EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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VA's EHR project is 'yellow trending towards red,' says report obtained by ProPublica

VA's EHR project is 'yellow trending towards red,' says report obtained by ProPublica | EHR and Health IT Consulting | Scoop.it

The Department of Veterans Affairs' EHR contract with Cerner has been plagued by multiple roadblocks during the past year, including personnel issues and changing expectations, according to a ProPublica investigation.

 

Former VA Secretary David Shulkin, MD, released the agency's plan to scrap its homegrown EHR VistA for a Cerner system during a news briefing in June 2017. Almost one year later, the VA finalized a $10 billion no-bid contract with Cerner to implement its EHR systemwide over a 10-year period, beginning with a set of test sites in March 2020.

 

However, a recent progress report by Cerner rated its EHR project with the VA at alert level "yellow trending towards red," according to ProPublica. To investigate the underlying factors that have contributed to the EHR project's problems, the publication reviewed internal documents and conducted interviews with current and former VA officials, congressional staff and outside experts.

 

Here are five details from ProPublica's investigation:

1. When Dr. Shulkin initially announced his plan to implement Cerner at the VA, he emphasized the EHR would provide "seamless care" to veterans, since the Department of Defense had also recently signed a contract with Cerner. However, in September 2017, the VA convened a panel of industry experts who objected to this claim, noting two health systems using Cerner doesn't mean they will be able to share all data with one another.

 

2. At another meeting, Cerner representatives gave a presentation on how their software would be able to share data with private providers, three people present told ProPublica. However, Dr. Shulkin noticed the representatives were only talking about prescription data, rather than the full record of health data, lab reports and medical images that the VA would need. Dr. Shulkin reportedly cut the meeting short and told Cerner to come back with a better solution.

 

3. Cerner's off-the-shelf product didn't match the VA's EHR needs, according to ProPublica. While Cerner's software successfully helps private hospitals bill insurers, the VA doesn't need these same functionalities, since the agency serves as the sole payer for its patient population. Cerner's product also didn't have features for some of the VA's core specialties, such as post-traumatic stress disorder, since these conditions aren't as common in the general population.

 

4. Dr. Shulkin, who left the VA in March, reportedly wanted to find a CIO with a background in healthcare and experience leading major software transitions to helm the EHR project. The VA enlisted two search firms, which identified several qualified candidates, according to sources who spoke with ProPublica. However, the Presidential Personnel Office rejected them, and the White House instead proposed candidates who had worked on the Trump campaign but didn't have a background in health IT.

 

5. At a recent subcommittee hearing, some lawmakers questioned the VA's work on the Cerner project and asked whether the DOD should head up its implementation. Instead, the VA and DOD secretaries opted to sign a joint statement Sept. 26 pledging to align their EHR strategies. However, industry experts warned ProPublica that the agencies have different medical priorities, as the DOD treats young people with acute injuries while the VA provides long-term care to those with complex illnesses.

 

VA spokesman Curt Cashour declined to answer specific questions from ProPublica, saying that "efforts thus far have been successful and we are confident they will continue to be successful." The White House didn't provide answers to a list of questions ProPublica sent, and Cerner also declined to comment.

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Stanford Launches App That Connects to Epic EHR & Healthkit

Stanford Launches App That Connects to Epic EHR & Healthkit | EHR and Health IT Consulting | Scoop.it

tanford Health Care today announced its new iOS 8 MyHealth mobile health app for patients. Developed in-house by Stanford Health Care (SHC) engineers, MyHealth connects directly with Epic’s EHR, Apple’s HealthKit and cloud services for consumer health data monitoring.

The SHC MyHealth mobile app is designed to make it quick and simple for patients to manage their care right from their iPhones, including:

• Make appointments

• Get test results – your lab results are automatically made available in the palm of your hand

 

Communicate with your care team through a secure messaging system where your information is always kept confidential

• Have a video visit with your doctor through the new ClickWell Care clinic which gives you the convenient option of a “virtual” appointment

 

• Manage your prescriptions and medications

• View your health summary

• Access and pay your bills

• Share your vitals with your doctor via HealthKit integration

Secure Messaging


With the new MyHealth app, patients can communicate directly with their care team through a confidential and secure messaging system. In addition, the app automatically syncs with wearable and wireless products, allowing patients to take vital signs at home or on the go. That data is automatically and securely added to the patient’s chart in Epic for their physician to review remotely.

“The SHC MyHealth app allows patients to connect their lives with their health care,” said Pravene Nath, MD, Chief Information Officer, Stanford Health Care. “By integrating with companies like Withings, our physicians have access to meaningful patient data right in Epic, without having to ask the patient come in for an appointment. We believe this is the future of how care will be delivered for many types of chronic conditions.”

 

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Don't Overlook EHR Communication

Don't Overlook EHR Communication | EHR and Health IT Consulting | Scoop.it

Through all of the planning and preparation that goes into an Electronic Health Record (EHR) implementation, EHR communication is often overlooked and undervalued. With everyone focused on delivering the system, building applications, testing hardware and validating workflows, end user preparedness, outside of training, can be overlooked.

 

Sure, they’re going to be trained on the system, but it’s important to remain engaged with end users in the months and weeks leading to go-live, but also beyond go-live. In many aspects, post-live communication is more vital to day-to-day operations throughout the organization.

 

In this post, we’ll discuss the primary types of communication that must be considered, carefully planned for and thoughtfully executed to serve end users best as they prepare for and live in the new world of the EHR.

 

Types of EHR Communication

 

Internal Marketing, pre- go-live
Transitioning to an EHR is daunting for everyone. It’s exciting and new, but it is scary. It’s a daunting task for leadership and project teams, but for end users, this new technology will completely disrupt their professional lives – especially those that have never used the technology.


The merits of the new system, how it will help them in the long run, and how it will benefit patients must all be sold to end users who, in most cases, have always worked a certain way – without technology. The system must be sold to them because there will be resistance, some kicking and screaming, all the way through go-live.


Change Communications
Don’t listen to anyone that tells you that you’ll be able to relax once the system goes live. If anything, the importance of clear, concise communication escalates exponentially after go-live.


Technology, by its nature, evolves. And electronic health records are not exempt. One of the primary features of the technological age we live in is that the systems we use can, and will, be updated.
When changes are made to the system, there must be a coordinated Change Management procedure featuring robust communication to all impacted employees.


System Updates/Downtime Messaging
EHR’s and the infrastructure they run on are fallible. No matter how well the system is designed and built, there will be issues and downtimes that negatively impact end users, and if not planned for accordingly, patients.


System Update (SU) and Downtime procedures must be carefully developed and communicated throughout the organization to ensure that employees know the protocols that are in place in the event of a system outage.


Additionally, communications processes and protocols must be installed throughout the organization to ensure that vital information can be delivered to end users crisis situations – and that end users can communicate what’s happening on the ground with leadership and IT.


Ultimately the goal here is to ensure that clinicians can continue to care for their patients in the event of a system outage and proper communication is key.


Targeted Messaging
This comes down to a simple realization – clinicians are extremely busy people that don’t have time to wade through waves of content to find what pertains to them.
Messaging designed with a specific user group in mind that includes a concise, actionable message works best. Think providers or nurses.


This audience also benefits from a well-known or trusted sender. They don’t pay attention to mass emails from generic inboxes. Their bosses, Chief Medical Officers, Chief Nursing Officers, or a department head usually garner the most respect, and the most attention, in clinical circles.


Patient Communication
This change is disruptive for patients as well, especially during go-live. Taking the time to thoughtfully communicate the change to patients will help ease the transition for them as well.
They’ll have questions. Why is my doctor on that computer so much? Is my medical information online? Is it secure?
Without going into the minutia around the EHR, device integration, real-time data, secure servers, firewalls, data centers, etc. – take the time to explain the change to patients, at least at a high level. They will appreciate it.


myChart & Meaningful Use
On the surface, Meaningful Use and MyChart communication don’t immediately come to mind when thinking of the EHR communications plan. They should, though. Soon after go-live, the focus shifts to stabilization and optimization, which includes myChart and Meaningful Use.


While they’re paired together here because they’re add-ons that don’t necessarily fall under the initial communications scope, these two are very different and need their own comprehensive communications plans and delivery methods as the content, audience, and implications are drastically different.


