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

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

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

 

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

 

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

 

Here are five details from ProPublica's investigation:

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

 

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

 

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

 

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

 

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

 

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

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Stanford Launches App That Connects to Epic EHR & Healthkit

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

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

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

• Make appointments

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

 

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

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

 

• Manage your prescriptions and medications

• View your health summary

• Access and pay your bills

• Share your vitals with your doctor via HealthKit integration

Secure Messaging


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

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

 

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Workflow Analysis, Ease of Use & Best Practices

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

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

 

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

 

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

 

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

 

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


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

 

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

 

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

 

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

 

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

 

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

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Pediatric EHRs Must be Treated Differently

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Electronic Health Records Consulting 

Electronic Health Records Consulting  | EHR and Health IT Consulting | Scoop.it

For most health systems, investment in an electronic health record (EHR) is inevitable—and possibly one of the largest expenditures they will make. To achieve the clinical, financial, and operational return on investment, you need to be strategic in your selection, implementation, and utilization.

 

Why the EHR life cycle is just like raising a child 

 

No matter where you are in your journey, our services are designed to produce results that improve efficiency, effectiveness, and quality of health care for patients.

 

Our clinically-experienced IT consultants can support you through the entire EHR lifecycle, including:

 

  • Implementation strategy and planning: We guide clients through everything that goes on behind the scenes before the “go-live,” including a full assessment of current capabilities and workflows to determine what functionalities to look for in an EHR. From there, we lead the selection process for new EHR platforms by vetting qualified vendor options, identifying the initial vendor selection pool, orchestrating product demonstrations, and assisting in the negotiation process.

 

  • Go-live: To increase the usability of the EHR, we give clinicians the ability to learn about and personalize the technology before the go-live date, with items such as common procedures or prescriptions. Once we launch, we provide around-the-clock project management at every level and work to address any challenges that may come up during the process. 

 

  • Optimization: Whether after the “go-live” or as a standalone engagement, we work to develop strategies that optimize the EHR’s capabilities and produce results that drive value and profitability in the healthcare delivery model. We often optimize EHR platforms for:
    • HCC Capture
    • Medicare Annual Wellness Visit
    • Evidence-Based Guidance

 

  • Meaningful use attestation: Attesting meaningful use requires effort from many directions—from navigating regulatory changes to overcoming operational challenges. We take some of these tasks off clients’ plates by tracking federal updates, sending actionable alerts, and validating every aspect of the attestation plan. 

 

  • Life sciences support: To support customers and grow health system partnerships, life sciences firms are leveraging EHR strategies that align with industry trends and consumer priorities. Our experts help these firms determine high-yield, value-add strategy for implementing health IT resources into the EHR. 

 

And while we use these processes to guide our clients through the EHR lifecycle, we also support any IT platform using similar methodologies.

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EHRs and the Problem of Efficiency

EHRs and the Problem of Efficiency | EHR and Health IT Consulting | Scoop.it

Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.

 

And when it comes to doctors and their EHRs, there’s a fine line between efficient and lazy.

 

Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.

 

Four things I do to fight the downside of efficiency:

  1. Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I’ve typically crossed the line.
  2. Build narrative. My HPI and impressions represent an identifiable stream of thought. I don’t use smart phrases in my HPI or impression.
  3. Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
  4. Stay aware. All of this is a struggle for me. But my discussion and thinking around this make me aware of it. And that’s the first step to staying on top of it.

 

All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don’t be fooled. Take any doctor from the analogue age, give him two glasses of wine and he’ll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analogue pulldown.

 

Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.

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Consistent Compliance: A Smart Plan for 2016 

Consistent Compliance: A Smart Plan for 2016  | EHR and Health IT Consulting | Scoop.it

The dawn of a new year represents a logical time to look at current business operations and commit to making improvements. One key area that physician practices should focus on is compliance.

 

There are a myriad of rules and regulations of which practices must be aware. For example, with the ICD-10 code set in place, there are new and expanded coding guidelines. Similarly, organizations have to have strong procedures for safeguarding proper medical waste disposal, worker safety, and patient information.

 

Compliance in these areas can fall short, especially in smaller practices that have limited resources, and consequences can be severe, ranging from financial penalties to blemishes on a physician practice’s reputation. Organizations cannot afford this negativity given the competitive and costly nature of healthcare today.

 

Although keeping up with the multitude of regulations may seem daunting, it does not have to be. Even though different government requirements touch on diverse topics, organizations can take a similar approach to meeting all the rules. Not only is this cost effective, it also ensures that nothing slips through the cracks.

 

The following are some key resolutions that practices can make to commit to and execute upon a strategic compliance plan:

 

Appreciate the scope. First and foremost, physician practices must familiarize themselves with the applicable regulatory requirements. Getting a firm grasp on what an agency mandates is vital to understanding the extent of necessary compliance efforts. For example, two critical Occupational Safety and Health Administration (OSHA) regulations are the bloodborne pathogens standard and the hazards communications standard. These rules dictate that organizations must have detailed written policies that outline the risks present in the organization and describe how the practice plans to address those risks, including needlesticks, exposure to dangerous chemicals, and so on. On top of these two main standards, OSHA has other requirements that relate to personal protective equipment, hazardous chemicals, workplace violence, ergonomics, and so on. Like many other compliance areas, OSHA offers information about what’s required on its website, however, this can be overwhelming and a little unwieldy to navigate. Practices should look for resources, including consulting firms and online tools, to bring the regulations down to size.

 

Perform a gap analysis. After getting a handle on what’s required, the practice should compare its current performance against the applicable regulations to identify any holes. This may involve performing an in-depth review of existing policies and/or observing operations. In the case of HIPAA, an organization may also want to have conversations with staff about how they maintain patient health information security. Although a physician practice can do some of this on its own, an outside resource, such as a software program or other side-by-side comparison tool, can ensure the assessment process can be more thorough.

 

Provide training. Once a physician practice identifies compliance gaps, it should work to implement strategies to address them. Training is often necessary at this stage because it builds awareness with staff and can alter behavior so that the organization becomes more consistently compliant. For example, targeted staff training can help with coding compliance in that it demonstrates which codes a practice should use when and why. Training can take many forms, but should include real-world examples and opportunities to practice. To make sure staff retain information long term, facilities can employ knowledge retention strategies, such as periodically quizzing staff on certain compliance situations or having them engage in sample exercises.

 

Updating policies. Another applicable resolution for closing compliance gaps is to verify that the practice has all the appropriate policies in place and these documents contain the right level of detail. OSHA, in particular, is keen on whether an organization has comprehensive policies and whether the facility regularly reviews them. Even if a physician practice experiences a compliance breach, the regulatory agency may be more sympathetic if the practice can demonstrate that it has the correct policies and is aiming to consistently follow them.

 

Gain staff feedback. Staff can be a valuable resource in compliance efforts, and organizations should empower individuals to speak up about any perceived hazards or ways to improve compliance efforts. For example, if a staff member feels that waste disposal procedures are sub-par, he should feel comfortable bringing his concerns to practice leadership, and there should be an established method for securely and safely expressing opinions. Periodically surveying staff to get their thoughts and impressions is also a good idea. One thing to keep in mind is that employee concerns should be — at the very least —acknowledged, if not directly addressed. If a staff person shares feedback, but feels that nothing ever comes of it, he or she may be less likely to report concerns in the future.

 

Now, more than ever, is a good time to commit to renewed compliance efforts. By taking a strategic approach, organizations can meet the bevy of requirements while keeping costs in check—something that will ensure a better and safer environment as well as long-term practice viability.

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The Pros and Cons of Switching EHRs 

The Pros and Cons of Switching EHRs  | EHR and Health IT Consulting | Scoop.it

If you're not happy with your EHR system, making a change is not easier said than done. Take some time to weigh the pros and cons before a making this big decision.

 

"The advantage of keeping a sub-par EHR is that you don't have to go through the arduous process of changing EHRs," says Wanda is also president of the American Academy of Family Physicians. "However, one of the biggest disadvantages of keeping an EHR you don't like is that it tells the staff that they're not worth the investment in a better solution. Don't avoid making a switch because of the effort involved or the money you've already spent."

 

The advantage of making a change is that you'll hopefully pick a system that's more compatible with your needs. "Because you have the experience of what doesn't work in your current system, you can look for one that works better for your needs,” says John Meigs, Jr., a family physician at Bibb Medical Associates in Centreville, Ala., who is president-elect of the AAFP.

 

Filer's organization ultimately decided to change EHRs because, "the software was an unmitigated disaster. It was an incredibly expensive and time-intensive project to undertake, but I'm absolutely glad we switched EHRs."

 

Meigs, who has supported the use of EHRs for more than 20 years, hasn't liked any of the EHRs he's used. "Our current system takes too many clicks to do basic things, and the data isn't displayed in a way that is useful for patient care," he says. "The advantage to sticking with the devil you know is just that — you know what issues, challenges, and hassles you have to face."

