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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How to Choose the Right EMR?

How to Choose the Right EMR? | EHR and Health IT Consulting |

MR is an acronym for Electronic Medical Records.

EMR is a computer based electronic system for maintaining patient data.

EMR systems are intended to keep track of patient’s entire health and medical history in a computerized format instead of the paper and folders that occupy entire racks and sometimes rooms in a clinic. These records grow over time and it become increasingly difficult to manage them. EMR makes these records more easily retrievable.


EMR systems have not been adopted by physicians and providers of healthcare as quickly as they should have been. There are several issues and reasons ranging from cost, issues of privacy, standardization and above all, physicians lack of knowledge of computerized systems and adaptability.

An ideal EMR should be able to provide complete, accurate, and timely data, alerts, reminders, communications, and other help at all points of care for all healthcare professionals at all times in a way that quality of healthcare can be dramatically improved. However, these promising functions are far from being realized in current EMR, and the resistance to current EMR from healthcare professionals is still strong.


Will this dream ever be realized? Will EMR ever be accepted universally by healthcare professionals? What is wrong with EMR?

Paper based records are still the preferred method of recording patient information for most physicians and providers, rather than EMR. The majority of doctors still find their ease of data entry in paper versus EMR and low cost hard to part with. However, as easy as they are for the doctor to record medical data at the point of care on paper, they require a significant amount of storage space compared to EMR. Most states require physical records be held for a minimum of seven years. The costs of storage on paper including the space it requires is much higher as compared to EMR. When paper records are stored in different locations, getting them to a single location for review by a provider is time consuming and complicated, whereas the process can be simplified with EMR.

Because of so many benefits of EMR, federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of EMR across the country. Congress included a formula of both incentives (up to $44K per physician under Medicare or up to $65K over 6 years, under Medicaid) and penalties (i.e. decreased Medicare/Medicaid reimbursements for covered patients to doctors who fail to use EMR’s by 2015) for EMR/EHR adoption versus continued use of paper records as part of the American Recovery and Reinvestment Act of 2009.

How to Choose the Right EMR?

There are many factors that should go into deciding which EMR software is the best for your practice. There are some key EMR areas that must be decided before you can commit to any EMR. There are literally 100s of EMR software today and choosing the right EMR can be the difference between success and failure.

First and foremost, EMR software must be Certified under the new ARRA guidelines.

Ease of Use

Any EMR software must be easy to use. If you have EMR software that is difficult to use, it might be time to scrap it and look for another EMR software solution. A big mistake many practices make is once they choose an EMR software company, they feel as if they are stuck with them. This should not be the case. Your best option would be to choose the right software for your practice the first time, but this doesn’t always happen.

Software Updates

In the ever-changing EMR world, updates are key more so given that requirements from ONC are changing everyday and requires EMR companies to be certified and re-certified. Software that is current one week, is out-of-date the next week. How often does your EMR software company provide updates? Are they releasing critical updates often? With web-based technology, EMR vendors are now able to update servers quickly, thus updating the software is painless.


The cost of everything is going up, and EMR software is no exception. EMR software companies have raised their rates drastically in the last 5 years. While many physicians are aware of the cost that an EMR solution requires, make sure your EMR software vendor is not ripping you off. There are lots of Great EMR solutions out there and some are drastically cheaper than others. Look for a Certified Web Based EMR that has all the bells and whistles but will not rip your pocket.


If you are having a problem with your EMR Software, you might need to call support. This is inevitably going to happen so make sure you know who to call in case your EMR software is not working properly. How good is your vendor’s EMR software support? Will they be able to solve my problem fast and easily?

Technical Dr. Inc.'s insight:
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Will Altering EHR Incentive Programs Raise EHR Implementation?

Will Altering EHR Incentive Programs Raise EHR Implementation? | EHR and Health IT Consulting |

While the HITECH Act and meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have truly increased the number of healthcare providers implementing and utilizing EHR systems, new research suggests that these federal regulations may have also led to specific disparities in patient care. A study stemming from Weill Cornell Medical College found “systematic differences” between doctors who were avid participants in the EHR Incentive Programs versus those who did not invest as much time and resources into meeting meaningful use requirements.

The study was published in the June edition of Health Affairs and analyzed more than 26,000 doctors across the state of New York. Additionally, the researchers looked at payment data from the Centers for Medicare & Medicaid Services (CMS) and the state Department of Health.

The payment data analyzed in the study stemmed from the years 2011 to 2012. The results show that participation in the Medicaid EHR Incentive Program increased by 2.4 percent during those two years. However, participation in the Medicare EHR Incentive Program rose much more quickly, showing a 15.8 percent increase in the number of providers taking part in the program and implementing certified EHR technology.

The results show that early and consistent provider participants in the EHR Incentive Programs have more financial capacity, better organization and resources for supporting EHR implementation, and previous experience using health information technology.

While meaningful use requirements pushed EHR adoption forward, the process of using the systems on a constant basis had a new set of challenges that some providers were unable to attain, the researchers said. However, the differing rates of participation in the EHR Incentive Programs is leading to higher quality care at some physician offices while others are lacking and administering lower quality healthcare services.

“The expectation is that physicians and hospitals should be electronic,” senior author Dr. Joshua Vest, an Assistant Professor of Healthcare Policy and Research at Weill Cornell Medical College, said in a public statement. “How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don’t have the resources or capability to adopt EHRs.”

The researchers explained that there is a “digital divide” among different healthcare providers due to the participation in the EHR Incentive Programs. These results may play a role in the future of healthcare policy. Since there are certain providers who dropped out of the Medicaid EHR Incentive Program, it may behoove federal agencies to make some significant changes to the objectives within this particular program in order to keep providers participating.

“Electronic health records are vital not only because of their ability to efficiently provide physicians with a comprehensive portrait of and decision support for their patients, but also to drive new healthcare delivery models that can improve the value and quality of clinical care,” Dr. Rainu Kaushal, Chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell, said in a public statement.

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The Blocking of Health Information Undermines Interoperability and Delivery Reform

The Blocking of Health Information Undermines Interoperability and Delivery Reform | EHR and Health IT Consulting |

The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Today we delivered a new Report to Congress on Health Information Blocking that examines allegations that some health care providers and health IT developers are engaging in “information blocking”—a practice that frustrates this national information sharing goal.

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

This report is important and comes at a crucial time in the evolution of our nation’s health IT infrastructure. We recently released the Federal Health IT Strategic Plan 2015 – 2020 and the Draft Shared Nationwide Interoperability Roadmap. These documents describe challenges to achieving an interoperable learning health system and chart a course towards unlocking electronic health information so that it flows where and when it matters most for individual consumers, health care providers, and the public health community.

While most people support these goals, some individual participants in the health care and health IT industries have strong incentives to exercise control over electronic health information in ways that unreasonably interfere with its exchange and use, including for patient care.

Over the last year, ONC has received many complaints of information blocking. We are becoming increasingly concerned about these practices, which devalue taxpayer investments in health IT and are fundamentally incompatible with efforts to transform the nation’s health system.

The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details. Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking. And for reasons discussed in our report, this behavior may become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature.

There are several actions ONC and other federal agencies can take to address certain aspects of the information blocking problem. These actions are outlined in our report and include:

  • Proposing new certification requirements that strengthen surveillance of certified health IT capabilities “in the field.”
  • Proposing new transparency obligations for certified health IT developers that require disclosure of restrictions, limitations, and additional types of costs associated with certified health IT capabilities.
  • Specifying a nationwide governance framework for health information exchange that establishes clear principles about business, technical, and organizational practices related to interoperability and information sharing.
  • Working with the Centers for Medicare & Medicaid Services to coordinate health care payment incentives and leverage other market drivers to reward interoperability and exchange and discourage information blocking.
  • Helping federal and state law enforcement agencies identify and effectively investigate information blocking in cases where such conduct may violate existing federal or state laws.
  • Working in concert with the HHS Office for Civil Rights to improve stakeholder understanding of the HIPAA Privacy and Security standards related to information sharing.

