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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Docs urge big changes to health records program

Docs urge big changes to health records program | EHR and Health IT Consulting | Scoop.it

A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.

Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.


"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.

"Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers’ needs, patient safety, and product innovation," the letter stated.

The coalition called on regulators to decouple the certification of electronic health records from Meaningful Use, which imposes a timetable for EHR adoption and a series of penalties and incentives based on doctors' compliance.

The groups also asked the Office of the National Coordinator to reconsider alternative software testing methods and to incorporate stakeholder feedback on a variety of technical matters related to Meaningful Use.

The healthcare world has been struggling with the migration to digital records, arguing that the Meaningful Use standards are hampering their ability to deliver good care.

Advocates for Meaningful Use argue it is helping speed the transition to EHRs, which will ultimately boost care and prevent deadly medical errors.

The program has undergone several delays as doctors and hospitals fail to attest to its various stages.


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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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IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?



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Physician Office EHR Adoption Increases, Meaningful Use Lags

Physician Office EHR Adoption Increases, Meaningful Use Lags | EHR and Health IT Consulting | Scoop.it
Physician offices continue to adopt EHR technology so why is meaningful use participation being ignored by these eligible providers?

Physician office EHR adoption continued its upward swing between 2013 and 2014, but less than half of physicians in a recent survey report plans to attest for Stage 2 Meaningful Use.

The last bit of news comes from a survey of nearly 2000 members of SERMO, the online social network for physicians. Frank Irving of Medical Practice Insider reports that 55 percent of respondents will not demonstrate Stage 2 Meaningful Use in 2015, 994 of 1816 to participants.

Eligible professionals have until the end of next month — February 28 — to attest for meaningful use in 2014. According to the Centers for Medicare & Medicaid Services (CMS), more than 257,000 EPs are receiving 2015 Medicare payment adjustments for failing to demonstrate meaningful use as part of the Medicare EHR Incentive Program prior to 2014. That number is less close to 60,000 EPs who successfully filed for a meaningful use hardship exception during one of the two application periods in 2014. Those failing to demonstrate meaningful use in 2014 will be subject to Medicare payment adjustments in 2016.

It is unclear whether respondents to the SERMO survey are referencing their 2014 meaningful use reporting as the attestation period runs through the end of February 2015 or if they have chosen one of several options in a meaningful use flexibility rule or received a meaningful use hardship exception. That 55 percent could therefore prove misleading.

Continued growth of physician office EHR use

Whatever the reasons behind these responses from SERMO members, physician office EHR adoption is on the rise. An ongoing study by SK&A indicates a ten-percent increase in physician office adoption of EHR technology between 2013 and 2014. What’s more, it provides a breakdown of the top-five EHR vendors nationally and regionally.

At the national level, Epic Systems controls 30 percent of the market followed by eClinicialWorks (22%), Allscripts (19%), Practice Fusion (16%), and NextGen Healthcare (13%).

A closer look by region shows a close competition between Epic Systems and eClinicalWorks for EHR selection by physician offices.

The former dominates the West, Midwest, and East regions of the United States. The latter holds sway in the South and New England regions. Here’s a region-by-region breakdown:

West
Epic (25%)
eCW (23%)
Practice Fusion (20%)
NextGen (17%)
Allscripts (15%)

Midwest
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

South
eCW (30%)
Allscripts (23%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

East
Epic (33%)
Allscripts (24%)
eCW (18%)
Practice Fusion (14%)
NextGen (11%)

New England
eCW (31%)
Allscripts (24%)
Practice Fusion (17%)
Epic (16%)
NextGen (14%)

Interestingly, where neither is first both companies drop to the third or fourth spots. Considering that both companies specialize in working with health systems and hospitals, their domination of various markets may indicate the ownership of physician practices and use of that health system’s or hospital’s EHR technology.

Despite the increased implementation and use of EHR technology by physician offices, their physicians have a ways to go in order to keep pace with the evolution of the EHR Incentive Programs.


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

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

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

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

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

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

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

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

Stage 3 is expected to begin in 2017.


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OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com

OMB Reviewing Proposed Stage 3 Meaningful Use Requirements | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services is one step closer to issuing a notice of proposed rulemaking (NRPM) for the next stage of meaningful use requirements for the Medicare EHR Incentive Program.

The Office of Management and Budget (OMB) is currently reviewing the proposed rule for Stage 3 Meaningful Use that is expected to be published in February.