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ONC Posts Health IT Policies for Improved Accountable Care

ONC Posts Health IT Policies for Improved Accountable Care | EHR and Health IT Consulting | Scoop.it

The Office of the National Coordinator for Health IT (ONC) has released a full document containing health IT policy levers on its website, giving various healthcare professionals access to different ways states leverage health IT to increase accountable care.


The document, entitled the State Health IT Policy Levers Compendium, reportedly lists nearly 300 different health IT policy levers and explains how states are able to use them to advance the use of health IT, interoperability, and system delivery reform.



For example, the document starts off by discussing how accountable care organizations (ACOs) can work to leverage different health IT policies. ACO payers such as Medicare or Medicaid within different states can require participants to use an interoperable EHR or participate in a health information exchange (HIE).

State entities contracting with providers for participation in an accountable care arrangement can align provider requirements with activities supporting interoperability. For instance, providers may be required to demonstrate they have adopted interoperable health IT or are participating in a health information exchange service in order to participate in the arrangement. Providers who can demonstrate adoption of interoperable health IT could also be provided with opportunities to earn greater rewards/access to shared savings under the terms of the arrangement.

These policy levers work by incentivizing different health IT capabilities. When the states implement certain health IT requirements, or create rewards for using different capabilities, they support the impactful adoption of health IT. All in all, this can help advance the triple aim of healthcare for better care, better spending, and better patient health.


“A health IT policy lever can be defined as any form of incentive, penalty, or mandate used to effectuate change in support of health IT adoption, use, or interoperability,” ONC writes in aCompendium overview. “This tool will help advance the country toward a delivery system with better care, smarter spending, and healthier people.”

The Compendium lists several different healthcare programs that can leverage health IT, and shows that many of them can help advance interoperability. For example, state appropriated funds can be focused on statewide HIE programs, or state lab requirements can include provisions regarding interoperability.


Some of the initiatives can also be leveraged to improve quality care and patient safety. State insurance commissioner policies can be focused on care quality through meaningful adoption ofinteroperable health systems. Additionally, state privacy and security policies can include provisions that “allow for more computable privacy while ensuring appropriate data is protected and shared.”


In addition to describing different potential policy levers, ONC lists the different states that have already embraced such levers. For example, when describing the state privacy and security policies, ONC reports that 16 states have already adopted that lever, including Alaska, Arizona, Arkansas, Colorado, Illinois, Iowa, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, Texas, Utah, and Wisconsin.


The compendium also has several limits. In lacking a full examination of how these different policy levers have worked for the states, the compendium is limited in giving a truly meaningful list of policy suggestions. Additionally, ONC acknowledges that its data sources are limited, and that state policymakers should consult other data sources in order to get a full view of how different policy levers would work to better their health IT use.


In all, the ONC hopes to continue to build on this document as the varied uses of health IT continues to grow. This will help ensure that states adjust their policies with each change that the industry sees.

“ONC expects to maintain the Compendium via periodic updates,” ONC writes in its document overview. “This initial launch will serve as a foundation upon which ONC will work with states to update and refine the information in the tool. It will also allow ONC to make improvements to the structure and possibly the format of the Compendium.”

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HITPC Claims Interoperability Progress Not Fast Enough

HITPC Claims Interoperability Progress Not Fast Enough | EHR and Health IT Consulting | Scoop.it
Four general policies and developments could help speed up the interoperability initiative.


As a part of a federal mandate to improve EHR use, interoperability, and connected care, the Health IT Policy Committee (HITPC) has submitted its December report to Congress explaining barriers and policy suggestions with regard to interoperability.


Develop Health Information Exchange (HIE) Measures

The first policy suggestion the HITPC explained to Congress was the establishment of HIE-sensitive measures which would not only measure the amount of information providers were exchanging amongst one another, but the meaningfulness and impactfulness of that information. In order for providers to receive high scores on these measures, the information exchanged would need to be used meaningfully, as to reflect an important use of the information.


“In order to enhance the strength of incentives that drive interoperability, a set of specific measures should be developed that focus on the delivery of coordinated care, facilitated by shared information across the entire health team (including the individuals and families) and throughout the continuum of care settings,” the HITPC explained. “An example of an HIE-sensitive measure would look at medically unnecessary duplicate testing.”


This new policy could be effective in strengthening incentives by first allowing payers to incorporate these measures into their payment methods, and second by integrating these measures into public reporting that would in turn reveal which providers give the highest level of coordinated care.


Develop Vendor HIE Measures for Certification

Just as providers should be tested against certain HIE-sensitive measures, as should vendors. Such measures could potentially serve as a direct catalyst to improve vendor developments and performances.


Specifically, HITPC is looking for these measures to occur in practical use -- not in a lab -- and to take into account needs that go beyond certification measures for the EHR Incentive Programs.

“Today, purchasers of EHR systems lack such measures to inform purchasing decisions or to use as a lever to put pressure on vendors to improve,” HITPC confirmed. “Although vendors have strong incentives to pass the interoperability requirements for EHR certification, this process is “one-time” and occurs in a lab. It has not been shown to translate into interoperability that is affordable or easy to implement in the field.”


HITPC also listed a few specific measures that could record vendor HIE performance:

  • Number of data exchanges from external sources, which could include other providers, community social-service organizations, consumers, payers, etc. (denominator that measures ability to exchange data with another electronic system such as an EHR, HIE or consumer application (app));

  • Percentage of external data elements viewed (numerator that measures perceived value of the external data);

  • Percentage of external data elements incorporated/reconciled with internal records (represents meaningful data); and

  • Percentage of time viewing of external data changed current activity (e.g., appeared in clinical decision support, led to change in order being written), which demonstrates impact of external data.

Accelerate Incentive Payments for Interoperability

HITPC maintained that in order for providers and vendors to make interoperability progress, they must have adequate incentive payments. Not providing incentive payments encourages providers to deal with internal needs rather than prioritize interoperability.

Today, the lack of palpable financial incentives for interoperability favors the status quo. Pressing internal priorities compete for attention and resources are needed to achieve interoperability, especially when specific actions to enact interoperability are complex and time-consuming. This results in slow progress. Moving interoperability up the priority list will likely take financial incentives that are more targeted than a broad shift from fee-for-service to pay-for- 17 value. To have the desired effect, the incentives must be strong and specific, with clearly defined measures and a deliberate implementation timeline and effective dates.

Initiate Sustained Multi-Stakeholder Action

In order for the above-mentioned goals to be met, HITPC explained that multiple stakeholder groups will need to take action in the overall interoperability efforts. Several of the policy suggestions, such as creating HIE-sensitive provider measures, require multiple voices for development, and multiple interpretations of the ONC Interoperability Roadmap.

Thus, HITPC suggested creating an interoperability Summit of various industry stakeholders in order to collaborate on interoperability efforts.

The output of the Summit would be an action plan with milestones and assigned accountabilities for achieving the milestones in the context of this larger interoperability initiative. We expect the compelling call-to-action would engage the stakeholders to continue their activities after the Summit as a way of meeting the payer-driven incentives that reward HIE-sensitive measures of coordinated care.

Earlier this year, Congress requested a report from the Office of the National Coordinator for Health IT (ONC) which detailed the issues surrounding information blocking. In the report, the ONC both defined information blocking as a practice, and provided examples.

Specifically, ONC defined information blocking as using criteria of interference, knowledge, and lack of justification for refusing to share information.


The information provided in this most recent report from HITPC could potentially put an end to those negative information blocking practices by providing incentives for fostering HIE and interoperability. Between monetary incentives and a clear prescription of HIE measures, both providers and vendors could ideally implement more effective interoperability strategies.


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Best Practices for Approaching EHR Optimization Projects

Best Practices for Approaching EHR Optimization Projects | EHR and Health IT Consulting | Scoop.it

EHR optimization projects are set to be an industry focus in light of the increased adoption of health IT. This focus is perhaps a natural transition, as providers are realizing that just because a healthcare organization adopts an EHR does not mean they are gleaning the most they can from it.


EHR optimization strategies are important options for organizations to look into. Optimizing an EHR system can help enhance a healthcare organization’s revenue cycle, patient care, or even contribute to better clinical analytics, depending on the focus of the optimization project.



In fact, studies show that EHR optimization is slated to be one of thehighest priorities for healthcare organizations in 2016. As more organizations complete EHR adoption and become comfortable with their systems, they see that it is time to develop strategies to better use this technology.

Below, we list the best strategies for beginning EHR optimization.


Reassess your EHR system


When organizations adopt a new EHR, it is natural that they learn the bare basics and take some time to adjust to using the new technology. However, after using the EHR for a while, it is important to reassess how the system is working within the care setting and looking for ways to more impactfully use it.


To begin EHR optimization, organizations should examine how the EHR has functioned within the organization thus far. IT staff can look at how the interface is functioning, financial support can examine the revenue cycle payoff the system yields, and physicians can examine the system’s clinical effectiveness.

From there, staff can develop optimization plans centered around the organization’s goals. For example, if an organization wants to optimize its EHR to improve revenue cycle results, it can concentrate on optimizing the system for clinical documentation and coding improvement.


