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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The Evolution of Enterprise Databases and EHR Interoperability

The Evolution of Enterprise Databases and EHR Interoperability | EHR and Health IT Consulting | Scoop.it

There are many parallels between the enterprise database sector and EHRs. Can the evolution of this database industry guide progress in the EHR front? I think there are a number of similarities and solutions which can address the proposed problems facing EHRs and the global healthcare system.

Oracle, the first commercially available database system, has been in existence for more than 35 years.  As a company, Oracle has encountered numerous competitive, technologic and economic challenges forcing it to re-think, re-engineer and re-develop its platform while maintaining backward access to huge volumes of data for its customers.  Many enterprise database companies have since entered the marketplace, all bringing a unique and proprietary set of options, designs and performance.

Despite these differences, enterprise database systems, along with open source and the relatively new NoSQL databases are able to interoperate to meet the demands of customers who are dependent on reliable, scalable, high performing, usable and secure access to data.

Dr. Donald Voltz

Hospital EHRs are babies when compared to enterprise database systems, but they share a great deal of similarities and have become a central player in our healthcare system. Physicians, patients and other healthcare providers are becoming dependent on EHRs for the daily management of patients. Meanwhile, administrators, insurers and regulatory bodies have been developing policies, process and practices to using EHR data for population health, patient engagement and development of best practices at a systems level. 

With the development of large scale, high performance ways to store and access increasingly larger data sets, enterprise applications have evolved to utilize the changing functionality with a commensurate understanding of customer demands leading to increased database functionality.

A cycle of sorts advanced the capabilities and allowed for the migration of application-centric software applications which were slow to change due to interdependencies. Looming was the real possibility of losing business critical functionality during upgrades to software as a service models (Saas) allowing for better scalability, more frequent software updates and higher reliability with lower overall costs.

The history of enterprise databases, and that of other enterprise software, shared similar criticisms as technologic advances occurred. The integration of legacy systems with evolving technology presented the greatest barrier to adoption, even when validated claims of higher performance, increased functionality, and lower costs were realized. These same criticisms have been voiced for EHR technology and are not likely to quite any time soon. 

The problem of integrating new and old technology or bringing technology into an area traditionally administered by manual, static and labor intensive means, boils down to the misapplication and misunderstanding of prior solutions. In enterprise database applications and others, middleware integration architecture was introduced, but was slow to fix these challenges.

Middleware was dispelled and slow to be applied to the enterprise software problem, stemming from attempting to solve integration problems of evolving technology with middleware platforms built upon prior technology.  

EHR interoperability in the early state of implementation and development does not have the legacy middleware problem since nothing existed before. In light of health information exchanges, proposals to develop data sharing standards, little has been presented on the middleware as a viable solution to the interoperability problem in healthcare. Although early in the implementation of EHR’s, they have made a large splash in healthcare and will be required to quickly scale to the available technology, including mobile.  Medicine is many years behind other fields in the deployment of enterprise software solutions to meet the needs of hospitals and patients. 

Oracle recently announced the release of a node.js database driver. This is yet another example of how large, proprietary enterprise software understands the need to implement middleware access so other innovative and motivated companies can develop new solutions to business, personal and social needs.

As we look forward, patient engagement with their health data, insurance, medical decisions and access to healthcare providers will necessitate additional development onto existing and emerging technologies.  If healthcare follows the trends of other enterprise software, and there is no reason to suggest it will not, middleware has been the only architectural pattern to solve the integration problem in a cost effective way while supporting scaling, security and reliability of critical business operations.



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Can True EHR Customization Help Physician Practices Survive?

Can True EHR Customization Help Physician Practices Survive? | EHR and Health IT Consulting | Scoop.it
In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.

It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.

Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today’s world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.

This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from “corporatized” healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.

Capable and cost-effective?

So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government’s evolving mandates that regulate healthcare record-keeping.

In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.

And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way, and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence ‘Rusty’ Hofmann in The Huffington Post, describes it, EHRs are like Model T Ford: Any Color You Want As Long As It’s Black.” The majority of these solutions hitting the market today just don’t cut the mustard when it comes to really addressing the needs of our country’s doctors and healthcare practices.

Furthermore, while the creators of many of these packaged EHR solutions claim to be “customizable,” they are actually merely “configurable.” Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.

These solutions also require heavy reliance on a computer screen, which often hinders a doctor’s ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.

Diversity and true EHR customization rule

So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.

In short, it is crucial that developers of these software tools accommodate doctors’ needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.

This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.


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Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com

Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10.  More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together.  But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process.  Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.

“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions.  The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.

Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them.  Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues.  They will address issues as they occur and learn as they go after implementation.  They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.

