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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Electronic Data Key for Patient Engagement Initiatives

Electronic Data Key for Patient Engagement Initiatives | EHR and Health IT Consulting | Scoop.it

Patient engagement initiatives within the healthcare industry are moving past the patient portal, as pilot programs called OpenNotes allow patients to view their medical doctor’s notes taken during the visit. The latest version of the initiative even allows patients to comment and correct any information available in the physician records.


The New York Times reported on one patient that followed his own medical records and healthcare data with rigor. Steven Keating, a young doctoral student from the Massachusetts Institute of Technology’s Media Lab, had a brain scan eight years ago that found an anomaly and required monitoring over the years.


In a follow-up scan three years later, no issues were uncovered. However, based on his own research, Keating knew the problem was located near the olfactory center of the brain and, when he began smelling vinegar, he knew these were “smell seizures.” Three weeks after conducting an MRI, surgeons removed a cancerous tumor from his brain.


Medical experts believe this type of patient engagement and self-education can be gained when patients have full access to their own healthcare records. These type of patients are thought to be better able to stick to their prescription drug regimen and even identify early symptoms of disease.


Today, more and more hospitals and physician practices are adopting patient portals to meet Stage 2 Meaningful Use requirements as well as offer patients easy access to their medical information. Through the OpenNotes program, more patients are integrating wellness goals in their everyday life, taking their medications on time, and gaining a better understanding of their chronic diseases.


Currently, more than 5 million patients have received open access to their physician notes through these pilot programs. Nonetheless, Keating told the news source that obtaining one’s own medical information still has its share of barriers.


“You can get (access to data), but the burden is always on the patient. And it is scattered across many different silos of patient data,” Keating said.


Federal agencies are providing policies to support patient engagement initiatives and access to medical data in order to overcome these barriers. For instance, the Stage 3 Meaningful Use proposed rule sets forward a key objective for boosting patient engagement initiatives.

Health IT Now, a coalition of physician and patient groups that advocates health information technology, finds the Stage 3 proposed rule and the 2015 edition health IT certification criteria favorable, especially regarding its patient engagement initiatives.


“These changes are important steps forward. The Patient API change in and of itself is elegant. It allows patients to control more of their information while expanding interoperability,” Joel White, Executive Director of Health IT Now, stated in a press release. “We also support reducing burdens on healthcare providers, the folks who have to implement these changes. We believe HHS could go one step further and only approve measures that can be reported electronically. We need to scrap paper and pen in the health IT program.”


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Vermont Gets More Robust With Data Exchange

Vermont Gets More Robust With Data Exchange | EHR and Health IT Consulting | Scoop.it

Southwestern Vermont Medical Center (SVMC) and Vermont Information Technology Leaders (VITL) have just completed a project that developed five connections to transmit health data from the hospital to the Vermont Health Information Exchange (VHIE).

According to officials of the organizations, the five interfaces were built to:

  • Send immunization data from SVMC to the VHIE. The immunization data is then forwarded on to the Vermont Department of Health Immunization Registry.
  • Modernize the existing laboratory results interface from SVMC to the VHIE.
  • Send patient demographics, radiology reports, expanded laboratory results (pathology, microbiology and blood bank), and transcribed reports (information about procedures, admissions, discharges and consults) from SVMC to the VHIE.

The SVMC interfaces complete VITL's goal of connecting all 14 Vermont hospitals to the VHIE, the statewide health data network operated by VITL. Although SVMC has been contributing laboratory results to the VHIE for over eight years, the four new connections will increase the amount of clinical and demographic data available to providers involved in a patient’s care, better informing health care decisions, its officials say.

The final phases of the SVMC interface project included the addition of a move-in process, where engineers, analysts and project managers met face-to-face at the VITL office in Burlington. The interface teams met for two in-person sessions that lasted two weeks at a time, and allowed them to completely focus on integration and quality assurance testing of health data flowing from SVMC into the health information exchange, according to officials.

The new clinical interfaces allow SVMC data to be shared with any provider in Vermont. “Southwestern Vermont Medical Center has been a part of the VHIE for over eight years, and we have actively used the data network to distribute electronic lab results to primary care practices in the southwestern Vermont health care service area,” Rich Ogilvie, chief information officer at SVMC, said in a statement. “The additional connections deliver data and reporting abilities that will enhance the provider-patient care relationship in the Bennington service area and across the state.”