While not explicitly responsible for building or activating the EHR system that will revolutionize your organization, it’s important to have a person or team dedicated to communicating with your end users – at all stages of the system’s life cycle. Uninformed end users are disgruntled end users, and it pays to have communications people that have experience with IT and EHR delivery as it is a world unto itself.

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Workflow Analysis, Ease of Use & Best Practices

Workflow Analysis, Ease of Use & Best Practices | EHR and Health IT Consulting | Scoop.it

As a healthcare organization, innovation and change can be a challenge. And while many changes are forced, either by government mandate, financial incentive, or patient care necessity, each organization must make a series of decisions that will dictate their technological, financial and cultural future. Though the EHR journey, from selection and implementation to maintenance and upgrades, is not easy. It is necessary. In this series, we reached out to Terri Couts, VP of Epic Application Programs at Guthrie Clinic, for her thoughts on the end-to-end EHR journey.

 

Workflow Analysis, Ease of Use & Best Practices
A major part of any EHR installation is workflow analysis. Every organization practices, functions, and cares for patients a little differently largely due to training, culture, and patient demographics that they serve. Knowing all of this, there is still an unrealistic expectation that healthcare technology is plug-and-play. Being trapped in this misconception can lead to end-user frustration, delays in care for patients, delayed revenue or revenue loss, and an overall mistrust of the product and the IT implementation team.

 

Workflow analysis should start the day you sign your vendor contract. Of course, during the implementation, each vendor will have suggested workflows but most only consider the technological use of their product. They do not address any policies or procedures established by your institution. They do not include any State or local regulatory requirements that your organization is bound to. Finally, they do not consider the culture of your organization including the providers’ independence of practice. When I state providers’ independence of practice, I am not suggesting that standard tools and workflows should not be implemented and encouraged. What I am suggesting is that identifying workflows at your organization and having the tools to support those workflows is the first step to a successful go live and sustainability.

 

To accurately collect and document workflows, your IT team will need to heavily engage the subject matter experts. These include registration staff, transporters, nursing, physicians, surgeons, back office staff, medical records, pharmacists, radiologists, and the list goes on. Once the analyst understands how each of the users practice within the organization, they can start to configure the technology to support the workflow.

 

Technology should never define the workflow. But it should support and enhance the work, drive patient outcomes, and increase patient safety.


While performing workflow analysis, ease of use and best practices should always be considered. Most electronic health record (EHR) early adopters implemented their systems with the driving desire to fill the Meaningful Use agenda to ultimately receive incentives and avoiding penalties. Thankfully, those days are behind us and there have been many lessons learned. Physician burnout is one effect stated to be caused by EHR requirements and we have all heard the complaint about “too many clicks”. The role of the provider should not be defined by the number of clicks in the EHR. Be careful to design technology for ease of use, clean and intuitive workspaces, and to not take away from the patient experience.

 

In my opinion, users should not only be involved in the definition of the workflows and design of the product, but also the testing of the design. Usability testing is just as important as the initial workflow analysis. This gives us the chance to identify gaps in the design and user adoption before implementation.

 

The product and documentation that comes from the workflow analysis should also serve as the foundation of training for the system. I have found that EHR training cannot just be about the technical aspects of the system. It should also include relevant scenario-based training to include policies, and procedures held at the organization. End users want to know how this affects them personally. They also need to know the effect of not completing or performing a particular workflow. For example, if the system is built to drop a high dollar charge only if a particular box is clicked, how would the clinician know the downstream impact of revenue loss if they are not educated on the entire workflow. Finally, build the scenario training to include scenarios that the providers can relate to. If something does not seem realistic to a provider, he or she will be lost in that concept and not focused on learning the system.

 

The EHR journey can span years and effectively dictates, at least in part, the healthcare organization’s path and culture. This series examines the experiences of healthcare leaders that have been through it. Whether you’re selecting an EHR for the first time or replacing an existing system, the EHR journey is a daunting one. These lessons learned could be priceless to you and your organization.

 

Check back soon as the next post in this series will cover change management and governance and their importance throughout your EHR Journey.

 

Make sure to subscribe to our blog for the latest thought leadership in healthcare IT delivered directly to your inbox. You can also follow us on LinkedIn, Twitter, and Facebook to join the conversation. Check back for our next Center Stage feature in the coming weeks.

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Epic Launches Sonnet with Rhyme and Reason

Epic Launches Sonnet with Rhyme and Reason | EHR and Health IT Consulting | Scoop.it

The long-anticipated launch of Epic’s new scaled-down Electronic Health Record (EHR), known as Sonnet, took place in March at HIMSS18 with tremendous excitement. Sonnet is intended for smaller to mid-sized hospitals, critical access hospitals, post-acute care facilities, long-term care facilities, and physician practices, who either do not require all of the functionality of a full version EHR or don’t have the budget or the resources needed to implement the full version of Epic. Through the use of Sonnet, these smaller systems will have access to a scaled-down version of Epic which falls at a more competitive price point and with a significantly quicker implementation timeline.  “It’s still the same Epic, it has a fully integrated inpatient-outpatient, rev cycle, and patient portal,” Adam Whitlatch, Epic’s research and development team lead, told Healthcare Dive in February. Additionally, Sonnet will allow smaller hospitals a clear and attainable add-on/upgrade path with the ability to adopt different features of Epic as they expand.

 

It’s an exciting move for Epic on the heels of Epic CEO Judy Faulkner’s call for a shift in collective thought when she announced she would now refer to the EHR as CHR.  To Judy, and I believe many of us, the letter change represents the bigger picture. “Healthcare is now focusing on keeping people well rather than reacting to illness. We are now focusing on factors outside the traditional walls,” Faulkner told Healthcare IT News.  In the future, the CHR will include more types of data, such as social determinants, sleeping patterns, diet, access to fresh foods, exercise, and whether they are lonely or depressed because all of those factors can have an enormous impact on an individual’s health.

 

Epic continues to increase its footprint with the addition of Sonnet; aiming to capture a market segment which KLAS research identified in 2016 as the most significant buyers of EHRs in the U.S. accounting for nearly 80% of all sales. This portion of the market has historically been dominated by Athena Health, e-Clinical works, NextGen and the like.

 

It will be interesting to watch how Sonnet is received in the market and if Epic can successfully move into the community hospital space. It can be argued that Epic is the undisputed leader in the healthcare IT market with Cerner a close second as it pertains to healthcare organizations over 300 beds. The ultimate question is if a scaled-down Epic EHR can garner the same level of success in this space? If Epic can balance the functionality needs to support the complexity of healthcare, while maintaining a light-version of Epic that is easy to maintain and satisfactory to providers, then they will be successful.

 

Still, with an implementation of this size, there is a lot of complexity. As with all implementations, it is vital to have a structured plan in place that includes how to most efficiently manage the retirement of legacy systems, an effective communication and change management strategy, resource allocation, and the proper training of your current staff. Getting it right the first time is the differentiator of a successful install.  Engaging with the right advisory partner can be the key to managing costs. The right partner can aide in making decisions regarding how to best approach an installation from a best practices/”lessons learned” perspective. Often, a new install is the largest investment many hospitals of this size will make in a fiscal year. Doing it right can have great reward, but missing the mark, can have costly implications.

 

As a community hospital, if the implementation of your EHR isn’t correct, the future care of your patients and the financial stability of your organization could be in jeopardy. Optimum Healthcare IT has the people, the expertise, and the experience to ensure that your EHR is implemented correctly and smoothly.

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Alen Smith's comment, October 26, 2018 12:49 PM
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Sharing What You Know for EHR Consultants

Sharing What You Know for EHR Consultants | EHR and Health IT Consulting | Scoop.it

In the world of Healthcare IT consulting, it is important to share what you know. HIT Consultants work long hours to get the job not only done but won.  They know how to put their thinking to work.  These rock stars stay focused longer than others to push the success needle forward for their clients.  But, before their work is done, there is one more win that can add tremendous value – knowledge sharing.  It’s the next best step that can lift the lid of consulting services to higher levels.  Here’s how.