While these actions are important, they do not provide a comprehensive solution to the information blocking problem. Indeed, the most definitive finding of our report is that most information blocking is beyond the current reach of ONC or any other federal agency to effectively detect, investigate, and address. Moreover, the ability of innovators and the private sector to overcome this problem is limited by a lack of transparency and other distortions in current health IT markets.

For these and other reasons discussed in our report, addressing information blocking in a comprehensive manner will require overcoming significant gaps in current knowledge, programs, and authorities. We believe that in addition to the actions above, there are several avenues open to Congress to address information blocking and ensure continued progress towards the nation’s health IT and health care goals.

Information blocking is certainly not the only impediment to an interoperable learning health system. But based on the findings in our report, it is a serious problem—and one that is not being effectively addressed. ONC looks forward to working with Congress, industry, and the health IT community to properly address this problem and ensure continued progress towards achieving the goals of an interoperable learning health system.

ProModel Analytics Solutions's curator insight, April 17, 2015 11:37 AM

Karen DeSalvo-Leads the Office of the National Coordinator for HIT!

HITECH Stage 3 Security Rules

HITECH Stage 3 Security Rules | EHR and Health IT Consulting |

Some security experts are concerned that narrower risk assessment requirements in a proposed rule for Stage 3 of the HITECH Act "meaningful use" electronic health records incentive program could confuse healthcare organizations about the importance of conducting a broader risk assessment as required under HIPAA.

On March 20, the Department of Health and Human Services' Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking for Stage 3 of the Medicare and Medicaid EHR incentive program, and HHS' Office of the National Coordinator for Health IT issued the notice of proposed rulemaking for EHR software that qualifies for the incentive program: 2015 Edition Health Information Technology Certification Criteria.

The rules are slated to be published in the Federal Register on March 30, with HHS accepting public comment for 60 days. Regulators are expected to issue final rules after reviewing the comments, which could take months.

Under Stage 3 of the HITECH Act incentive program, eligible hospitals and healthcare professionals can qualify to receive additional incentives by "meaningfully" using certified EHR software to accomplish a list of objectives, including sending secure messages to patients and conducting a security risk assessment of EHR data.

Currently, depending upon when they began participating in the HITECH program, which launched in 2011, eligible hospitals and healthcare professionals are participating in Stage 1 or Stage 2 of program.

Under the HITECH Act, penalties for not using a certified EHR system will kick in beginning in January 2018. Hospitals and physicians participating in the Medicare program must meet a list of Stage 3 objectives and measurements to avoid reduced Medicare payments, a CMS spokesman explains. Those participating in Medicaid have through 2021 to qualify for financial incentives under the HITECH program, and are not subject to financial penalties for failing to meet the objectives.

Meaningful Use Proposals

One of the most significant proposed changes for Stage 3 requirements deals with risk assessments.

While healthcare providers are still expected to conduct broader HIPAA security risk analysis as part of their HIPAA compliance, the Stage 3 proposals state that healthcare providers must conduct annually an assessment that specifically looks at technical, administrative and physical risks and vulnerabilities to electronic protected health information created or maintained by the certified EHR technology.

The proposal addresses "the relationship" between this EHR-related measure and the HIPAA Security Rule risk assessments. "We explain that the requirement of this proposed measure is narrower than what is required to satisfy the security risk analysis requirement under [HIPAA]," the proposal says.

"The requirement of this proposed measure is limited to annually conducting or reviewing a security risk analysis to assess whether the technical, administrative and physical safeguards and risk management strategies are sufficient to reduce the potential risks and vulnerabilities to the confidentiality, availability and integrity of ePHI created by or maintained in [the certified EHR technology]," says the proposal.

"In contrast, the security risk analysis requirement under [HIPAA] must assess the potential risks and vulnerabilities to the confidentiality, availability, and integrity of all ePHI that an organization creates, receives, maintains or transmits. This includes ePHI in all forms of electronic media, such as hard drives, floppy disks, CDs, DVDs, smart cards or other storage devices, personal digital assistants, transmission media or portable electronic media."

Seeking Clarity

Security expert Tom Walsh, founder of consulting firm tw-Security, says the proposed rule offers some clarity of what's expected of healthcare providers.

"With the new MU Stage 3 there was clarification that this was the original intent" to assess the security risk of EHR data, he says.

However, the focus on the annual security risk analysis of EHR data may inadvertently water down the importance of conducting broader HIPAA risk analysis, he says.

"Some organizations, especially smaller organizations that do not have a dedicated information security professional on staff, think that the only risk analysis they need to conduct is just for the certified EHR," Walsh says. "The HIPAA Security Rule requires that all applications and systems that store or transmit ePHI need to have a risk analysis conducted."

John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, expressed disappointment with the risk assessment language in the proposed meaningful use rule. "The MU3 security requirements are less than HIPAA requirements in that they focus only on the EHR and not all information flows. Since security is an end-to-end process, it is not clear to me why the security focus of MU should be less than HIPAA."

Halamka suggests that "maybe a balanced approach is to require a HIPAA Security analysis - NIST 800-66 for example - once every three years, then ask for yearly progress on the plan, rather than yearly re-audits."

Secure Messaging

Another security issue spotlighted in the meaningful use requirements proposed for Stage 3 is secure messaging.

The proposal call for healthcare providers ramping up patient communication using secure messaging, especially after patients are discharged from a hospital or emergency room. For instance, the proposal says that providers should electronically send secure messages to more than 35 percent of all patients seen by a provider or discharged from a hospital during the EHR reporting period. The secure message should be sent "using the electronic messaging function of the certified EHR technology to the patient - or the patient's authorized representatives - or in response to a secure message sent by the patient or the patient's authorized representative."

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How Medical Practices Can Stay Ahead of EHR Adoption

How Medical Practices Can Stay Ahead of EHR Adoption | EHR and Health IT Consulting |

Physicians Practice has been asking physicians and practice administrators about their use of technology for over a decade. Now, many practices are on a second or third EHR system, and an increasing number use a cloud-storage solution for patient data.

Technology expert Derek Kosiorek, a consultant with the Medical Group Management Association, says "We see, especially [in] the healthcare sector, certain timeframes when there is a wave of technology adoption. … The big upgrade [for practices] was moving to the EHR." Chances are, your practice is somewhere in the process of implementing a new EHR, upgrading old systems, or adding new technology like a patient portal. If you are wondering where your peers are on the EHR adoption continuum, here's what we found out.

Data systems

Hands down, EHRs are the largest piece of technology that medical practices purchase. Whether your practice is part of a large integrated delivery system or a small independent "shop," EHR is the scaffolding that supports all other technology use. According to our 2014 Technology Survey, Sponsored by Kareo, which asked over 1,400 physicians and practice administrators how they are using technology in their practices, 53 percent of respondents say they have a "fully implemented EHR," and another 17 percent use a system provided by a hospital or corporate parent.  Only 20 percent of respondents say they do not currently have an EHR. When compared to past years, the trend is a slow but steady adoption of EHR: In 2010 (the year meaningful use became effective) 48 percent of responding practices had implemented an EHR, in 2014 that number was 70 percent.

*Check out the complete data from our 2014 Technology Survey to see how your peers are navigating the tech curve.

John Squire, president and chief operating officer of Amazing Charts, says his EHR company, which caters to small primary-care practices (one to five docs), sees similar adoption patterns. Approximately "half of the practices we contact are coming from paper. We get about 30 percent of our business from 'switchers,' somebody who has adopted another EHR system or is getting off of it," says Squire. He notes that many non-adopters are finally deciding to purchase technology, a concept he calls "the last mile," because their attitudes on technology are changing and with the extended deadline for meeting meaningful-use targets, physicians can still take advantage of the financial incentives.

Even if practices decide to opt out of government programs like meaningful use, an EHR can support many practice operations like keeping clinical records and generating patient billing statements. Squire says his company also sees an increase in interest in patient portals for similar reasons. For those practices that are preparing to attest to the Stage 2 rules of meaningful use, it is a necessity to have a portal, but for those that don't the benefits to patients and practice alike are still very real — for instance, removing the burden of "call-backs" to answer routine patient questions.