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The HealthIT Data Hogs of Healthcare

The HealthIT Data Hogs of Healthcare | EHR and Health IT Consulting | Scoop.it

Keeping data within one's EHR is a great business model for both large-scale users like hospitals and EHR companies alike. You can charge what you want, lock customers in, and keep competitors out. Keeping data within your own software or institution is a huge competitive advantage.

System resident EHR companies are doubling down on this model by acquiring cloud-based EHR companies. Some are moving data out of facilities and into their own cloud-based lockbox. Some are setting their table to be the single click-point as Kayak is to the travel industry.

The winner will become the data supermarket to healthcare.

Except, these strategic movements are mostly about hospital data  (which is crisis data and of very limited use in population health), and has limited value to all of the other health and care things that have to be done to move the quality, health status, and cost dials from fiscal Armageddon to sustainability.

That's where hospital-centric strategy will get hospital-centric companies into the cook pot. Healthy people without medical emergencies or crises and not needing sophisticated diagnostics and invasive procedures is bad for hospital business, so, it is understandable for companies to cater to them. Expecting a voluntary, or even some sort of sincere, attempt, however, at a 180-degree transition from a trillion dollar plus, fee-for-service-dependent medical crisis industry to the physician world of a few bucks for prevention is just, how do I put it delicately — disingenuous.

That's why we should not only be skeptical of the motives of these business models, but physicians should step away carefully and demand EHR companies to serve their needs. And, they can be pigs about it because the company that successfully becomes a data supermarket will feed the entire industry.

In the hospital world, controlling data is a competitive advantage, a point of physician control, and a means to continue to extract trillions from insurers long enough to try to make a transition or just keep the industry anchored in their harbor by their sheer size. Hogs that, when they are fat enough have eaten the economy into starvation, will become food instead.

In the physician world, sharing data is a competitive advantage, a point of hospital control, and a means to actionable information to perform population health and create analytics that will derive and extract their value from insurers by what they save, not consume. Also in the trillions. Warm, pink, fuzzy, cute, and sustainable.

This is where we come full circle to the data collection and warehouse world and the real question for the data collectors of healthcare: Are you the hogs or the pigs?

There may be better metaphors to wrap this argument around, but pigs are just so darn cute.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Health Data Outside the Doctor’s Office | The Health Care Blog

Health Data Outside the Doctor’s Office | The Health Care Blog | EHR and Health IT Consulting | Scoop.it

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive.  If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

Why is it important to pursue this ambitious goal? There has been an explosion of data that could help with all kinds of decisions about health. Right now, though, we do not have the capability to capture and share that data with those who make decisions that impact health—including individuals, health care providers and communities.

The new report, called Data for Individual Health, builds upon the 2013 JASON report, A Robust Health Data Infrastructure.  It lays out recommendations for an infrastructure that could not only achieve interoperability among electronic health records (EHRs), but could also integrate data from all walks of life—including data from personal health devices, patient collaborative networks, social media, environmental and demographic data and genomic and other “omics” data.


This report, done in partnership with the Agency for Healthcare Research and Quality (AHRQ) and the Office of the National Coordinator for Health Information Technology (ONC) with support from the Robert Wood Johnson Foundation, comes at a pivotal time: ONC is in the process of developing a federal health IT strategic plan and a shared, nationwide interoperability roadmap, which will ensure that information can be securely shared across an emerging health IT infrastructure.

Data sharing is a critical piece of this equation. While we need infrastructure to capture and organize this data, we also need to ensure that individuals, health care professionals and community leaders can access and exchange this data, and use it to make decisions that improve health.

Initiatives like Blue Button and OpenNotes are already empowering patients and allowing them to take a more active role in their care. But giving individuals access to integrated streams of data from inside and outside the doctor’s office can increase the ways in which people engage directly in their own health and wellness.

Broadening data beyond the four walls of the doctors’ office will give health care professionals a more holistic view of their patient’s health. Sharing that data among members of the health care team will also lead to greater care coordination. Ensuring this data is used in meaningful ways will of course require training our health care workforce to a higher level of quantitative literacy.

Efforts now underway like County Health Rankings guide community leaders in setting priorities for improving health. With access to more data, communities can make faster, smarter decisions that support health—creating healthier homes, schools, workplaces and neighborhoods. For example, if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding.