Identify staff needs


Although looking at EHR outcomes to determine opportunities for optimization is important, it is also useful to consult with EHR users to find user-oriented optimization solutions.


Emory Healthcare is an example of this approach through its recent physician-facing EHR optimization project.


As Emory Healthcare CMIO Julie Hollberg, MD, explained to EHRIntelligence.com in a past interview, the EHR provides a great framework for physicians, but optimization is important for teaching them how to engage with the interface and the information on it.

"The technology like many things does amazing things, but it’s just a tool. You have to learn how to use it just like everything else. We have coupled this with required training so that people have a skeleton from which to hang new knowledge from the coaches when they are in clinic," Hollberg explained.


Also important to user-facing optimization is strong support, according to Hollberg. Emory made sure there was consistent communication between operations staff and users to ensure adequate optimization.

"During the week of go-live we have twice a day conference calls with the physician lead, clinical operations and administrative practice leads to go over the ongoing list of what the issues are and be able to react to those real time," she noted. "The week after go-live, we move from move from twice a day conference calls to three times a week.


However, the coaches are there on an ongoing basis and have a daily meeting or debrief and issues that are a problem are escalated to us."


Carefully cultivate your EHR optimization team


Although EHR optimization sounds as though it could primarily engage the EHR vendor, it is in fact a multi-disciplinary effort. Impact Advisors’ Physician Executive Tanya Edwards, MD, MMM, told us in a recent interview that it takes several team members to implement an EHR optimization strategy.

“Definitely, there is vendor involvement as far as improving usability. But there's a lot that's involved just from an individual organization standpoint,” Edwards explained. “There is a lot that health systems can do themselves as far as usability, taking a look at what those workflows really are. Sometimes, that involves looking at the clinical workflow, streamlining it, and then having IT support that. But sometimes it's really just inside IT and how you choose to build within the product.”

Although the optimization team should ideally be multi-faceted, Edwards told us that these teams should be led by operations experts who will  not only be able to accurately execute the work, but direct where the work should go next.


“It is a multi-disciplinary team that needs to be operationally-led because it is the people doing the work who understand the work,” Edwards said. “They understand why things need to be done in a certain order. They understand what the barriers are. Once those workflows are developed, then it's up to IT to come in and try to support that.”


As stated above, several industry experts predict that EHR optimization will be a main focus for healthcare organizations in 2016. Because of the lack of major project slated for the upcoming year, Edwards says she agrees with those predictions.


"It seems like we may have an opportunity in the next year to have a breather, be able to focus a little bit more on being able to optimize these systems, and really try to get the value out of the millions and millions of dollars that we have put in."

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Monitoring ICD-10 Post-Implementation Issues

Monitoring ICD-10 Post-Implementation Issues | EHR and Health IT Consulting | Scoop.it

Planning and execution efforts toward successful ICD-10 implementation have been the largest resource-intensive undertaking by healthcare in decades. The last couple of years have enlisted dedicated planning by government agencies, healthcare plans, EHR vendors, and health information educators in facilitating the transition from ICD-9 to ICD-10.


The cost of ICD-10 preparation was a valid concern for healthcare. Physicians and other qualified healthcare providers were impacted financially with making initial capital investment in certified EHR systems. The cost of initial training for their private clinics or group practices added to expenditures. Time and resources have been allocated to electronic data exchange testing over two fiscal years in anticipation of possible system interface and program incompatibilities. Concurrently, healthcare professionals had prepared for the code system changes by participating in provider-to-vendor testing while EHR companies, clearinghouses, and healthcare plans have been focused on vendor-to-payer data transmission.


The healthcare industry had ample time to analyze the factors that currently affect efficient and uninterrupted quality healthcare, but have healthcare providers anticipated the factors that will affect their practices after implementation?


A national effort to transition to a new and improved, but vastly different coding system inevitably affects various groups and multiple healthcare transactions. As a result of inaccurate data capture and delays in medical billing, it is critical that providers and administration examine how ICD-10 impacts patient care and reimbursement.

There are different factors that contribute to inferior health data reporting and to delays in provider cash flow:


INACCURATE DATA CAPTURED


1. EHR keywords tend to mimic the alphabetic index of the code book and are not set up in user-friendly clinical terms. Physicians and other qualified healthcare providers may have difficulty in locating the most specific and accurate ICD-10 code when using keyword search and look-up tools in their EHR.


2. Physician documentation practices may not correlate to main terms and subterms in which the ICD-10 code book or electronic code books are organized, making it more challenging for coders or other designated staff members to find the most appropriate code based on the completed notes.


3. Lack of physician engagement and the decision to not seek training in ICD-10 documentation lends itself to inconsistencies of code assignments from one healthcare provider to another. Many EHR products carry over the diagnosed conditions in the patient's current and past medical history. Other providers from the same practice may choose to assign these same ICD-10 codes previously noted in the record. Even if the providers were to decide to assign their own code and not carry over the previous ones, the lack of uniformity in the practice not only implies that there are coding errors being made, but that the data collected by insurance carriers, independent research groups, government agencies, and public health organizations is not a valid representation of current illnesses. Additionally, incorrect data exchanged across electronic systems is useless information and potentially harmful to the patient's health when shared with outside healthcare providers and facilities involved in the care of the same patient. The movement toward ICD-10 was fueled by a critical need to improve the quality and effectiveness of patient care. Inconsistent and inaccurate data quality thwarts this purpose.


4. General Equivalent Mapping (GEMs) resources are intended to provide the most approximate equivalent code from ICD-9, cross-walked to each possible ICD-10 code. The translation is not a perfect one because ICD-10 includes a plethora of information that previously had not been part of the ICD-9 code description. For example, ICD-10-CM introduces combination codes that detail the underlying disease and current manifestation, routinely seen in diabetes affecting other organ systems. The new coding system has established several new concepts and features for


ICD-10 diagnostic codes, allowing providers to:


• Include information on laterality

• Identify if it is the patient's initial encounter

• Identify the gestational trimester in which the disease process was diagnosed (including the severity of illness)

• Include the external cause

• Expand on the description of injuries, fractures, complications, adverse effects, and poisonings to now include very particular information, such as:

– The Gustilo grade of an open fracture

– If underdosing or noncompliance is due to medication cost-reduction

– If the provider is treating a pregnant patient for a particular condition that first developed during the mentioned trimester and not the episode of care that she presented for

– If the resulting complication resulted intraoperatively or postoperatively


While GEMs serve as a time-saving tool, the matching ratio from ICD-9 to ICD-10 is most frequently not a perfect 1:1 correlation. Most ICD-9 codes will map out to multiple possible options for correct ICD-10 code selection. Exclusive reliance on the GEMs will lead to incorrect code submission on billing claims.


REVENUE DELAYS AND REIMBURSEMENT REDUCTIONS


1. The medical profession continues to be reimbursed on our current fee-for-service (FFS) system. National and Local Coverage Determination policies issued by CMS list and detail the diagnostic codes for symptoms and conditions that necessitate commonly performed diagnostic or therapeutic procedures. These acceptable diagnostic codes support the ordering or performing of any diagnostic tests or treatments. Incorrect ICD-10-CM assignment increases the number of "medical necessity" denials for CPT and HCPCS II procedures billed by physician practices.


2. CMS released data on healthcare providers, clearinghouses, and billing companies that participated in their July 2015 end-to-end testing with MACs and DMEs. Medicare published information stating 29,286 claims were received, but only 25,646 were accepted. Additionally, 52.7 percent of all submitted claims were professional services from healthcare providers, 2.6 percent of claims denied by CMS were due to submission of invalid ICD-9-CM codes, and 1.8 percent were due to invalid ICD-10 codes. This 4.4 percent denial rate was higher than the 3 percent reported in April's end-to-end denials. Health information managers (HIM) and providers spent 36 years learning how to assign three-digit to five-digit codes for a complete code selection. Now, providers and coders have to correctly select the required number of alphanumeric characters — anywhere from three characters to seven characters. Denials for invalid code submission further delay provider reimbursement.


3. Code assignment errors increase with untrained clerical and ancillary staff responsible for reviewing billed codes. Coding errors include: incorrectly assigned unspecified codes, codes of lesser specificity, missed diagnostic codes, and symptoms. This is especially critical for practices engaged in the HCC Risk Adjustment coding incentives in which captured data for severity of illness and comorbidities is directly tied to annual financial incentives for the practice.


4. The nearly quintuple growth in available diagnostic codes presents challenges when physician practices redesign their encounter form or superbill. Practices have to be selective about which commonly used diagnostic codes will be featured on the superbill for quick reference and which will be excluded.


5. Medical coders increase the number of queries addressed to healthcare providers for incomplete documentation and unspecified diagnostic conditions. While this is most likely to occur in the inpatient setting, physician practices with in-house medical coders will have billing claims held until the providers adequately respond to clarification requests.


