade was delayed or unable to be implemented at all. If we combine the numbers of those who successfully attested to Stage 2 and those who will rely on the flexibility rule, more than 95% of hospitals are able to attest in 2014. Again, that percentage does not look like a disaster; it shows that the tremendous efforts these hospitals put toward readying themselves for Stage 2 in 2014 paid off for more than half, and CMS’ lifeline worked.

Taking the same approach for eligible professionals (EPs), 57,595 and 139,299 of Medicare EPs attested to Stage 1 Year 1 in 2011 and 2012, respectively. This means 196,894 EPs are supposed to be in Stage 2 in 2014. Per CMS data, 16,455 EPs successfully attested to Stage 2 by Dec. 1, 2014, which accounts for an 8.36% success rate for that group. Of course, the number appears low at this juncture. However, based on the trend for EHs, we expect the numbers to grow tremendously as the majority of the EPs would also rely on the last calendar quarter as their reporting period (Oct. 1, 2014, to Dec. 31, 2014), and EPs can complete their 2014 attestation within the first two months in 2015. In short, it is too early to draw conclusions regarding EP attestations. The real story still remains to unfold for the EP Stage 2 attestation.

Many have touted the misleading data and message that meaningful use is a failure as a reason to push CMS to reduce the reporting period in 2015 from one full year to one three-month quarter or 90 days. We agree with the many benefits that a shortened reporting period in 2015 would provide, and we offer an alternate rationale based on our analysis of the data.

First, so far, about two-thirds of EHs that are scheduled to be in Stage 2 in 2014 have successfully met the requirements. Based on research conducted among our members, we found that the shortened reporting period in 2014 played a critical role in their success. They would not have been able to attest or found it to be significantly challenging if any longer than a three-month quarter reporting period were imposed in 2014. This is because they would not have sufficient time to completely implement and stabilize the 2014 Edition CEHRT and to adjust existing or implement new workflows. In addition, the longer reporting period would equate a higher denominator, making it more difficult or nearly impossible for the providers to achieve the required threshold.

Stage 2 also introduced more complex objectives such as View, Download and Transmit, and Transitions of Care. These two objectives alone required many hospitals to deploy their IT capabilities in new territories of patient engagement and information exchange. As we’ve previously discussed, these two objectives are arguably the most challenging in Stage 2, and the majority of providers who attested showed marginal performance around the required thresholds. These two objectives are significant first steps toward something greater in health care, and it will take time to improve performance in these areas. CMS recognized these challenges and enacted the flexibility rule in 2014. It certainly would not hurt the forward momentum of the meaningful use programs to allow such an option in 2015.

Second, the meaningful use program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the meaningful use program is to promote better care and better health for consumers/patients, including ourselves.

Per a recent report, patients value providers’ use of EHRs, appreciate the ability to access their data in a timely manner and seek even more robust functionalities in EHRs. So far, one of the great accomplishments of the meaningful use program is the significant growth of EHR adoption among providers. This leads to higher recognition of its values among consumers. The meaningful use program should continue, but at a more measured pace, so we all can achieve the goal with little to no compromises.

We hope that these numbers and rationales provide a meaningful perspective as CMS and ONC continue to make data-driven decisions in setting the policy in 2015 and Stage 3. We think that when one asks for leniency, showing great results so far and good faith based on accurate data would trump defensive arguments.

Nevertheless, while there is no further change in the existing policy, providers should continue to keep up their efforts and push to achieve the higher goal of better care and better health.


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EHR Technology Patent Lawsuit Deemed Abstract, Ineligible | EHRintelligence.com

EHR Technology Patent Lawsuit Deemed Abstract, Ineligible | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

MyMedicalRecords has failed in an EHR technology patent lawsuit brought against numerous competitors, according to an Electronic Frontier Foundation report.

The court’s ruling applies to a consolidation of cases with MyMedicalRecords as the plaintiff and the following as defendants:

  • Walgreen Co.
  • Quest Diagnostics, Inc.
  • WebMD Health Corp; WebMD Health Services Group Inc.,
  • Jardogs, LLC; Allscripts Healthcare Solutions, Inc.

United States District Judge Otis D. Wright, II, concludes that the MyMedicalRecords ’466 in patent ineligible on the grounds that it pertains to “long-known abstract idea.”

