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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Successful EHR interoperability starts locally

Successful EHR interoperability starts locally | EHR and Health IT Consulting |

Interoperability is one of the most difficult challenges with electronic health record optimization: The ability to share clinical data across health systems and respective EHRs. Sometimes it takes a personal experience to drive home the meaning of interoperability, not only to the healthcare professionals who regularly interface with the EHR, but the patients.

When EHR interoperability hits home

For those that read my last post, you know that I lost my 40-year-old brother to a heart attack in 2015.  I had a physical about two months after my brother died, but due to my family history of heart disease, I also made a long-overdue appointment to see a cardiologist. Both my primary care physician and cardiologist work within the same system and use the same ‘integrated’ EHR. And yet the scheduler for the cardiologist requested I fax my EKG and history, including labs, to the office prior to my appointment.

Needless to say, we know interoperability will doubtlessly improve patient care and experience. But it can often feel like a mammoth, unachievable task. Some staff are accustomed to jumping through hoops to access data, but it doesn’t have to be that way. The secret is to approach interoperability on a smaller scale and address the changes you can make more locally to move the needle forward. Interoperability is a spectrum, and the right answer for one health system may not be the same for another. 

Small steps toward interoperability

Every health system executive has interoperability on their priority list these days, with exciting strides in personalized medicine, the day-to-day demands of care management and reducing unwarranted care variation.

So where should you start?

First, as leaders in this industry, we need to recognize interoperability isn’t just a technology problem. Opening up access to clinical data across different care settings must be a strategic priority that starts with an honest assessment of a health system’s technical capabilities against the imperative to deliver better patient care. Health systems can’t afford to be left behind here, but can’t do it alone. In an industry rife with mergers and acquisitions, health systems should work from the inside out. While that might seem obvious, many systems struggle to make sure internal stakeholders have access to data on the system in some way or another. 

Second, there’s more than one right technique to achieve some level of interoperability. While a truly integrated EHR is the ultimate goal, it’s typically more costly, time-intensive and organizationally disruptive than other options. There is a myriad of interface engines/brokers, health information exchange tools, APIs and custom-built options that can be implemented much more quickly and provide real value, at the point-of-care, now.

Most health system executives assume that to achieve interoperability, they need to implement or migrate every provider in their system onto the same EHR. And often this course of action is advised. However, I’ve seen clients use some innovative methods to tackle interoperability.

One of my favorite examples is a large health system in the northeast that explored different methods to standardize access to data without moving to the same EHR platform.

As the health system acquired new physician practices, it faced limitations that made an integrated EHR financially and operationally prohibitive. After exploring its options, the health system opted to create an HIE, a safe way to send and standardize patient records between EHRs. While the data are not truly in one single place, HIEs give clinicians access to data across separate systems within a couple clicks.

Achieving interoperability will be a long journey that will only grow in importance as healthcare shifts from a volume to value mindset. When possible, health systems should move to an enterprise EHR architecture and go beyond minimally meeting regulations. There’s no such thing as true, complete interoperability: There will always be a new source of data with a different set of access issues. But in the interim, work with community partners to craft solutions to affect patient care now.

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Avoiding Legal Troubles Stemming from EHR Liabilities

Avoiding Legal Troubles Stemming from EHR Liabilities | EHR and Health IT Consulting |

I'm a big supporter of the EHR and its promise to make documenting patient care more accurate, easier, and clear. I also have a healthy respect for the dangers of the EHR — and see new dangers pop up constantly.

With all good technological tools, there are hazards that need to be recognized. The EHR can pose a liability for providers and institutions, and the legal profession is beginning to exploit this weakness in malpractice actions against providers and institutions.

Modern EHRs have a significant learning curve, and require a complete change in the process of documenting patient care. Many functions are a double-edged sword; including record cloning, automated dictation, medication dose checking, documentation templates, automatic record population, etc. The functionality of the EHR can make the job of providers much easier in generating a record, but this same functionality can introduce bad data, wrong dosages, and other errors that can harm patients.

The bottom line is that providers are ultimately responsible for what is charted in the EHR. Here are just a few examples of these new liabilities and how to avoid them.