“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”

“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.”  Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.

“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.

“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.

Will EHR vendors and billing partners pick up the slack?  Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education.  The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists.  One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.

The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are.  CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing.  ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed.  Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so.  “Articles on ICD-10 are fear-based,” said a participant.  “I try not to go there.”

So where will they go?  To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions.  It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs.  ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.

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FDA Expands EHR Data Analytics with Active Surveillance System

FDA Expands EHR Data Analytics with Active Surveillance System | EHR and Health IT Consulting | Scoop.it

The Food and Drug Administration’s Sentinel Initiative, one of the first active surveillance infrastructures focused on identifying patient safety issues related to pharmaceuticals and other medical products, will expand past its pilot phase this year, announced Janet Woodcock, MD, Director of the Center for Drug Evaluation and Research in a blog post.  As a planned continuation of the Mini-Sentinel project, the full-scale system will allow the FDA to leverage advanced EHR data analytics by scanning millions of files for adverse events linked to drugs that fall under the Administration’s purview.

“Over the past five years, the Mini-Sentinel pilot program has established secure access to the electronic healthcare data of more than 178 million patients across the country, enabling researchers to evaluate a great deal of valuable safety information,” Woodcock writes. “While protecting the identity of individual patients we can get valuable information from Mini-Sentinel that helps us better understand potential safety issues, and share with you information on how to use medicines safely. We have used Mini-Sentinel to explore many safety issues, helping FDA enhance our safety surveillance capabilities, and giving us valuable input in decision-making on drugs and vaccines.”

The Sentinel Initiative differs from previous drug safety monitoring efforts in that it allows FDA researchers to actively dive into EHR data and insurance claims to analyze potential adverse events and establish links to specific pharmaceutical products.  This allows the FDA to work more quickly to identify problems than if they continued to rely on voluntary reporting alone.  Mini-Sentinel has previously confirmed the safety of two vaccines intended to protect infants against rotavirus after the voluntary recall of a third product that raised the risk of intussusception in patients who received the immunization.

The expansion of the project will build upon successful use cases from Mini-Sentinel, Woodcock says.  The FDA will refine its EHR data analytics methodologies as it continues to grow into what the Administration hopes will be a national resource at the center of an industry-wide collaboration between researchers, pharmaceutical developers, and other healthcare stakeholders.

The success of this vision relies on cooperation from academic and research partners, all of whom will need to further develop industry data standards for the system to function effectively.  “This work will allow computer systems to better ‘talk’ to each other and, ultimately will lead to better treatment decisions as clinicians will have a more complete picture of their patients’ medical histories, including visits with other providers,” Woodcock wrote in a previous blog post touting the success of the pilot system.  “Defining standards for capturing data from clinical trials, and using standard terms for items such as ‘adverse events’ or ‘treatments’ will allow researchers to combine data from different clinical studies to learn more.”

“From the outset, the goals of the Sentinel Initiative have been large and of ground-breaking scale,” she concludes. “We knew it would be years in the making, but Mini-Sentinel’s successful completion marks important progress. We look forward to continuing and expanding our active surveillance capabilities as we now transition to the full-scale Sentinel program.”


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Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR

Are Best Of Breed EMRs Going Out Of Fashion? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.



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Ingredients to a Successful ICD-10 Implementation - HITECH AnswersHITECH Answers

Ingredients to a Successful ICD-10 Implementation - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

Have you ever thought about just how many moving parts there are in an ICD-10 implementation? The whole process can seem overwhelming to a practice and as a Practice Management/EHR vendor who needs to understand all of these different pieces, we’ve found that the best way to approach this is by breaking down the implementation into three main ingredients: People, Processes & Technology. So what do these mean, what’s your role and how do you formulate a plan for ICD-10 success?

People – Because a successful ICD-10 implementation affects all departments in your practice, awareness, preparation, testing and training should already be well underway. Medical coders and physicians aren’t the only people who require high ICD-10 competency. The key to preparing your entire staff for ICD-10 readiness is identifying what training is required by role, who conducts the training, budgeting for training costs and downtime, timing and finally, ensuring staff is adequately prepared and capable. ICD-10 readiness should include regular communications with management, IT staff and clinical staff about new procedures and new or updated software such as Practice Management and EHR systems. Staff also needs to be able to handle new requirements and forms, such as paper superbills, as part of the new billing, claims and documentation procedures.

Processes – The impact of ICD-10 on practices can vary depending on specialty, patient mix, top diagnoses and payer mix. Solo and other small practices will typically have greater risk and deeper impacts due to fewer resources and available funds. Moving to ICD-10 will require tremendous effort and process coordination of nearly every workflow. Processes to manage 120,000 new codes in a way that allows simple, accurate look-up and application of codes requires collaboration across the practice – including your IT systems and people. Productivity standards may have to be redefined, requiring additional coding staff, existing staff may need to be retrained, and providers may need to change how they document with more detailed diagnosis information.