Patient portals also give a competitive advantage to your practice. Kosiorek notes that patients have come to expect online access to services like banking. He predicts that, soon, practices won't really have a choice. "I think it is going to be a competition thing. Your competition down the street across town has that portal, so any patients are going to start migrating toward that, especially newer patients," he says.

According to our survey, attitudes about the challenges of technology adoption are also shifting. Three years ago, our survey indicated that "cost" was the primary concern for technology adopters. This year, that has changed: EHR adoption and implementation concerns came in first and cost slipped to third place. That dynamic is slightly different if the numbers are sorted by independent and hospital-owned practices. But not as much as one might think: Adoption and implementation of EHR is the primary concern for both groups, with interoperability and cost in a near tie for second place for independent physicians. For hospital-owned practices cost is much less of a worry.

Hospital-owned advantages

When planning on acquiring an EHR, one way practices can address the twin issues of cost and technical support is by becoming part of a hospital or integrated delivery system; especially in rural areas that have fewer resources and large numbers of uninsured patients. Once abhorred by independent physicians, for some, the financials are proving hard to resist. Our survey indicates that 64 percent of respondents are in independent practice, while 36 percent are owned by a hospital. A slight majority of independent docs, 42 percent, say they are in solo practice and 33 percent practice with two to five physicians. That differs significantly when compared to the hospital-employed physicians, where there is a greater spread in practice size. On one end of the spectrum, 32 percent of respondents say they practice with two to five physicians, and on the other, 20 percent practice in a group with over 50 physicians.

Jo Orquia runs a small family medicine practice — located in a suburb of Atlanta — that consists of himself, a new physician partner, and a nurse practitioner. However, because his practice belongs to a large integrated delivery system, he's actually part of a multi-specialty group that has over 700 providers and is spread out over many locations. He's been in practice for over 20 years, and during that time he's vetted and partially implemented three different EHR systems, all with the help of his hospital network. Orquia firmly believes that his practice has benefitted from having access to hospital resources and IT support. He says that had he been in independent practice, he would have been pressured to pick a much less expensive EHR system.

Even though Orquia started his quest to adopt EHR in 2002, he's presently only a month into implementation of the hospital system's new EHR. While he says it has slowed down productivity, from prior experience he knows work flow will improve when he masters the learning curve.

However, he's less than pleased with the bureaucratic processes associated with his new system. "The frustration that I have now is simply, it takes so much time to do the things [EHR] requires me to do," he says, referring to his health system's requirement that as the physician, he must personally order tests and studies that previously he relied on his NP to order, with his supervision.

Forty-seven percent of respondents to our survey indicated that implementation of an EHR made their practice work flow more efficient; while 32 percent said they had not benefitted from new work flows. However, as Orquia notes, it takes time to fully implement and train staff members on a new system. Seventy percent of responding practices said that they had a fully implemented EHR (software/ hardware installed, and all providers and staff trained and using the system as needed) within one year of acquisition.

Independent practice concerns

Brandon Peters' solo practice, Northeastern Family Medicine, has been providing care to the citizens of Elizabeth City, N.C., since 1872. It is truly a family practice: before Peters, his father ran the practice, and before him, his grandfather and great uncle did. Elizabeth City is a small town about 50 miles south of Norfolk, Va., where 28 percent of the population lives below the poverty line. For Peters, that means a negative impact on his practice revenue.

"Unfortunately, some folks that make the commute up to the tidal area to have service have insurance, but we have a large uninsured population," Peters explains. That was part of the impetus for him to abandon his standalone practice management system two years ago and to adopt a new EHR system. He feels strongly that newer reimbursement models will depend heavily on reporting quality patient-care measures.

Squire sees the same trend in terms of practices adopting and using data systems that will not only document patient visits and facilitate automated billing tasks, but are also integrated with regional healthcare delivery networks. "[Primary-care physicians] see a little bit of everything," says Squire, "… they are basically the triage for the healthcare system. And they've got to interact with all these delivery systems; hospitals and larger [integrated delivery networks] and ACOs … and want the data portability and the ability to fit into all those systems."

Even for those physicians who are not wholly connected to data networks, Squire says the majority of physicians he talks to are embracing technology like e-prescribing and automating lab orders. "There's a clear payback there. If you look at one screen and see all your lab results come in, it's very convenient vs. a pile of faxes."

Another benefit to practices that adopt EHR will come through better transitions of care; for instance being notified when a patient is discharged from the hospital. Squire says that process is not as smooth as it should be, but CMS is working to automate it — and provide for greater provider reimbursement. New procedural codes for transitions of care will "allow the physician to basically make more money [for] follow-up care," Squire notes.

Peters does believe there is value in collecting and reporting patient data, but he's not convinced that translates into better patient care or improved work flow. He's even changed the structure of the questions he asks his patients during the office visit, so that he can better enter the data into the EHR. He fears that change will tarnish the patient-physician relationship. He likens the EHR-directed patient visit to driving 70 mph on the interstate, where changing direction is not an easy maneuver.

Peters also says he struggles with completing patient notes and often stays late at night trying to finish up. In that regard he is not alone. A third of respondents to our survey said EHR made their work flows more difficult. Peters says he cannot afford to hire someone to help him enter patient data. "I know some people have scribes … so you are not trying to collect [data] in real time while the patient is right there in the office. But the value, the charge for each one of our visits is so low … we're only getting $35, $40 per patient," he explains.

Using a medical scribe may be a concept before its time: Only 21 percent of our survey respondents indicated that they used a scribe to help enter patient data.

Since his practice consists only of himself, a receptionist, and a nurse, Peters must wear multiple hats — which make further drains on his time and pulls him away from patient care. "If we had somebody in-house to run the system, to customize the system, to keep it running, to do the updates, to make sure the printers worked, to make sure everything ran together [it would be better]."

New tech tools

If you contrast the hospital-owned group versus the independent practice contingent, it is clear that goals like implementation, access to new technologies, and IT support are more easily attained with the help of an integrated delivery system.

Robert Goldszer is chief medical officer at Mt. Sinai Medical Center in Miami Beach, Fla. Mt. Sinai is a 600-bed teaching hospital that also has five multi-specialty satellite clinics located within a 10-mile radius from the main campus.

The hospital uses an EHR that is accessible to providers on inpatient, outpatient, and teaching services. It can also be accessed remotely through laptop, tablet, smartphone, or whatever device is convenient. Goldszer says that physicians who treat patients at satellite clinics carry no patient charts. "I [the provider] just drive there, I log in to the desktop or my iPad, and I can do all the computing and look at every chart, write my notes, and see all the results I need," he explains.

Goldszer notes that Mt. Sinai has implemented several of the newest healthcare technologies: a HIPAA-compliant texting application; a heart-rhythm monitoring and reviewing application that uses telemetry; a diagnostic imaging application that can be viewed on mobile devices; and a patient portal.

The hospital also supports its residents' technology use by giving them an education allowance — which many use to buy an iPad.

"In this hospital on … teaching rounds, there's an attending, two interns, and three of the people have their iPad out. One of them is reading something from UpToDate or technology that they have online; the other person is looking at the X-ray; and the other person is writing the orders," says Goldszer.

In summary

While most practices have adopted an EHR, concerns about implementation are still front and center.  Here are some ways to make technology work for your practice:

• Use hospital/laboratory data networks to share/transmit patient records electronically;

• Write and transmit prescriptions electronically;

• Avoid printing and faxing reports, lab results, and prescriptions;

• Select EHR systems that allow remote access to patient data on mobile devices; and

• Use a cloud solution to store patient data — reducing expenses for upgrades, maintenance, and support.

Erica Sprey is an associate editor at Physicians Practice. She can be reached at

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Go Beyond Using Your EHR; Practice Heads Up Medicine

When providers and their staff don’t have the time or tools to effectively communicate with patients, a slew of issues can result: from physicians missing important cues and misdiagnosing patients to preventable hospital readmissions and poor outcomes because patients didn’t understand or follow care guidelines.