6. Productivity rates decrease because of the increased time required to document properly for specific codes. Medical coders and HIM professionals take additional time to accurately locate and sequence the appropriate codes based on documentation. The increase delay in billing the professional claims increase the number of days in A/R and adversely affect the practice's cash flow. Independent providers and provider practices had been advised to budget for the anticipated financial impact at least six months prior to implementation.


EFFECTIVE MANAGEMENT AFTER OCT. 1


Several measures should be taken in order to streamline the transition in medical practices. Examination and revision of internal policies and processes is essential to ensuring that quality patient data is captured, while maintaining compliance in billing practices.


1. Provider practices should seek assistance from the EHR vendor.


• Vendors are best equipped to provide training and can also instruct office managers on how to run reports detailing the 50 most commonly used diagnostic and symptom codes in the practice.


• EHR companies can effectively re-label many diagnostic codes so that the keyword or main term appears as the clinician deems natural, and not necessarily as the medical coder is trained to look them up in the alphabetic index of the code book.


2. Practices should rely on industry resources for proper coding guidance.


• The American Hospital Association (AHA) publishes quarterly guidance on ICD-9-CM and now ICD-10 code assignment. Many challenging coding questions have been posed to the AHA by medical coders and the responses are available and organized by ICD-9 and ICD-10 codes.


• CMS has publicly released physician guidance on ICD-10-CM coding in multiple medical specialties. Information tips are available to registrants of their listserv. Also, the "Road to 10" online resources are specifically designed to assist physician practices in raising awareness and promoting physician engagement, as well as offering free training for physicians and other healthcare providers.


• The National Center for Health Statistics (NCHS), an agency under the Centers for Disease Control, has additional resources. NCHS offers official guidelines on proper ICD-10-CM and ICD-10-PCS code assignment.


• The ICD-10-CM/PCS Transition Workgroup is an online community forum hosted and managed by the NCHS (on phConnect Collaboration for Public Health) to assist physicians in this implementation (visit bit.ly/PHC-ICD10 for more information).


• The American Health Information Management Association (AHIMA) offers a number of physician coding resources, including an "ICD-10 Toolkit" developed in 2012 which still proves relevant and instrumental today (visit bit.ly/AHIMA-ICD10-toolkit for more information).


• The AMA has printed and electronic ICD-10 publications on coding and documentation intended for providers. They offer online and live training for physicians.


Practices will need training and retraining after reevaluating post-implementation operations. Staff members come and go and providers may take medical posts in other organizations. Consistent and high-quality data reporting is essential and will directly impact practices as our healthcare industry phases out the FFS model and moves toward a value-based payment model. Practices should be making provisions for educational reinforcement after ICD-10 implementation, and should strongly consider the benefits of employing certified medical coders and HIM professionals.


BEST PRACTICES


The financial health of physician outpatient practices is affected by accurate ICD-10 coding. Just as importantly, patient health outcomes are directly tied to proper coding. Proper planning is key to compliance and optimal revenue management.


Continuing education and employment of certified coders will minimize coding errors. Close monitoring of the revenue cycle and reassessment of internal processes will help identify gaps. Utilizing industry resources is a cost-effective means of improving processes. All of these combined are ingredients in the best recipe for post-implementation success.

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Exporting EHR Data to Excel Improves Finance Reporting

Exporting EHR Data to Excel Improves Finance Reporting | EHR and Health IT Consulting | Scoop.it

EHR and practice management (PM) systems come with built-in reporting capabilities but digesting all that information can be overwhelming. However, leveraging the power of Excel to sort and manipulate the data stored in your EHR can help you spot trends faster and implement steps to drive revenue growth.


“Excel is a great way to slice and dice your practice management data so you can really use it to improve,” says Nate Moore, CPA, MBA, an independent consultant and coauthor of “Better Data, Better Decisions: Using Intelligence in the Medical Practice.” “Excel allows you to filter, trend, and get your arms around reams of data.”


Excel offers an interactive tool called pivot tables that allow users to quickly sort, filter, and manipulate data, says Moore, who moderates the Excel Users Medical Group Management Association Community, an online resource for practice administrators. It gives users much more flexibility than an EHR, which typically offers a limited number of canned reports.


For example, your PM system can probably produce a general report on your collection rates at the front desk at the point of service. But a pivot table would allow you to slice that data in a variety of ways, such as individual employees’ collection rates by location or time of day.

In addition, you can connect Excel to the server where your data is stored so you are always working with the most current numbers, says Moore. That allows you to quickly run the same types of reports with updated data.


“A lot of practice administrators don’t run reports as often as they’d like because they take so much time to run and analyze using the PM and EHR,” says Moore. “Using Excel streamlines the process, making it more likely that reports will actually get produced.”


Moore offered a few examples of how pivot tables might be used to dig deeper into financial reports and zero in on potential problems:

1. Focus on overdue accounts. A general report on aging accounts receivable from your PM system might contain hundreds of pages, making it difficult to focus on specific trends. Exporting that data into pivot tables allows you to zero in on problem areas, such as claims overdue by 60 days categorized by insurer.


2. Gage productivity. If your compensation system is based on productivity, you can look at work relative value units by individual providers or during certain time periods.


3. Monitor workflow. Larger practices can monitor and compare activity at different locations. For example, how many patients did one employee register at a specific location vs. another employee at a different office?  How many appeals or claims did each individual employee process at each office?


4. Analyze your patient base. Using a basic pivot table, you can see all of your new patients in a given year categorized by month of visit, referring physician, diagnosis code, insurance, or clinic location. Analyzing the data reveals trends, such as how many patients each physician saw in each year over the past five years.


5. Group data. You can group data to spot referral trends. For example, how many commercially insured patients did one group of referring physicians refer to each individual provider in your practice, for each of the past five years?

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BI4Results's curator insight, November 10, 2015 2:33 PM

Really, exporting to Excel? This process should be a fully automated self-service BI solution

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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The EHR Journey – Selecting an EHR Vendor

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Epic Launches Sonnet with Rhyme and Reason

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

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

 

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

 

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

 

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

 

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

 

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

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Alen Smith's comment, October 26, 2018 12:49 PM
Great Post.
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Fix the EHR!

Fix the EHR! | EHR and Health IT Consulting | Scoop.it

After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.

 

Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing.

 

Mashing up all these functions — charting, clinical ordering, billing/compliance and quality improvement — inside the EHR has been a disaster for the clinical user, in large part because the billing/compliance function has dominated. The pressure from angry physician users has produced a medieval solution: Hospital and clinics have hired tens of thousands of scribes literally to follow clinicians around and record their notes and orders into the EHR. Only in health care, it seems, could we find a way to “automate” that ended up adding staff and costs!

 

As bad as the regulatory and documentation requirements are, they are not the largest problem. The electronic system's hospitals have adopted at huge expense are fronted by user interfaces out of the mid-1990s: Windows 95-style screens and drop-down menus, data input by typing and navigation by point and click. These antiquated user interfaces are astonishingly difficult to navigate. Clinical information vital for care decisions is sometimes entombed dozens of clicks beneath the user-facing pages of the patient’s chart.

 

Paint a picture of the patient. For EHRs to become truly useful tools and liberate clinicians from the busywork, a revolution in usability is required. Care of the patient must become the EHR’s central function. At its center should be a portrait of the patient’s medical situation at the moment, including the diagnosis, major clinical risks and trajectory, and the specific problems the clinical team must resolve. This “uber-assessment” should be written in plain English and have a discrete character limit like those imposed by Twitter, forcing clinicians to tighten their assessment.

 

The patient portrait should be updated frequently, such as at a change in clinical shifts. Decision rules determining precisely who has responsibility for painting this portrait will be essential. In the inpatient setting, the main author may be a hospitalist, primary surgeon, or senior resident. In the outpatient setting, it’s likely to be the primary care physician or non-physician provider. While one individual should take the lead, this assessment should be curated collaboratively, a la Wikipedia.

 

This clinical portrait must become the rallying point of the team caring for the patient. To accomplish this, the EHR needs to become “groupware” for the clinical team, enabling continuous communication among team members. The patient portrait should function as the “wall” on which team members add their own observations of changes in the patient’s condition, actions they have taken, and questions they are trying to address. This group effort should convey an accurate picture (portrait plus updates) for new clinicians starting their shifts or joining the team as consultants.

 

The tests, medications or procedures ordered, and test results and monitoring system readings should all be added (automatically) to the patient’s chart. But here, too, a major redesign is needed. In reimagining the patient’s chart, we need to modify today’s importing function, which encourages users indiscriminately to overwhelm the clinical narrative with mountains of extraneous data. The minute-by-minute team comments on the wall should erase within a day or two, like images in SnapChat, and not enter and complicate the permanent record.

 

Typing and point and click must go. Voice and gesture-based interfaces must replace the unsanitary and clunky keyboard and mouse as the method of building and be interacting with the record. Both documenting the clinical encounter and ordering should be done by voice command, confirmed by screen touch. Orders should display both the major risks and cost of the tests or procedures ordered before the order can be confirmed. Several companies, including Google and Microsoft, are already piloting “digital” scribes that convert the core conversation between doctor and patient into a digital clinical note.