Technology – This is the backbone of a successful ICD-10 implementation and gives your practice, people and processes a foundation to guide your operations and improve coordination of benefits and care. When properly configured to an ICD-10 environment, technology can help ensure critical processes are performed – such as documentation, coding, billing and bi-directional data transmission – all while ensuring third-party integrations can do the same. As the ICD-10 crossover date approaches, the risk of having non-compliant IT systems grows exponentially. By paying close attention to your existing IT environment and examining it against changes required to accommodate new data, new workflows and potentially new people prior to implementation, you can greatly increase your ICD-10 readiness.

As you can see, we all have a responsibility to understand the ingredients that make up an ICD-10 implementation, which will increase our knowledge in these areas and in turn, reduce risk. Look for opportunities for training, industry webinars and vendor testing. Some vendors are even offering ICD-10 Risk Assessments to assist practices in understanding the impact of ICD-10 and providing recommended actions based on the assessment results. All of these opportunities will support the success of the People in your practice performing Processes that are supported by your Technology. When these three ingredients are understood, planned for and in sync, we’ll be able to achieve ICD-10 success together!



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What Is A Medical Grade Computer? -

What Is A Medical Grade Computer? - | EHR and Health IT Consulting | Scoop.it

Not all innovations lead to improved patient care or lower operating costs, but many of them do so your health care operations needs to stay current with the latest breakthroughs. This may require initial investments of money and training but the payoff can be worthwhile. Medical grade computers are a technology that can improve patient outcomes and make your practice more efficient.

Currently, there is no standard definition of a medical grade computer, but there are certain features to look for when selecting one for your health care setting. The first consideration is basic functionality. All medical grade computers need to be able to run 24/7 as healthcare never stops. Then, check to make sure that the computer supports HIPAA compliant electronic health record (EHR) practices and that it is compatible with your current operating system and software. Increasingly, medical facilities are requiring any electronic device used to carry certifications regarding electrical charge and flow from the device. Some of the common certifications desired are CE, FCC class A or B, EN60601-1 and UL60601-1. Finally, another component of a medical computer may be an anti-bacterial coating over the enclosure which helps cut down the spread of MRSA and other infections.

Use of Medical Grade Computers for EHR

Some physicians still hold out for paper health records, but EHRs are now the norm. The American Recovery and Reinvestment Act (ARRA) of 2009 includes provisions for financial incentives for Medicare providers who demonstrate meaningful use of technology for EHR by meeting Stage 1 and Stage 2 criteria.

Some benefits of storing patient records on medical grade computers include the following:

  • Complete set of records with no risk of paper loss of important data.
  • Accurate records with less chance for human error upon data entry or retrieval.
  • Less chance of conflicting treatments, such as drug interactions.
  • Faster diagnosis, since all information is available in the single patient file.
  • Easy and clear viewing of electronic imaging records such as Xrays and MRIs.

A good medical grade computer needs to quickly process complete patient health records to get through a patient visit in a timely manner. As patient privacy is becoming more of a concern, these computers must be able to maintain HIPAA compliance according to the HITECH Act within the ARRA of 2009. Look for a computer with the following characteristics:

  • Supports the operating system needed and patient record software.
  • Securely connects to a network to allow various medical providers, but no unauthorized users, to access patient records.
  • Can easily be backed up to prevent data loss.
  • Can have RFID reader or barcode scanner type attachments if needed for use in tracking treatment.

Surgical and Diagnostic Applications

Medical grade computers have the potential to assist in patient care because of imaging capabilities. For example, computers with the proper graphics processor, CPU performance, screen display, and software compatibility can visualize patients’ inner workings to guide surgeons during surgery. In diagnostics, computers display MRI and CT scans providing radiologists with critical information. New software and high definition screens enable a diagnostician to see better than before and more quickly detect what they are looking for.

Medical Computers provide a platform for Digital Imaging and Communications in Medicine (DICOM) files which can be used anywhere in the hospital to display medical images such as Ultrasounds and X-rays. This lets all members of the health care team access the information needed at the time they focus their attention on the patient to provide diagnostic and monitoring services. When looking for a medical grade computer, consider exactly what it will be used for to make sure you select one that supports the necessary operating system, visual display, and software needed.

Compatibility with Your Current Setup

Medical grade computers are a costly investment but do provide a high ROI (Return On Investment). Justification for allocating the money upfront includes the potential for better patient care, along with reduced operating costs due to greater efficiency. A good medical grade computer is compatible with your current technology network and software, as well as configurable for future applications.