Few details about the requirements for Stage 3 appear in the rule submitted to the OMB by the Department of Health & Human Services as part of the Unified Agenda — that is, with the exception of the following:

In this proposed rule, CMS will implement Stage 3, another stage of the Medicare and Medicaid EHR Incentive Program as required by ARRA. We are proposing the Stage 3 criteria that EP’s, eligible hospitals, and CAHs must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients.  Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.

The rule before the OMG also indicates that CMS will coordinate with the Office of the National Coordinator for Health Information Technology to ensure that EHR certification criteria and certified EHR technology will be in place when Stage 3 goes into effect no earlier than 2017.

During a Health IT Policy Committee meeting in March, the group voted to approve 19 objectives recommended by the Meaningful Use Workgroup. Those recommendations fall into four categories of care improvements:

Improving Quality of Care and Safety
1. Clinical decision support
2. Order tracking
3. Demographics/patient information
4. Care planning — advance directive
5. Electronic notes
6. Hospital labs
7. Unique device identifiers

Engaging Patients and Families in their Care
8. View, download, transmit
9. Patient generated health data
10. Secure messaging
11. Visit Summary/clinical summary
12. Patient education

Improving Care Coordination
13. Summary of care at transitions
14. Notifications
15. Medication reconciliation

Improving Population and Public Health
16. Immunization history
17. Registries
18. Electronic lab reporting
19. Syndromic surveillance

Before any of the proposed rule’s requirements for Stage 3 Meaningful Use are enacted, the NPRM must made available for public comment which has the potential to influence the requirements of the final rule. Given the resistance CMS has faced as a result of Stage 2 Meaningful Use, the federal agency is likely to receive requests for greater flexibility and timing from healthcare organizations and industry groups.


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US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com

US Immigration Dept. Sees Advantages of New EHR Infrastructure | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
A centralized EHR infrastructure is promoting care quality improvements in the US Immigration and Customs Enforcement department.

The US Immigration and Customs Enforcement (ICE) system is celebrating the completion its EHR infrastructure implementation, which transformed the agency’s paper-based healthcare system into a centralized, web-based system that allows health information exchange to improve care coordination while cutting costs.  For its quick and successful implementation, the team charged with developing the EHR infrastructure has received a 2014 Director’s Award for meritorious service for outstanding performance and inspiring accomplishments advancing the mission of ICE.

As with other governmental healthcare systems, the ICE Health Service Corps (IHSC) must track and coordinate care for persons that may travel between facilities or have a history of care at private providers.  IHSC, which operates under the Department of Homeland Security, provides care to around 15,000 ICE detainees at more than 20 facilities, the department’s website says.  Patients in the system also receive care from external providers when necessary, which requires the 900-strong IHSC staff to exchange health data electronically in order to ensure continuity.

“The very nature of detainee health care requires sending medical information across different locations,” said Capt. Deanna Gephart, deputy assistant director of Operations for IHSC in a press release.  “Now that we have the capability to share data electronically, the detainee health care system is much more efficient, which translates into increased quality health care provided to detainees.”

“I couldn’t be more proud of the effort of the team who dedicated their time and effort to modernizing this system,” added Jon Krohmer, assistant director of IHSC. “In less than 15 months, they successfully acquired, installed, configured, trained and deployed the system to all 22 IHSC-staffed facilities.  In the process, ICE has realized a $2 million annual cost avoidance.”

The EHR will allow ICE to better complete public records requests, including the release of data under the Freedom of Information Act, Congressional inquiries, and routine audits.  ICE also believes the new system will contribute to a reduction in the risk of medical errors, improved standardization of care, and the ability to better measure and achieve high performance on quality metrics.

Gephart previously noted that the department’s health information management system lacked sufficient interoperability “ICE has a frequent need to send medical information across different locations, which is cumbersome when each site has its own system,” she said in September.  In 2012, ICE completed 220,000 intake screenings and 104,000 physical exams while conducting more than 13,000 emergency room or off-site referrals, highlighting the need for robust care coordination throughout the busy system.

The successful EHR implementation comes amidst massive modernization efforts by the Department of Veterans Affairs and Department of Defense (DOD), both of which operate on an even larger scale.  Interoperability and care coordination cross multiple facilities are equally critical to these projects, and are some of the major criteria for the vendor selection process as the DOD seeks to leave its legacy systems behind in favor of a newly centralized infrastructure.


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EHR Requires You to Reconsider Your Workflow

EHR Requires You to Reconsider Your Workflow | EHR and Health IT Consulting | Scoop.it

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.