 

Four questions that EHR Consultants can ask themselves:

 

What do I know?
There are a plethora of skills that consultants bring to the table that range from core functional skills to having a good knack for people, talent development, and team building.  A general thought among consultants is that their knowledge is common knowledge.  Everybody knows this, right?  Think again. What’s common to them may not be so common to their peers or their clients.  Plus, their experience and knowledge may have paved a different road from other consultants so knowledge sharing is a definite gain.

 

Who can benefit from my knowledge?
Without question, consultants add value to the clients by knowledge sharing.  They can also add value to their peers by passing on their proven record of how to’s, quick wins, best practice solutions and lessons learned.  Their peers can share their added value with their clients.

 

What do I need to know?
It’s always a good rule of thumb to place ourselves between teaching and learning.  And even the most knowledgeable consultant can benefit from learning. In addition to sharing your knowledge, ask your peers what they have learned.  A proactive approach to knowledge sharing will ensure success for everyone.

 

Who do I need to know?
Get to know peer consultants who know more and whose experience has exceeded yours.  It’s great to be able to have this person handy for quick huddles to field any questions you have.

Creating intentional opportunities for high performers to collaborate is a big deal.  It gives consultants with all levels of skills and experiences a forum and space to both learn and share the sharpest innovative tools in the market with their clients.  Everybody wins.

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Smaller Practices are Choosing Cloud-Based EHR 

Smaller Practices are Choosing Cloud-Based EHR  | EHR and Health IT Consulting | Scoop.it

The medical field has spawned all kinds of new technology that takes patient care to the next level. Regulations demand that even smaller practices need to make the jump to electronic medical record systems (also known as electronic health records). These EMR/EHR solutions provide an interface that gives providers and patients a way to keep themselves connected to each other--a tool to promote a more efficient delivery method for these services. We’ll take a look at these EMR and EHR solutions that are hosted in the cloud, giving your organization more information to make an educated choice on implementing this software.

 

EMR/EHR


EMR/EHR is a critical piece of software for any modern healthcare provider. EMR/EHR is an interface that gives physicians, healthcare providers, and insurers access to updated information about their patients, all at a glance. Since the patient has access to their own file, it can help to promote transparency and collaboration between healthcare providers and patients to improve the quality of their care.

 

Major Considerations


Healthcare is expensive for both patients and providers, which should prompt them to consider a cloud-hosted solution as a viable strategy to minimize costs associated with this industry. Unfortunately, many providers are somewhat reluctant to implement cloud-hosted solutions, even in the face of regulatory compliance laws. There are many serious questions that need to be considered by any organization hoping to take advantage of electronic records--particularly those who store electronic protected health information (ePHI). One of the many considerations any practice needs to consider is the incredible incentive offered to businesses that implement “meaningful use” EMR/EHR technology. To qualify as “meaningful use,” the following variables need to be met:

 

  • Engaging patients in their own care
  • Improving quality, efficiency, safety, and reducing health disparities
  • Improving care coordination
  • Improving public health and health education
  • Meet HIPAA regulations for the privacy of health records


Some of these might seem like common sense, but the costs associated with meeting all of these requirements might be used as an excuse to not invest in these qualifications. Cost is one of the most important factors to consider, and in a high-risk market like healthcare, industry providers generally don’t want to spend more than they have to. The end result is that an organization might utilize cloud-based technology to cut their costs, but there is no guarantee that they will be able to sustain “meaningful use” as it’s defined above.

 

With that said, cloud computing has really come into its own over the past few years, providing even more great services (including security) than ever before--services that EMR/EHR can really benefit from. If you want to implement a solution that can help your medical practice reduce costs and improve functionality, or if you just want to meet the changes in industry regulations, look no further. SouthBridge Consulting can help your business implement high-quality technology solutions designed to increase profits and efficiency. To learn more, reach out to us at (281) 816-6430.

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EHR Market Needs Competition & Innovation

EHR Market Needs Competition & Innovation | EHR and Health IT Consulting | Scoop.it

I spend a fair amount of my days engaged in conversations with family physicians and policymakers on how to improve our nation's health care system. These conversations and the feedback they generate are the engines that drive the AAFP's advocacy. There are dozens of pertinent issues impacting family physicians and their patients, but there are two themes that emerge in every conversation. The first is the disdain family physicians, really all physicians, have for electronic health records. The second is how the EHR industry, to date, has failed in its core mission.

 

On Jan. 20, 2004, President Bush made the following statement as part of his State of the Union Address: "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care."

 

On April 26, 2004, the Bush Administration formally launched the Promoting Innovation and Competitiveness campaign(georgewbush-whitehouse.archives.gov), which was aimed at accomplishing the goals outlined in his SOTU address. The campaign made several observations and had several goals, but I would like to highlight three:

 

A patient's vital medical information is scattered across medical records kept by many different caregivers in many different locations – and all of the patient's medical information is often unavailable at the time of care.


Innovations in electronic health records and the secure exchange of medical information will help transform health care in America -- improving health care quality, preventing medical errors, reducing health care costs, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care.
Within the next 10 years, electronic health records will ensure that complete healthcare information is available for most Americans at the time and place of care, no matter where it originates.
Within the next 10 years?

 

Guess what? Time's up, and none of this happened. It is reasonably safe to say that in the 14 years since President Bush issued his call to action, the promise of EHRs has failed epically to meet the expectations outlined in the SOTU speech -- avoid dangerous medical mistakes, reduce costs and improve care. Some would argue that we have digressed in each of these areas.

 

I struggle to find an articulate and elegant way to describe what is so frustrating about electronic health records, but I think I have found a way to do so succinctly -- they suck. They suck as products, and they suck the life out of everyone that uses them.

 

Ponder this, since President Bush issued his 2004 challenge, the following innovations hit the market -- Facebook (2004), Reddit (2005), Twitter (2006), iPhone (2007), Airbnb (2008), Thumbtack (2008), Rent the Runway (2009), Uber (2009), Instagram (2010), Pinterest (2010), Snapchat (2011), Alexa (2014), Bumble (2014), and dozens of others targeted at specific industries or activities. Each of these platforms changed an industry or changed the way we communicate and share information with each other. They have made positive contributions to our economy and our lives.

 

It is a shame that the efficiencies realized from these platforms have not translated to health care via EHRs. Instead of streamlining the healthcare industry, EHRs have created a plethora of cottage industries and consultants; required physicians to incorporate "workaround;" and, most sadly, the EHR has contributed significantly to the onset of an actual epidemic -- physician burnout.

 

A few weeks ago, I was in San Francisco and had the opportunity to meet Andrew Hines(canvasmedical.com), an engineer who has spent his professional career working in and around the technology industry, including work for a major EHR company. During our conversation, he said something that really stuck with me, both for the boldness of the statement and the fact that, deep down, I think we all know it may be true. He said, "I used to think we could improve the electronic health record from within, but now I realize the only way to truly improve electronic health records is to start over."

 

A Harvard professor known for his work in disruptive innovation, describes this as sustaining versus disruptive innovation. Incumbents focus on incremental improvements in their products whereas new entrants succeed with disruptive innovations. The problem with healthcare and EHRs specifically, is that incumbents have all the market power.

 

Steven Waldren, M.D., director of the AAFP Alliance for eHealth Innovation, summed it up as follows: "The reason EHRs suck is not due to a lack of innovation in technology but rather in a lack of innovation in health care. It seems that the health care industrial-complex, unlike other industries, is insulated from such innovative challenges from new players."

 

Waldren summarized his thoughts in a simple statement, "Without competition, we will not see the technology innovations in health care we have seen in other industries."

 

There are no easy solutions in health care, and improving EHRs is no different. However, we desperately need innovation and meaningful competition in the health information technology and EHR space. The following are three objectives the AAFP is pursuing to increase competition and spur innovation:

 

Make it easier for new companies to enter the health IT marketplace -- The AAFP continues to work on expanding interoperability to allow appropriate access to data stored in EHRs, in a timely manner. The AAFP is aggressively advocating for policies that force EHR vendors and other health IT products to be interoperable based on a defined set of standards. We also believe that all data in the EHR should be available for use by third-party vendors, of course with appropriate privacy.