Cleanliness for Your Health Care Environment

Computers and computer equipment may seem clean, but invisible bacteria can easily build up. Typical PCs are not sterile enough for a hospital or other health care environment where staying sanitized is a top priority. In fact, a standard home or office computer may have three times the number of germs as a toilet seat. A medical grade computer has features that promote hygiene such as the following.

  • Fanless design to prevent debris from building up in the fan.
  • A fully sealed enclosure, which is easy to clean with sanitizer without getting moisture inside.
  • An antimicrobial touchscreen and enclosure, which can prevent the spread of MRSA.
  • Fewer wires so the room remains easy to clean.

Medical grade computers are essential in modern health care settings to increase efficiency and support patient care. When you search for a medical grade computer, make sure it supports all the technical functions you need and contributes to a sanitary environment.



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Change is Coming: What to Expect in Health IT in 2015 -

Change is Coming: What to Expect in Health IT in 2015 - | EHR and Health IT Consulting | Scoop.it

In 2015, healthcare information technology will continue to drive towards solutions that respond to the industry challenges of providing increased quality of care at a lower cost in a changing regulatory environment. Providers must respond to declining reimbursement models, quality demands of consumers and payers, along with increasing EHR mandates. Payers are striving to align care and cost incentives across both providers and consumers. Consumers are being asked to bear more of the cost of care and in the process are becoming more price sensitive, quality aware, and more personally responsible for their own care.

In support of these goals, the macro-level trends will be on continuing the significant support for Electronic Health Record systems, providing actionable analytics, and improving the infrastructure. For health IT in 2015, these macro-trends will result in a healthcare industry focus on the following areas:

  1. EHR On-going Upgrades, Enhancements and Support: These costs have become so high and ubiquitous that are not often regarded as trend, but it is a trend that will continue
  2. Meaningful Use: Responding to the next level of Meaningful Use requirements and the ability to better respond to Meaningful Use Audits will also be required
  3. ICD 10 Compliance: Compliance with ICD 10 can be expected to finally arrive in 2015, and   investments will be needed to updating the update systems and develop more specific reporting that ICD 10 will allow
  4. Data Interoperability: Increasing the ability to collect consistent, timely, meaningful and trusted data across diverse sources (e.g., clinical data systems, claims data, operational data) will increase the ability to provide improved quality and lower costs, and the increased data interoperability will be leveraged in systems used by providers, payers and consumers alike.
  5. Clinical Decision Support: Providers (and Payers) will be driving improvements in evidence-based care, predictive outcomes and risk management
  6. Operational Decision Support: Operational decision support will be required to provide better insights into care delivery processes, into the total cost of care at a patient and procedure level, into operational costs and into consumer factors affecting the cost of care
  7. Security: An on-going threat across all industries, maintaining security of Personal Health Information will require increased vigilance. As health information and operational systems become more interconnected the security challenges and risks become exponentially greater.
  8. Cloud: Data center management need not be a core competency in healthcare. More and more organizations will realize others can better manage their data and systems at a lower cost, and integration between on-premise and cloud-based systems will become more common.
  9. Patient Portals / Engagement / Mobile User Devices: Payers, providers and consumers have incentives and interests to leverage technologies that will help to better manage consumer health (e.g., chronic conditions, post-acute care, overall wellness, etc.) and associated costs.  Personal health monitoring devices are becoming more sophisticated and consumers are largely willing to share this data with their provider.
  10. Tele-health: Tele-health has the ability to provide more immediate care, especially for those in rural areas and where cost pressures have decreased the availability of more local providers.  Tele-health will be see increasing use for non-acute and follow-up appointments.

The one constant in the healthcare industry for the foreseeable future will be change. Supporting that change will be ever more sophisticated technologies that will completely change the provisioning of healthcare as we know it today. The trends above will be realized in different ways and times by different organizations, but all healthcare organizations will need to adapt in order to survive into even the near future.



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Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com

Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Developments during the last week of January will have a serious effect on the progress of meaningful use, interoperability, and health reform in the coming year.

Perhaps the most important development for health IT was a reduction in meaningful use reporting requirements in 2015. After months of feedback criticizing the meaningful use requiring for reporting in 2015, the Centers for Medicare & Medicaid Services (CMS) finally decided to opt for a 90-day reporting period rather than one requiring a full year’s worth of EHR data.

In a CMS blog post, Patrick Conway, MD, the Deputy Administrator for Innovation & Quality and CMO, highlighted three meaningful use requirements the federal agency is considering for an upcoming proposed rule.