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What are the Benefits of EHR

What are the Benefits of EHR | EHR and Health IT Consulting | Scoop.it

Electronic Health Records (EHR) is one such constituent of information technology in the healthcare sector that has been researched extensively in the recent times post the Health Information Technology for Economic and Clinical Health (HITECH) Act.

With an ability to streamline medical records and initiate integrated healthcare, EHRs can transform the way in which care is given. With an increased access to patient’s medical history, EHR is the future of healthcare. Once implemented the benefits of EHR outweigh the cost incurred in its application.

When completely functional to the extent that the information present can be exchanged with doctors, there are innumerable benefits of EHR which include.
  • EHR Can store comprehensive health information from lab results to radiology tests, medicines, and even allergies.
  • EHR not only stores information but also computes it with the inclusion of Electronic clinical decision support alerts, which aid in monitoring drug interaction checks and thereby reduces medication errors and improves the overall quality of healthcare.
  • EHR with their enhanced ability to store and analyse data prompt healthcare providers with preventive measures for the patient at the point of care thus enhancing clinical decision making.
  • Through EHR The health history can be shared with other health care providers in nursing homes, hospitals, across state and even across country at any given time.
  • Electronic Health Records (EHR) can be accessed on any gadgets such as laptops, tablets, phones.
  • It improves the efficiency of the care givers who can quickly refer to the health history of the patients via EHR and track the treatment progress with greater ease.
  • It enables quick access to the medical records of the patient.
  • It aids in lowering the health cost by preventing redundant medical tests.
  • EHR reduces paperwork and saves time and space required to store or search for any medical history.
  • It improves clinical decision making by integrating patient information from various sources and making it available to the physicians thus encouraging integrated healthcare.
  • It ensures safety of the patient and promotes productivity of the health care staff by reducing medical errors that arise due to missing information, a common occurrence with manual charts.
  • EHR encourages proper documentation with legal and accurate billing.
  • It promotes e prescribing thereby reducing any reading errors by the pharmacist and in turn ensures patients safety.

Therefore in a nutshell Electronic Health records (EHR) with its many benefits are definitely the future of healthcare. It is convenient, reliable and also saves cost in the long run. An exhaustive use of this system will certainly improve the quality of health care eventually.


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Lesa Moore's curator insight, January 3, 2015 11:36 AM

I bought a online service for my family and parents to use/share between us so we can help each other at any time if there is an emergency.

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Study: EHR Modification Can Help Meet Quality and Safety Goals - iHealthBeat

Study: EHR Modification Can Help Meet Quality and Safety Goals - iHealthBeat | EHR and Health IT Consulting | Scoop.it

The ability to easily modify electronic health record systems can help providers meet safety and quality goals, according to a study published in Electronic Data Methods, Politico's "Morning eHealth" reports (Gold, "Morning eHealth," Politico, 12/23).

Study Details

For the study, researchers at Baylor Scott & White Health investigated an integrated care health system's use of EHRs to implement procedures to prevent and mitigate intensive care unit patients from developing delirium. Providers commonly use an evidence-based practice called daily awakening and breathing trials, formal delirium screening, and early mobility -- or ABCDE bundle -- to prevent delirium in ICU patients (Collinsworth et al., EDM, 12/18).

Specifically, researchers aimed to identify best practices by designing a tab in the EHR system's patient viewer, allowing providers to track the progress of tasks within the ABCDE bundle and view the processes' effects.

Study Findings

Overall, researchers found that EHR customization was complex and time-consuming. Specifically, they said certain steps were necessary to customize EHR systems, including:

  • Allocating sufficient time for such a project, which took longer than researchers expected;
  • Gaining buy-in from senior leadership to secure resources to modify EHR systems;
  • Involving the different team players in EHR design;
  • Training clinical staff on proper EHR use and its importance; and
  • Understanding varying workflows in a multidisciplinary care team (Hall, FierceEMR, 12/22).

The researchers noted that while the study mainly focused on mitigating and preventing delirium, their research processes and takeaways "are generalizable to other health care settings and conditions." Moreover, they said that "the creation of learning health systems is contingent on an ability to modify EHRs to meet emerging care delivery and quality improvement needs" (EDM, 12/18).