 

Moreover, interactive data visualization must replace the time-wasting click storm presently required to unearth patient data. Results of voice searches of the patient’s record should be available for display in the nursing station and the physicians’ ready room. It should also be presentable to patients on interactive whiteboards in patient rooms. Physicians should be able to say things like: “Show me Jeff’s glucose and creatinine values graphed back to the beginning of this hospital stay” or “Show me all of Bob’s abdominal CT scans performed pre- and postoperatively.” The physician should also be able to prescribe by voice command everything from a new medication to a programmed reminder to be delivered to the patient’s iPhone at regular intervals.

 

Population health data and research findings should also be available by voice command. For example, a doctor should be able to say: “Show me all the published data on the side-effect risks associated with use of pembrolizumab in lung cancer patients, ranked from highest to lowest,” or “Show me the prevalence of postoperative complications by type of complication in the past thousand patients who have had knee replacements in our health system, stratified by patient age.”

 

AI must make the clinical system smarter. EHRs already have rudimentary artificial intelligence (AI) systems to help with billing, coding, and regulatory compliance. But the primitive state of AI in EHRs is a major barrier to effective care. Clinical record systems must become a lot smarter if clinical care is to predominate, in particular by reducing needless and duplicative documentation requirements. Revisiting Medicare payment policy, beginning with the absurdly detailed data requirements for Evaluation and Management visits (E&M), would be a great place to start.

 

The patient’s role should also be enhanced by the EHR and associated tools. Patients should be able to enter their history, medications, and family history remotely, reducing demands on the care team and its supporting cast. Patient data should also flow automatically from clinical laboratories, as well as data from instrumentation attached to the patient, directly to the record, without the need for human data entry.

 

Of course, a new clinical workflow will be needed to curate all of this patient-generated data and respond accordingly. It cannot be permitted to clutter the wall or be “mainlined” to the primary clinical team; rather, it must be prioritized according to patient risk/benefit and delivered via a workflow designed expressly for this purpose. AI algorithms must also be used to scrape from the EHR the information needed to assign acuity scores and suggest diagnoses that accurately reflect the patient’s current state.

 

Given how today’s clinical alert systems inundate frontline caregivers, it is unsurprising that most alerts are ignored. It is crucial that the EHR be able to prioritize alerts that address only immediate threats to the patient’s health in real time. Health care can learn a lot from the sensible rigor and discipline of the alert process in the airline cockpit. Clinical alerts should be presented in an easy-to-read, hard-to-ignore color-coded format. Similarly, hard stops — system-driven halts in medication or other therapies — must be intelligent; that is, they must be related to the present reality of the patient’s condition and limited to clinical actions that truly threaten the health or life of the patient.

 

From prisoners to advocates. The failure of EHRs thus far to achieve the goals of improving healthcare productivity, outcomes, and clinician satisfaction is the result both of immature technology and the failure of their architects to fully respect the complexity of converting the massive health care system from one way of doing work to another. Today, one can see a path to turning the EHR into a well-designed and useful partner to clinicians and patients in the care process. To do this, we must use AI, vastly improved data visualization, and modern interface design to improve usability. When this has been accomplished, we believe that clinicians will be converted from surly prisoners of poorly realized technology to advocates of the systems themselves and enthusiastic leaders of efforts to further improve them.

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Moving into post-EHR era

Moving into post-EHR era | EHR and Health IT Consulting | Scoop.it

Consultants weigh in on what hospitals should expect from them as healthcare moves beyond digitization and into the age of consumerism.

 

Healthcare information technology is evolving in many ways, and quickly so. That means health IT consulting has to change with the times, to evolve alongside the technology consultants help healthcare provider organizations, master.

 

Consultants from top firms across the health IT consulting spectrum have various ideas about what firms must do next to successfully aid provider organizations with technology. Call them next-generation health IT consulting goals.

 

For example, health IT consultants must move beyond prediction, said Jeff Geppert, a senior research leader at Battelle, an independent research, consulting and development organization that applies science, technology, and engineering to challenges in various industries, including healthcare.

 

“The current narrative on health IT consulting services is becoming commonplace,” he said. “The focus is on data science and applications that leverage large and connected datasets, powered by predictive analytics and artificial intelligence/machine learning running in the cloud.”

 

However, there is nothing very transformative about prediction, he cautioned.

 

“It is by necessity short-term and event-driven,” he said. “Healthcare provider organization CIOs should be looking for health IT consultants with a compelling long-term and goal-driven vision, and a plan to work with them to bring that vision about.”

 

"The focus [of health IT consulting] will shift to extracting more value from investments and identifying which new investments are necessary to drive competitive advantage for the system."

“Health IT consulting today seems like the auto industry a hundred years ago with multiple companies competing to build the most technologically advanced car,” he said. “Somewhere out there is the Henry Ford of health IT who will build something inexpensive, standardized, aligned with the needs of people, and scalable from individuals to the federal government.”

 

Healthcare provider organization CIOs should be looking to partner with health IT consultants with demonstrated longevity across multiple industries, he added.

 

John Curin, vice president of innovation at Burwood Group, a healthcare consulting firm that focuses on direct acute care, physician workflow and health IT, said he sees healthcare CIOs watching consulting services expanding beyond the EHR.

 

“The vast majority of the health IT consulting space has been overwhelmingly EHR-centric up to this point,” he contended. “Today, EHR and revenue cycle systems migration is largely complete or well-understood. The focus will shift to extracting more value from those investments and identifying which new investments are necessary to drive competitive advantage for the system.”

 

Further, consultants will offer services to help healthcare providers transition – the shift will be toward internally developed interdisciplinary strategies with a focus on systemwide financial and clinical outcomes improvement, Currin said.

 

“For example, to make IT more successful, CIOs will stop reacting to external plans and timelines, such as regulatory compliance introduced by meaningful use or vendor roadmaps based on product lifecycle and implementation schedules,” he said. “Instead, they will start building frameworks to drive better financial and clinical performance.”

"The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage"

On another note, consumerism is significantly affecting healthcare today, forcing healthcare provider organizations to meet changing patient expectations. Along with receiving the best medical care available, today’s health care consumers also expect a first class experience across every touchpoint at an organization.

 

“With expectations becoming increasingly ‘consumerized,’ executives are realizing that their healthcare organization will be judged on how patients rate their overall experience,” said Rob Barras, executive leader, health solutions, at CTG Health Solutions, a clinical and financial IT consulting firm that serves healthcare provider, payer and life science organizations. “This means that meeting these demands needs to be front of mind for CIOs.”

 

This trend toward a consumerism approach will accelerate significantly, and health IT consultants will have to be on top of it to successfully assist healthcare provider organizations, Barras said. Soon, Amazon, Wal-Mart, CVS, and Apple will consider themselves care providers, he added. And while most traditional health systems are doing business as usual, smart CIOs will plan ahead to match the future expectations set by these retail giants in yet another industry, he said.

 

“Many of these major players believe there is an opportunity to capitalize on what they believe traditional providers have been slow to do – provide easy access and quality care at a reasonable and transparent price,” he said. “The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage, and for consulting firms to rush to assist with this stage in the planning process.”

 

And Barras said that moving forward, health IT consultants have to be getting healthcare provider organizations implementing the latest healthcare information technologies now, not later.

“For the past couple of years, many healthcare organizations have treated emerging technologies as somewhat of a luxury and not as something with immediate business value,” he said. “However, technologies have matured quickly and already are being implemented to meet business needs, meaning organizations without structured plans to roll out the latest in analytic, AI and IoT solutions are in danger of falling out of step with competitors.”

This means that health IT consultants must focus on becoming innovation hubs – as opposed to internal caretakers – of technology to provide true value to healthcare clients, Barras added.

 

“The right CIO can help change the mindset of an organization, but that change must be supported from the top down,” he advised. “A key to this is working with consulting partners who understand that using technology is a way to create a competitive advantage for the future. Providers should engage partners who can clearly articulate the value of their work and the vision.”

 

 

 
 
 
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The future of EHRs - and it's not even in the EHR 

The future of EHRs - and it's not even in the EHR  | EHR and Health IT Consulting | Scoop.it

Voice recognition and natural language processing will enable doctors and nurses to interact with electronic health record platforms in more comfortable ways.

 

Along with a fistful of cutting-edge technologies, an interesting trend has begun to emerge that may help predict a direction forward for the way users interface with electronic health records.

Hint: It’s not in the EHR. Instead, emerging technologies such as ambient listening, voice assistants and natural language processing will provide a subtle buffer between EHR data and users. Clinicians will be able to access and contribute to data within electronic health records software or cloud services, in fact, without having to touch the EHR itself.

 

Let’s take a look at how this could play out.

EHRs today

As they have evolved, EHRs have also become more complicated and “busy.”  They require significant investment in training, both prior to adoption and ongoing as new features are released. 

Telling a primary care group back in 2000 that 6-8 hours of classroom training was required for every physician would have been the ultimate non-starter. Today, this is the norm and accepted as reasonable and it also holds true for the analysts who configure and support these systems of record.