The problem has become endemic. According to one study, 80% of what doctors tell patients is forgotten as soon as they leave the office. Beyond that, 50% of what the patient did recall is incorrect. In addition to impact communication and follow up have on care and outcomes, patients are expecting a different experience than they once had. Nearly two thirds of patients now say they would consider switching to a physician who offers access to medical information through a secure Internet connection.

Just having the technology isn’t really enough. It is just as much about how you use it. Using an EHR, providing access to a secure patient portal, and other features are great but if you don’t take advantage of all they have to offer, you aren’t likely to change the physician patient dynamic.

That is where heads up medicine comes in because it is a process that engages patients with and in spite-of technology. It enables a variety of actions to be accomplished by a simple gesture, finger swipe, or tap rather than diverting your attention with complex navigation, keystrokes, spelling, or editing. As a result, you can focus your attention on your patient, instead of your technology.

The use of a truly mobile EHR can allow providers to practice heads up medicine by:

Enabling physicians to maintain eye contact with patients.
Allowing providers to have meaningful conversations with patients, share images, and educational materials, drug interactions, and more on the device.
Offering care recommendations to improve both preventive care and chronic disease management.
Assist the provider in capturing accurate information efficiently, yet without distraction.
Providing visit summaries and educational materials for review with patients before they leave the office.
Extending patient care beyond the boundaries of the office/office hours.

What all this requires from providers, aside from having the technology, is the commitment to using it completely. Many physicians want a truly mobile EHR but only a handful use one. My impression is that fear of learning and using new technology stands in the way. So here are my suggestions for getting comfortable with your mobile device so you can better engage with patients, improve outcomes, and increase satisfaction.

The use of a truly mobile EHR can allow providers to practice heads up medicine by:

Enabling physicians to maintain eye contact with patients.
Allowing providers to have meaningful conversations with patients, share images, and educational materials, drug interactions, and more on the device.
Offering care recommendations to improve both preventive care and chronic disease management.
Assist the provider in capturing accurate information efficiently, yet without distraction.
Providing visit summaries and educational materials for review with patients before they leave the office.
Extending patient care beyond the boundaries of the office/office hours.

What all this requires from providers, aside from having the technology, is the commitment to using it completely. Many physicians want a truly mobile EHR but only a handful use one. My impression is that fear of learning and using new technology stands in the way. So here are my suggestions for getting comfortable with your mobile device so you can better engage with patients, improve outcomes, and increase satisfaction.

Don’t skip the how-to: When you get new device, sit down for an afternoon and go through any and all tutorials on how to use your hardware and software. No one can do this part for you.
Use your device every day. Use it for everything from the beginning, not just documenting visits. Read books, do email, play games. The more you use it, the more familiar you’ll get with how to use it.
Tweak your templates. You’ll have preloaded templates in your EHR but you can customize them to fit better with your patterns. The more familiar the sequencing, the faster and easier you’ll be able to run through the template and document while talking to the patient.
Practice makes perfect. Do several test runs with staff or family before real patients to get your flow down. You want to get to the place where you can mostly tap and swipe without having to look at the device too much.

When it comes to choosing an EHR, take your time to get it right because the software and device are important. But if you want to practice a heads-up medicine approach, a big part of your success will also depend on getting comfortable with the device so you can focus more on the patient and less on the technology.

To discover more strategies to fully engage patients, download 10 Powerful Ways to Engage Patients.
ProModel Analytics Solutions's curator insight, March 26, 2015 11:49 AM

Using tech and still looking your patient in the eye!!

Mobile EHRs forge a patient journey platform

Mobile EHRs forge a patient journey platform | EHR and Health IT Consulting |

As last year wound down, Practice Fusion optimized its electronic health record service for Apple and Android tablets — and, in so doing, joined the growing number of vendors making mobile EHRs.

In addition to the obvious benefits of cutting the proverbial cord and arming clinicians with software tuned to specific devices, mobile-optimized EHRs lay a foundation for providers.

On tap for 2015? Patient check-in.

“Very soon the front office staff will no longer have to get out paper forms,” Practice Fusion CEO Ryan Howard says, stressing that this upcoming Practice Fusion feature would finally cover “every step of the patient journey.” 

Indeed, Practice Fusion revealed online check-in earlier this month and explained that patients will be able to submit insurance information, prescription status, and the reason for their upcoming visit before they even set foot in the doctor’s office. 

The company claimed that its new service will eliminate a quarter-billion pieces of paper this year by replacing the average 3-7 page forms patients complete at the doctor’s office.

Beyond check-in, Practice Fusion will also be looking to gear its cloud-based offering toward medical specialists.

“We’re pretty focused on flow sheets this year and really delivering a lot of functionality for subspecialties,” Howard revealed. 

As far as legislation and regulation go, ICD-10 and telemedicine mandates will be huge in 2015 and key at HIMSS15, Howard says. Meaningful Use Stage 3 will also be entering the fold this year, a fact the industry is hard-pressed to heed given the difficulties currently unfurling with Stage 2.

And EHRs optimized for mobile use will be underlying all of the above, Howard explains.

That’s because patients want mobility as much as doctors do.

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Stalking the "Perfect" EMR | Hospital EMR and EHR

Stalking the "Perfect" EMR | Hospital EMR and EHR | EHR and Health IT Consulting |

Everyone’s heard about it, but nobody’s seen it — the perfect EMR. You know, the one that satisfies every doctor, integrates easily with every related hospital system, plays well with HIEs and even makes coffee for the CIO.

In all seriousness, virtually every EMR installation seems to involve systems integration problems, workflow requirements, user interface design or a  baker’s dozen of additional problems that hang like a cloud of smoke over even the more successful rollouts.

In theory, you might be able to resolve these disputes by letting the staff choose which EMR they’d like to see in place. But in reality, that doesn’t work either, argues John Halamka, MD, MS, whose many titles include CIO of Beth Israel Deaconess Medical Center and CIO at Harvard Medical School.  “I’ve heard from GE users who want Allscripts, eClinicalWorks users who want Epic, Allscripts users who want AthenaHealth, and NextGen users who want eClinicalWorks,” he notes.

Worse, if you let every department and clinical constituency pick what they want to include in their EMR, you end up with “an unintegrated melange of different products that make care standardization impossible,”  Dr. Halamka suggests.

As nice as it would be to satisfy everyone, there’s really only one approach that works, Dr. Halamka says. IT leaders need to pick an EMR for their enterprise that meets the enterprises overall strategic goals, one “providing the greatest good for the greatest number.”  Then, follow up with substantial training, education, collaboration, user engagement support and healthcare information exchange, he says.

No matter what your EMR turns out to be, it’s going to fix some workflow and process issues while creating others, he suggests. The best thing healthcare CIOs can do is simply go with smart enterprise-wide technology and help providers user it effectively.

This argument makes a lot of sense to me, at least at this stage in the emergence of EMRs. In, say, five years when key features are more standardized, it might be easier to buy “off the shelf” EMRs that please almost everyone. Or will it?  What do you think?

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Health System Praises EHR Use After Fire at Paper Record Warehouse

Health System Praises EHR Use After Fire at Paper Record Warehouse | EHR and Health IT Consulting |

A health system spokesperson touted the use of electronic health records to store duplicate copies of patients' medical files after a seven-alarm fire at a document warehouse in Brooklyn, N.Y., this weekend sent charred papers from several medical institutions blowing through the streets, EHR Intelligence reports.

Fire Details

The CitiStorage warehouse -- located on the East River -- was stacked floor to ceiling with archived records, including those from the New York City Health and Hospitals Corporation and members of the Greater New York Hospital Association. 

The blaze -- the first seven-alarm fire in New York City since 2012 -- required more than 60 units and 275 firefighters to contain.

Fire Commissioner Daniel Nigro said no one was hurt in the fire, and the cause of the fire remains under investigation. Authorities have noted that the building was regularly inspected by fire authorities.