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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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Does your EHR meet your organization's unique needs? | Healthcare IT News

Does your EHR meet your organization's unique needs? | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

Different healthcare specialties have different electronic health record (EHR) requirements as there is significant variation in care processes, clinical content and decision support across care settings. For example, a primary care facility’s EHR “must-haves” are dramatically different from those of outpatient surgery center. While the primary care provider sees many patients for a variety of reasons, the surgery center delivers more focused, predictable and short-term care with unique workflow requirements. In the same vein, an ophthalmology practice requires technology to capture data from a number of instruments—often more than many other specialties. Likewise, a dermatology provider often completes numerous procedures in one visit, and an inpatient behavioral health setting with group counseling demands yet another approach to capturing and collecting patient care information.

Despite their diverse EHR needs, there is a commonality among these and other medical specialties: each requires a robust EHR that enables providers to easily gather data, completely and accurately document care, smoothly share information and facilitate good communication to achieve the best patient outcomes. To select the right EHR, specialty practices must fully appreciate how the technology addresses their particular needs and requirements.

Five considerations for selecting a specialty-focused EHR

Verifying that an EHR has the features clinicians need to provide care and manage patients is critical to its success. The following five considerations can guide a practice when evaluating an EHR to ensure the technology meets the organization’s clinical and business specifications, strengthening care delivery while safeguarding the practice’s future.

1.    The right content. The first step—and probably the most important—is to look at the depth and breadth of content the solution provides and make sure it fully aligns with the specialty’s requirements. This becomes more complex for a subspecialty. For example, an EHR with strong cardiology features may not meet the distinct needs of a pediatric cardiologist. In these cases, it is also important to select an EHR that can be supplemented with additional subspecialty information to better meet their needs.

2.    Configuration flexibility. When specialty practices can easily configure their EHR to reflect workflow nuances, they can optimize data capture, streamline care and improve outcomes. The EHR should allow physicians to easily configure their own templates, yet provide consistency to maintain a high standard of care. For instance, an OBGYN facility needs EHR flexibility for visits ranging from prenatal care and reproductive endocrinology to annual wellness exams. Physicians should be able to customize these forms to match workflow, yet maintain alignment with ACOG (American Congress of Obstetricians and Gynecologists) standards.

3.    Smooth integration with current technology. Specialty practices often have more diagnostic equipment feeding data into the EHR than primary care practices. For example, an ophthalmology group may have as many as 12 different devices capturing and sending data to the EHR. Because of this, a practice should closely review how well a potential solution interfaces with the practice’s current technology, particularly focusing on how the EHR incorporates the disparate data into workflow. Specialties linked to a hospital or health system should also assess how seamlessly the proposed EHR share key information with the larger organization. Ideally this is bi-directional!

4.    Facilitates the patient experience. Patients can be nervous when they see a specialist, and this can be exacerbated if the physician is more focused on navigating technology rather than talking with the patient. By choosing software that enables patients, medical assistants, nurses and others to capture as much data as possible in the EHR before the doctor enters the room, a practice can allow the physician to focus on the patient’s particular care needs instead of looking at a computer screen to input routine data. Remember, a good EHR gives physicians the right information at the right time to come to the right conclusion while they are in front of the patient. In other words, it keeps the patient at the center of the experience.

5.    Strong, Forward-thinking vendor. Not all vendors are equal, and spending time comparing the various options is a valuable exercise. As part of the vetting process, practices should gauge a vendor’s commitment to their specific clinical specialty and learn about plans for future technology development. In addition, consider the vendor’s organizational and financial strength to sustain the cost of supporting the specialty into the future and keeping up with regulatory compliance.

Although specialty practices have historically avoided jumping feet first into EHR technology, this is no longer an option for organizations that want to sustain and build referral volumes. In fact, by selecting and implementing a tool that consistently captures and shares specialty-focused data, providers can position themselves as the expert of choice for both peers and patients.


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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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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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What Gets Measured Gets Managed - HITECH AnswersHITECH Answers

What Gets Measured Gets Managed - HITECH AnswersHITECH Answers | EHR and Health IT Consulting | Scoop.it

Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I’ll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can’t deny that data doesn’t lie and when we measure data, we can manage it.

Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group’s practice manager was new to the organization and tasked with the responsibility of managing the eligible providers’ progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.

The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn’t sure if they could meet the patient engagement requirements and she didn’t know where they stood with the newly introduced objectives.

She asked for support through her network and found me.

Data > Information > Knowledge

I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)

 

I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).

They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.

We had 90 days to turn this around.

Team Work

Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.

Meaningful Use is a team sport, after all.

The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.

We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.

With each week’s reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.

Getting Creative with the Portal

In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.

Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and  gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.

They even told patients what to say:

Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]

This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.

The First Big Win

Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.

Their main focus on closing out the year was to keep up the good work.