Make it easier for innovators to design smarter health IT products -- One of the differences between health care and the general IT space is the complexity and fuzziness of the semantics of clinical data. The AAFP is committed to working with others to model clinical data in standard ways that allow developers to make health IT systems that can reason about clinical data and therefore help automate tasks physicians must perform.
Eliminate or reduce administrative requirements placed on health IT products -- The poor usability of EHRs is often due to external requirements established by regulators and payers, such as clinical documentation, which does not add clinical value. The AAFP is actively promoting policies that eliminate or, narrow, those requirements. We believe a reduction in administrative burden will help physicians, and also allow health IT developers to focus on features and functions that add clinical value.
Closing Thought


As you can tell, I am frustrated with the performance of current EHRs and the negative impact they are having on our health care system and each of you personally. The dominant companies in the market have produced products that have largely failed at the core goals established in the early 2000s. As I have noted, technology in every other industry tends to result in rapid improvements to function and efficiencies. Health care simply hasn't seen the same improvements, and the companies that make these products have seen windfalls in the billions, yet their products continue to underperform and fail to meet expectations of patients, physicians, and policymakers.

 

I remain a strong supporter of the broad use of EHRs in our health care system. The EHR still stands to improve the aggregation and distribution of medical information, which would improve our health care system. Without a doubt, the ability to access and transmit medical information among care sites and physicians would improve care and result in efficiencies for patients and the system overall.

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The EHR and Rage Against the Machine

The EHR and Rage Against the Machine | EHR and Health IT Consulting | Scoop.it

The EHR is the latest focus of our rage against the machine. Case in point: Chrissy Farr’s poke at the EHR in today’s Fast Company. Red meat for angry old doctors.

 

What might be interesting is to take a bunch of millennial doctors and make them work for a month with clipboards, fax machines, mailed letters and emulsion films on view boxes? Then we could write a story about the joy and efficiency of manilla folder medicine.

 

I suspect it would put things in perspective.

We fancy ourselves as victims of our technology. But while EHRs have a long way to go, it’s a long way back to paper.

 

I was in an elevator at Texas Children’s Hospital this weekend where there were a number of people looking at their smartphones.  An older gentleman in the elevator remarked shaking his head, “I remember a time when people used to talk.”

 

Actually, no one talked in elevators.  We’ve always stood the same direction and stared at the numbers at the top of the door.

 

It’s easy to blame technology on our human shortcomings.  It’s been suggested that the adoption of EHR has us ignoring patients.  But in the old days, we scribbled on paper.  Irresponsible resident and medical student conduct with social media are blamed on the platform.  But trainees have always done and said stupid things.

Blame it our chauvinistic human bias:  “It’s not me, it’s the machine.”

 

While there are those of us who share a perverse relationship with our tools, it’s important to remember that the world wasn’t necessarily rainbows and unicorns before [insert technology of choice] appeared.

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Are Providers Satisfied With Their EHR?

Are Providers Satisfied With Their EHR? | EHR and Health IT Consulting | Scoop.it

Physicians are expected to document encounters with patients. This ensures there is a record of crucial information for decision-making and dispute. A decade ago, around 90% of physicians updated their patient records by hand. By the end of 2014, 83% of physicians had adopted EHR systems. The combination of government incentives, advances in technology, and improved outcomes and operations fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. Electronic Health Records (EHRs) improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

A national survey of providers highlights their perspective on the benefits of having EHR in their practice:

  • 94% of providers report that their EHR makes records readily available at point of care.
  • 88% of providers report that their EHR produces clinical benefits for the practice.
  • 75% of providers report that their EHR allows them to deliver better patient care.

As the adoption of EHR grew over the last 10 years, so too did the need to change EHR systems within health systems, hospitals, and private medical practices. Growth in M&A activity fueled many healthcare organizations to combine data through EHR data conversion. Provider dissatisfaction has played a key role in encouraging change in EHR systems, also increasing EHR data conversion activity.

A study completed by Health Affairs showed, by and large, providers recognize the important advances that EHRs enable. Fewer than 20% of all providers said they would return to paper records. That being said, providers also noted negative effects of current EHRs on their professional lives and on patient care.  While excited about the possibilities provided by EHRs, providers have ultimately found poor usability that does not match clinical workflows, time-consuming data entry, interference with patient interaction, and too many electronic messages and alerts.

According to a 2014 survey of physicians conducted by AmericanEHR Partners:

  • 54% indicated their EHR system increased their total operating costs.
  • 55% said is was difficult or very difficult to use their EHR to improve efficiency.
  • 72% said it was difficult or very difficult to use their EHR to decrease workload.
  • 43% said they had not yet overcome productivity challenges associated with their EHR implementation.

These concerns about EHR usability are in alignment with others, including the American Medical Informatics Association, researchers, and practicing physicians. Given the rate at which many healthcare organizations have adopted EHRs, these organizations find themselves unable to wait for the long-run fixes. Healthcare organizations are now looking to change EHR providers in order to fix many of the providers’ concerns.

As healthcare organizations begin the process of changing EHR providers, there is an increased need for solutions to provide access to and maintain the integrity of data stored in the legacy systems. When this need arises, healthcare organizations have the choice to archive the legacy data, run multiple systems simultaneously, or complete an EHR data conversion.

Given the complexity of the data and variety of potential solutions, one might suppose that handling legacy data would be a complex affair. In many ways, that is true. However, it doesn’t have to be. To learn more about the state of EHRs and potential solutions for maintaining access and integrity of legacy data.

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Top 10 Epic EHR stories of 2017

Top 10 Epic EHR stories of 2017 | EHR and Health IT Consulting | Scoop.it

The biggest electronic health record company made plenty of big news this past year, beginning with the scoop that it would develop new technology aimed at smaller hospitals.

 

Epic Systems, and its founder and CEO Judy Faulkner were the subjects of well-read news throughout 2017. Here are the top 10 Epic Systems news stories as gauged by our readers' interest:

 

1. Epic CEO Judy Faulkner reveals two new EHR versions are in development

"We're developing some really nifty new software," Epic founder and CEO Judy Faulkner told Healthcare IT News at HIMSS17 in Orlando this past February.

Epic is ready to make good on its promise to provide new versions of the EHR technology, she said, including Sonnet, which has a lower price point, and is aimed at hospitals that don't require all the bells and whistles of the full Epic EHR

"We're finding that people need different things," said Faulkner. "If you are a critical access hospital, you don't need the full Epic. The two new versions of Epic in development can provide a pathway to adding all the features at a later time."

Earlier this month, Epic announced that Sonnet would be available starting in March.

 

2. Epic CEO Judy Faulkner standing behind switch from EHRs to CHRs

"Because healthcare is now focusing on keeping people well rather than reacting to illness, we are focusing on factors outside the traditional walls," Faulkner told Healthcare IT News.

"'E' has to go away now. It's all electronic," Faulkner said at the company's user group meeting in late September 2017. "We have to knock the walls down whether they're the walls of the hospital or the walls of the clinic." As she sees it, the 'E' should be replaced with a 'C,' for "comprehensive."

 

3. Epic to jump into medical billing, currently hiring for new unit

A want ad popped up on the Epic Systems website, looking for "bright, motivated individuals to join our new billing services team as we enter the world of medical billing.

"Our goal is to simplify the payment process by helping Epic organizations with the complexities of submitting claims and posting payments," the ad read. "Attention to detail is vital as you'll be posting payments and denials; reconciling payment files, claims, and statements; resolving posting errors; and calling payers to follow up on outstanding or unpaid claims."

 

4. Epic sued over millions in alleged anesthesia over-billing

In November, Epic was hit with a False Claims Act suit that alleged the company's billing system double bills the government for anesthesia services. According to the suit that was made public last November, an alleged glitch in the system resulted in hundreds of millions of dollars of overbilling. The company responded that the plaintiff's suit stemmed from "a fundamental misunderstanding of how claims software works."

 

5. Allscripts, Cerner, Epic signal more open EHRs ahead

Top executives at three electronic health record companies –  Allscripts, Cerner and Epic – revealed in March 2017 they were working to make their EHRs more open, embracing APIs as a means to enable third-parties to write software and apps that run on their platforms. Epic, for its part, was working on two new versions of its EHR and developing Kit to go with its Caboodle data warehouse (as in Kit and Caboodle). CEO Judy Faulkner said Kit "is making everything very open."