Following the application of a test from a related patent case (Mayo Collaborative Servs. v. Prometheus Labs., Inc.), Wright takes particular umbrage with the eighth claim of the MyMedicalRecords complaint because it lacks “inventive concepts”:

Claim 8 recites a method for providing a user with the ability to access and collect personal health records in a secure and private manner by: (1) associating access information with the user to access a server storing files; (2) providing a user interface; (3) receiving files at the server from a health care provider; (4) receiving requests through the user interface; (5) sending files; and (6) independently maintaining files on the server.  All six of these concepts are routine, conventional functions of a computer and server and therefore broadly and generically claim the use of a computer and Internet to perform the abstract purpose of the asserted claims.

According to Wright, the remaining claims similarly fail in adding anything of significance to the abstract idea of securing and sharing information.

Ultimately, the US District Court of the Central District of California sided with the defendants and their granted their motion judgment “without leave to amend.” For its part, MyMedicalRecords is still boasting a large patent portfolio that remains unaffected by the court order.

“MyMedicalRecords, Inc. will continue to pursue opportunities to monetize its 13 U.S. patents with more than 300 existing claims where appropriate in the burgeoning health information technology marketplace,” the company said in a public statement following the ruling.

As Adi Kamdar of EFF reports, the litigation being pursued by MyMedicalRecords works against meaningful use requirements that demand eligible providers perform each one of the activities listed by Wright.

“It falls in the category of threats from patent holders who decide to go after companies for abiding by new rules or regulations—doing so, they allege, infringes one or more of their patents,” he writes.

Without EHR technology certified to support, these providers would have limited options for selection EHR and health IT systems. For those opposed to “patent trolling,” the case of MyMedicalRecords raises questions about the patent application and acceptance process.


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What Gets Measured Gets Managed - HITECH AnswersHITECH Answers

What Gets Measured Gets Managed - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I’ll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can’t deny that data doesn’t lie and when we measure data, we can manage it.

Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group’s practice manager was new to the organization and tasked with the responsibility of managing the eligible providers’ progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.

The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn’t sure if they could meet the patient engagement requirements and she didn’t know where they stood with the newly introduced objectives.

She asked for support through her network and found me.

Data > Information > Knowledge

I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)

 

I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).

They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.

We had 90 days to turn this around.

Team Work

Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.

Meaningful Use is a team sport, after all.

The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.

We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.

With each week’s reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.

Getting Creative with the Portal

In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.

Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and  gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.

They even told patients what to say:

Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]

This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.

The First Big Win

Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.

Their main focus on closing out the year was to keep up the good work.

Non-Percentage Based Objectives

Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.

Lessons Learned

1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.

2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.


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

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

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

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

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

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

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

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

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

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

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


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Physician Office EHR Adoption Increases, Meaningful Use Lags

Physician Office EHR Adoption Increases, Meaningful Use Lags | EHR and Health IT Consulting | Scoop.it
Physician offices continue to adopt EHR technology so why is meaningful use participation being ignored by these eligible providers?

Physician office EHR adoption continued its upward swing between 2013 and 2014, but less than half of physicians in a recent survey report plans to attest for Stage 2 Meaningful Use.

The last bit of news comes from a survey of nearly 2000 members of SERMO, the online social network for physicians. Frank Irving of Medical Practice Insider reports that 55 percent of respondents will not demonstrate Stage 2 Meaningful Use in 2015, 994 of 1816 to participants.

Eligible professionals have until the end of next month — February 28 — to attest for meaningful use in 2014. According to the Centers for Medicare & Medicaid Services (CMS), more than 257,000 EPs are receiving 2015 Medicare payment adjustments for failing to demonstrate meaningful use as part of the Medicare EHR Incentive Program prior to 2014. That number is less close to 60,000 EPs who successfully filed for a meaningful use hardship exception during one of the two application periods in 2014. Those failing to demonstrate meaningful use in 2014 will be subject to Medicare payment adjustments in 2016.

It is unclear whether respondents to the SERMO survey are referencing their 2014 meaningful use reporting as the attestation period runs through the end of February 2015 or if they have chosen one of several options in a meaningful use flexibility rule or received a meaningful use hardship exception. That 55 percent could therefore prove misleading.

Continued growth of physician office EHR use

Whatever the reasons behind these responses from SERMO members, physician office EHR adoption is on the rise. An ongoing study by SK&A indicates a ten-percent increase in physician office adoption of EHR technology between 2013 and 2014. What’s more, it provides a breakdown of the top-five EHR vendors nationally and regionally.

At the national level, Epic Systems controls 30 percent of the market followed by eClinicialWorks (22%), Allscripts (19%), Practice Fusion (16%), and NextGen Healthcare (13%).