The first would require eligible hospitals like eligible professionals to report based on the calendar year, which would give these organizations time to implement 2014 Edition certified EHR technology (CEHRT). The second would change “other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” Lastly and most importantly, CMS is considering reducing the meaningful use reporting requirement from 365 days to 90 days.

As Conway noted, this proposed rule is separate from the one for Stage 3 Meaningful Use expected next month. However, the spirit of the two proposals is to reduce burdens on providers while promoting expanded use of CEHRT.

Most recently, the Office of the National Coordinator for Health Information Technology provided its earliest plans for enabling nationwide interoperability. The first draft version of the interoperability is the first iteration of the federal agency’s long-term plans for enabling a health IT ecosystem and infrastructure with the ability to exchange patient health data efficiently and securely.

“To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.

The lengthy draft comprises both long- and near-term goals for promoting standards-based exchange among healthcare organizations and providers. The document is current open to public comment through the beginning of April.

At a higher level, the Department of Health & Human Services (HHS) laid out its plans for shifting healthcare dramatically from volume- to value-based care. Secretary Sylvia M. Burwell has committed Medicare to making half of the program’s reimbursements based on value by 2018. Over the next two years, the department is aiming to shift 30 percent of fee-for-service payments into quality-based reimbursement paid through accountable care organizations (ACOs) or bundled payments.

The challenge for the department and the Medicare program is significant considering that accountable care comprises an estimated 20 percent of total Medicare payments. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement,” Burwell said.

While all these changes took place within HHS, President Barack Obama and members of Congress began revealing their plans for supporting personalized medicine. The President’s Precision Medicine Initiative is already on the table and offers $215 million to support the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and ONC. Meanwhile, the House Committee on Energy & Commerce is moving forward with the discussion phase of its 21st Century Cures initiative which aims at speeding along patient-centered regulation and supporting medical researchers, clinical data sharing, clinical research, and product regulation.

All in all, the last week of the first month of 2015 may go down in history at a pivotal moment in the real transformation of healthcare in the United States.


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Amazing Charts Releases 2015 Predictions for Medicine and Technology

Amazing Charts Releases 2015 Predictions for Medicine and Technology | EHR and Health IT Consulting | Scoop.it

Amazing Charts, a leading developer of Electronic Health Record (EHR) systems for physician practices, today issued its healthcare predictions for 2015.

1.      Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end Concierge Medicine, and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.

2.      Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.

3.      EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.

4.      Wearable Health Devices Empower Patients: Led by FitBit, the market for mobile health monitoring devices saw explosive growth in 2014. Now Apple is entering the scene, and 2015 promises to see even more apps and devices introduced to consumers. How the government regulates these devices may depend on how they are marketed. For example, a glucometer could be unregulated if the intent is for a user to monitor blood sugar levels for better nutrition. If the same glucometer is marketed for monitoring diabetics, however, it may be more strictly regulated as a medical device.

5.      EHR Interoperability Still Around the Corner: While all EHRs will not be able to seamlessly communicate in 2015, the core infrastructure for increased data liquidity will largely be in place. The data standards of the CCDA and its predecessor, the CCD, are increasingly used by EHR vendors. In addition, Meaningful Use Stage 2 mandates that patients can receive a digital summary of their own records on demand. These positive steps forward will combine in 2015 to get us closer to the promise of data interoperability.

6.      EHR Switching Accelerates: Many practices selected an EHR system lured by the promise of Meaningful Use incentives and now find themselves dissatisfied with their decision, primarily because the solution is not user friendly and slows them down. Despite barriers to switching systems, we will witness a mass conversion of solutions toward EHRs that better meet providers’ expectations and requirements.

7.      The Doctor Will NOT Be In: In 2015 and beyond we will see reimbursements drive the “virtual” appointment, whereby health plans will reimburse clinicians for online patient visits. Patients and their providers will connect over virtual platforms for scheduling, reviewing test results, writing prescriptions, etc. As they do, more and more insurers will follow suit as technology advances and claims its place in the doctor’s office.


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Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015

Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015 | EHR and Health IT Consulting | Scoop.it

This summer the DOD is set to award the multi billion dollar electronic health records contract. Each group that bid on it contains at least one company the provides product and one with heavy weight Gov’t/DOD presence.

Who is going to win? Who is in real trouble if they don’t? As far as the winner is concerned, my new, Christmas gift , Crystal Ball doesn’t have this level of experience yet. What I do know is that who the actual winner is will affect the entire Healthcare IT marketplace.

Of the bidders, there are a few companies “betting the farm” on winning this. More later on who, but they could be in serious trouble if they are not the winners.

The contract is scheduled to be awarded in early July. I’m sure there will be protests and pressure from the losers, so the contract’s full impact might be delayed briefly.