While there are an enormous number of uses for the data that we can imagine and many more we cannot yet anticipate, it will be vitally important that we all make every effort to protect the privacy and security of these data. The report highlights numerous ways to protect the data in ways that benefit health and wellness, while also prompting accelerated innovation.

We’re excited by the potential to take this emerging data and turn it into useable information to build a Culture of Health—a nation where everyone has the opportunity to live longer, healthier lives.

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Institute for Critical Infrastructure Technology's curator insight, December 8, 2014 10:13 AM

for more news on critical infrastructure see the Institute for Critical Infrastructure Technology blog http://icitech.org/latest-critical-infrastructure-news-cybersecurity-healthcare/

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Can Apple, Others Bring PGHD to the EMR?

Can Apple, Others Bring PGHD to the EMR? | EHR and Health IT Consulting | Scoop.it

Not settled with simply being the dominant device on which clinical data applications are hosted, Apple made another step towards becoming an even more ubiquitous presence at healthcare organizations last week when it launched ResearchKit.


ResearchKit is a platform that allows healthcare organizations to host apps that will get people to participate in clinical trials. During an event for the press, the company announced a few initial partnerships with major healthcare provider organizations to use ResearchKit, including Icahn School of Medicine at Mount Sinai, Penn Medicine, Dana-Farber Cancer Institute, Massachusetts General Hospital, Stanford Hospital, and more.


ResearchKit builds off HealthKit, which was a health platform Apple launched last year that aimed to connect personally-generated health data and clinical data. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.


The Cupertino, Calif.-based company is part of a wider movement in the industry to bring patient-generated health data (PGHD), from various portals and monitoring devices, into clinical data applications like the electronic medical record (EMR). The Office of the National Coordinator for Health IT (ONC), in its proposed rule for Stage 3 of meaningful use, made integrating PGHD into the EHR a requirement for eligible hospitals and providers.


Of course, this integration is easier said than done. Healthcare Informatics Senior Editor Gabriel Perna spoke with Rob Faix, principal advisor at the Naperville, Ill.-based consulting firm, Impact Advisors on the most recent edition of the Healthcare Informatics podcast. Faix discusses the challenges of bringing together patient and clinical data; why Apple has taken the lead in this category with many prominent healthcare organizations; and how ResearchKit can be a game changer.


“Integrating this data will be a significant challenge but I think it’s one that hardware device vendors, software developers, and EMR vendors are up for…it’s the next big opportunity,” Faix says. “


Faix talks about how this integration may happen. He predicts there will be a staging process, where PGHD is graded and reviewed. “Context will be important. The software and EMR vendors and the clinical community are really going have to think about that as we integrate PGHD into the EMR,” he says.


Sifting through a potential avalanche of data will present itself as a challenge, as will having to deal with potential issues of liability. “I have information in front of me that I chose to accept or discard, and therefore, it could be tied back to an adverse event,” Faix says.


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Can EHRs Be Secure and Fast?

Can EHRs Be Secure and Fast? | EHR and Health IT Consulting | Scoop.it

Are we ready to replace passwords with biometrics for access to our facilities' networks and EHRs? I know that I'm ready for something easier and more secure than my ever-changing facility login, a byproduct of being forced by the system to change my password every couple of months.

In its current iteration, the EHR at my facility takes three separate login steps to get into the record to document a patient encounter or retrieve information. This doesn't seem like much, but multiply it by 20 or 30 patients and it becomes burdensome and a significant time waster.

If a terminal is locked, I have to enter my credentials to access the system and from there, I have to enter my credentials to open the EHR. Then if I want to dictate any notes, I have to again enter my credentials to open the dictation software. It gets old in a hurry, and is a major complaint among members of the medical staff at my community hospital.

The IT team in our organization is experimenting with using the embedded "near field" chip in our ID cards as a way in which to log in to the EHR. It would be a big step forward and would eliminate the majority of authentication to access our EHR. It would also have the added advantage of encouraging all members of the medical staff to carry their hospital IDs, but not all software needed for charting supports this mode of authentication.

Fast Identity Online (FIDO) is the current buzz phrase that refers to all of the biometric authentication technology currently available or planned. We are already using our fingerprints in a variety of ways to unlock our phones and doors, and there are readily available technologies that rely on retinas, irises, face recognition, or voice recognition that are being developed to solve authentication and security problems. We have seen the future in a variety of science fiction films, and much of it is working and available technology.