 

6. CVS-Aetna merger will make an even bigger giant out of Epic

While early reports in mid-December about the planned $77 billion merger between CVS, an Epic customer, and Aetna focused on massive market share in the pharmacy and insurance realms, there was also the implicit promise of a new era in analytics, interoperability and population health. Alan Hutchison, Epic's vice president of population health, said that by using Epic's Care Everywhere and Share Everywhere interoperability tools, CVS and Aetna could provide the community with information and insights to improve care.

 

7. Epic tops 2017 Best in KLAS awards, securing top spot for 7th straight year; see complete winners

At the end of January 2017, Epic Systems again landed the top spot for Overall Software Suite in the 2017 Best in KLAS: Software and Services report. The win marked the seventh consecutive year Epic took top honors in the report, draws from healthcare provider feedback. Epic also earned the top Overall Physician Practice Vendor and Best in KLAS awards in eight segments.

 

8. What happened when GE tried to buy Epic and Cerner and was shut down within 5 minutes

Former General Electric CEO Jeffrey Immelt revealed at the beginning of December that GE had once tried to acquire Epic and Cerner at different times. He said Faulkner told him, 'No, not interested." Immelt recalled the meeting lasting less than five minutes. (As for Cerner, the price was too high.)

 

9. How the Coast Guard's ugly, Epic EHR break-up played out

What began as a straightforward software contract with Epic resulted in the U.S. Coast Guard starting its entire EHR acquisition process over some seven years after it began. EHR implementations are notorious budget-busters often fraught with missed deadlines and other unforeseen complications, but for an organization to abandon the project altogether and embark on a new beginning is uncommon. Indeed, this occurrence includes some finger-pointing from both sides. So, what exactly went wrong?

 

10. Mayo Clinic kicks off massive Epic EHR go-live

Mayo Clinic hit a milestone this year with its $1.5 billion system-wide Epic implementation. The first 24 sites went live on July 8. The organizations said Epic will replace Mayo's existing three EHRs, which include rivals Cerner and GE Healthcare, as the hospital system's sole electronic health record platform.

 

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5 EHR Benefits We Seem to Have Forgotten About

5 EHR Benefits We Seem to Have Forgotten About | EHR and Health IT Consulting | Scoop.it

Here are a few of the guaranteed EHR benefits:

  1. Legibility of Notes: Physicians' handwriting has been the topic of many jokes. While it’s funny to joke about, it’s not funny if you’re the physician receiving one of those illegible notes or the billing office trying to get paid based on some illegible chart note. The beauty of an EHR is that the notes are all typed in a font that can easily be read. The whole issue of physician handwriting goes out the window.
  2. Accessibility of Charts: Charts are more accessible in an EHR in two distinct ways. First, the concept of a lost chart basically disappears in the EHR world. When you want the chart, you search by the patient’s name or other identifier and instantly have access to the patient chart. No more searching through the chart room, the lab box, the nurses’ box, the box on the exam room door, etc. for the lost chart. Second, the chart can be accessed from anywhere in the world. Gone are the late night phone calls which require you to drive to the office to view the chart. An EHR can be accessed anywhere you have Internet.
  3. Multiple Users Accessing the Chart: How quickly we forget the fact that only one person could use the paper chart at a time. In fact, entire workflows were created around the fact that two people couldn’t work on the paper chart at the same time. In an EHR, the nurse, doctor, front desk, HIM, and billing staff can all work on the chart at the same time.
  4. Disaster Recovery: Many people are afraid of disaster situations with their EHR. While this is an important topic, an EHR can be so much better in a disaster than a paper chart. If your chart room goes up in flames, what could you do? Not much. Your charts were lost. In the EHR world, you can easily create multiple backups and store them in multiple secure locations including secure offsite storage. This takes some thoughtful planning to do it right, but EHR makes it possible to store multiple copies of your data which minimizes your risk of lost data. This is so much better than a paper chart in a disaster. With a cloud-based EHR this redundancy is often built in, and there is little or nothing you need to do.
  5. Drug to Drug and Allergy Interaction Checking: Yes, we’ve had Epocrates in our pocket for a long time. That was a huge improvement over those stacks of books on the shelf. However, EHR takes that one step further. Your EHR knows about your patients’ list of allergies and the drugs they’re taking. These extra pieces of information can provide a much deeper analysis of any drug you’re looking to prescribe. I don’t remember a prescription pad ever alerting you to an issue with an allergy when you were writing the script.

Obviously this is just a small list of the guaranteed benefits. We could create an even longer list of the possible, probable, and future benefits of an EHR as well.  I’ll just cap it off with one simple example. How are you going to handle pharmacogenomic medicine on paper? It’s coming. The simple answer is that you’re not doing pharmacogenomics on paper. You’re going to need technology, and it will likely be connected to your EHR.

While I still don’t think we’ve realised all of the benefits that we could have (and many might say should have) from an EHR, we shouldn’t forget the many benefits an EHR has already provided. Far too often we evaluate our current EHR implementation against the perfect EHR as opposed to the alternative. EHR software has already provided a lot of benefits, but the most exciting thing is that we’re really just getting started. The future benefits will be even more impactful than the benefits we’re receiving today.

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Physician viewpoint on How to remove 'stupid stuff' from EHRs 

Physician viewpoint on How to remove 'stupid stuff' from EHRs  | EHR and Health IT Consulting | Scoop.it

It's time to cut unnecessary work from the EHR, according to a perspective in The New England Journal of Medicine by Melinda Ashton, MD, a physician with Hawaii Pacific Health in Honolulu.

 

In the article, Dr. Ashton describes a program she and her colleagues launched in October 2017, called "Getting Rid of Stupid Stuff." In an effort to engage clinicians and reduce burnout, the program team asked all employees at the healthcare network to review their daily documentation practices and nominate aspects of the EHR they thought were "poorly designed, unnecessary or just plain stupid."

 

Along with fielding nominations from physicians and nurses, the team also conducted its own review of documentation practices, and removed 10 of the 12 most frequently ignored alerts the EHR pushed to physicians. The team also removed order sets that had not been used recently.

 

Dr. Ashton acknowledged the specific changes likely aren't relevant for other hospitals, but she advocated for the shift in mentality the "Getting Rid of Stupid Stuff" program initiated. "It appears that there is stupid stuff all around us, and although many of the nominations we receive aren't for big changes, the small wins that come from acknowledging and improving our daily work do matter," she wrote.

 

Here are four of the categories Dr. Ashton and her colleagues deleted from the EHR as part of the program:

 

1. One nurse who worked with adolescent patients asked to remove a physical assessment row labeled "cord," meant to reflect care of the umbilical cord remnant in newborns. The row, which was supposed to be suppressed for those older than 30 days of age, had still been present for other ages.

 

2. A nurse who cared for newborns said she had to click three times whenever she changed a diaper, as a result of EHR documentation for incontinence requiring the clinician to indicate whether the patient is incontinent of urine, stool or both. The team created a single-click option for children in diapers.

 

3. Multiple nurses highlighted the frequency of "head-to-toe" nursing assessments, which they are expected to complete upon assuming care of each patient. However, in some units, the EHR prompted nurses to document several of these assessments during a 12-hour shift.

 

"We sought to identify standards in the literature and found that some of our practices were in keeping with those standards," Dr. Ashton wrote. "In other units, we reduced the frequency of required evaluation and documentation."

 

4. An emergency medicine physician questioned why the EHR prompts employees to print an after-visit summary before scanning it back into the system. He hadn't noticed the patient was expected to sign the summary, which was stored in the record.

 

"His question led us to query other health systems and our legal team about the value of the signature, and we were able to remove this requirement," Dr. Ashton wrote. "The physician was delighted that he had been able to influence a practice that he believed was a waste of support-staff time."

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Kareo Integrates EHR with GoodRx to Reduce Prescription Drug Costs

Kareo Integrates EHR with GoodRx to Reduce Prescription Drug Costs | EHR and Health IT Consulting | Scoop.it

Kareo, a cloud-based EHR provider for independent medical practices has launched Kareo Rx Saver, an integrated solution with GoodRx that seamlessly delivers prescription cost savings to patients of physicians.