 

Documentation requirements continue to increase, too. The push to document in a codified way has become more important in order to inform not only electronic decision support but also to support population health management initiatives and advanced data analytics. Plus, medical knowledge is eclipsing providers’ capabilities to internalize it and incorporate it into their practice.

So what does this point to?

Voice recognition, NLP and remote scribes

Providers have already begun to adopt technologies such as voice recognition and natural language processing that allow them to distance themselves from the complexities of the EHR.

Since a clinician is technically in the record while dictating via voice recognition, he or she is interacting with the system with a software buffer that the typist does not have.

 

A more pronounced example is the scribe. Far from a new idea, the scribe allows the provider to see the patient and remain fully focused on the task at hand while someone else does the documentation on their behalf.  While this comes with a certain level of awkwardness for the patient, it has been widely adopted in some clinical settings.

 

Natural language processing has been discussed in concept and used in pockets for many years. While loaded with potential and extremely appealing, it has yet to take off as a full-fledged documentation solution.

 

More innovative alternatives are also being explored. Remote scribes allow the transcriptionist to listen to the visit in real time and document as the provider speaks their way through the examination.  his may be implemented as an audio-only solution or with audio and video through the use of a tablet or some other video-enabled device in the exam room. Ambient devices are also being investigated as alternatives — pairing voice recognition with a mostly hands-free documentation experience minus the scribe. Google Glass is another interesting alternative. In this concept, the provider is not only dictating as they examine the patient but also visualizing elements of the record as they go without having to refer to a computer or tablet.

Tech challenges and costs

These novel technologies are not without challenges.  For the remote scribe model to be successful – especially in the case of audio-only – providers need to run through their visits in a common way for the process to be accurate and efficient. The scribe also must document the right information in the right place in the record. If they are merely typing a free text note – the value of the data is lost. Decision support is one of the most compelling reasons to use an EHR. How can the provider receive this guidance if they are not interacting directly with the system? A hybrid solution could solve for this – with the provider manually performing order entry and prescribing tasks. Alternatively, technology developers may come up with an innovative solution to address the requirement in the future.

 

Patient perception is also a concern. As with the traditional human scribe, patients may react negatively to the notion of a virtual third party participating in their visit. How can the patient be sure that only the identified third party is listening/watching? How can they be assured that the visit is not being recorded or shared? What type of consent is required and what details need to be shared with the patient in order for them to be aware of the process? What if the patient declines to participate in this type of visit?

 

Security, of course, will be paramount both for the patient and the hospital.  We all hear of major security breaches on a weekly basis. Executives and (increasingly) patients will need guarantees that these solutions are secure and insulated from the risks that come with the possibility of a data breach.

 

Traditionally the solutions that allow providers to document patient care without interacting with the record have been utilized mainly in the ambulatory, urgent care, and emergency department settings. Is there an option that would work for inpatient providers? Is there an option that would be suitable for nursing documentation? It may very well be that the answer is “no” and that these caregivers will continue to document directly in the record (either manually or with traditional voice recognition) for the foreseeable future.

Back to the future

There is, of course, a financial component to all this as well. Scribes and the more advanced technologies described are not inexpensive.  It will be up to technology developers and service providers to clearly articulate the return on investment.  It is noteworthy that some of that ROI will be difficult to quantify in terms of dollars or efficiency as it relates to provider happiness.

Even with all of these questions, it is clear that the trend of providers moving further away from direct interaction with the EHR is real and likely to continue. 

 

Ideally, EHR developers and regulatory agencies will see this as a challenge to simplify their products and documentation requirements. It’s possible that this is the push the industry needs to rethink usability and truly develop intuitive systems that are easy to learn and easy to use. This will require not only creativity and skill but also a willingness to rethink many of the constructs the industry has operated under for the last decade-plus.

 

It is more likely that the burgeoning trend will continue to progress and we will find ourselves in a “Back to Future” scenario where providers use the medical record to access information but harness various forms of new age dictation to keep it updated.

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Deciding to Ditch or Detain Your EHR

Deciding to Ditch or Detain Your EHR | EHR and Health IT Consulting | Scoop.it
Is it time to go a new route with your EHR system? Before you decide yes or no, weigh the positives and negatives.
 

Only 34 percent of physicians are satisfied or very satisfied with their EHR systems, according to a recent survey conducted by the American Medical Association and AmericanEHR Partners. Another survey published in the American Academy of Family Physicians' journal, Family Practice Management reported that only 39 percent of respondents who changed EHRs were pleased with their new system.

 

The results of these surveys outline how the decision to change EHR systems or not is a difficult one. After all, it's a significant financial investment and staff have spent a lot of time learning how to implement and use their system. If you change, your practice will have to foot these costs all over again. In addition, you face the potential loss of data and problems with data migration. 

 

HANG IN THERE

 

"A well-designed EHR should be physician centric, specialty specific, and serve as a tool for the physician to document a patient's visit," says John Pitsikoulis, managing director of Berkeley Research Group, LLC, a firm located in Hunt Valley, Md. "The EHR must also meet the practice's business needs, including the revenue cycle. When an EHR doesn't align with a practice's specific day-to-day work flows, it makes the physician's job more difficult by increasing [his] administrative and compliance workload. By negatively impacting the physicians' time, patient care is impacted."

 

While it's tempting to want to replace something that doesn't meet your expectations, under certain circumstances you may want to give it more time. "First, determine if your current system offers enough functionality for managing your practice and achieves meaningful use requirements set forth by CMS. Also, verify that the vendor's strategy for future enhancements outweigh any short-term disadvantages," Pitsikoulis advises.

If your practice likes some of the core features and functions of the system, already developed specialty-specific templates, and can live with navigating through notes, orders, and prescribing without overwhelming frustration, living with the current system makes sense at least for the short term, Pitsikoulis continues.

One common complaint of physicians is that they have become data entry clerks at the expense of patient care. "This is a common physician finding, regardless of the EHR system," Pitsikoulis says. "But changing systems could result in the same functionality."

 

The truth of the matter is that a lot of systems aren't lacking in functionality and can be beneficial if you take the time to learn how to use them, says Eagan, Minn.-based Derek Kosiorek, principal consultant of Medical Group Management Association (MGMA) Healthcare Consulting Group. One way to determine if this is the case at your practice is by finding out which physicians successfully use the EHR. If it's more than half, then the EHR isn't the problem and other doctors need to invest more time in learning to use the system more efficiently. See if those doctors can assist others in learning the system.

 

TROUBLESHOOTING

 

Before throwing in the towel, see if the vendor is willing to work with you on resolving issues. Work with the vendor to identify each problem and then ask if the vendor can offer a solution, says Mechanicsburg, Pa.-based David J. Zetter, founder and consultant at Zetter HealthCare.

 

If it is more difficult to order tests or enter information into the medical record than before having the EHR, something is wrong, says Ann Arbor, Mich.-based Joette Derricks, owner of Derricks Consulting, LLC. The EHR should streamline the work flow, not add more steps. If employees are printing out information and still depending on paper, something is probably not set up properly. Open communication is critical to identify and resolve problems.

 

Making some enhancements to the EHR documenting process with voice recognition software, streamlining the physician coding function with built-in coding software, and optimizing the EHR features and functions with templates, could provide some shortcuts that make an EHR more desirable, Pitsikoulis says.

However, be cautious when adding these enhancements. Engage consultants with operational, technical, and coding compliance expertise to integrate the physician's work flow with the technology. "Otherwise, you might end up with similar performance dissatisfaction with the next tool," Pitsikoulis says.

 

PULL THE PLUG

 

Sometimes, despite your best efforts, you may want to call it quits. Poor technical support is a key reason to get a new vendor. "Oftentimes, marketing staff is very accessible early on and then a year after implementation you can't get a basic question answered," Derricks says. In this instance, it's time to move on.

 

Furthermore, if the vendor does not update its software to facilitate new medical technology or contractual payment updates, that's problematic, Derricks says.

In addition, if an EHR lacks the ability to integrate with other software such as laboratory tests, diagnostic tests, practice management systems, and so forth, it's probably time to start anew, adds Zetter. Other reasons to say "adios" are if staff cannot effectively use the system, if it impedes patient care, or if it's just too costly to continue to use.

 

Or, if information is consistently incorrect because the system is set up poorly, or you're finding bad data, start over, Kosiorek says.

 

MAKING A DECISION

 

Even though EHRs may pose a lot of challenges, their ability to exchange health information electronically has enormous benefits. EHR capabilities, such as electronic prescribing, improve patient and provider communication, while providing for the patient.

 

If you're unhappy with your EHR, it's important to understand what went wrong in your last EHR selection so you don't repeat those mistakes. Perform a needs assessment by categorizing the current deficiencies and determine if these can be improved. If not, then it's time to begin the process of selecting a better EHR.