A closer look by region shows a close competition between Epic Systems and eClinicalWorks for EHR selection by physician offices.

The former dominates the West, Midwest, and East regions of the United States. The latter holds sway in the South and New England regions. Here’s a region-by-region breakdown:

West
Epic (25%)
eCW (23%)
Practice Fusion (20%)
NextGen (17%)
Allscripts (15%)

Midwest
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

South
eCW (30%)
Allscripts (23%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

East
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

New England
eCW (31%)
Allscripts (24%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

Interestingly, where neither is first both companies drop to the third or fourth spots. Considering that both companies specialize in working with health systems and hospitals, their domination of various markets may indicate the ownership of physician practices and use of that health system’s or hospital’s EHR technology.

Despite the increased implementation and use of EHR technology by physician offices, their physicians have a ways to go in order to keep pace with the evolution of the EHR Incentive Programs.


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The Myth of Too Many Clicks

The Myth of Too Many Clicks | EHR and Health IT Consulting | Scoop.it

We have seen a number of recent blog posts and tweets complaining about EHRs having ‘too many clicks.’ A number of people have proclaimed that reducing the number of clicks in an EHR as a method to improve EHR Usability.


Multiple clicks are not a deterrent to usability and user satisfaction, in fact there are many occasions where having more clicks may actually improve usability. In our experience facilitating a large number of usability tests, people don’t complain about having too many clicks. Making the click is automatic.The crux of the matter is that each click represents a decision point within a workflow. It isn’t too many clicks, it is too many decisions!


“Vague, non-descript (click here, learn more), misleading or jargon-filled links cause people to hesitate, to question. Is this the right decision? This amplifies the click itself and it is what has created this myth of ‘too many clicks.’


Imagine taking a road trip to someplace you’ve never been and your directions don’t quite match up with the road signs. Was that Exit 7 or Route 7? Main Street or Main Avenue? Your trip would feel much longer and you’d arrive much grumpier than if you made the same journey with clear directions. You’d say, “Wow, that didn’t take as long as I thought,” regardless of the turns in the road.” (Stephanie Lumas)

The difference is confidence. If someone is confident knowing what they will find, or what happens after they make a click, it is a non-decision.


Don’t worry about having multiple clicks on your EHR, but just make sure your users knows, in advance, the effect of clicking will have on their workflow.


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Doctors Reject Electronic Health Record Mandate

Doctors Reject Electronic Health Record Mandate | EHR and Health IT Consulting | Scoop.it

In an effort to increase the use of electronic health records by doctors, hospitals, and other health care providers, Congress passed the Health Information Technology for Economic and Clinical Health Act, more often known as the HITECH Act, in 2009. The law provided both incentives and penalties to encourage widespread adoption, but so far many hospitals and doctors have failed to comply.

On December 17, 2014, the Centers for Medicare and Medicaid Services (CMS) announced 257,000 doctors had failed to achieve what it termed “meaningful use” of electronic health records, and would have payments for Medicare services reduced by 1 percent as of January 1, 2015.

According to the American Medical Association, that is more than half of all doctors covered under the HITECH act.

Dr. Joe Bentivegna of Rocky Hill, Connecticut says electronic health records are expensive and impractical.

“Doctors struggle because the user interfaces are slow and there are too many questions,” Bentivegna said. “It works poorly with ophthalmology, my profession.”

Incentives and Penalties

Early on the HITECH act provided taxpayer funds to medical providers to help pay for the adoption of electronic health records. Those incentives will remain through 2016, but penalties have also kicked in for those who haven’t satisfied the CMS meaningful use requirement. The 1 percent reduction in 2015 will rise to 5 percent over five years, taking a significant bite out of many doctors’ revenue.

Dr. Stephen Stack, president-elect of the American Medical Association, expressed dismay over the news 257,000 doctors would be penalized in 2015.

“The Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency,” Stack said in a statement. “Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients.”

Stack charged the meaningful use requirements “are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden.”

Increasing Government Control

Twila Brase, president of the Citizens’ Council for Health Freedom, sees the meaningful use requirements as a backdoor way for the government to play a heavier role in directly controlling medical care.

“So if you want to control the entire health care system, what do you need?” Brase asked rhetorically. “You need to know what the doctors are doing, you need to decide what you want them to be doing, and then you need a system to record how far they are removed from what you want them to be doing to that you can financially penalize them.”