 

Prescription drug prices often vary significantly across pharmacies, making it difficult for a patient to select the least costly option. To address this problem, Kareo has integrated its clinical EHR with with prescription and drug savings provider GoodRx to present real-time cost comparisons between local pharmacies during e-prescribing while also delivering money-saving coupons. With KaroRx Saver, independent physicians can directly and instantly help lower the cost of care for their patients when prescribing medication.

 

Kareo, a cloud-based EHR provider for independent medical practices has launched Kareo Rx Saver, an integrated solution with GoodRx that seamlessly delivers prescription cost savings to patients of physicians.

 

Prescription drug prices often vary significantly across pharmacies, making it difficult for a patient to select the least costly option. To address this problem, Kareo has integrated its clinical EHR with with prescription and drug savings provider GoodRx to present real-time cost comparisons between local pharmacies during e-prescribing while also delivering money-saving coupons. With KaroRx Saver, independent physicians can directly and instantly help lower the cost of care for their patients when prescribing medication.

 

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The EHR Journey – Selecting an EHR Vendor

The EHR Journey – Selecting an EHR Vendor | EHR and Health IT Consulting | Scoop.it

As a healthcare organization, innovation and change can be a challenge. And while many changes are forced, either by government mandate, financial incentive, or patient care necessity, each organization must make a series of decisions that will dictate their technological, financial and cultural future. Though the EHR journey, from selection and implementation to maintenance and upgrades, is not easy, it is necessary. In this series, we reached out to Terri Couts, VP of Epic Application Programs at Guthrie Clinic, for her thoughts on the end-to-end EHR journey.

 

EHR Vendor Selection
The easiest part about selecting an EHR vendor is making the decision that you need one. The selection itself can be, and in my opinion, should be a challenging task. No matter what vendor you choose, you can be sure that it will be a large financial investment. In the past, organizations would tend to steer towards the “best of breed” approach. This approach can lead an organization down the path of silo systems and disjointed processes creating additional work and costs.

 

There are many vendors who deliver an excellent product, but do you understand what your requirements are of the system? Defining the scope, requirements, and the desired outcomes are all part of the first step. Many users look to the technology to address a need and ask questions like “what can Epic do for me?” However, I would challenge our users to understand their requirements ahead of time and use those requirements to drive your selection process. List out the requirements and make sure to have a rating scale for each when you meet with vendors.

 

I have found that attending several vendor demos can help you identify the requirements that you ultimately want to have in your EHR. If they are good vendors, they have already done a great deal of research for their development. Use their investment to your advantage. Participate in as many demo sessions as you need to come up with a robust and complete RFP.

 

Also, make sure you have the right stakeholders at the table when defining the requirements. Be careful not to get sidetracked by the shiny new object and focus on how it can align with the organization’s goals, value, and mission. Vendors are good at showing the functionality around the new buzzwords such as big data, population health, and the newest artificial intelligence features. However, if they cannot meet the organization’s core function needs, none of that will matter.

 

Every organization’s needs are different based on their type of patients, variation in care, location, and finances. Therefore, there is not a single checklist that all organizations can use. However, I have found that the more integration the system offers, the better. Taking away silos within departments allows for the highest level of transparency driving an increase in patient safety and outcomes.

 

Again, I believe the hardest part of selecting a new EHR is identifying what you want out of the system. Once you know that, you can make the system work for you and instead of you working for the system. The decision to implement a new EHR is one you will have to live with for a long time. It’s an investment in your organization’s future. Put the effort and work in ahead of time to be sure the investment is something you can live with and scale.

 

The EHR journey can span years and effectively dictates, at least in part, the healthcare organization’s path and culture. This series examines the experiences of healthcare leaders that have been through it. Whether you’re selecting an EHR for the first time or replacing an existing system, the EHR journey is a daunting one. These lessons learned could be priceless to you and your organization.

 

Check back soon as the next post in this series will cover workflows and their importance throughout your EHR Journey.

 

Make sure to subscribe to our blog for the latest thought leadership in healthcare IT delivered directly to your inbox. You can also follow us on LinkedIn, Twitter, and Facebook to join the conversation. Check back for our next Center Stage feature in the coming weeks.

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Here we go again ... EHR Reset, Refuel, Optimize

Here we go again ... EHR Reset, Refuel, Optimize | EHR and Health IT Consulting | Scoop.it

At some point, we all thought the Electronic Health Record (EHR) implementation lifecycle would stabilize and transition into the ever elusive “maintenance mode”. Costs would go down, patient quality and care would improve, physicians would be more efficient and effective in the care of their patients, physicians would actually “like” the system, and the world would go back to normal. Right? Well, that is partially right. And now it would seem that it’s time for an EHR reset.

 

The introduction of the integrated EHR did accomplish many of these goals. We can quote statistics of a positive move towards gaining all of these benefits. However, we can also bring to light many frustrations with physicians, clinical teams, operations teams and even patients.

 

Pro-Active EHR Optimization is a Necessity
Why is this? For one, we forgot that the expectations, the functionality, and the potential are always moving farther to the right. These expectations are supported by advancing capabilities within EHRs but are also driven by the need for data science capabilities that provide innovative, real-time solutions to deliver patient care when, where and how it is needed.

 

Vendor sponsored EHR capabilities advance on a regular basis by introducing new functionality and capabilities, by expanding their capabilities for integration, analytics, and other critical functions and by offering alternative solutions to support the changing needs of the market (e.g., Community based solutions, organization acquisitions and organic growth, lower cost solutions with rapid implementation timelines, etc.)


The healthcare market is ever changing as is the expectations of those who work in the healthcare field. Introducing an integrated EHR is the first taste that required healthcare providers and operators to open their minds about “how it could be”. Now that we have asked them to think this way, the door is open. EHR vendor capabilities and their integration with other third-party systems that support integration, analytics and even data science are now the “norm” to operate in a more global healthcare market. Users of these systems are now asking, “what if the system could do this?”


Organizations of all types and sizes are reevaluating the current structure and use of their Electronic Health Record (EHR) and deciding to not just optimize, but also completely re-implement the system. With an eye towards market growth, transformation and innovation, healthcare leaders are initiating a major program effort to re-implement their EHR focusing on leading-practice standardization, leveraged capabilities, cost-efficient support structure, decision-focused analytics and most importantly, the patient experience.

 

There are many reasons healthcare organizations are considering a complete reimplementation of their current system.

 

Function-specific EHR implementation where multiple activities may still be supported by many, disparate and/or non-integrated systems


Rapid installation timeline with minimal use of the potential system capabilities


Continuation of technology “isolation” where decisions are not driven by clinical and operational stakeholders and technology teams are still focused on the singular activities of taking care of their world


An installation that is on an outdated version with a highly customized build and non-standardized workflow components
Need for a foundation to support an organization’s market expansion through acquisitions, connect alternatives or other market growth


Whatever the reason, organizations and their leaders now understand that the initial implementation was not the end. Rather, it was only the first step in creating a technological foundation that supports the organization’s vision and strategy for continued excellence in care, growth, innovation, and viability in the market.

 

The encouraging side to all of this is:

 

You have already gone through an implementation so completing an “EHR reset” requires a similar structure, effort, and rigor, and
You get a “do-over”, or said differently, an EHR reset provides a new chance to transform your organization and establish a foundation for moving forward in the organization’s vision and strategy.
If your organization is considering an EHR reset, Optimum’s team of experts can help. Optimum Healthcare IT has a dedicated Advisory Services solution line that brings years of healthcare clinical, operational, and IT knowledge.

 

Our team brings years of healthcare clinical, operational, and IT knowledge. Using our experience and expertise, we design project plans that turn your goals from vision to reality. Working with your staff, we refine the approach, the methodology, and define the resources needed to execute on time and on budget. We work with you to make sure you are leveraging your technology to increase the safety and quality of care you provide to your patients throughout the continuum of care.