• Scribes. Much of the charting that is done on the front end of a hospital admission is performed by the nursing and ancillary staff, or in the ER, scribes. This is very helpful in a busy inpatient and/or outpatient department, and speeds patient care and documentation. However, unless the provider verifies the accuracy and completeness of the record, significant errors can made.

• Cut and paste. The "cut and paste" function is one that is familiar to anyone using a computer in the modern age. This can interject errors, and propagate them when one does not exercise due diligence in making sure that the final record reflects the actual encounter. There are tools available which make searching for repetitive text in a record very easy. Obvious propagation of narratives and erroneous data, over and over again, is hard to defend in a court of law, and demonstrates that care was not taken. It also introduces doubt into all areas of the records being scrutinized.

• Note cloning. "Cloning" is another issue that works much like cutting and pasting. Cloning is the practice of copying an entire previous record into a new, editable record. The hazard here is obvious, and similar to the previously discussed practice of cut and paste. It goes without saying the more information and data that you "clone," the greater the risk you are going to miss something, and propagate erroneous data.

• Use of templates and macros. Macros for things such as review of systems and physical examination can really make you look bad when another provider or lawyer is reviewing your record. It is easy to miss that you called a positive physical finding negative, if you don't carefully review the record prior to finalizing it.

• Pull-down menus. Finally, clickable pre-populated components and pull-down menus can be hazardous in that it is sometimes easier to choose the wrong thing than it is to use "free text" to customize the finding or information.

On the bright side, templates for procedures help providers quickly and accurately document informed consent, indications for the procedure, the actual procedure, and the post procedure care by giving the provider a concise and complete format for documentation. The other benefit of the EHR from the provider standpoint is allowing the provider to make a more complete record in support of the level of care that is being billed.

I have to admit that in the past, I have used all the functionality of the EHR, and have made mistakes in my documentation. After studying these issues, and becoming aware of the hazards to patient safety and care, I'm much more sophisticated in my use of the functionality of the EHR. I still use macros and auto-text, but my use of cut and paste is limited to including diagnostic test reports that don't auto-populate. I never use cloning even though the functionality is still allowed in our EHR.

One of the big changes for me has been the deployment of enterprise level dictation in our EHR. Now, even though I can type 60 WPMs, I can much more rapidly and accurately dictate a unique HPI, PE, and plan, and better ensure that the record is accurate.

Take the time to understand EHR technology, and avoid the pitfalls that can be expected to increase your liability in the delivery of patient care.

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Is EHR Interoperability Being Blocked by Health Systems?

Is EHR Interoperability Being Blocked by Health Systems? | EHR and Health IT Consulting |

EHR interoperability has been the topic of discussion among many healthcare stakeholders in recent months. On a national level, federal agencies like the Office of the National Coordinator for Health IT (ONC) are gearing toward advancing secure and effective healthcare data exchange.

While EHR interoperability is a major goal among top stakeholders, there are alleged healthcare providers and health IT designers that may be participating in a practice called “information blocking.” On April 10, ONC released a Report to Congress on Health Information Blocking to address these concerns.

Health information blocking essentially takes place when individuals or organizations knowingly impede the sharing of electronic medical data. The report specifically states steps that the federal government can take to deter this practice and move toward nationwide data exchange.

This blockage of EHR interoperability goes against the ultimate goals of the EHR Incentive Programs. The amount of time and funds the federal government invested in the implementation of EHR systems and health IT tools may be in vain if health information blocking spreads across the country.

At this moment in time, it is difficult to pinpoint how much health information blocking is impeding healthcare data exchange among medical care entities. It is also a complex term to define, as some aspects of preventing the exchange of information could be related to ensuring patient privacy and data security.

Earlier this year, ONC released the Shared Nationwide Interoperability Roadmap to further advance the connection of EHRs and health IT systems in an attempt to share healthcare data across state borders. While the roadmap discussed the challenges associated with EHR interoperability, it set out specific steps developers and providers can take to meet this overarching goal and ultimately improve patient care.

ONC explains that there are certain individuals within the health IT industry that are incentivized toward managing health information in ways that interfere with its effective exchange across the medical sector. In order to overcome some of the issues around information blocking, ONC offers several suggestions.

