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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A secret shopper’s perspectives on the EHR and clinical workflow 

A secret shopper’s perspectives on the EHR and clinical workflow  | EHR and Health IT Consulting |

As someone who has practiced medicine using both paper and electronic records, and someone who's been focused on the health tech scene for the past 20 years, you might think I've seen it all. Indeed, during my 35 year career in medicine and tech I've traveled the world and learned a lot about healthcare, clinical practice and the intersection between medicine and technology. However, there's nothing like being a secret shopper to get a little reality check on where things stand with electronic health records and clinical workflow.


For the past couple of months, and likely continuing for most of the next year, I am charged with helping a family member through treatments for an all-too-common medical problem--cancer. That means I am accompanying my family member through diagnosis, surgery, chemotherapy, radiation therapy, and eventually medical monitoring and follow-up. Let me tell you, there's nothing like being in the trenches of a patient care experience to see how far we've come, and how far we still need to go to fix healthcare.

The hospital and health system we are visiting uses one the major EHR solutions. However, even within the same institution, departments seem anything but connected. When we have multiple appointments on the same day in different departments, we are still filling out paper forms asking the same questions in every department we visit. Worse yet, even when we make our second or third visits to those departments we are again presented with forms to fill out. Wouldn't it be better to fill out that information on a tablet device or kiosk and make it available to all departments at once? Wouldn't it be better on subsequent visits for us simply to review the information on an electronic screen and edit or update it as needed? Where's the single version of the truth?


In the exam room I've noted how much time clinicians and support staff are spending in front of the computer, rather than with the patient. The only doctors not doing this are the super-specialists who foist most of that burden on scribes or other members of their support staff. Furthermore, the computers in the exam rooms are mounted to a wall or sitting on a counter, often forcing the user to have his or her back to the patient. Clinicians must assume a kind of sideways posture with head bobbing back and forth between the machine and the patient. Where are the mobile devices--the laptops, tablets, and smartphones? Has anyone really given a thought to the importance of mobility in clinical workflow?

Then there's the clinical user interface that looks like it came from the dark ages. It took one of our providers about ten minutes just to key in an order for a durable medical supply and print it out for our insurance company. The user interface to the institution's patient-facing portal is equally bad. A web-savvy teenager could likely do better. Today's portals need to look and work more like Facebook or LinkedIn than something from the dawn of the Internet.

Another inefficiency I have observed isn't so much about bad tech as stupid billing mandates. Even when visiting different physicians in different departments on the same day, during each visit staff enter the exam room to take and document vital signs. Over and over again the thermometer and blood pressure come out, even though vital signs were just taken and documented 30 minutes ago in a different department. I finally asked why this was necessary only to be told that unless it is done the physician will not be paid. Has anyone considered what this totally unnecessary and duplicative workflow is costing our hospitals and health systems in wasted staff time? Let's stop the insanity.

By now, I'm sure you are thinking I've grown old and crotchety. I probably have. But please future generations of software developers, EHR vendors, regulators, and others; can't we do better for our clinicians and patients? I'm sure we can.

If you would like to become more familiar with the work Microsoft is doing in health and the healthcare industry (in cloud computing, mobility and devices, productivity and collaboration, and advanced analytics) please contact your account executive or visit Microsoft in Health.

Bill Crounse, MD      Senior Director, Worldwide Health         Microsoft 

Technical Dr. Inc.'s insight:
Contact Details : or 877-910-0004

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Interoperability and the Future of Care Delivery - HITECH AnswersHITECH Answers

Interoperability and the Future of Care Delivery - HITECH AnswersHITECH Answers | EHR and Health IT Consulting |

The healthcare industry has done a remarkable job of replacing traditional paper charts with electronic health records (EHRs). Information that used to be sharable only by the most rudimentary means — it’s been said that fax machines lasted so long only because of healthcare — is now captured and stored electronically in a readily transmittable form.