When all this is sorted out the need for qualified people to work on the project is going to be huge and securing a position there will be considered a prize for many because the contract itself is going to last for at least 8 years.

Basically this means that if you are looking for a position, there are going to be a huge amount of health IT job opportunities available. As professionals move to the DOD contract, most will need previous experience. Where are they going to come from? These experienced professional departures will create job opportunities when they leave.

For employers, you might want to look into your employee retention efforts. Some companies out there are going to have a major problem with retention. You may be putting out fires all summer long as the experienced health IT marketplace shifts.


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EHRs: It's time to start from scratch

EHRs: It's time to start from scratch | EHR and Health IT Consulting | Scoop.it

A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing.


They have multitudes of unnecessary meaningful use buttons that must be clicked because the government says so. They have data formats that are incompatible with other EHR systems. Doctors fumble around trying to enter orders using electronic physician order entry (POE). There is terrible user support. And so on. At the end of the day there is decreased productivity, doctors are unhappy, and patients are unhappy. Big brother in the form of the hospital and the state have more big data to look at, but certainly there doesn’t seem to be many benefits to patient care. The major benefit is to the companies that make these proprietary closed-source EHR systems. They get obscenely rich.

But surely there can be benefits to EHR systems? What about the ease of access to the patient’s chart? No more waiting for the chart to come up from medical records. In fact, no more medical records department at all! Aren’t we saving health care dollars by cutting out those jobs, as well as medical transcriptionist jobs and unit secretary jobs. Surely paper charts were worse?

Doctors should not turn away from information technology. After all, we use all sorts of sophisticated computer technology every day, from the internals of the ultrasound machine to the software running an MRI scanner, to the recording system used in electrophysiology procedures. There is a role for technology in our record keeping as well.

The problems with current EHR systems are manifold. They are hack jobs, with nightmarish interfaces that obviously were never user tested. They are overly ambitious, trying to do all things and thus doing nothing well. They are ridiculous. I mean, having doctors enter orders directly into a computer — seriously? EHR companies have no incentive to improve their user interfaces, because government mandates require that they are used no matter how awful they are. Those who don’t adopt these systems are penalized by loss of Medicare dollars.

I think it is an interesting thought experiment to consider how EHR systems would have been designed if they had been allowed to evolve naturally, without the frenzied poorly thought out incentives that exist in the real world. Imagine a world where physicians, the primary users of these systems, drove development and adoption of these systems. Imagine that there were no mandates or penalties from the government to adopt these systems. If a system was developed that improved physician workflow, it would be adopted. Nothing that slowed productivity, as the current EHR systems do, would ever be bought by a practice if the physicians made the call. Imagine EHR companies visiting practices, analyzing workflows, seeing areas that could be improved by computers, and recognizing areas that wouldn’t, at least with current technology. Imagine EHR companies testing their user interfaces using doctors from a spectrum of computer experience, as major software companies like Apple and Google do. Imagine them competing with each other not on how many modules they can provide, but on how few keystrokes or mouse clicks their system used to do the same work as another system. Imagine no government mandates for meaningful use, no dummy buttons that say “click me” but otherwise do nothing.

Think about how you would design a system. Certainly it is useful to have old records available online and we would want to keep that. The problem is how to get them there. Having physicians enter data is probably the least efficient way. Dictation and handwriting are still the fastest data entry methods. If Dragon is good enough (I’m not convinced it is) use it, or keep your transcriptionists around. They are very nice people who need jobs anyway. If handwriting recognition is good enough (I don’t think it is yet) use that, otherwise just store the written notes as pictures and be satisfied. In the ideal world, rather than force physicians to become typists and data entry specialists, we would wait until computer artificial intelligence was developed enough to allow the physicians to continue to do things the old way, with the computer processing the doctors’ notes transparently. If the technology isn’t there yet, develop it, but don’t push it on us prematurely.

Medical records primarily should exist to document important information about patients. It should not be primarily a means to ensure maximum billing of patients. If we eliminate that aspect, EHRs become much simpler. I would envision a small tablet that the MD carries everywhere with him or her. Keep the old workflow. Pull up patient records on the tablet. Write notes on the tablet in handwriting or dictate into it. The tablet transcribes the input and files it appropriately.

Need to give patient orders? Select from some templates or write them in. If the software is not good enough to transcribe written orders on a tablet, hire some unit secretaries to do this like they used to. Let them learn the intricacies of computerized order entry, and let the doctor deal with the intricacies of making diagnoses, doing procedures, and looking patients in the eye and grasping their hands when they are ailing — things that doctors do best. Minimize the interactions with the computer and maximize the interactions with the patients.