First, it is beneficial to have greater transparency in the development processes of certified health IT products or services. ONC also recommends Congress to establish rulings that deter information blocking in the healthcare industry. When illegal business practices are uncovered, these individuals should also be immediately referred to appropriate law enforcement agencies.

ONC also encourages the federal government to continue collaborating with the public and private sectors in establishing new technologies that aim to improve interoperability of healthcare data across the country. The report also states that Congress could stimulate EHR interoperability by working with the Centers for Medicare & Medicaid Services (CMS) to discourage information blocking and reward medical organizations through payment incentives for successful EHR data exchange.

ONC believes that it is vital to overcome the issues surrounding information blocking in order to ultimately meet the major goals behind healthcare IT implementation and provider access of patient data. The federal government will need to address these problems in the coming years as the healthcare industry poises to expand health data exchange around the country.

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Healthcare Industry Reacts to Stage 3 MU Proposed Rule

Healthcare Industry Reacts to Stage 3 MU Proposed Rule | EHR and Health IT Consulting |
On March 20, the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health IT (ONC), and the U.S. Department of Health and Human Services (HHS) announced that the latest proposed ruling on Stage 3 Meaningful Use requirements have been released for public comment.

The announcement emphasizes how the proposed rules will give providers more flexibility under the EHR Incentive Programs and increase EHR interoperability to improve the access and sharing of patient health information.2015-01-12-chime-small

The healthcare industry as a whole is currently processing the proposed ruling and preparing to contribute during the comment period. Some public statements about the Stage 3 Meaningful Use proposed ruling from leading organizations have been released.

A statement from the College of Healthcare Information Management Executives (CHIME) said: “CHIME is closely evaluating both the CMS Meaningful Use rule and the ONC certification rule. Based on our initial review, we are pleased to see flexibility built into the Stage 3 proposed objectives. We are still trying to understand the implications of moving all Medicare providers to a single definition of MU by 2018, but are encouraged by the potential for this policy to simplify and streamline the long-term viability of Meaningful Use. While we and other stakeholders have been critical of the program over the last two years, we have always underscored how vital Meaningful Use is to modernizing our nation’s healthcare system. We look forward to digging further into the rule, looking for elements that will allow providers to build on their IT investments, specifically in the areas of care coordination, patient engagement and interoperability.”

“We do, however, urge CMS to quickly publish the proposed rule alluded to in Dr. Conway’s January 29 announcement. We were encouraged by the signals to shorten the 2015 EHR reporting period from 365 to 90 days and make other program improvements through a follow-on rule. We call on CMS to propose policy changes to the ‘all-or-nothing’ construct, lengthen timing between required Stage upgrades, and consider much-needed revisions to the hardship exception categories. These changes will enable far better participation among providers, which will in turn, keep them on a path towards improved care through health IT.”

With the inclusion of some more policy changes, CHIME recognizes that Stage 3 Meaningful Use regulations will play a pivotal role in expanding health IT adoption across the country and thereby improving the quality of care. Another statement comes from the American College of Cardiology President Kim Allan Williams Sr., M.D., on the organization’s reaction to the proposed ruling.

“The American College of Cardiology has long supported the adoption of electronic health records (EHRs) as a mechanism for improving patient outcomes,” Williams said. “The EHR Incentive Program as currently structured has been focused more on ‘checking the box’ than changing care delivery to achieve the goal of improved patient care.”

“Although the ACC is still reviewing the proposed regulations, the College is concerned by the proposal to require all providers, even first-time participants, to report for a full calendar year,” the American College of Cardiology President continued. “Implementing an EHR system in a physician practice or a hospital is not as simple as flipping a switch; it takes time, financial investment, careful consideration and planning, as well as education for all staff. The program must take this learning curve into consideration.”

Some players within the healthcare industry find the EHR reporting period of a full calendar year problematic and are urging CMS to transition to a 90-day reporting period instead.

Additionally, there may be too many regulations that are being put forth to advance the meaningful use of health IT systems instead of addressing the various problems in the medical industry today. A statement from the American Hospital Association (AHA) underscores this point.