Non-Percentage Based Objectives

Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.

Lessons Learned

1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.

2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.


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Bright Futures VisitPlanner iPhone and iPad medical app review

Bright Futures VisitPlanner iPhone and iPad medical app review | EHR and Health IT Consulting | Scoop.it

“Bright Futures” is a national children’s health promotion initiative that has been adopted by the American Academy of Pediatrics for well-child care and is used in most pediatric practices.

These guidelines include recommendations in 26 categories covering 32 recommended well-child visits from newborns to 21 year-olds, and keeping track of recommendations at each visit is a challenge. Making these recommendations more accessible is the challenge the Bright Futures VisitPlanner app from the AAP attempts to address.

The home screen opens to the “Doctor’s Dashboard,” which may be a bit off-putting to non-physician primary care providers.


Users can choose “visits” or “patients.” Choosing visits brings up the “Visit Plan Builder,” where users can select one of the 32 recommended visits or create their own custom visit. The planner can be connected to a specific child or used generically. Users can input recommended immunizations scheduled (if connected to a specific patient) or view generic schedules under the “immunizations” tab. Under the “Anticipatory Guidance” tab, users can input some or all specific recommended anticipatory guidance questions for the patient’s age.


Users can also input, under the “notes” tab, information on guidance given, immunizations, and patient info. Selecting “patients” enables users to add new patients with demographic data, photos, records of illnesses, and birth information. The records of illnesses do not come pre-programmed with any list of conditions or ICD-9 codes, so requires all free text. Also, the birth information is limited to time and anthropometric data, without fields for newborn screens (e.g., the congenital heart screen, hearing screen, metabolic screens) or even free text information. Once the build is complete, users can view the “visit plan” which includes recommended screening and physical exam maneuvers under the “perform” tab, immunizations, the selected anticipatory guidance questions, and any inputted notes. Once the visit is selected, users have to return to the visit screen to edit the visit, while users in the “in visit” mode can check off immunizations or anticipatory guidance questions as completed. The header is helpfully different — blue in the “visit plan builder” mode and green in the “in visit” mode.


The visit summaries can be emailed or AirPrinted once completed, with the app warning about the data security of email — although there is no mention of data security elsewhere on the app.


The app also includes PDFs of the “Bright Future” Previsit questionnaires and parent handouts for each recommended well-child visit, although they are only in English and not available in Spanish. Starting in adolescence with the 11 year-old visit, the app includes separate parent and patient handouts. There is a section for “Tools and Resources”, which has useful information, although mostly via embedded web links to the AAP’s Bright Futures website.


There are also BSA and BMI calculators, a PDF of the summary “Bright Futures” schedule, and a useful PDF on “Coding for Pediatric Preventive Care”. None of the PDFs can be opened in any other PDF app. Lastly, the app includes a section on “Doctor’s Contacts” where users can input other providers and their contact information and link those providers to specific patients.


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

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

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

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

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

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

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


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Developing a Specialty-Specific Action Plan for ICD-10

Developing a Specialty-Specific Action Plan for ICD-10 | EHR and Health IT Consulting | Scoop.it

As the calendar turns over to the beginning of a new year, the healthcare industry begins yet another countdown towards an autumn implementation date for ICD-10.  With just under ten months left until the most recent deadline of October 1, 2015 – and that date likely to stick thanks to Congressional support and a growing chorus of healthcare stakeholders endorsing the switch – healthcare providers may not have the luxury of banking on an additional delay.  Organizations can make the most of their remaining time by using CMS resources to develop a specialty-specific action plan that will carry them through their ICD-10 prep for the rest of the year.

The Centers for Medicare and Medicaid Services has provided a number of transition resources to providers who may not be sure what is required for the ICD-10 switch or how to achieve transition benchmarks.  Among these Road to 10 tools is an interactive timeline feature which allows providers to select their practice type, size, progress, and business partners to formulate a personalized plan.

The action plan tool provides common specialties with tailored information, including the clinical documentation changes necessary for the most common ICD-10 codes and sample clinical scenarios for practice.  For cardiologists, for example, the literature reminds practitioners that a myocardial infarction is only considered acute for a period of four weeks after the incident in ICD-10 compared to 8 weeks in ICD-9.  Orthopedists are prompted to remember the specificity requires to accurately code a bone fracture, including the type of fracture, localization, healing status, displacement, and complications, while obstetricians will need to distinguish between pre-existing conditions and pregnancy-related issues when documenting complications.