A good EHR system can simplify drug reconciliation, pull in drug data from patient pharmacies, and automatically identify patients who are being “overprescribed” pain meds. The system can look up recent relevant medical articles, can show appropriate medical guidelines, and can provide sophisticated medical calculators. There are so many good things computers can do for medicine. They’ve gotten an awfully bad rap from the current iteration of EHR systems. I think the technology exists or can exist to do all these good things, but there is no incentive if we remain satisfied with the status quo. The current systems don’t do any of these things. They just get in the way.

If we lived in an ideal world it would be time to chuck the lot and start over.


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General Surgery News - Promise of EMR Systems Yet To Be Fulfilled for Many

General Surgery News - Promise of EMR Systems Yet To Be Fulfilled for Many | EHR and Health IT Consulting | Scoop.it

For more than a decade, electronic medical records (EMRs) have been called a critical step forward in modern medicine. The idea was that transitioning from paper to electronic records would increase efficiency, safety and savings in health care. The potential for EMRs to make patient records more accessible, reduce medical errors, allow medical institutions to communicate more seamlessly and save the health care industry billions of dollars each year was too tempting to pass up.

Despite this, the reality of EMRs seems not to have lived up to the hype. EMR systems have been costly to implement and are often laborious and confusing to learn. There is no universal system that all physicians can use; instead, medical professionals are faced with more than 100 systems, all competing for users and many of which cannot communicate with one another. But perhaps most notably, these systems do not appear to improve patient care, as promised, and in some cases may make care worse.

Nevertheless, the use of EMRs has ballooned in the past 10 years. In 2005, fewer than 25% of physicians’ offices and hospitals had adopted an EMR system, but today more than 80% use one. Despite the rapid spread, the central concerns about EMR systems remain the same: high cost, lack of standardization and interoperability, privacy issues and inferior patient care (Health Aff 2005;24:1103-1117).

But even before this spike in usage, many medical professionals were already well aware of the issues. In a 2004 report, researchers who had conducted 90 interviews with EMR managers and physicians found that “most physicians using EMRs spent more time per patient for a period of months or even years after EMR implementation. The increase resulted in longer workdays or fewer patients seen, or both, during that initial period …. Most respondents or their colleagues considered even highly regarded, industry-leading EMRs to be challenging to use because of the multiplicity of screens, options and navigational aids” (Health Aff 2004;23:116-126).

In a 2013 survey conducted by RAND Health, and sponsored by the American Medical Association, physicians echoed many of the same sentiments. In fact, physicians rated EMRs as a main reason for their job dissatisfaction. Summing up the results of the report, the RAND researchers wrote: “Despite recognizing the value of EHRs [electronic health records] in concept, many physicians are struggling to use their EHRs, which they describe as negatively impacting patient care in several important ways and undermining their professional satisfaction.”

In the study, the authors interviewed 24 practices about EHRs, 22 of whom were currently using a system. On the plus side, about one-third of the physicians reported that the EHR improved their job satisfaction and 61% said it improved quality of care. These physicians noted that their EHR system enhanced their abilities to access patient data at work and at home, provided guideline-based care and tracked patients’ disease.

In contrast, many physicians also expressed concerns over their EHRs, with about 20% saying they would prefer to return to paper charts. The central issues boiled down to inferior patient interactions, an inability to exchange information between different systems and a labor-intensive and time-consuming learning curve and data entry.

“Just because something is more expensive doesn’t mean it’s better,” said Peter Kim, MD, associate professor of surgery, Albert Einstein College of Medicine of Yeshiva University, New York City, who was not involved in the study. “For instance, the EMR giant Epic received $302 million from New York City, in 2013, for use in about 11 New York City public hospitals. But even within the same system, not all Epic EMRs are alike. An EMR’s functionality depends on who is programming it as well as the local needs of the institution. The same system may end up working well in one hospital, but poorly in another.”

Although people often assume that technology will reduce errors, that also is not the case. “In our hospital, administrators try to make our EMR sound perfect, but in reality, we have encountered huge errors and have had no audits of the system,” said Guy Voeller, MD, FACS, professor of surgery at the University of Tennessee Health Science Center, Memphis.

Along these lines, Dr. Kim recalled an incident when a toxic drug dose was written for the wrong patient, which missed all of the EMR system’s checks and balances. “Although that error could have happened with the old system, it wasn’t prevented by the EMR as it should have been,” Dr. Kim said. “We still need that human element in care, where a person is checking and verifying orders.”

Regarding patient interactions, physicians in the RAND study who complained that EHRs interfered with in-person patient care found that they were forced either to divide their attention between the patient and the computer or to give patients their attention but then spend hours inputting data afterward.