“Hospitals are implementing electronic health records at a brisk pace in order to improve patient health and health care, but they must do so under the crushing weight of government regulations,” Linda E. Fishman, Senior Vice President of Public Policy Analysis and Development at AHA, said in a public statement. “The release of today’s rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today. In January, CMS promised to provide much-needed flexibility for the 2015 reporting year, which is almost half over. Instead, CMS released Stage 3 rules that pile additional requirements onto providers. It is difficult to understand the rush to raise the bar yet again, when only 35 percent of hospitals and a small fraction of physicians have met the Stage 2 requirements.”

“We urge CMS to release the 2015 flexibility rules immediately. Information technology holds the promise of enhancing care for patients and communities,” Fishman continued. “America’s hospitals are committed to adopting technology but need today’s problems to be addressed to make progress for patients and communities.”
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Researchers Call for Improving EHR Interoperability Policy

Researchers Call for Improving EHR Interoperability Policy | EHR and Health IT Consulting |

Health IT including EHR systems play a major role in lowering costs and increasing access to healthcare information necessary for advancing patient safety and care. Meaningful use requirements have brought forth many benefits for spearheading EHR adoption and improving the quality of care. However, there is still a lack of significant EHR interoperability.

The Brookings Institution released a policy brief that details some of the challenges of current health IT standards as well as provides advice for repairing some of these issues. Greater interoperability and data exchange, for instance, would reduce redundant data entry and duplicative information.

To lead the nation toward greater EHR interoperability, the Office of the National Coordinator (ONC) for Health IT recently released an Interoperability Roadmap that outlines a ten-year plan for promoting health information exchange.

This is a step in the right direction, but health IT policy will need to focus on progressing further with EHR interoperability. Many healthcare providers have not seen the benefits of health IT systems, as there is still inconsistent information flow among medical facilities.

The Brookings policy brief encourages arranging IT initiatives directly with payment reforms, improving patient health outcomes, and incorporating data standards for vital information in clinical practice.

With the country’s shift from pay-for-volume to value-based payments, the IT infrastructure around the nation will need to be more flexible and effective in meeting some of the demands of healthcare reform.  Through improved EHR interoperability, the costs associated with administrative duties and reporting should decline.

More adaptation and specialty focus in EHR design along with the alignment with current payment models will also support the expansion of health IT and improvement in quality of care.

While Stage 1 Meaningful Use requirements focused on adopting electronic prescribing and incorporating allergy and drug lists into EHRs, the later stages of meaningful use are keen on enhancing patient outcomes.

However, providers have found the meaningful use requirements at fault for having only one single set of mandated methods and workflows for collecting data. This “one-size-fits-all” approach leads the usability of EHR systems to decline among providers. The uniformity of these requirements are too simplistic for the complexity of the healthcare system. Whether it is a specific specialty, the patient population differs, or a provider’s needs vary greatly, the specific set of standards under EHR Incentive Programs are impairing the usability of health IT systems.

The policy brief suggests that it may be beneficial for meaningful use payment incentives to focus more on providers improving value and outcomes instead of meeting required health IT processes.

The report also advises providing vendors with opportunities to include user-centered design into healthcare workflows. Additionally, it is beneficial to support and enable the reporting of outcome and value-based measures through EHR systems.

While the EHR Incentive Programs have stimulated the adoption of health IT, there is concern in the healthcare community that the lack of EHR interoperability will lead the improvements within the sector to stagnate. The advisements in this policy brief may provide much-needed answers.

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Key Big Data Challenges Providers Must Face

Key Big Data Challenges Providers Must Face | EHR and Health IT Consulting |

Everybody likes to talk about the promise of big data, but managing it is another story. Taming big data will take new strategies and new IT skills, neither of which are a no-brainer, according to new research by the BPI Network.

While BPI Network has identified seven big data pain points, I’d argue that they boil down to just a few key issues:

Data storage and management:  While providers may prefer to host their massive data stores in-house, this approach is beginning to wear out, at least as the only strategy in town. Over time, hospitals have begun moving to cloud-based solutions, at least in hybrid models offloading some of their data. As they cautiously explore outsourcing some of their data management and storage, meanwhile, they have to make sure that they have security locked down well enough to comply with HIPAA and repel hackers.