Brase expressed concern the electronic health records created in compliance with the HITECH Act will be used to ration care, pointing to comments by controversial MIT economist Jonathan Gruber.

“Gruber says they only want people to get the right care for the right things,” Brase explained. “They’ll sometimes talk about ‘right place, right time, right patient, right care,’ as though we were all sort of widgets in the system. Their plan is to use all of our data to standardize the practice of medicine, to put those standardized treatment protocols on the electronic health system, and nothing else.”

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Decide Consulting's curator insight, February 4, 2015 7:46 PM

Should physicians be penalized for not satisfying meaningful use requirements? EHRs are meant to be customizable and helpful, but many doctors only see the burden.

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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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Functional Limitation Reporting in Your EMR

Functional Limitation Reporting in Your EMR | EHR and Health IT Consulting | Scoop.it
There are a lot of myths, misconceptions and fears about functional limitation reporting. The bottom line is that clinicians who see Medicare patients after July 1, 2015 must use functional limitation codes on their documentation for the initial evaluation, at least once every 10 visits, and at the time of discharge or they won’t get paid.

All practitioners need is an EMR system that prompts them to select one of the functional limitation measures and the goal codes at the appropriate time. It’s then a simple matter of sending the claim to the clearinghouse and on to Medicare for approval and payment. Functional limitation reporting is essentially a goal-oriented process.

 Clinical Judgment

The judgment of the physical therapist is critical in meeting functional limitation reporting requirements. Therapists will need to document the patient’s condition at the initial visit, the selected treatment plan, severity of the client’s limitation and the expected outcome when therapy is completed.

In Touch EMR™ provides clinicians with prompts for all the information, G-codes and modifiers needed and at the appropriate times to remain within compliance. The data automatically goes into the patient file for transmission.

Supporting Evidence

Documentation to support every decision, measure taken and treatment is critical. Therapists must maintain a record of the patient’s level of function upon their initial visit using their best clinical judgment, combined with the information obtained from the patient.

Listen closely to what the client says and observe their range of movement to accurately select the level of severity under which they’re functioning. Meticulous records are necessary to document the condition of the patient at each treatment session and when the patient is discharged from further therapy. The process begins again if further treatment is required.

The EMR clinicians choose should have the ability to prompt them at the three major checkpoints of functional limitation reporting – initial evaluation, the 10th visit, and at discharge. In Touch EMR™ provides practitioners with that functionality, making it easy to remain in compliance and get paid.


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Make sure your biller knows the ins and outs of FLR!

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Mayo taps Epic for EHR, revenue cycle management

Mayo taps Epic for EHR, revenue cycle management | EHR and Health IT Consulting | Scoop.it
Dive Brief:
  • Mayo Clinic announced this week that it would be abandoning its three current EHR systems in favor of a new contract with EHR giant Epic, which will now be the healthcare icon's sole EHR provider and strategic partner, according to a Mayo press release.
  • The plan is to deploy a single, integrated Epic EHR and revenue cycle management system at Mayo's main campus. Jilted in the deal are GE and Cerner, who were the providers of Mayo's current systems.
  • "With our staff working together on a common system, we will be able to accelerate innovation, enhance services and provide a better experience for our patients," said Dawn Milliner, MD, Mayo's chief medical information officer, in the release. The current schedule will see the project team assembled by  April of this year, with the actual system being built between then and 2016, and a final implementation target of 2017.
Dive Insight:

If this were any other press release from almost any other provider and vendor, it would not be news. But the words "Mayo" and "Epic" make this an important milestone in an incredibly competitive race.

First, it's a game changer for the Mayo Clinic, as it will completely overhaul its existing system from scratch. Moreover, it's a bodyblow to Cerner, who we predicted had a good shot at swiping the top spot in the EHR biz from Epic earlier this year. We'll be the first to admit this is a big win for Epic, and while it's not big enough to put Cerner down for the count, it's a good way for Epic to start the year (and not so good for Cerner).


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Docs urge big changes to health records program

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

A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.

Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.


"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.

"Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers’ needs, patient safety, and product innovation," the letter stated.

The coalition called on regulators to decouple the certification of electronic health records from Meaningful Use, which imposes a timetable for EHR adoption and a series of penalties and incentives based on doctors' compliance.

The groups also asked the Office of the National Coordinator to reconsider alternative software testing methods and to incorporate stakeholder feedback on a variety of technical matters related to Meaningful Use.

The healthcare world has been struggling with the migration to digital records, arguing that the Meaningful Use standards are hampering their ability to deliver good care.