Ian Michaels, a spokesperson for HHC, said, "Fortunately, as an early adopter of electronic medical record systems, HHC keeps vital patient records in electronic form and we do not anticipate this will affect our patient-care operations".

According to AP/CBS New York, the fire could take at least a week to put out.

Privacy Concerns

While electronic data breaches are likely more common than warehouse fires, many observers say they are concerned by the private information that the fire has sent blowing into nearby streets.

According to the New York Times, the scattered papers include:

  • Copies of checks containing bank account numbers;
  • Documents marked "confidential";
  • Health insurance forms with Social Security numbers; and
  • Medical reports containing patient names.

Spencer Bergen, a nearby resident, said in an interview with the Times, "They're like treasure maps, but with people's personal information all over them." He reported finding half-charred scraps of documents several blocks from the warehouse.

The city has deployed disaster recovery contractors to collect the documents.

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Survey: Physicians See Benefits, Drawbacks in EHR System Switches

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

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

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

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

Survey Findings

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

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

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

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

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

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

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

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

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Lots of docs will be skipping Stage 2 meaningful use | Healthcare IT News

Lots of docs will be skipping Stage 2 meaningful use | Healthcare IT News | EHR and Health IT Consulting |

A new survey of physicians by Healthcare IT News' sister site finds that 55 percent of them won't attest to Stage 2 meaningful use this year. It's "almost impossible" says one specialist polled by Medical Practice Insider.

"The following sentence is false 100 percent of the time: 'We completed meaningful use stages 1 and 2 and as a consequence the care we provide for our patients has improved,'" said another skeptical doc – one of nearly 2,000 polled by MPI in partnership with SERMO.

There are plenty of reasons that physicians find it preferable to forgo this next, much-harder stage of meaningful use. For many, it just doesn't make sense for their practice – or for their patients.

"It requires patients to have emails and engage my EHR," said a cardiologist. "Well, I have a lot of patients in their 80s and 90s, and they don’t have computers, let alone email."

"My patients are reluctant to use messaging and I personally do not like the interface for my portal," said a family practitioner.

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

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

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

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

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

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

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

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People Aren't Perfect and EHRs Can't Change That | Physicians Practice

People Aren't Perfect and EHRs Can't Change That | Physicians Practice | EHR and Health IT Consulting |
George W. Bush got one thing right and one thing wrong. He was right when he announced that he was "The Decider." He was wrong when he chose where he would get the information on which to base his decisions. He understood that he could never know everything about everything, therefore it didn't really matter if he knew nothing about anything, as long as he could apply his instincts for deciding to knowledge that was supplied and explained by others.

Keep that in mind while we think about healthcare practitioners. Being human, there are two things about which you can be sure:

1. People can't perform an operation flawlessly, in precisely the same way time after time after time; and

2. People can't keep track of (remember) all of the things that hallucinating managers and regulators think that they should.

It's just the way human brains are constructed. It may not be what anyone wants to hear, but it's a fact and no amount of wishing will alter the facts.

So, the worst thing that an EHR can do is to add to the number of procedures that people must perform flawlessly and the number of things that they must remember to do. Being the worst thing possible, that is, of course, exactly what most of them do do (and why some think that they are do-do).

Computer systems will never make good deciders and people will never make good robots.

For an EHR to be useful, it should focus on documenting events, keeping track of work in progress, and alerting people in useful ways when new information becomes available that might require a decision. Then it should present that new information, in context, so that people can make the best decision possible.

When the available information is skewed, biased, incomplete, or just plain wrong, bad decisions will be the result. When information that could be available is not available, the decisions that get made will be a total crap shoot.
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How Medical Software Can Help Your Medical Practice

How Medical Software Can Help Your Medical Practice | EHR and Health IT Consulting |

What Are the Different Types of Medical Software and How Can They Help Your Medical Practice?

There are plenty of software solutions on the market today offering services to solve some of the more traditionally complex tasks inherent to a medical office. For a medical practice, it can be a little overwhelming to sort through all the platforms and their features, from medical billing software to medical scheduling software, practice management software to medical information systems.

What you may find as you explore the various medical software brands is that there is a lot of overlap, with some services offering a little of this and that. To help give you an overview of some of the medical software options available, we put together this quick roundup.

There’s often confusion between EMV vs. EHR, so here’s the difference. An EMR (Electronic Medical Record) is all the internal information a practice collects on a given patient. This data is built up over various visits to a doctor. As such, EMRs are not usually shared outside the walls of a medical practice, but are kept on-hand internally to help treat and track the patient’s various diagnoses and progress. EMR software makes it easier for doctors and staff to keep, store, organize, and access this information whenever needed.

On the flipside, EHR (Electronic Health Record) is very similar to EMR, except they’re meant to be more comprehensive with medical history and shared amongst various practices for the benefit of both doctors and patients. EHR software has been around for a while, but government incentives to go digital have made its use a lot more prevalent. Really solid EHR software will allow your practice to save and access an incredible amount of aggregated patient data with just a few clicks.

Practice Management Software
Every medical practice needs some degree of organization to be successful. Practice management software can help your business take control of its day-to-day activities by streamlining operations. Common to this type of software are features such as appointment scheduling, patient registration, insurance filing, specialized calendars and billing.

Medical Scheduling Software
Few things can be more frustrating for a practice than having a patient schedule an appointment and then not show up. It’s an incredibly frequent occurrence that costs the U.S. healthcare system up to $150 billion annually in lost revenue. Medical scheduling software can help with this problem by sending automatic alerts and notifications to patients to remind them of appointments, which has been shown to reduce no-shows. It’s worth noting that there are lots of different types of medical scheduling software available, even some free versions, and you may also find this type of functionality already included with certain EMR/EHR and practice management services.

Medical Billing Software
Every medical practice needs to keep its lights on, and medical billing software certainly makes it a lot easier for your staff to do just that. Good medical billing software allows you to manage insurance and patient payments, and track their status through the submissions process. It’ll also keep you updated on evolving payer rules, and changes to codes and formats. Collecting your revenue for services rendered shouldn’t be a headache, and medical billing software will take the sting out of it.

These are just a few of examples of the various types of medical software available to practices that can help make their professional lives a little easier.

Technical Dr. Inc.'s insight:

Contact Details : or 877-910-0004

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Keep Calm and Interoperate On

Keep Calm and Interoperate On | EHR and Health IT Consulting |

Following the recession, the Obama administration sought shovel-ready projects.

One unlikely shovel wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 % of the stimulus towards digitizing medical records.

Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between electronic health records with the implication that such an exchange is a public good and so government intervention is justified.

Robert Wachter, voted the most influential physician by Modern Healthcare, sums the optimism and frustration with the electronic health record (EHR) in Digital Doctor – which stands to be a classic.

It was Bush Jr., not Obama, who started the digitization. Seeking bipartisanship after the war in Iraq, Bush was inspired by his closest ally, Tony Blair, who was wiring the National Health Service (NHS) – a $16 billion initiative which has since failed, spectacularly.

Bush founded the Office of National Coordinator of Health Information Technology (ONC) and appointed David Brailer – a physician, quant and entrepreneur – as head. Brailer wanted interoperability so that hospitals shared information. It is because of interoperability that we can use our debit cards in New York and Singapore. The market must agree on a common language, such as the TCP/ IP for the internet, to achieve interoperability.

Patients suffer when systems can’t talk. Were patients, not a third party, bearing the full costs of care – a free market – they might have forced hospital information systems to talk. Rightly or not, healthcare is not a free market and hospitals have little motivation in making cross-talking simpler.

Brailer wanted the ONC to be an enabler not dictator of common standards. Fearing that market innovation would be ruined by regulatory over reach, he drew a fine line. A budget of $42 million suited his libertarian ethos. Following the HITECH Act, the budget for ONC increased to $30 billion and Brailer’s line was wiped.

With unabashed Keynesianism, the government subsidized the purchase of EHRs by physician practices from certified vendors. The logic was sound. Expecting practices to digitize voluntarily is like expecting people to buy roads to make Interstate-95. The cost of digitization is high, yet all will, one day, benefit from the wiring, not just practices which choose to be wired.