Staffing:  Health IT leaders may need to look for a new breed of IT hire, as the skills associated with running datacenters have shifted to the application level rather than data transmission and security levels. And this has changed hiring patterns in many IT shops. When BPI queried IT leaders, 41% said they’d be looking for application development pros, compared with 24% seeking security skills. Ultimately, health IT departments will need staffers with a different mindset than those who maintained datasets over the long term, as these days providers need IT teams that solve emerging problems.

Data and application availability: Health IT execs may finally be comfortable moving at least some of their data into the cloud, probably because they’ve come to believe that their cloud vendor offers good enough security to meet regulatory requirements. But that’s only a part of what they need to consider. Whether their data is based in the cloud or in a data center, health IT departments need to be sure they can offer high data availability, even if a datacenter is destroyed. What’s more, they also need to offer very high availability to EMRs and other clinical data-wrangling apps, something that gets even more complicated if the app is hosted in the cloud.

Now, the reality is that these problems aren’t big issues for every provider just yet. In fact, according to an analysis by KPMG, only 10% of providers are currently using big data to its fullest potential. The 271 healthcare professionals surveyed by KPMG said that there were several major barriers to leveraging big data in their organization, including having unstandardized data in silos (37%), lacking the right technology infrastructure (17%) and failing to have data and analytics experts on board (15%).  Perhaps due to these roadblocks, a full 21% of healthcare respondents had no data analytics initiatives in place yet, though they were at the planning stages.

Still, it’s good to look at the obstacles health IT departments will face when they do take on more advanced data management and analytics efforts. After all, while ensuring high data and app availability, stocking the IT department with the right skillsets and implementing a wise data management strategy aren’t trivial, they’re doable for CIOs that plan ahead. And it’s not as if health leaders have a choice. Going from maintaining an enterprise data warehouse to leveraging health data analytics may be challenging, but it’s critical to make it happen.

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EHR Interoperability Stressed in DeSalvo’s Keynote Address

EHR Interoperability Stressed in DeSalvo’s Keynote Address | EHR and Health IT Consulting |

To conclude the 2015 HIMSS Annual Conference and Exhibition in Chicago that brought in 35,000 healthcare IT professionals, providers, and other key stakeholders, Dr. Karen B. DeSalvo, National Coordinator for Health IT, delivered a keynote address. EHR interoperability was a major topic of DeSalvo’s speech.

“It has been a great week here at HIMSS,” DeSalvo starts. “I’m so optimistic about the bright future that we have ahead to leverage health information technology and enable better health for everyone in this country.”

“Last year, I stood before you as a brand new National Coordinator and shared what I saw as the need to move our focus beyond adoption and focus on interoperability,” she said. “Unlocking the data can [put it] to many important uses demanded by consumers, hospitals, doctors, and others who are part of our learning health system. We’ve had a very busy year. We took the time to listen, to understand, and to shift our strategic focus to see that we can built upon the strong foundation that we all have built.”

“I personally had the chance to participate in or host two dozen listening sessions across the country. In those sessions, I was able to hear from people on the front lines about what matters most to them,” DeSalvo stated. “I became more and more optimistic as I heard how people are committed to see that we would leverage health IT to the advancement of everyone’s health.”

“In Alabama, adoption can still be a debate in some circles. They have challenges like lack of broadband access in rural communities. In New Jersey, the close proximity to other states and differing state privacy laws when crossing state lines has become an increasing challenge,” DeSalvo continued.

“In the Silicon Valley, the entrepreneurial community is moving past the notion of an electronic health record and is thinking about the next phase – the person-centered health records and the Internet. In places like Chicago and Minnesota, a history of collaboration showed me that when we let go of our own interests, communities move further when they work together instead of against each other and we can put priorities like the public’s health at the top of the agenda.”

DeSalvo also acknowledged her team who have attended HIMSS and spent time listening and discussing the challenges of EHR interoperability as well as the solutions that can improve nationwide data exchange.

“We [need to] continue the great progress and get to a place where every American has access to their electronic health information,” DeSalvo continued. “They, like me, remain steady and unwavering in that vision. Indeed, that was the vision more than a decade ago when President Bush signed an executive order and asked David Brailer to stand in the Office for the National Coordinator for Health Information Technology. In 2009, Congress codified the role and we carry out those responsibilities every day on behalf of the people in this country.”