For the 27% of providers who have not planned to start their ICD-10 testing as of November, and especially the 30% who admitted that a lack of understanding had them stalled, the Road to 10 timeline provides detailed steps to achieve internal and external testing of systems.  From identifying sample cases for testing to coordinating with external business partners and fixing any problems that arise from the process, the resource allows providers to review checklists and suggestions that will set them on their way towards a successful testing period.

CMS suggests that healthcare providers have their internal testing already completed by this point in the process, and is currently seeking volunteers for their end-to-end testing week scheduled for the end of April.  According to the timeline, the external testing process is likely to extend through July as organizations coordinate with their payers and clearinghouses, but the number of providers that are significantly behind these recommended timeframes means that many in the healthcare industry are likely to experience a sharp crunch up against the October deadline.

Providers that are struggling with the sheer volume of tasks associated with the ICD-10 switch may benefit from using the Road to 10 toolset and exploring CMS resources on the transition to identify common pitfalls that may strike their specialty or size of practice.


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

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

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

The traditional EHR has its challenges

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

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

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

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

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

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

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

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

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

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

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

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

What are your main concerns? Do you have any questions to ask as you seek to move forward and upgrade your practice to electronic health records?
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101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85 | EHR and Health IT Consulting | Scoop.it

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

85. Test, retest, and test the network and wireless
Far too many EHR implementations fail because of basic technology issues. Of course, the blame usually gets placed squarely on the head of the EHR company. However, in many of the cases, the EHR company has no control over the issues you have. Your local wireless and network is one place where you can doom an EHR installation and the EHR company can do nothing about it. If you want to have a great EHR installation make sure you have a great network and/or wireless infrastructure set up and tested.

84. Have ONE number to call
This recommendation applies more to large EMR installations than it does to small ones. The basic suggestion is not to give one phone number for EMR issues (ie. I can’t login) and another for technology related issues (ie. my PC crashed). The problem with multiple lines is that people don’t generally know the difference between an EMR issue and a PC issue. At the end of the day, they’re likely to consider almost everything an EMR issue. So, they’re going to call the same number anyway. You might as well just have one number that knows how to triage the issue well and direct them to the right support resource.

83. Remember who the support team’s customers are
Another recommendation for hospital EHR support. It is a great idea to remember that the support team’s customers are the clinicians that are calling for help. Prepare them for the calls they’re going to get. While clinicians are highly educated, that doesn’t guarantee that their education included even basic computer skills. You’ll be surprised how many of the issues have to do with basic computer skills as much as any EMR specific support.

82. Have a communication strategy for when things go wrong
Things are bound to go wrong. So, be ready to communicate those issues. Don’t sweep the issues under the rug either. Communicate more than is necessary. It won’t hurt as much to over communicate as it will to not communicate something important.

81. Make all of your planning very public within your organization
The fastest way to get buy in for an EHR project is to involve your organization in the planning process. Yes, that means that you’re going to hear some harsh feedback from people about what you’ve planned. Be grateful that you’re hearing the feedback during the planning stage when you can work to do something about it. That’s much better than being half way through the project and hearing the harsh criticism of your project.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

85. Test, retest, and test the network and wireless
Far too many EHR implementations fail because of basic technology issues. Of course, the blame usually gets placed squarely on the head of the EHR company. However, in many of the cases, the EHR company has no control over the issues you have. Your local wireless and network is one place where you can doom an EHR installation and the EHR company can do nothing about it. If you want to have a great EHR installation make sure you have a great network and/or wireless infrastructure set up and tested.

84. Have ONE number to call
This recommendation applies more to large EMR installations than it does to small ones. The basic suggestion is not to give one phone number for EMR issues (ie. I can’t login) and another for technology related issues (ie. my PC crashed). The problem with multiple lines is that people don’t generally know the difference between an EMR issue and a PC issue. At the end of the day, they’re likely to consider almost everything an EMR issue. So, they’re going to call the same number anyway. You might as well just have one number that knows how to triage the issue well and direct them to the right support resource.

83. Remember who the support team’s customers are
Another recommendation for hospital EHR support. It is a great idea to remember that the support team’s customers are the clinicians that are calling for help. Prepare them for the calls they’re going to get. While clinicians are highly educated, that doesn’t guarantee that their education included even basic computer skills. You’ll be surprised how many of the issues have to do with basic computer skills as much as any EMR specific support.

82. Have a communication strategy for when things go wrong
Things are bound to go wrong. So, be ready to communicate those issues. Don’t sweep the issues under the rug either. Communicate more than is necessary. It won’t hurt as much to over communicate as it will to not communicate something important.