Advocates for Meaningful Use argue it is helping speed the transition to EHRs, which will ultimately boost care and prevent deadly medical errors.

The program has undergone several delays as doctors and hospitals fail to attest to its various stages.


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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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Patient portals and EMRs: Each requires a different skillset

Patient portals and EMRs: Each requires a different skillset | EHR and Health IT Consulting | Scoop.it

Most readers know that an EMR (electronic medical record) is the back-end software that runs a health care organization. EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, and view clinical information.


I’ve written at length about the differences between B2B software and B2C software and how B2B software is generally not very good (particularly from a usability perspective). And it’s not very good simply because it can get away with not being very good. B2B companies often just need a good salesperson that can lock-in long-term contracts to be successful. Once the software is purchased, it’s not easy for users to switch.

B2C companies, on the other hand, need an incredible product to be successful. If your user experience isn’t flawless, you cannot survive in the B2C space. The switching costs for consumers are near zero — the user experience must be incredible. Product is much more important than distribution. B2C user satisfaction scores are significantly higher than B2C scores.

Applying this to health care, if you’re a hospital and your EMR is hard to use, your employees will still use it because they have to — they can’t easily switch to a competitor.

But if your patient portal is bad you will lose patients instantly. It’s too easy for patients to switch to something else.

The Healthcare Information and Management Systems Society (HIMSS) published a good report talking about patient portals.  They noted that despite the difficulty of building a wonderful online consumer experience and the totally different skill set required to execute on it, 80 percent of hospitals surveyed chose their patient portal vendor simply because it was the same vendor that provides their EMR (the top three portals were made by Epic, Cerner and McKesson). All of these vendors have been building B2B enterprise software systems for more than 30 years. They’re all wonderful companies. But they have no idea how to build a patient facing product. Their management, engineering talent, sales force, culture and DNA is all about B2B. They have almost no chance of building a world class consumer product. That’s not a knock on these companies; it’s just reality. You can’t be good at both.

As we transition to a world where the patient is in the driver’s seat, exposing patients to old-fashioned enterprise software code and interfaces is not a good idea. Hospitals shouldn’t let a piece of software touch their customers unless it’s been vetted and tested fully, and it’s clear that patients love it. If you check out the satisfaction scores for most patient portal apps, you’ll find that most patients despise them (one of them I looked at last week had 2,000 reviews in the iOS app store and more than 1,500 of them were only 1 star).

Patients are becoming consumers. They want slick, easy, mobile, beautiful, simple and seamless web experiences. If the software that touches patients doesn’t give them that they’re going to go somewhere that does.

Now, in defense of these hospitals let it be known that there aren’t a lot of great consumer-focused software companies building-out patient portals. So in the short term, they might have no choice. But I’d encourage CIOs that are making patient portal investments to consider the consumer and to cautiously enter into flexible and short term contracts with these patient portal vendors.

You should be careful about buying groceries from the company that fixes your car. And you should be careful about buying consumer-facing software from the company that built your EMR.


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

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

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

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

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

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

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

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

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

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

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

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

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Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015

Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015 | EHR and Health IT Consulting | Scoop.it

This summer the DOD is set to award the multi billion dollar electronic health records contract. Each group that bid on it contains at least one company the provides product and one with heavy weight Gov’t/DOD presence.

Who is going to win? Who is in real trouble if they don’t? As far as the winner is concerned, my new, Christmas gift , Crystal Ball doesn’t have this level of experience yet. What I do know is that who the actual winner is will affect the entire Healthcare IT marketplace.

Of the bidders, there are a few companies “betting the farm” on winning this. More later on who, but they could be in serious trouble if they are not the winners.

The contract is scheduled to be awarded in early July. I’m sure there will be protests and pressure from the losers, so the contract’s full impact might be delayed briefly.

When all this is sorted out the need for qualified people to work on the project is going to be huge and securing a position there will be considered a prize for many because the contract itself is going to last for at least 8 years.

Basically this means that if you are looking for a position, there are going to be a huge amount of health IT job opportunities available. As professionals move to the DOD contract, most will need previous experience. Where are they going to come from? These experienced professional departures will create job opportunities when they leave.

For employers, you might want to look into your employee retention efforts. Some companies out there are going to have a major problem with retention. You may be putting out fires all summer long as the experienced health IT marketplace shifts.


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IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?



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Bright Futures VisitPlanner iPhone and iPad medical app review

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

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

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

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


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


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


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


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


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


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