The reformers wanted a Goldilocks system in which doctors delivered neither too much nor too little care. To pay doctors for doing the right thing, not just for doing, an electronic repository was necessary, so that payers knew which doctors followed guidelines, encouraged prevention and practiced high value care.

If only payers could measure doctors they could reward the good and punish the bad. EHRs would be the treasure trove of that information. If mandating health insurance was crucial to reforming insurance, the EHR was essential to reforming physician payment. Thus, the EHR transmogrified into an electronic version of Bentham’s panopticon.

The government could not subsidize physicians unconditionally. The conditions were named, with unintended irony, “Meaningful Use.” Regulators no longer were concerned just with interoperability but how the technology was being used. It was like Steve Jobs and Bill Gates selling computers only if used for activities they both approved.

In a dialectic not odd in healthcare, HITECH is a success and disaster. The adoption of EHR, which increased from 10 % to 70 % of practices, would not have happened so quickly without the subsidies. The Blitzkrieg has consequences – many physicians loathe EHRs, viscerally.

The paradox of automation is at once diminution and magnification – fewer but more catastrophic errors. Wachter narrates how a young male received an obscenely high dose of an antibiotic because of a user-unfriendly prescription interface. The bad tool might blame the workman. Whether the tool or the workman is at fault is a distinction without a difference.

Why are doctors deskilled by EHRs when they use I-pads, power point and Yelp? EHR is like a library which throws all books all at once at you when all you wish to read are books by Herman Melville. The information overload fatigues.

EHRs serve many masters including administrators, payers, risk managers and researchers. EHRs must also capture the nuances of a doctor-patient interaction. By bloviating the EHR with information rather than trimming the interface with context, the vendors have pledged their servitude to the comptroller not the foot soldier; which would be fine but it is the foot soldier who uses the EHR predominantly.

Wachter is no Luddite. He speaks in measured tones with subtle angst and his sharp analysis will please Luddites as well as Futurists. He occasionally invites the reader to disagree. Wachter believes EHRs, though flawed, have improved healthcare delivery. I might argue with that. The loss of clinical context is tangible. But would I return to paper records? Truthfully, probably not.

Computerization of records was inevitable. Had it emerged organically, through dispersed agents and trial and error, the way advised by Friederich Hayek in his landmark essay “Use of Knowledge in Society”, arguably we might have interoperability. The precocious adoption of EHR may have stunted its growth.

Imagine if the government had subsidized the purchase of cars in 1896. Perhaps all Americans would have owned cars before the twentieth century, and horse buggies would have disappeared sooner. But would Henry Ford have innovated beyond the Quadricycle?

Mr. Ford might have envied the EHR-vendors. I do. They enjoy a rare carapace which shields them from unhappy customers. Disgruntled doctors are summarily dismissed as change-phobic dinosaurs. Hospital administrators don’t admit that they have misjudged costly technology. Some contracts forbid doctors from shaming vendors openly, even as taxpayer’s money flows to the vendors. Free market advocates will protest that this is not capitalism. To be fair, neither is this socialism. Whatever this innominate political economy will be named, it seems quite unique to US healthcare.

John Maynard Keynes famously said that in a recession there was value even in the government burying bottles with bank notes and luring private enterprise in to retrieving them. HITECH didn’t exactly bury the bottles but handed them out, with $30 billion in them. In return for the bottles we have strategic plans, shared goals, pages and pages of rules but no interoperability. Instead, the ONC is remonstrating with hospitals not to block information. Might the stimulus have been better spent on tinkerers? Brailer believes so.

To quote Seneca: to be everywhere is to be nowhere. The reformers may have asked too much, too soon of electronic health records, which may deliver too little, too late. Time will tell, of course, and in twenty years either the tinkerer or the central planner will have the satisfaction of “I told you so.” But both will applaud Wachter’s tome.

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ONC Slams EHR Vendors, Health Providers for 'Information Blocking'

ONC Slams EHR Vendors, Health Providers for 'Information Blocking' | EHR and Health IT Consulting |

Some health IT vendors and health care providers are intentionally blocking the sharing of patient information, impeding progress toward a national data sharing goal, according to a report by the Office of the National Coordinator for Health IT, the Wall Street Journal reports.


Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. According to the Journal, the incentive payments have helped nearly 80% of eligible professionals and 60% of eligible hospitals convert from paper files to EHRs. However, just 20% to 30% of providers are able to share EHRs with outside providers, according to the Journal.

Report Details

The report was written in response to a December 2014 request from Congress

For the report, ONC examined allegations that some health IT developers and providers have engaged in "information blocking," which ONC describes as a practice in which "persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information".

Report Findings

In the report, ONC listed several complaints that it has received, including that vendors have:

  • Charged high fees to establish connections and share patient records;
  • Required customers to use proprietary platforms; and
  • Made it prohibitively costly to change EHR systems.

Further, the report found that many hospital systems complicate the transfer of patient records to rival providers to control referrals and enhance market dominance.

The report noted that ONC does not have the authority to regulate prices and that many of the actions in question do not violate laws. The agency wrote that it could decertify EHR systems that intentionally block data sharing but warned that doing so would wrongly penalize customers.

ONC wrote, "While many stakeholders are committed to achieving this vision, current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use." It added, "These concerns likely will become more pronounced as both expectations and the technological capabilities for electronic health information exchange continue to evolve and mature".


ONC outlined several actions that can be taken to address information blocking, including:

  • Assisting federal and state law enforcement agencies in identifying information blocking cases that violate current laws;
  • Bolstering oversight of certified health IT capabilities "in the field" through new requirements;
  • Creating a nationwide health information exchange governance framework;
  • Requiring certified health IT developers to disclose additional costs, limitations and restrictions associated with their products;
  • Working with CMS to create incentive payments that reward interoperability and health data sharing; and
  • Working with HHS' Office for Civil Rights to educate stakeholders on how HIPAA privacy and security standards apply to information sharing.

The Electronic Health Record Association, a trade organization, said that its members aim to share patient records but that it requires time and money to build connections used by several different stakeholders.

Meanwhile, some vendors have said they do not depend on connection fees. For example, vendors in the CommonWell Health Alliance -- which comprises about 70% of the acute care market and 24% of the ambulatory care market -- say they seek to create a network with low-cost connections that make it easy for physicians to find patient records throughout the system.

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Finding the Right EHR for Meaningful Use Attestation

Finding the Right EHR for Meaningful Use Attestation | EHR and Health IT Consulting |

Starting with a new EHR system or switching vendors requires hours of training — something many physicians are reluctant to do. However, switching EHRs is sometimes a necessary step to successfully attesting to meaningful use.

Understandably, physicians get frustrated about having to learn a whole new EHR system, so practice managers and administrators have to approach training delicately.

"I think that some physicians have felt over the years that they may not have gotten everything that they needed from their vendor from a partnership standpoint and may not have gotten it in a timely enough manner," said Trenor Williams, managing partner at The Advisory Board's consulting and management division.

Williams added that integrated technology solutions are, "one of the things that clinicians, administrators, and their operators are thinking about and, to me, that's one of the major drivers that we're seeing outside of meaningful use to get physicians to think about changing their electronic health records."

According to a 2014 survey by Medical Economics, 67 percent of physicians are dissatisfied with their EHR's functionality. However, recent research from the American Academy of Family Physicians showed physicians who did switch their EHR vendors were not necessarily happier about their new purchase. Out of 305 physicians who changed EHRs, 43 percent said they were happy with their new software and only 39 percent were pleased with the new system as a whole.


Whether implementing a new EHR system due to an acquisition or another scenario, according to Bill Fera, principal in the Advisory Health Care practice of Ernst & Young, it's best to tread lightly when training on a new system is required.

"As with any implementation, the approach should be tailored to the persona of the physician," Fera said. "Physicians who had trouble adapting to an EHR the first time around, will probably have trouble again and will probably exhibit a greater level of frustration. They will need more time and attention for training."