81. Make all of your planning very public within your organization
The fastest way to get buy in for an EHR project is to involve your organization in the planning process. Yes, that means that you’re going to hear some harsh feedback from people about what you’ve planned. Be grateful that you’re hearing the feedback during the planning stage when you can work to do something about it. That’s much better than being half way through the project and hearing the harsh criticism of your project.


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CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com

CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

While this week marks the end of one and beginning of another year, those in the healthcare industry should take note of all that transpired in the previous year to avoid similar setbacks in 2015. This is especially true for matters scheduled to have been addressed over the last 12 months.

ICD-10 delays, meaningful use changes, health IT vendor competition, and EHR implementation gaffes. Based on the interest of our readers, those were the most popular topics of 2014 on EHRIntelligence.com.

ICD-10 transition delay one more year

More than any other topic on our news site, ICD-10 garners the greatest amount of our readership’s attention and given its high stakes, it makes sense. This past October was supposed to usher in a new era of clinical coding — the move from ICD-9 to ICD-10 — and put the United States on par with other leading nations in terms of healthcare documentation.

The Congressional debate over the sustainable growth rate (SGR), however, swiftly dashed those visions. Close to one week after expectations began to build that Congress would vote on an SGR patch that included a one-year ICD-10 compliance delay, the Senate voted in favor of the bill. While the rest of the nation took this as business as usual on the Hill, the healthcare industry scrambled to put new plans together for postponing their 2014 ICD-10 implementation activities.

What the delay meant to providers depended on where they practices. Larger healthcare organizations reported high levels of ICD-10 readiness while some smaller physician groups and practices were completely unsure where they stood. No matter their view of the most recent ICD-10 delay, most are committed to removing ICD-10 implementation pain points to be ICD-10 ready by Oct. 1, 2015.

The bending but not breaking of meaningful use

This past year began with eligible professionals and hospitals working to achieve Stage 2 Meaningful Use, but that is hard to do when certified EHR technology is unavailable.

Early hints of changes to meaningful use reporting in 2014 emerged as early as February when the Centers for Medicare & Medicaid Services (CMS) introduce a new meaningful use hardship exception dealing with a lack of available CEHRT.

In September, the federal agency finalized a rule intended to give providers greater flexibility in meeting meaningful use requirements in 2014 — known as the flexibility rule. However, this did not turn out to be CMS’s final move.

The flexibility rule was followed by the reopening of the meaningful use hardship exception application submission period for both EPs and EHs and the extension of the 2014 meaningful use attestation period for EHs and critical access hospitals through the end of the year.

Despite their intentions, neither has put to rest repeated calls for 2015 meaningful use reporting requirement changes by industry stakeholders.

Heading to a showdown

Prognosticators in health information technology (IT) have foreseen consolidation in the marketplace over the next few years. But it is unlikely that they saw things playing out as they did in 2014.

Cerner’s acquisition of Siemens Health Siemens over the summer is an example of how quickly and dramatically the market can change. Most viewed the maneuver as a power play by the Kansas City-based health IT company to contend with Epic Systems and its market share among health systems and hospitals.

While the growth of both Cerner and Epic continues to loom large over the industry, they still have to contend with numerous other players in the ambulatory care space, especially given Epic’s recent loss to athenahealth as the top overall software vendor over the past year.

Expect more to come.

Squeaky wheel gets the grease

When EHR implementations go well, those involved in the process are more than willing to share details of their experiences. When they don’t, it is like pulling teeth.

Poorly managed EHR implementations can prove costly. The University of Arizona Health Network saw red of a different variety as a result of its Epic EHR adoption. Whidbey General Hospital felt the financial effects of a software glitch in its MEDITECH EHR that crippled its billing system and left it short on cash. Meanwhile, a Cerner EHR implementation gone awry led to the dismissal of Athens Regional Medical Center’s CEO.

If 2014 was a busy year, then 2015 is only likely to be busier. Stay with us as we continue our coverage of meaningful use, EHR and ICD-10 implementation, and anything else health IT-related that comes our way.



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11 indicators that you need a new EHR

11 indicators that you need a new EHR | EHR and Health IT Consulting | Scoop.it

Often so deeply immersed in looking for ways to make their practice more efficient, physicians sometimes fail to see the most obvious hurdle preventing this very process from occurring; their EHR. If your Electronic Health Record (EHR) solution is not up to the mark, you might be losing out on precious profits, and incurring costs that you can easily overcome.