“The flurry of work in the five years since the HITECH Act, through a set of grant programs, certification programs, the EHR Incentive Programs, has brought us all to a tipping point. Today we know that adoption is strong.”

“We have much work to do to digitize the care experience across the entire care continuum. We also have to see that we achieve true interoperability – not only exchange,” DeSalvo said. “What became clear quickly is that we need to develop a strategic approach that would leverage health IT beyond electronic health records using levers beyond meaningful use to bring not only better healthcare but better health.”

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What Has Hindered Progress toward EHR Interoperability?

What Has Hindered Progress toward EHR Interoperability? | EHR and Health IT Consulting |

EHR interoperability and the many forces working to promote interoperability of healthcare information are receiving a lot of attention these days. As well it should be!

It has been more than ten years since the Office of the National Coordinator for Health Information Technology (ONC) under the leadership of our first National Coordinator David Brailer, MD, published a seemingly straightforward four-step plan: implement EHRs, connect clinicians — remember regional health information organization (RHIOs)? — bring patients online, and enable population health.

Ten years and $30 billion of taxpayer funding later, we can report immense progress in EHR adoption, yet we are miles away from the ability to fluidly share patient records among providers and a partisan Congress wants to know the reasons. The $2 billion invested in health information exchange (HIE) startup grants has yielded very mixed results, with sustainable HIEs operational in few communities.

Many reasons can be cited for the limited progress — this list is not exhaustive.

For all the latest on interoperability in the healthcare inudstry, visit our new online publication

It isn’t that easy! The frequent comparison of healthcare information exchange to the ATM network greatly oversimplifies our challenge. Healthcare is a far more complex data model, and provider organizations vary widely across the country.

Stages 1 and Stage 2 Meaningful Use regulations include only limited interoperability goals. Hospitals and eligible providers attesting to meaningful use achieved those targets. Six years into the program most of the incentive funds have been received, only limited penalties remaining to further incent providers. Providers will surely weigh those penalties against the cost of Stage 3 Meaningful Use compliance.

Many of today’s standards are imprecisely defined, leaving room for flexibility in their interpretation by technology vendors and provider organizations. This has accommodated the structural differences among EHR products as well as the variation within and between provider organizations while leaving apples-to-apples comparisons across organizations difficult. The Continuity of Care Document (CCD) and the Consolidate CDA (C-CDA) standards in use for exchange across organizations are insufficiently granular to enable vendors to populate the EHR for convenient access and use by physicians.

Congressional restriction on exploring unique patient identifiers leaves us with various matching algorithms to identify and combine patient records across organizations. The best routines, including reconciliation by staff, are claimed to yield a 98-99% accuracy rate. Some organizations report mismatches in excess of 10%. Every mismatch becomes a patient safety issue, with either missing patient information or information incorrectly combined.

Organizations like HL7 and the Argonaut Project continue to advance the art and science of interoperability standards. CHIME recently announced a $1 million HeroX National Patient ID Challenge for the perfect patient matching solution. Both are essential to providing our physicians the information necessary for the best care they can give to their patients.

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Nurses Call for Greater Device and EHR Interoperability

Nurses Call for Greater Device and EHR Interoperability | EHR and Health IT Consulting |

Medical professionals throughout the industry have put EHR interoperability into the forefront of healthcare reform. A new survey from West Health Institute shows that nurses are looking for greater medical device integration and more data sharing capabilities among healthcare tools.

The report states that 91 percent of polled nurses would spend more hands-on time with their patients if they could reduce the amount of time spent managing devices. As much as 72 percent of nurses interacted with two or more electronic devices while working. Out of all respondents, 41 percent stated spending three or more hours per shift working with medical devices.

One out of two nurses said they noticed a medical error due to inadequate device integration. Additionally, 74 percent of respondents agreed that it is taxing to coordinate all of the data stored in medical devices.

Improved EHR interoperability and medical device integration could be key for the healthcare sector in order to reduce medical errors and prevent as many as 210,000 deaths occurring in hospitals every year. The most common medical errors include drug prescription inaccuracies, failure to prevent injury, and diagnostic flaws.