Mary Griskewicz, senior director of healthcare information systems for the Health Information and Management Systems Society, said the initial training on an EHR takes about two days. "Then reinforcement of about two weeks to three weeks of using it over and over again is what is typically needed," Griskewicz said. "Having an expert user on hand is best as well as peer-to-peer training, when possible, to train the staff."

Another factor causing practices to change EHR vendors is the need for enterprise-wide functionality, Fera said.

"Practices who were ahead in selecting EHRs often chose ambulatory-specific products that may not be easily integrated into an enterprise strategy," said Fera. "As the industry emphasizes hand-offs and seamless transitions for patients from one care venue to another in the context of re-emerging risk based payment models, the consistent flow of information through an enterprise related to all aspects of a patient's care become paramount. In these cases, physician practices are often being switched to an enterprise product for ambulatory care."

Griskewicz said some of the resistance to training by physicians is because they don't want to take time away from seeing patients.

"Sometimes what [practices] will do is shut down for a couple of days or do appointments in the mornings and then do training in the afternoons where they'll shadow either with the super user or another physician," she said. "Giving clinicians time to learn the system is really important. There's no way around that."

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Epic’s App Exchange, will the most popular EHR open up or remain closed?

Epic’s App Exchange, will the most popular EHR open up or remain closed? | EHR and Health IT Consulting |

Epic’s EHR has grown exponentially over the past few years and now dominates medium and large practices, as well as many of the major health systems across the country. Epic already provides a host of integrative features for providers and patients including EpicCare Link, Bedside, Care Everywhere, myChart (patient-controlled portal), Haiku (mobile and secure physician access to patient records and imaging), and Lucy (a freestanding patient personal health record).

With the ubiquity of Epic in the healthcare marketplace, there has been a lot of buzz about a planned addition to that suite – the Epic App Exchange. Although details haven’t been released, descriptions of the Epic App Exchange liken it to the Apple App Store. Epic will provide the instructions for creating and integrating apps with Epic’s network infrastructure. This would potentially open Epic to app developers to produce innovative solutions for Epic customers to improve patient care.

The news broke a few weeks ago at a Wisconsin Innovation Network by Mark Bakken, co-founder and former CEO of Nordic Consulting and founder of HealthX Ventures, where the Epic App Exchange was touted to be the next big thing that would “open the floodgates” for app developers and “cement [Epic’s] long-term legacy.”

For some that have followed Epic over the past 2 years, this may conjure memories of the release of Open.Epic with hopes that it would lead to greater interoperability. However, Open.Epic only allowed developers to input data from patient wearables and sensors passively into Epic and the API did not allow free exchange in and out of the Epic system. The recent Epic App Exchange announcement has been met with tempered hope and excitement, as the ultimate utility depends on as-yet unreleased details.

The question becomes how “open” will this Epic App Exchange be and will any and all developers have access to the API. At this time, it is impossible to know whether the Epic App Exchange will only be an exchange of apps for its closed-system customers, or whether it will be open to developers and innovators to create products on top of the Epic system, thus propelling the country towards greater national interoperability.

The Epic App Exchange comes prior to the announcement of the final contract for the Defense Healthcare Management Systems Modernization (DHMSM) and Department of Defense. The DHMSM program has a mission to “acquire, test, deliver, and successfully transition to a state-of-the-market electronic health record (EHR) system” for it’s 9.6 million beneficiaries and 153,000 personnel across 1,200+ worldwide locations. Key features to incorporate include a “patient-centric system” that is “flexible and open” and “enable full patient engagement in their health.” The report by DHMSM also emphasized the importance of interoperability and “collaborative partnerships to advance national interoperability.” There are 4 teams being considered for the DHMSM and DoD contract worth upwards of $11 billion over a few years. One of the 4 teams includes Epic partnered with IBM.

In order to move healthcare forward and focus on value and quality in medicine, there is a tremendous need for national interoperability of electronic health records. To make this dream a reality, it will take some of the major players in healthcare IT, like Epic Systems, to allow developers to create innovative solutions on their robust network infrastructures. We hope that the Epic App Exchange is a step in the right direction, but the devil lies in the details and we don’t have those details yet.

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Solving Problems that Arise Due to EHR Use

Solving Problems that Arise Due to EHR Use | EHR and Health IT Consulting |

In plastic surgery, we live by the maxim that to correct a problem in one area is to create (or expose) a problem in another area. That is what I see happening with the transition to EHRs. The use of EHRs has rapidly increased and expanded over the past five years. The HITECH Act and the onset of meaningful use have provided significant incentives to assist practices and providers to implement EHRs in their practices.

Many initiatives to improve care delivery and patient handoffs have also expanded the emphasis on EHRs, leading to expanded use in both emergency departments as well as outpatient settings. According to the National Center for Health Statistics, the use of EHRs in the emergency department nearly doubled from 46 percent to 84 percent in the five years preceding 2011. The growth on the outpatient side was even more significant with a change of 29 percent in 2006 to 73 percent in 2011.

EHRs allow us to leverage the power of computers to provide a better quality of service to the patients who rely on us for their care. They provide great benefits to care delivery, including automated evaluation of drug interactions, preventative healthcare suggestions, persistent patient problem lists, and electronic prescribing, among other components.

While there has been fantastic progress made toward the goal of successfully implementing EHRs at all levels of the U.S. healthcare system, we still have work to do to ensure the process works smoothly for patients and providers.

Problems are arising as they are being solved.

Providers have expressed concerns about needing to refine the EHR process to enhance productivity, not decrease it, as well concerns about perceived reduction in patient satisfaction and attentiveness to patients.

Another issue is the very real problem with fraudulent documentation. The EHR was created to assist providers and hospitals for properly documenting the care that is delivered in support of appropriate, higher level coding. However, a small but significant level of falsification of records is occurring, facilitated by the utility of the EHR, that is driving up healthcare costs. To combat this, insurance carriers and CMS are employing increasingly sophisticated tools to detect fraud in the EHR, and going after providers and facilities to recover fraudulent reimbursement, among other penalties.

I still believe in the promise of the EHR. I’m confident that the EHR will fulfill its potential to become one of the more valuable tools that we have in modern medicine to improve the care we give to patients.

How can we combat some of these problems that are arising due to EHRs? Here’s my prescription:

• Provide more and continuous training resources for providers in the use and utility of EHRs.
• Clearly define and explain how EHRs can contribute to and result in fraudulent and nefarious practices. It is also the responsibility of the provider to understand this issue, as ignorance of the laws and regulations is no defense.
• Provide more tools to make it easier for providers to focus on patient care, and not the process of charting and ordering in EHRs. Examples include biometric log on to systems and enterprise level medical dictation to cut down on the time drain that EHRs represent in the current deployment.
• Be patient. A transition is a change from one paradigm to a new one. It takes time, money and resources to change something as significant as the way in which we document the care that we provide.

I discover additional utility in the two EHRs that I use daily by being inquisitive, and working with IT and the representatives of the software providers. It can seems like a daunting task due to the time pressures under which we all operate in our respective clinical environments, however, the benefits will be far worth it in the long run. With the proper training, and support, we can reach our potential and get the focus back where it belongs — on patient care.

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Will Cerner Let Mayo Clinic Move to Epic Easily?

Will Cerner Let Mayo Clinic Move to Epic Easily? | EHR and Health IT Consulting |

As most regular readers know, we don’t try to get into the rat race of breaking news on things like EHR selection, the latest meaningful use, or whatever else might be time sensitive healthcare news. Sure, every once in a while we’ll report something we haven’t seen or heard other places, but we’re more interested in the macro trends and the broader insight of what various announcements mean. We don’t want to report on something happening, but instead want to tell you why something that happened is important.

A great example of this is Mayo Clinic’s decision to go with Epic and leave behind Cerner, GE, and other systems. There’s a good interview with Mayo Clinic CEO, Cris Ross, that talks about Mayo’s decision to go with Epic. As he says in the interview, GE Centricity wasn’t part of their future plans, and so they were really deciding between Epic and Cerner. Sad to see that Vista wasn’t even part of their consideration (at least it seems).