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Is Your EMR Hooked Up To The World? | Hospital EMR and EHR

Is Your EMR Hooked Up To The World? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

A few months ago, I was having a conversation with a vendor executive about the challenges EMR companies face.  He said that in his mind, the big differentiator won’t be interfaces or even key features, but the extent to which the vendor has hooked up with key outside services.

According to this man — whose story, to be honest, I haven’t been able to verify — it can three months or more to link up with big laboratory providers like LabCorp or Quest.  Partnering with payors is another nightmare, even for vendors that run a practice management system already handling billing issues. And what about synching up with radiology information systems

Now, don’t get me wrong:  Service providers are getting wise to this problem. LabCorp, for example, now boasts about its EDI interface and touts its connections with 300+ EMR, practice management and laboratory information service vendors. It also offers eLabCorp, a Web-based solution for test ordering and test result retrieval.

Private software vendors are also in the mix. For example, I stumbled across one vendor offering bundles that connecting physicians, payors and radiology information systems.

But most of the interface development seems to be ad-hoc, with the costs borne by the healthcare provider rather than the EMR vendor.  And it’s a costly problem.

As things stand, after all, creating flexible, functional interfaces between EMRs and key service providers is still largely a job for specialized experts, and they don’t come cheap.  (As readers know, it’s not that your crack IT team can’t build the interfaces on its own, but where will staffers find the time?)

However, my guess is that as IT users get their bearings, they’ll demand a better range of connected partners from EMR vendors.  Rating how connected vendors are to labs, payors and other transaction partners is likely to rise close to the top of RFPs and internal checklists.

Ultimately, even high-end EMR systems will begin to look similar as the hospital industry standardizes on Meaningful Use-driven features and functions. (You’d think a multi-million dollar system would have a unique footprint, but let’s face it, anything can get commoditized.)

Soon, to get hospital business, they’ll have to offer options which directly improve operations or generate profits. And it’s not a moment too soon.

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MA Gives Details on EHR Proficiency Requirement for Licensure | EHRintelligence.com

MA Gives Details on EHR Proficiency Requirement for Licensure | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Massachusetts will allow physicians to demonstrate EHR proficiency in multiple ways to retain their medical licenses.

Physicians in Massachusetts will be able to choose from several options to demonstrate their EHR proficiency in order to renew their licenses in 2015, according to final regulations provided by the state’s Board of Registration.  The controversial provision that initially required providers to attest to meaningful use in order to retain their ability to practice medicine has been modified to allow for flexibility and certain exemptions.

The rule prompted outrage and disappointment among Massachusetts providers, and the Massachusetts Medical Society (MMS) has lobbied heavily against the restrictive requirements of the original language.  Opponents of the EHR proficiency provision decried the mandate as an unwanted intrusion into the practice of medicine.

“Collectively, these requirements increase administrative demands, add costs to the practice of medicine, and to the health care system as a whole,” said former Massachusetts Medical Society President Ronald Dunlap. “They will take time away from direct patient care and drive small to midsize practices to seek alignment with larger entities that have the capacity to fulfill the requirements, potentially causing further consolidations in the healthcare market.”

Starting on January 2, 2015, Massachusetts providers looking to renew their licenses will need to meet one of several methods of proving that they can adequately use an EHR system to provide quality care.  Participating as an eligible professional (EP) in the EHR Incentive Programs, or being employed by an eligible hospital (EH) that has attested to meaningful use, can both satisfy the provision.

But providers who are not eligible for meaningful use participation can still prove their competency by completing at least three hours of accredited CME courses on EHR use or becoming an authorized user of the Massachusetts Health Information Highway, which is the state’s designated health information exchange.

All physicians renewing their licenses before March 31, 2015 will be provided with a one-time waiver from the requirements, while physicians with renewal dates within 60 days of the end of March could submit their application early and qualify for the automatic exemption.  Additional exemptions are available for providers who are applying for limited licenses as an intern or medical resident, those who are applying for licenses but are not actively practicing medicine, or providers on active duty in the National Guard who are called up during a national emergency or crisis.  Physicians may also apply for a 90-day “undue hardship” exemption under certain circumstances.

“The Massachusetts Medical Society believes that electronic health records have enormous potential for patient care, and the Society’s extensive policy on EMRs declares support for them and a desire to work toward improving them,” said MMS President Richard Pieters, MD.  “We are grateful that the Board of Registration in Medicine has taken a reasonable approach on this issue, exhibiting utmost concerns for patient safety and access to care.”



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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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