“With EHRs, physicians and nurses are looking at a computer screen and have their backs to the patient,” said Dr. Voeller. “Physicians and nurses are forced to devote time to their computer, not their patient.”

Another report revealed similar results. A team at Medscape surveyed 18,575 physicians in 25 different specialties from April 9, 2014, to June 3, 2014, about their EMR use. Of those, 4%, or 743 participants, were general surgeons.

The report found that about one-third of respondents felt their EHR systems worsened clinical operations and patient services, although about the same percentage reported the opposite. In terms of patient interactions, 70% of respondents said their system decreased their face-to-face time with patients and 57% said it lessened their ability to see patients, while about one-third felt their system enhanced their ability to respond to patients and effectively manage treatment plans.

Patient privacy was another major worry for physicians, approximately half of whom expressed concern about losing patient information because of a technological malfunction or about their lack of control over who can access patient data. About 40% of participants were also concerned about HIPAA compliance and hackers getting to data.

Similarly, of physicians who opted not to purchase an EHR system, the top reason was that the technology would interfere with the doctor–patient relationship (40% of responses). The other most frequent complaints were that EHR systems are too expensive (37%), and that the incentives and penalties from the Centers for Medicare & Medicaid Services are not worth the hassle of adopting a system (32%). Other reasons were that EHRs hurt patient privacy (22%) and were too complicated to learn (16%).

The financial burden of EMRs appeared to be increasing as well. According to the Medscape survey, in 2014, 23% of respondents said their EHR system cost $50,000 or more per physician to purchase and install, whereas in 2012, only 7% of respondents said their EHR system cost that much. Another report that evaluated the cost of EHRs, using survey data from 49 community practices in a large EHR pilot project, found that “the average physician would lose $43,743 over five years; just 27% of practices would have achieved a positive return on investment; and only an additional 14% of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive” (Health Aff 2013;32:562-570).

Currently, Dr. Kim said, the federal government is forcing institutions to have an EMR system, which is driving many physicians out of business and into a hospital on a salary or into retirement.

“Besides the cost of implementation, evidence already is accumulating that doctors order more—not fewer—imaging studies when [an] EMR is used,” wrote David Cossman, MD, a vascular surgeon in Los Angeles, in a 2012 piece in General Surgery News (May 2012, page 1).

As for billing, Dr. Voeller noted, “the way we bill through EMRs lends itself to fraud because physicians can document more complex visits that come with a higher price tag and reimbursement.”

Amid the confusion and ambivalence, some surgeons are holding out hope that as companies iron out the kinks in the current systems, EMRs may eventually live up to the early hype. Others remain skeptical that there is a magic bullet that will vastly simplify and improve EMRs.

Reflecting on the current state of the technology, Dr. Cossman wrote: “The big problem is that HAL [the sinister computer in Stanley Kubrick’s film “2001: A Space Odyssey”] is once again stalking us with the sweet siren song of untold efficiencies, cost containment and protection from human fallibility if we only move over to the passenger seat and let it drive. Don’t believe a word of it. Medicine cannot be practiced on autopilot. We will crash and burn without the human touch at the controls.”



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The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data. One way to bridge this gap is through standardized role-based education.

Conclusion
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort. Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT. As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.
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Fiona Ehret-Kayser's curator insight, December 23, 2014 3:28 PM

This is a really interesting take on the use of data in a patient's records. I wonder if ...?

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Drchrono uses Apple Touch ID to let doctors into electronic health record

Drchrono uses Apple Touch ID to let doctors into electronic health record | EHR and Health IT Consulting | Scoop.it

Apple opened up the Touch ID fingerprint reader to third-party developers when it released iOS 8, and some in the health care world are beginning to take advantage of it.

Drchrono, which makes an electronic health record optimized for use on iPads, has now used that capability to authenticate doctors into the patient record — and to keep unauthorized users out.

This may be part of a wider push by Apple to get iPhone 6s and iPads into the tech arsenals of enterprises like large medical groups and hospitals. The new iPad Air 2 and the iPad Mini 3 now come with Touch ID, as do the iPhone 5s, iPhone 6, and iPhone 6 Plus.

Where the medical record is concerned, the Touch ID button could be hugely effective in providing secure yet easy access. For care providers using drchrono, three taps will get them into the medical record. They rest their finger on Touch ID to get into the iPad, tap the drchrono EHR app, and then, when the app is open, they hit Touch ID once more to get into the EHR. They no longer have to enter a passcode.

“The amazing thing about Touch ID is that people sometimes forget password and PIN codes,” Drchrono COO and cofounder Daniel Kivatinos wrote on the company’s blog. “This changes the game even more … touch technology in health care.”


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