Based on Cris Ross’ comments, he commented that he liked Epic’s revenue cycle management and patient engagement options better than Cerner. Although, my guess is that they liked Epic’s ambulatory better than Cerner as well since they were going away from GE Centricity. Cris Ross’s double speak is interesting though:

As we looked at what met our needs, across all of our practices, around revenue cycle and our interests around patient engagement and so on, although it was a difficult choice, in the end it was a pretty clear choice that Epic was a better fit.

Either it was a difficult choice or it was a pretty clear choice. I think what Cris Ross is really saying is that they’d already decided to go with Epic and so it was a clear choice for them, but I better at least throw a dog bone to Cerner and say it was a hard choice. Reminds me of the judges on the voice that have to choose between two of their artists. You know the producers told them to make it sound like it’s a hard choice even if it’s an easy one.

Turns out in Mayo’s case they probably need to act like it was a really hard choice and be kind to Cerner. Mayo has been a Cerner customer for a long time and the last thing they want to do is to anger Cerner. Cerner still holds a lot of Mayo’s data that Mayo will want to get out of the Cerner system as part of the move to Epic.

I’ll be interested to watch this transition. Will Cerner be nice and let Mayo and their EHR data go easily? Same for GE Centricity. I’ve heard of hundreds of EHR switches and many of them have a really challenging time getting their data from their previous EHR vendor. Some choose to make it expensive. Others choose to not cooperate at all. Given Mayo’s stature and the switch from Pepsi to Coke (Cerner to Epic, but I’m not sure which is Pepsi and which is Coke), I’ll be interested to see if Cerner lets them go without any issues.

I can’t recall many moves between Epic and Cerner and vice versa. Although, we can be sure that this is a preview of coming attractions. It will be interesting to see how each company handles these types of switches. What they do now will likely lay the groundwork for future EHR switching.

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BIDMC’s Internal EHR and A Possible Epic Future

BIDMC’s Internal EHR and A Possible Epic Future | EHR and Health IT Consulting |

One of the surprising reactions for me in the announcement of Athenahealth’s acquisition of Beth Israel Deaconess Medical Center’s (BIDMC) in house webOMR platform was by John Halamka. As I mention in the linked article, it really isn’t a pure software acquisition as much as it is Athenahealth going to school to learn about the inpatient EHR space. However, John Halamka’s reaction to this announcement is really interesting.

As I read through all of the coverage of the announcement, John Halamka seems to have shifted gears from their current in house EHR approach to now considering a switch to some other external EHR vendor. This is very interesting given this blog post by John Halamka back in 2013. Here’s an excerpt from it:

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC. We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch. Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth? Will Epic’s total cost of ownership become an issue for struggling hospitals? Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?

Based on John Halamka’s comments it seems that his belief might have changed or at least he’s considering the option that an in house system is not the right approach moving forward. No doubt Athenahealth is hoping that they’ll delay the decision a few years so they have a chance to compete for BIDMC’s business.

If you look at the rest of the blog post linked above, Halamka was making the case for Epic back in 2013. I think that clearly makes Epic the front runner for the BIDMC business at least from Halamka’s perspective. We’ll see how that plays out over time.

It seems like we’re nearing the end of the in house EHR hospital. Are there any others that still remain?

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Questions to Ask Before Choosing an EHR

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

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

Is the Software Vendor Knowledgeable and Reliable?

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

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

What Kind of Training is Available?

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

How Does the Software Company Handle Upgrades?

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

Does the Software Vendor Provide Good Customer Service?

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

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

Key Takeaway:

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

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The Benefits of Electronic Health Records

The Benefits of Electronic Health Records | EHR and Health IT Consulting |

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

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

Financial Benefits of Electronic Health Records (EHRs)

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

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

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

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

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

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

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

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

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

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

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HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News

HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News | EHR and Health IT Consulting |

It's more of a requisite first step than milestone, but the Department of Health and Human Services sent the proposed rule for meaningful use Stage 3 to the Office of Management and Budget.

There’s precious little detail in these submissions, but HHS foreshadowed the major problems it intends to address with this next, and perhaps final, stage of the federal EHR Incentive Program.

"Stage 3 will focus on improving health care outcomes and further advance interoperability," according to OMB’s website. "Stage 3 will also propose changes to the reporting period, timelines and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements."

The Office of the National Coordinator for Health IT also submitted a rule to OMB proposing a new 2015 Edition Base EHR definition, as well as modifications to the ONC Health IT Certification Program, "to make it more broadly applicable to other types of health IT health care settings and programs," another OMB web page states.

ONC’s proposed rule would establish capabilities and criteria, and specify standards and implementation specifications that EHR makers must meet, to "at a minimum support the achievement of meaningful use" for customers including eligible hospitals and eligible providers looking to attest and receive incentives.

OMB ranks both proposed rules as “major” but the in the form’s legal deadline field the status is none.

Stage 3 is expected to begin in 2017.

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Why most EHR’s will fail, is yours next? - referralMD

The main goals when it comes to the healthcare industry today, the care of the patient in the most efficient manner possible. Time is also a factor in both the care and efficiency.

The purpose of EHR – Electronic health records is to get the needed information quickly and make sure the patient is on the right path for his or her medical care. The other big concern is the safety of these records.

The traditional EHR has its challenges

In an article on Government Health IT (July 16, 2012), Craig Collins, wrote about the problems involving the management of health records in a traditional data-center. His concerns are listed below.

Forty percent of large patient health data breaches involve lost or stolen devices, according to the U.S. Department of Health and Human Services.
The actions of insiders – negligence or willful misconduct by employees and contractors – accounted for nearly three times as many patient record security breaches as external attacks, said a report last year by the Privacy Rights Clearinghouse.
Less than 2 percent of healthcare data breaches were from hacking. More than 10 percent were from insider theft or data lost or stolen when being physically transported somewhere else, according to a 2011 survey by the Identity Theft Resource Center.
Insider attacks are more costly than outsider attacks, both in dollars and damaged reputation, said a cyber-security survey by CSO magazine last year.

Robert Rowley, MD, also writing for the same site on (July 18, 2012) talks about how the EHR Market is being flooded with vendors.

As a result, large established EHR companies, some of whom have been around for 15 years or more, are experiencing competition from a wave of smaller start-ups – some successful, others not.
The beginning of the end – EHR failures

This scenario seems ripe for consolidation. Market forces, however, are rather Darwinian – novel approaches abound (“mutation”), but many will not achieve market penetration (“selection”). Failure of products, even well-designed ones, are part of the start-up experience – true in all market spaces, not just health care.

These companies are reaching out to two distinct categories of EHRs, ambulatory and the hospital. Dr. Rowley goes into detail in his July 15th article, Comprehensive EHR market analysis.

It is important for all medical practices on any level to do as much research as possible to make sure that their investment is a solid, well-chosen one. Attention to Security, by means of a Secure socket layer (SSL) and AES-256 bit encryption should be used. Accessibility, and integration with other networks is critical in our hi-tech world.

According to EHR Scope, in their article, “Is an EHR Usable” (May 25, 2012), there are three main components.

User Satisfaction
Check out this article we wrote called “When was the last time you gave your practice a Checkup” and learn some ways to make your office more efficient

All of this helps to keep lost time under control. Lost time, lost reports mean lost money and that is not needed in today’s economy. Efficiency, effectiveness, action as well as follow through are the keys to keeping it all under control. Make sure you know how the system functions so you can recognize the benefits you will get through using an electronic health records system.

When it comes to user satisfaction, does it fit your needs? Are you able to personalize settings in the system menus, in the screens and reports? When these are available “their comfort level improves.”

What can develop over time is a smoothly functioning network of physicians, specialists and outpatient testing. As everyone becomes more familiar with how efficient the system functions, it will build up a solid rapport among them. There will be more satisfied patients as well.
Concerns about the current system?

What are your main concerns? Do you have any questions to ask as you seek to move forward and upgrade your practice to electronic health records?
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