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Pediatric EHRs Must be Treated Differently

Pediatric EHRs Must be Treated Differently | EHR and Health IT Consulting | Scoop.it

When it comes to healthcare, there are many different types of facilities and settings. There are acute care hospitals, specialty care hospitals, nursing homes, long-term care facilities, ambulatory care centers, surgical centers, outpatient clients, physicians’ offices, rehabilitation centers, pediatric care hospitals, and many more. What all of these different care settings have in common is that they most certainly benefit from some form of electronic health record (EHR) software, each with their own specific needs. What they do not have in common, is the type of patients or type of care they provide. Pediatric patients and healthcare facilities require the right approach to install their Pediatric EHR.

 

An acute care hospital’s primary task is to provide short-term care for people with varying degrees of health issues. These usually stem from injury, disease, or genetics. They are open 24/7/365 and bring together physicians from varied specialties, a skilled nursing staff, technicians, and specialized equipment. Most hospitals offer a wide range of services including emergency room, labor and birth, scheduled surgeries, and lab work. Acute care hospitals utilize standard EHR software where each department has a specific module with tailored functionality to meet their needs.

 

The difference between the standard acute care hospital and pediatric care hospitals is, of course, the patients. Though it may seem obvious, teams in pediatric facilities must recognize that infants, children and those with special needs are not merely small adults and they cannot be treated as such. Caregivers must pay additional attention to how they interact with pediatric patients and their families. Bedside manner, psycho-social considerations, and family dynamics have to be considered during the course of care.  In many respects, the Pediatric EHR must be treated the same.

 

Pediatric facilities have unique requirements that dictate many aspects of their EHR software adoption.  Hardware and device placement have unique needs to facilitate documentation where the patient is – many times patients aren’t located in their bed or assigned room.  Specific attention and adherence to isolation requirements are vital. Also, close attention should be given to screen visibility to include parents or other approved family members engaged in care planning, patient teaching, and patient education.  Consideration is also given to the multi-disciplinary care team engaged with a pediatric patient – case management, social work, therapies, child life services, etc.

 

Hospitalizations are essential for both adults and children. How a healthcare organization chooses to treat them is even more critical. Pediatric organizations require special machines, special tests, special nurses, special doctors, and more importantly SPECIALIZED Pediatric EHR software systems. While the primary objective for healthcare organizations is to provide high-quality patient care, they must also make money.  Reimbursement rates continue to decrease which calls for consistent best practices for both hospitalized adults and child to ultimately reduce the length of stays.  Effective and efficient use of the EHR coupled with the power of the data it provides is crucial to patient satisfaction and improved care.  Additionally, healthcare organizations can save money and improve patient care by partnering with healthcare IT consulting companies who have the knowledge and methodologies to ensure that when an EHR is implemented, no matter the setting or patient type, it will be done correctly.

 

Whether it is a standard acute care hospital or a specialized pediatric hospital, Optimum’s expert resources recognize these needs and facilitate incorporation of the “triangle of care” – meaning patient, family and caregiver/device.  In the majority of our activations, we have provided expert support for pediatric inpatient settings, PICU settings, Leve 2, 3 and 4 NICU’s, Pediatric Trauma and Emergency Room settings while implementing their Pediatric EHR.

 

While preparation is undoubtedly a key ingredient for success, all the planning in the world can yield minimal results if you don’t have the right people in place to execute the plan. In addition to the years of experience Optimum brings to the table, we also specialize in allocating the right resources – the right people – for your project at the right time. Optimum Healthcare IT uses its SkillMarket portal to not only manage your go-live resources, but to optimize resources based on your needs, their skillset, and geo-location.

 

Our commitment to your needs ensures that your implementation will be successful throughout your planning, go-live, stabilization, and optimization. And once you make it through the arduous task of implementing an electronic health record, the challenge then becomes sustaining it and meaningfully using it. Optimum Healthcare IT has the best team in the business.

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Become an EHR Super User

Become an EHR Super User | EHR and Health IT Consulting | Scoop.it

When I visit clinics to help them optimize EHR use, there is a clear difference between the super users and other users. While the super users may still have complaints about the system, they are nowhere near as frustrated as the other users. This is because they have invested the time in understanding how to leverage the EHR to significantly speed up their everyday workflow.

 

Most EHRs have built-in "accelerators," tools and shortcuts similar to what you find in Microsoft Word or Excel, for greater efficiency. The problem is most physicians don't bother to learn them because they've either exhausted many systems in their career or there is not ample time in the day to do anything other than "survive" in the clinic. But taking the time to learn to use something you use for hours a day every day pays off, and investing as little as an hour each week learning to better use your EHR has been shown to increase physician satisfaction.

 

Three tips to get you started


1. Make sure you understand and spend some time loading your system's "macros." You want to make checking off boxes or typing a rare, unique action, not a routine one. One rule of thinking is that if you are doing the same thing the third time, you should spend a moment to save it, memorize it, macro it or whatever your system calls it.

 

2. Get a good tool for finding diagnosis codes. I recommend Problem IT Plus. Try it and you'll thank me if you are doing this now without it.


3. Make sure you understand how your system enables team-based care. Allowing everyone to practice at the top of their license and contribute to the delivery of care is crucial. Empower the care team to create notes and use automated tasking and messaging within the EHR whenever possible.


It is an exciting time for healthcare IT: leverage tools such as the EHR and allows them to help you refocus on the business of medicine instead of the business of administration. It takes an extra hour or so a month, but allows you to focus on the three things that matter most: your patients, your practice, and yourself.

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Are Medical Practices Taking Advantage of Cloud-Based EHR?  

Are Medical Practices Taking Advantage of Cloud-Based EHR?   | EHR and Health IT Consulting | Scoop.it

In today’s medical field, technology is a big player. With regulations dictating that even independent practices attempt to make the jump to a dedicated EMR/EHR. An EMR/EHR, or electronic medical record/electronic health record interface, provides physicians and patients a way to connect to promote efficient healthcare delivery and organizational profitability. Today, we will look at how smaller healthcare providers are utilizing EMR/EHR solutions that are hosted in the cloud, bucking the trend of hosting their patient information locally.

 

EMR/EHR


For the modern healthcare provider, the EMR/EHR is a major piece of software. The EMR/EHR is an interface that physicians, healthcare providers, and insurers use to update the information on each patient. As the patient has access to their own EMR/EHR file as well, it makes it a very useful guide for all parties involved to manage an individual patient’s care.

 

Major Considerations
With the massive cost of health care, it isn’t much of a stretch to say that there are some very serious considerations that have to be made to the way that doctors and health organizations utilize cloud-hosted technologies. Many providers, however, are reluctant to do just that as there are serious questions about the viability of cloud computing for regulation-covered information such as electronic protected health information (ePHI). One such consideration is the massive incentives offered to organizations who implement “meaningful use” EMR/EHR technology. In order to meet the “meaningful use” criteria, however, many separate variables have to be met, including:

  • Engaging patients in their own care
  • Improving quality, efficiency, safety, and reducing health disparities
  • Improving care coordination
  • Improving public health and health education
  • Meet HIPAA regulations for the privacy of health records

 

So while many of these variables seem to be common sense, there are additional costs that go along with this kind of comprehensive use of EMR/EHR functionality, which, for smaller medical practices, can be enough of an impetus to not meet those qualifications. Cost usually supersedes most other qualifications, even in a high-stakes, results-based business model like healthcare. That means that even though utilizing cloud technology will cut costs, there is no guarantee that a practice will meet the necessary criteria for “meaningful use”.

 

That said, cloud computing has more resources available to maintain data security than ever before, and organizations can still move to an EMR/EHR solution that will benefit their users, and their staff. If you are looking for a solution to help your medical practice cut costs, get dynamic web-based functionality, or get your technology in a position to meet industry regulations, contact the experts

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Getting the Most Out of Your EHR - Healthcare IT Consulting

Getting the Most Out of Your EHR - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.

 

8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and training can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.

 

EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.

 

EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.

 

Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.

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EHR and Challenges of the Modern Medical Note

EHR and Challenges of the Modern Medical Note | EHR and Health IT Consulting | Scoop.it

There was a time when documentation was an almost inconsequential process. After seeing a patient, the doctor would scratch a note, close the folder, and file it on a shelf until the next visit.

 

Things are different and the medical note has evolved. As it’s evolved, electronic health records (EHR) have brought efficiencies to the medical note while introducing new challenges. And like the cognitive biases that impact patient care, the problems inherent in documentation need attention.