 

CHOOSE RIGHT THE FIRST TIME

 

After incorporating a new EHR system, many physicians will have to change the way they've done their job since beginning their careers. "They are being asked to take information in their paper chart, shuffle it like a deck of cards, and then have it presented to them in various places on a computer screen," says Eagan, Minn.-based Derek Kosiorek, principal consultant of the Medical Group Management Association Healthcare Consulting Group. "Then, they have to get used to navigating to where the information is relocated. This can be difficult, as some vendors in the early days of creating EHR software didn't design it in the most user-friendly way for physicians."

 

Fortunately, this is evolving, but as a result it's leaving some physicians wondering whether to stick with the old or upgrade to something new.

 

Whether selecting an EHR for the first, second, or third time, the selection, implementation, and integration of work flow with new technology is complex, and requires continuous process improvement. "Usually, the need to make a decision and begin the implementation process gets in the way of a complete and thorough understanding of the technology and the practice's needs," says John Pitsikoulis, managing director of Berkeley Research Group, LLC.

 

When beginning the process of selecting an EHR, a practice's providers and staff should have an opportunity to "kick the tires." Yet, very few often do, says David J. Zetter, founder and consultant at Zetter HealthCare. Trying out a potential system gives users a chance to determine if it's a good fit. For example, they should ask the vendor "How will the EHR work with the practice's way of documenting a patient encounter? How will the practice management part of the software suite work? And, what is the reporting like?" And to make sure that the EHR will fit your unique needs, talk to other same-specialty practices that use the same system.

 

In addition, practices often fail to thoroughly check references. "Don't accept only a few names as references," Zetter says. "Ask proper questions of many practices that have implemented it, such as 'Would they choose it again? Why or why not?'"

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3 Best Practices For Effective EHR Replacement, Adoption

3 Best Practices For Effective EHR Replacement, Adoption | EHR and Health IT Consulting | Scoop.it

When beginning an EHR replacement project, it is important to carefully consider your practice's true needs and intentions.



The health IT industry is changing, and an upsurge in EHR replacement makes that change clear. From ever-changing meaningful use requirements to varying practice needs, healthcare organizations find that their original EHR acquisition may not have been the best choice. Upon facing substantial EHR difficulties, these organizations seek to find a better replacement for their technology.


Changing EHR replacement trends can be credited to the ubiquitous adoption of the technology following the meaningful use program implementation and the changing landscape of the healthcare industry.


As more healthcare organizations are expected to replace their EHRs, it is important for them to understand best practices to keep them from having to undergo the same process years down the road. Below are some of the industry’s best advice for successful EHR replacement:

Be thoughtful and patient when determining practice needs

Organizations considering an EHR replacement do so because they have some considerable problem with their existing technology. Because of that, it might be easy for the hospital’s health IT leaders to quickly jump to what they think may be a cure-all solution to their problems.


Industry experts caution against this, explaining that IT leaders should be patient when developing an idea of what they specifically need in a new program. By taking the time to flesh out exactly the kinds of issues the practice has been dealing with, and exploring different options for fixing those issues, an IT team can better assess the direction in which they need to go.


Mark Hess of Stoltenberg Consulting Group, a company which guides practices through EHR replacements, says this has been his most successful practice in helping to facilitate an effective EHR replacement. Choosing a slower EHR replacement process is key to alleviating biases IT teams may have due to failures of old systems.

"Optimally, if we can get them down this road, we see the biases become diluted, they become more objective, and many times they'll come up with a very different decision than they would've had they gone the 90-day or quick-turn process," Hess told EHRIntelligence.com.


"By having corporate site visits, by having several rounds of demos, they come to a different way of thinking about how to make a decision,” Hess continued. “It's more global and enterprise-wide, more strategic in nature, less biased, and really what's best for the organization."


Foster physician buy-in, positive hospital culture

Once IT teams have chosen their new EHR software and taken time to determine new goals for using the software, it is important for them to foster physician buy-in.


Physician buy-in is crucial because if a physician doesn’t believe in the benefits the product promises to display, he won’t use the technology to its fullest potential. Physician resistance to EHR systems is one way that otherwise successful implementations fail.


IT teams and other organizations leaders need to remember that although their EHR system may be changing, it is their hospital culture that will make all of the difference. In a 2015

KLAS publicationImplementation Potholes 2015: How to Smooth Out the Ride, researchers explain that an EHR vendor can’t change practice culture; only leaders can.


One of the best ways to facilitate physician buy-in and promote good morale and positive workplace culture is to emphasize the patient safety benefits an EHR system will bring. IT leaders should also emphasize the long-term benefits of the system to negate the short-term difficulties providers are sure to face in replacement.


Showing executive commitment to the provider may also boost morale and facilitate positive culture. Providing ample help resources to providers when implementing an EHR was one way Avera McKennan CEO Dave Kapaska, MD, was able to see success.


“We tried to put as much help at the shoulder as we could so they weren’t left swimming at sea with the process,” Kapaska said. “[We] just committed ourselves both as on the administrative side but most of all on the physician side to get this to a point where it was functional and efficiently effective.”


Consider meaningful use changes


A new added foil to the EHR replacement issue is the impending change to meaningful use requirements.


Since the start of meaningful use, many providers have shaped their EHR adoption and replacement intentions around meaningful use requirements. However, since the Centers for Medicare & Medicaid Services (CMS’s) Andy Slavitt’s announcement that the meaningful use programs will essentially be broken down and restructured, providers will have new meaningful use concerns.


Per Slavitt’s announcement, the meaningful use programs will most likely focus more on provider needs to give quality care to the patient rather than abiding by sometimes arduous government requirements. Because of this, IT teams will need to take into account provider needs when selecting potential EHR replacements.


IT teams may have more EHR options going forward, too. Slavitt explained in his statement that one of the tenets of the future meaningful use is flexibilities for vendors to develop systems that cater to provider needs. This could make all of the difference when approaching EHR replacement.



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Analyzing the Alleged Death of Meaningful Use

Analyzing the Alleged Death of Meaningful Use | EHR and Health IT Consulting | Scoop.it

Earlier this week, Andy Slavitt, Acting Administrator for CMS, told a group of attendees at the J.P. Morgan Annual Health Care Conference that meaningful use is on its way out.


“Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending meaningful use and moving to a new regime culminating with the [Medicare Access and CHIP Reauthorization Act of 2015] (MACRA) implementation,” Slavitt told attendees. “The meaningful use program as it has existed, will now be effectively over and replaced with something better.”


The idea that meaningful use, a program which began in 2011 and aimed to incentivize or penalize physicians for adopting an EHR system, would be over, naturally caused many physicians to celebrate. Melissa Young, an endocrinologist in Freehold, N.J., and a member of the Physicians Practice Editorial Board, e-mailed a three word reaction to the news: “Hooray! ‘Nuff said.”


The AMA had a more formal way of celebrating this news. Of Slavitt, AMA President and CEO, Steven Stack, an emergency physician, told Beckers Hospitals Review in a statement: "He listened to working physicians who said the meaningful use program made them choose between following Byzantine technological requirements and spending more time with their patients. This is a win for patients, physicians and common sense."


In his speech, Slavitt talked about winning the “hearts and minds” of physicians back. Getting rid of meaningful use would undoubtedly help the federal agency achieve that goal, as evidenced by the rising number of docs who opted out of the program due to its stringent requirements.  “The concept of meaningful use was always doomed to failure and it has been proven that there is no improvement in the quality of our healthcare delivery system and it has not reduced the costs of the provision of medical care,” Jeffrey Blank, a podiatric physician in Loxahatchee, Fla., and a member of the Physicians Practice Editorial Board, said via email.


Hold that Thought


Despite the excitement, Robert Tennant, health information technology policy director for the Medical Group Management Association (MGMA), says physicians should keep the champagne on ice. For one thing, they will still be judged on EHR and technical capability.


At the conference, Slavitt talked about MACRA, which authorized the creation of the Merit-Based Incentive Payment System (MIPS). MIPS will measure and compensate physicians on quality, practice improvement, cost, and use of technology. Within MIPS will be elements of meaningful use. Rather than rewarding physicians for using technology, MIPS will aim to pay them on using it towards improving their outcomes.


While Tennant says a reworked meaningful use is “potentially very positive,” the guidelines for MIPS are supposed to be released and finalized this year, which he notes could be a problem for physicians. “Payment under MIPS is supposed to take effect in 2019. If the traditional approach of using a two-year look back [to make those adjustments] is in place, it would mean reporting would begin in 2017,” he says. “If you look at the timing from a regulatory process, we’re concerned with how this would be accomplished.”


In essence, vendors would have to redevelop software around the guidelines, train customers, and practices would have to go live within the space of a year. Moreover, Tennant says if MIPS regulations are finalized in December of this year, they’d likely overlap with a new presidential administration.


“Any new administration, the first thing they do is typically put all pending regulations on hold and review them before they approve,” he says.  Tennant also notes practices still have to be concerned over meaningful use regulations for 2016, including a full-year reporting period and the fact that Stage 3 of meaningful use is technically supposed to be mandatory in 2018.