While there is a tremendous upside to FIDO technology, there are also significant downsides in the form of privacy. We constantly see that passwords are not 100 percent secure, and companies tasked with protecting our personal data stored on their servers also fail. It is not too much of a stretch to raise concerns about personal biometric data being stored on vulnerable servers, and the privacy vulnerability that this represents to us all as individuals.

There should be similar concerns with biometric security data. My fingerprints are stored on my phone as a security measure, but could an enterprising criminal find a way to use that data to reconstruct my fingerprints?

As always, computer technology and software are well ahead of privacy protections and personal security, and will remain so for some time, possibly forever.

To make it work on an EHR, we need enterprise level solutions, as the thought of customizing my FIDO login separately at each terminal in the hospital, defeats the purpose and intent of making this simultaneously easier and more secure.

It seems that an enterprising technology company would see the opportunity in allowing medical providers to quickly and securely sign into an EHR. I know that there are a lot of smart people working on this problem in an attempt to make this both easier and more secure for those of us in the trenches.

As the pace of technology development and implementation becomes more rapid, so does the need for increasing security and privacy, as well as reducing the technological burden on the healthcare providers who daily have the use this technology in the performance of their jobs. These competing trends get more important everyday as the penetration of the EHR becomes more ubiquitous.


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Electronic Health Record Vendors Take Patient Data Hostage: What Should We Do?

Electronic Health Record Vendors Take Patient Data Hostage: What Should We Do? | EHR and Health IT Consulting | Scoop.it

In today’s interconnected world it seems intuitively true that instant access to comprehensive medical patient histories will help physicians to provide better care at a lower cost. This simple argument was persuasive enough for the federal government to spend $26 billion to incent medical providers to adopt electronic health records (EHR) systems so that they can electronically share medical records. The initial investment appeared to be large, but it was an economically sound solution to control the rising healthcare expenditure. The resulting HITECH act is one of the few healthcare laws that maintains bipartisan support. To establish a nationwide health information exchange network, officials designed a two-stage plan. First, incent every medical provider to create an electronic archive of their patients’ medical records. Second, connect these electronic archives together so that the providers can share their patients’ records. The $26 billion in federal incentives was a lucrative source of revenue for hundreds of different software vendors to develop and aggressively market their own type of EHR products in a medical market that knew little about information technology. According to the Office of National Coordinator for Health IT, in 2008, less than 10 percent of hospitals had basic EHR systems, and a mere five years after, 94 percent of the hospitals use a certified EHR system.

The next step forward is to connect these electronic silos together so that physicians can share their patients’ records. The billions of dollars in federal spending will only have any tangible benefit if this is done successfully. EHR vendors have taken patient data hostage and are not willing to release it unless they receive a big ransom. They typically claim that technical problems limit the interoperability of their products. This prevents physicians from sharing their patient records with other doctors. This is like T-Mobile claiming that its users cannot make calls to AT&T customers. The claimed interoperability limitation does not end here. The vendors are proposing hefty charges to allow data sharing between their own customers.

As I have discussed in detail before, this a hole that the government has dug for itself. A nationwide health information exchange network sounds great, but it is not possible to achieve this goal without the proper alignment of economic benefits for every player in the healthcare market. In the face of this problem, the government has three choices:

  1. Pay EHR vendors the ransom that they are asking to release their hostage and allow sharing of the patient data among medical providers.
  2. Regulate the industry and force the EHR vendors to allow sharing of patient data among medical providers.
  3. Do nothing.

The government appears to be following the first plan. Officials had not anticipated interoperability challenges and assumed that all of the providers with EHR systems would have the capacity to exchange records. Based on this assumption, the third stage of the EHR incentives program was designed to encourage physicians to actively engage in the exchange of medical records. Today nearly every physician has an EHR system and although many of them also want to exchange information, the EHR vendors do not allow them. The incentives, which were initially planned to encourage physicians, will end up with EHR vendors and help drive future profits. As Rep. Phil Gingrey (R-GA) put it, "we have been subsidizing systems that block information instead of allowing for information transfers, which was never the intent of the [HITECH] statute.”

Regulating the industry seems like the only feasible solution to this problem. Rep. Michael Burgess (R-TX), the leader of the House Energy and Commerce trade subcommittee is drawing up a bill to enforce data sharing. The benefits of regulating the EHR industry, if any, will take a very long time to become tangible. The EHR vendors will furiously push back against any kind of regulation and will insist that technical challenges are a real barrier to interoperability. Congress is poorly situated to adjudicate this claim. Time is a critical factor in the long term success of HITECH plans, which threatens the viability of this strategy.