 

Thinking about these challenges becomes important in documenting care and training the next generation of health professionals. Here are a few that I think about

Auto Documentation

One of the powers of the EHR is that it allows users to auto-populate the medical record with chunks of pre-fabricated text known as smart phrases. But these personally created building blocks of the medical note create the potential for one-clip-fits-all documentation. As I’ve said in the past, the smart phrase is not new technology.

 

I work to keep smart phrases out of my history of present illness and impression where individualized narratives show what’s unique about a case. Free text keeps me real.

Replicability

While smart phrases represent the dropping of self-created language, we have the ability to clip and paste information from other parts of the chart. This may include bits and pieces from notes penned by another medical professional.

 

While we all lift bits of language from places like CT and biopsy reports, issues arise when the origination of our language is that of another health professional. Epic now allows visualization of a phrase’s origin when not created by the author.

 

I’m careful about what I copy. I’m twice as careful with what I paste as a representation of my own thinking.

Size and absence of constraint

While smart phrases are limited only by our imagination, a digital note with no constraints predisposes to note bloat, one of the looming threats to modern medicine. Pre-digital notes were constrained by writer’s cramp.

 

I’ve laboured through notes where every single lab drawn on a complicated patient is dumped into the note. Pages and pages of marginally abnormal CBC and metabolic panels create a scenario where it’s difficult, if not impossible, to discern what data is relevant to the decisions made.

 

I try to consider the needs of the end user of the note. Of course, this is challenging when our opinion of what constitutes a ‘good note’ varies from that of the note read.

Ambiguity of purpose

This is the most remarkable phenomenon of the modern medical note. Medical notes have traditionally had pet purposes. Medical students learn early on that ‘the right way to write a note’ varies not only by speciality but by the whim of the individual physician responsible for the note. Physicians with firm views regarding what constitutes the purpose of a note may even morph their perspective depending upon the nature of an individual case.

So if you ask 3 physicians the purpose of a medical note and you’ll get 5 answers ranging from billing and quality documentation to legal coverage and professional communication. Over time the medical note has morphed into all of these things at once.

 

The problem with an ambiguity of purpose is how to manage the expectations of the end user. A physician who feels compelled to paste three months worth of blood results into the data portion of a note will be at odds with someone like myself who believes that a note serves to offer nothing other than concise support for what I’m thinking and planning.

 

As notes become more visible to more folks we can expect ambiguity of purpose to become more pronounced. Digital notes and their capacity for customization amplify this divergence of purpose.

Scaling visibility of the EHR

Once restricted to the shelves of offices in big buildings, medical documentation has traditionally been siloed. This was fine because notes existed for the doctors who occupied those individual offices.  The medical note is now enjoying new freedom in its electronic shape. More notes are more visible to more professionals. This is evident within consolidated health systems where networks of offices connect to big hospitals.

 

Beyond professionals, patients are watching and, in some cases, editing their own notes. OpenNotes is a related program based in Boston’s Beth Israel hospital. Regular patient review and revision represent a revolutionary move in medical documentation.

This scaling visibility of the modern note brings greater scrutiny for what we do or don’t do.

 

This idea of the medical note and its evolution gets little attention yet it represents the core medium of all documentation by medical professionals. It deserves more thorough attention and study.

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What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration | EHR and Health IT Consulting | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

 

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

 

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS? Learn how Pivot Point can help with your value-based strategy.

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Pros and Cons of Patient Access to Electronic Medical Records

Pros and Cons of Patient Access to Electronic Medical Records | EHR and Health IT Consulting | Scoop.it

Doesn’t it seem faintly ridiculous that patients have to jump through hoops to get access to information that, since it is in digital format, would be so readily available to them? Today’s patients are quite accustomed to being able to access data on demand, from whatever location on Earth, as long as they have Internet access and a mobile device or laptop computer.

 

They can, for example, log into their financial institution’s website to check their latest details. Parents of school-aged children routinely access a portal developed by their school to get information about upcoming tests, new requirements, and so on.

Furthermore, the advent of email, text messaging, and social media updates has lead to people becoming accustomed to easy communication with one another. But think about how much of an effort it is for patients to communicate with a medical practice (waiting on hold on the phone to leave a message for a nurse practitioner, for example, and then having to wait more for a reply that might not come until the following day).

 

You may have already deployed a patient portal for your organization, but are not quite sure about the protocols for sharing information. Or, you are somewhat familiar with patient portals, but you’re still not sure whether it’s a good idea to even have one and you would like more information before making an investment in this software solution.

 

Familiarizing yourself with the pros and cons of patient access to electronic medical records is essential before you pull the trigger and launch a patient portal at your organization.

Modern medical practices that have forward-thinking leaders will already have electronic health record or EHR software installed or are about to deploy it. An EHR is a database of all the records for your patients. It’s much more efficient than an antiquated, paper-based method for organizing charts in your practice. The EHR lets you keep track of all important information, from medical history, current diagnosis, details of the treatment plan and any medications that have been prescribed.

One feature of Electronic Medical Records software that medical professionals should be aware of is the patient portal, along with its benefits and potential drawbacks.

Pros of Allowing Patients to Have Access to their Electronic Medical Records

A major pro of patient portals is that they improve patient engagement. Engaged patients are more likely to stay loyal to a practice as compared to other organizations that don’t make much of an effort to connect.

Your staff can easily receive messages from patients over the portal, in a process that’s as easy as email. This cuts down on a lot of wasted time on both ends (patients forced to stay on hold to leave a message by phone, and staffers having to write down the message).

 

A patient portal reduces the total amount of time spent on the phone and can cut down on unnecessary visits. What’s more, it has been proven to reduce the number of no-shows.

Patients will be happier, since they can access their medical information using their own electronic devices, even when on the go.

They will also appreciate being able to check prescription information and request refills online. When patients need to schedule an office visit, they simply sign into the portaland make a request. This makes things easier for them as well as for your staff.

 

Finally, a patient portal eliminates one of the great drudgeries of modern medicine: patients having to fill out a big stack of paper intake forms before they have their first meeting with the doctor.

You can let them input their information through the portal (such as at a kiosk in your waiting area, or from the patient’s computer). They won’t have to fill in their address or list of allergies more than once, and your staff won’t have to transcribe information from potentially messily handwritten documents.

Cons of Allowing Patients to Have Access to their Electronic Medical Records

While there are a number of clear benefits to using a patient portal with your EHR or EMR, there are also some drawbacks to be aware of, so you can address them head-on.

For example, when you enable outside access to your EHR information via a portal, data security concerns will naturally come up. The system must use strong passwords and should include the latest encryption and other protections. Otherwise, patient data could be compromised, leading to fraud and identity theft.

A portal can be tough for some patients to comprehend, especially if they have been used to doing things the old-fashioned way. However, you can educate and acclimate patients to the portal when you explain the benefits to them.

There is also the issue of patients being exposed to more medical jargon then they are used to, including acronyms and strange Latin terms for body parts. But they can always look up terms they are unfamiliar with, or simply ask a member of your team for an explanation.

 

Your older patients may not be very tech-savvy, which could hinder their efforts to log in and access data through the portal. But portals interfaces can be easily simplified and a simple training brochure or online video could make a big difference in getting more patients used to the idea of using the system.

It’s natural to have a number of questions about installing an EHR and activating a patient portal for your practice. Once you have a better idea of how patient portals can empower your staff as well as your patients, you’ll be on your way toward deploying one in your organization.

Key Takeaway:

  • Electronic health record or EHR software enables you to activate a special patient portal.
  • A patient portal is a great way to let patients access their own information on demand.
  • One con to keep in mind with patient portals is that some patients may not have much experience with computers, preventing them from getting the most out of it.
  • Another drawback is the potential for data breaches, so you’ll need to work with a vendor that provides robust, secure EHR software.
  • Patients will appreciate being able to check into the system to set an appointment or request a prescription refill.
  • Your staff will waste less time because patients can leave them electronic messages via the portal, instead of having to stop what they are doing to respond to a call.
  • Patients find it liberating to gain more access to their lab test results through the portal, rather than waiting for the report to come by surface mail or a phone call from the physician.
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