If both EHRs and devices could “seamlessly communicate and share data,” patient safety as well as provider satisfaction could be increased. According to a recent study by HIMSS Analytics, more than 90 percent of hospitals use six or more tools that could be integrated with EHRs, but only one out of three hospitals have consolidated these devices with EHR systems.

With the help of Harris Poll, the West Health Institute surveyed 526 nurses about their interaction with technology and medical devices in the healthcare setting. The survey results show that nurses are unhappy with the many uncoordinated devices that they work with when interacting with patients.

The majority of nurses polled feel that EHR interoperability and device integration would significantly add to patient care and decrease medical errors. When it comes to the most difficult aspect of medical devices, 39 percent mentioned their lack of communication or data sharing capabilities.

Almost all respondents – 96 percent – felt that device coordination could at least slightly decrease the number of medical errors within the healthcare system. Essentially, these healthcare professionals are looking for technology that is capable of sharing information automatically in a coordinated manner.

The majority of respondents also stated that, in order to improve patient safety and the quality of care, bedside nurses need to focus on patients’ needs without distraction. About half of nurses felt that at least 10 percent of medical errors responsible for adverse events could be prevented if hospital medical devices could share information seamlessly.

“Devices that are connected to each other – such as a patient chart to vital signs machines, to blood glucose monitors, etc. – would eliminate data entry, which is a huge risk of error,” one registered nurse was quoted in the survey results.

Adopting standards for EHR interoperability and device integration will need to be incorporated into national legislation in order for the US healthcare system to reduce medical errors associated with adverse events and preventable deaths.

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Draft Bill Proposes New Plan for EHR Interoperability

Draft Bill Proposes New Plan for EHR Interoperability | EHR and Health IT Consulting |

Within the federal government, there has been significant debate as to whether the financial incentives put into the meaningful use program have actually improved EHR interoperability in a way that allows health information exchange (HIE) to occur on a national level.

In Congress, Rep. Michael Burgess of Texas has introduced a draft bill – called Ensuring Interoperability of Qualified Electronic Health Records – that emphasizes the need to develop new standards for measuring EHR interoperability during the design process, reports.

After five senators, including Senator John Thune and Senator Pat Roberts, stated in a release their disapproval of EHR interoperability several years after the HITECH Act was passed, Burgess called for the dismantling of the advisory committees responsible for recommending and advising on health IT measures. This included the Health IT Standards and the Health IT Policy advisories. The new legislation suggests appointing a new bipartisan committee instead.

“There is widespread consensus among healthcare leaders that the interoperability of health records is the leading health IT problem in America for doctors and patients alike,” Burgess told the news source. “Billions of taxpayer dollars have been spent to incentivize the integration of EHR systems, yet the federal government has failed to ensure that providers and patients can efficiently operate within them.”

In the draft bill, the establishment of a Congressionally-appointed committee called a “Charter Organization” of 12 members is advised to inform vendors whether EHR systems are meeting interoperability criteria and qualify for the EHR Incentive Programs. This establishment would report to the Department of Health and Human Services (HHS) on EHR interoperability principles.

There are three important qualifications that an EHR should meet to be considered interoperable, according to the draft bill. These are:

  1. Allowing authorized users complete, open access to all of a patient’s data within an EHR
  2. Prohibiting the need for multiple interfaces by providing authorized users with needed information through one location
  3. And allowing users to share information with other EHR systems.

The bill also calls for the members of the advisory board to be EHR developers, healthcare providers, and health insurance representatives. The draft also expects HHS to publish a report by the end of 2017 expanding upon whether widespread EHR interoperability has been achieved. This would involve determining whether major EHR vendors are meeting the interoperability standards. Additionally, the legislation states that vendors who do not meet the criteria by January 1, 2019 will no longer be offering certified EHR technology.

If the bill is passed in Congress, HHS will have to publish a list of non-compliant vendors on their website once the 2019 deadline elapses. This is not the first legislation to call for de-certifying EHR technology that blocks the sharing of health information, as the fiscal year 2015 Omnibus Appropriations bill has certain leanings toward this effect.

“The ultimate goal is to provide private sector-centered mechanisms that will accelerate innovation and make meaningful improvements to the overall quality of care,” Burgess told the Executive Gov publication.

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