The best solution for the government is to do nothing. The new pay for performance payment methods in which the medical providers are being paid a fixed amount for treating patients would drive them to become more efficient and increase their profit margin by seeking solutions such as health information exchange to cut costs. Because the market for new EHR products is now saturated, the only revenue source for EHR vendors are charges for data exchange. Currently, they can get away with outlandish charges because they know the incentives from the federal government allow doctors to cover their costs. But if the free money from the government were to stop, then EHR vendors would have to persuade the physicians to pay for the exchange fees. Just like any other service, the highest price that the medical providers would pay is equal to the value of the service for them. If the electronic exchange of information helps medical providers to cut back on their costs and save some money they will be willing to pay a fair price for it. EHR vendors will end up lowering their fees to a reasonable level or will eventually go out of business.


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Is EHR Optimization Possible? | Hospital EMR and EHR

Is EHR Optimization Possible? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

At the Healthcare Forum Heather Haugen, PhD posited that the Promise of an Electronic Health Record (EHR) is that it “has the potential to transform healthcare by providing clinicians access to comprehensive medical information that is secure, standardized and shared.”  She then proceeded to remind us how far we have come on the journey of adoption, but that we still haven’t gotten where we need to be.  EHR is indeed a lofty goal, but we haven’t gotten there yet.

Plus, Dr. Haugen suggested that far too many people are focused on the EHR implementation and yet that’s only one milestone along the EHR journey.  In fact, she compared looking at EHR implementation numbers to talking about the number of weddings as opposed to the success of those weddings.  EHR implementations are just an event, but we continue to talk about the wedding instead of the marriage.

When you start to look at EHR as a journey, the first steps of Selecting, Building, and Installing are relatively short parts of the journey.  However, the EHR journey also includes: leadership engagement, speed to proficiency, performance metrics, and adoption sustainment.  Each of these are crucial to EHR adoption, but are much longer journeys than the initial implementation steps.

The journey of adoption is challenging, messy and dynamic and we may never actually arrive at “EHR Adoption.”   EHR adoption has a lifecycle that’s influenced by many factors including staff turnover and software upgrades.  So every organization must be prepared for ongoing education, training and engagement with their end-users to keep the EHR journey moving forward.

When considering this challenge, Dr. Haugen asked the question: Can data help us? And then she offered the following suggestions on how data can help an organization.

  • Data saves time and resources by focusing on the right patients
  • Data incents actions
  • Data removes subjectivity

As Dr. Haugen said, “Measurement has impact.”  She then offered five key measurement areas where healthcare leaders can evaluate their EHR project.  Have users:

  • Understood how the application impacts their job?
  • Understood why the application was implemented?
  • Felt that the leadership team is committed to the success of the project?
  • Felt that the organization’s leadership helped them understand what they need to do to adopt the new system?
  • Felt that communication from the leadership team helped make them feel more comfortable about the change?

Each of the above measurements is really focused on making sure an organization has user buy in for the EHR journey.  After you get past the EHR implementation stage, Dr. Haugen offered a series of other important questions you should understand and measure in order to optimize your EHR:

  • How is the application being used?
  • How are upgrades being adopted?
  • How do we overcome workarounds?
  • Who is struggling to use the new system?
  • What areas of the application are confusing and could lead to clinical errors?
  • How can we gain increased productivity?
  • Inefficient workflows – what are they and how do we change them?

Each of these questions and measurements can help an organization realize where end users could use more or better EHR education.  Dr. Haugen suggested that the best way to close any learning gaps is to offer scenario-based learning that helps end users become more knowledgeable and confident in their work.

Dr. Haugen also offered a number of other early findings from their research on the EHR journey.  First, only a small percentage of users need one on one help.  Second, software upgrades erode adoption over time and so with every upgrade you need a commensurate effort to retrain adoption.  Third, optimization is the responsibility of clinical leaders.  Fourth, users want education delivered at the time of need.  Fifth, data still lives on paper.  Sixth, there is a lot of opportunity to improve productivity through more efficient workflows.

Dr. Haugen concluded that “Feet on the street are probably not going to be how we solve the optimization challenges.  The right data could help us solve the optimization challenges.”  The right data with fast, effective and sustainable training will take us a long way on the EHR journey to a secure, standardized, and shared medical record.



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