“We don’t know what we are moving ahead to,” Tennant says. For practices, he advises to select software that fits their clinical needs and to not worry about “arbitrary and potentially changing” regulations. “Don’t focus on 2017 or beyond. We don’t know. The vendor doesn’t know.”


Even still, he is “cautiously optimistic” about Slavitt’s remarks. “We’re hoping CMS takes this opportunity to leverage MACRA to develop a program that is achievable and clinically relevant,” he says.


Blank is interested to see what lies ahead with government regulations, but is not as optimistic as Tennant. “I'm sure that many interest groups and the insurance industry will profit and doctors like me will continue to struggle,” he says.

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All I Want For Christmas: Seven Things I Wish My EMR Could Do

All I Want For Christmas: Seven Things I Wish My EMR Could Do | EHR and Health IT Consulting | Scoop.it

Dear Santa,


I’ve been a very good doctor all year. I have checked all my boxes and aced all my Meaningful Use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:


1) I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniature window. That would save time and help me not miss abnormal results.


2) I wish the patient’s next appointment date was displayed next to any incoming report I have to review. That would help me decide if I need to contact the patient about the results or if I’m seeing them soon enough that I can talk about the report then.


3) I wish I could split my computer screen so I could see an X-ray or consultation report or a hospital discharge summary at the same time as I type or dictate the narrative of my office note. That would help me quote them correctly.


4) I wish, when I open a patient’s actual visit note for today, the place where I do my documentation, that I could automatically see at least the beginning of the latest of every category of information we have received – latest labs, X-rays, outside reports and phone calls. It takes too much time to go searching in the places for each category separately just in case there might be something recent to catch up on in the visit.


5) I wish my EMR would know that prn medications, such as nitroglycerin, are not meant to be used for only a limited time, like 30 or 90 days, and would agree to e-prescribe them without a “duration”. If I could do that, they would not disappear from the medication list all the time.


6) I wish my EMR would automatically display the patient’s kidney function and allergies next to where I pick what medications to prescribe. That would make prescribing quicker and safer.


7) I wish my EMR wouldn’t alert me to drug warnings and interactions that are too obvious to need reminders for. I mean, any doctor would know that adding a second diabetes pill can cause low blood sugar (that’s why we do it) and that combining two drugs that can cause fatigue may cause even more fatigue! More intelligent warnings would be taken more seriously; now my trackball finger is automatically poised to close the “warning” pop-up, because I’m expecting it to be irrelevant.


I’m sure if I tried, I could think of an even ten wishes, or maybe even twelve – one for each day of Christmas. But these seven things illustrate the underlying, fundamental wish I have: that my EMR will evolve to be more user friendly. I wish, now that the basic functionalities of EMRs are in place, that somebody comes back to people like me and asks how to take this thing to the next level.

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An Early Retirement for the EHR Incentive Programs in 2016?

An Early Retirement for the EHR Incentive Programs in 2016? | EHR and Health IT Consulting | Scoop.it

The coming year will be the last for the EHR Incentive Programs as a result of no longer proving valuable to eligible hospitals and professionals, according to DirectTrust.


The non-profit association with the mission to support health information exchange and interoperability made the claim as one of its six predictions for 2016.



"Having accomplished the significant goals of greatly expanded EHR adoption and baseline interoperability via Direct, but also having alienated almost the entire health care provider community by overreaching for the final, Stage 3 version of its regulations, the Meaningful Use programs will be phased out by the end of 2016," the organization maintained in a public statement. "Providers are particularly worried because the requirements of Stage 3 MU do not align well with MIPS and MACRA, the new rules under which Medicare will pay for value and performance, rather than for volume of care."

DirectTrust sees things playing one of two ways.


"It may occur as a result of massive defections by providers willing to face fee schedule penalties rather than spend more resources on health IT that doesn’t add value to their practices and hospitals, it continued. "Or, it may happen as a result of Congressional action, or because CMS and ONC see the hand-writing on the wall and scale down and bow out gracefully."


The organization's prediction echoes the sentiments of Beth Israel Deaconess Medical Center CIO John D. Halamka, MD, MS, who less than a month ago asserted that meaningful use had served its purpose and ought to give way to Medicare Access and CHIP Reauthorization Act (MACRA).


Similarly, both DirectTrust and Halamka consider the lofty aims of Stage 3 Meaningful Use are sufficient cause for moving away from the federal program.


Elsewhere in its health IT predictions for 2016, DirectTrust expects patients to take on a more significant role in ensuring the electronic exchange of their health data:

Patients will have greater access to their clinical records, and they will be able to more freely and easily move those records whenever and to whomever they choose. Health care consumers will take as their right control of their own health information in much greater numbers. The corresponding willingness of provider organizations to permit this patient engagement — and to view it as positive and productive to attaining better health outcomes — will also become more evident across the U.S.

The consequence will be a freeing of data and an increased focus on patient-facing applications although it may not go as smoothly as desired.


"This will not happen linearly; rather it will grow explosively, and then suffer hiccups and setbacks as the privacy and security risks of such systems are first exposed, and then dealt with. But it is going to happen," the group added.


This is likely to tie in with another of its predictions — the coming to the fore of health data security and privacy in 2016.


"The cost of data breaches in health care is simply too high to be tolerated," DirectTrust stated. "As use of electronic health information exchange soars, we will experience a corresponding rise in concern about and actions taken to mitigate the risks of exposure of both data at rest and data in transit. Parties involved in electronic data exchanges will insist on more and more rigorous certification, accreditation, and audit of security and identity controls as a first condition of participating in data sharing."


In its remaining predictions, the organization anticipates a movement toward greater interoperability on the part of federal and state agencies as well as a growing reliance on Direct exchange for enabling the secure and interoperable movement of health data between and among providers for the purposes of care coordination.

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Epic Shows Inconsistent EHR Performance Internationally

Epic Shows Inconsistent EHR Performance Internationally | EHR and Health IT Consulting | Scoop.it
Different EHR vendors perform better in various different countries, according to a new KLAS Global Performance Report.


Despite having distinct popularity and success throughout the United States, Epic Systems is not necessarily the top-performing EHR product throughout the globe, according to a recent KLAS report.


The KLAS Global Performance report breaks down user-perceptions of various different EHR systems by region, such as Asia/Oceania, Europe, Latin America, the Middle East, and North America. Results show that although Epic Systems receives high praise throughout the US, and also performs well in Europe, the vendor does not have a stronghold in other regions.


The the best vendor performances in multiple regions, in fact, belonged to Cerner and Intersystems with high performances in Europe, Asia, and the Middle East.


One of the significant barriers vendors face in implementing their systems abroad are state contracts which limit certain functionality. Several companies, such as Cerner and Intersystems, have trouble implementing in Australia due to contractual issues.


Cerner’s implementation in the UK serves as an example of EHR systems that can be successfully implemented provided full adoption and fewer contractual limitations.


Although Epic is not seeing solid performances or high adoption rates in all regions, it is seeing success at larger health systems in other countries. Of the seven international Epic users interviewed, all of them reported full adoption of the systems, and strong functionality and support.


Vendors that do not see success at larger health systems include Allscripts and Phillips. Allscripts users report complications with implementation and support, while Phillips states that it faces difficulty garnering larger users to adopt their systems.


Cerner has garnered the most success throughout Europe, with the most ubiquitous successful adoption throughout the entire continent. That said, Epic has nearly 100 percent approval ratings from European users, though they are almost entirely located in one nation (the Netherlands).


As previously stated, Cerner’s clients in Australia are having difficulty with implementation. This is because of the way in which user contracts are established. Reported issues include a need for increased functionality, more system training, and increased systems optimization.


Despite Epic’s inconsistent international ratings, the EHR vendor continues to prove successful in the US. Between Epic’s many users’ awards, as well as Epic’s own honors, the vendor maintains its foothold as a health IT giant.

At the start of this year, Epic was awarded KLAS’s “Best in KLAS” award. Specifically, Epic won out in the Best for large ambulatory management category, among eleven other product awards.

Additionally, Epic won out in a recent Peer60 study of the physician-ranked most innovative EHR systems. Among the C-suite executives surveyed in the study, Epic won out as the overall best EHR system in operation. The vendor was also selected as one of the most intuitive and easy-to-use models on the market, and the top choice for CIOs.

Cerner and its users were also successful in the US this year, receiving KLAS’s best small ambulatory EHR award for 2014. Cerner also received two other KLAS awards in 2014.

In the aforementioned Peer60 study, Cerner was ranked as one of the most intuitive models on the market, as well as a top choice for COOs.

Perhaps most notably, Cerner was recently selected as the choice EHR for the Department of Defense EHR modernization project in partnership with Leidos Partnership for Defense Health. The partnership, which is currently valued at approximately $9 billion, was a significant feat for the EHR vendor.

“The Leidos Partnership for Defense Health is honored to have partnered with the Military Health System for nearly three decades, and we are committed to continuing our work in support of its mission to improve the health and medical readiness of our military,” Leidos representatives said in a public statement. “Our team stands ready to lean forward with the DoD to implement a world class electronic health records system.”


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