That’s powerful stuff. Think of all the ways we as individuals move information electronically through email, online destinations, and the applications we access as part of daily life that would have been impossible less than two decades ago. That convenience is coming fast to health information, and the race is on to put that information to beneficial use through interoperability.

“EHR interoperability” can take many forms. It can refer to the ability of dissimilar EHRs to exchange health records, its most commonly understood meaning. It can also refer to the ability for EHRs to interact with dissimilar devices and with applications that are well beyond the realm of the health record itself. Interoperability is all of these things and more, coming together to advance care in ways that were unimaginable in the days of paper charting.

Interoperability among EHRs

In the first phase of electronification, health data was captured and stored in individual EHRs operating as providers’ personal information silos. The next task is to enable those EHRs to exchange patient data efficiently and securely with each other.

Meaningful use Stage 2 is a driving force in this aspect of interoperability. Stage 2’s consolidated clinical document architecture (C-CDA) requires EHRs to exchange diagnoses, allergies and medications in real time, a great first step (and another good reason to upgrade to a Stage 2-certified EHR). More complete information exchange is still needed, and the industry is making great progress in this arena, largely thanks to such cooperative initiatives as the CommonWell Health Alliance and Healtheway Carequality program. We should ultimately see all clinical data necessary for quality care shared among EHR systems, so it won’t matter whether a person is receiving care near home or while traveling across the country — his or her pertinent information will be available at the point of clinical decision-making in any location.

Interoperability with dissimilar devices and applications

Delivering patient data from one EHR to another is one piece of the interoperability puzzle; clinical information is often needed for decision-making beyond the reach of EHR-connected computers. Mobile devices are leading the way in putting patient data in the hands of providers wherever it’s needed via apps on tablets and smartphones. Patients also need remote access to health data, a role filled by the patient portal, which is fast growing in importance for patient engagement. As portals and EHR-to-EHR interoperability advance further, healthcare consumers will be able to manage information across multiple providers from a central location, just as today it’s possible to go online and personally manage finances by moving assets across accounts and institutions.

Interoperability with patient populations

The exchange of electronic health records with other EHRs, mobile devices and portals is all about individual care, which of course is tremendously important. Equally important is patient engagement for purposes of population health management, which occurs outside the walls of care facilities and patient appointments. Shifting payer models increasingly hold physicians accountable for outcomes, and tools that leverage EHR data are beginning to assist in that regard. We’re nearing an era in which each time a patient with a chronic condition makes an appointment, the provider will know whether or not that patient is overdue for a screening test, a foot exam or any other measure needed to fulfill a recommended preventive care program…and can administer that care at the same time.

These are just some of the ways interoperability is beginning to transform healthcare, and innovation is accelerating. In the not-too-distant future, “health IT interoperability” will largely be taken for granted, with information flowing in beneficial ways we can only dream of now — and as we are all consumers of healthcare, we’ll all benefit tremendously from breakthroughs to come.

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ICD-10 PCS - We Don't Know What We Don't Know

ICD-10 PCS - We Don't Know What We Don't Know | EHR and Health IT Consulting |

After decades of experience with ICD-9, we have learned and come to grips with its quirks. We do not yet have that comfort level with ICD-10—after all, it’s still pretty new to most of us in the U.S. I’m not really concerned about the diagnosis side of ICD-10 and its clinical modification, ICD-10-CM. But what does concern me is ICD-10-PCS (procedure coding system). So far, we don’t have a good idea of how this is going to impact reimbursement, and what documentation requirements are really going to be needed. We really don’t know what we don’t know.

ICD-10-PCS coding demands a new level of documentation and coding specificity. There are few procedure codes in ICD-10 that will allow nonspecific or “not otherwise specified” codes, as are allowed in ICD-9. In the ICD-9 coding environment, it is still possible to generate a code and get reimbursed even with minimal specificity. But under ICD-10, if specificity is lacking, there may not be a procedure code that can be used, and the reimbursement will therefore suffer.

Let’s look at “lysis of adhesions” to see how this applies. If a surgeon performs a laparoscopic procedure to free up something in the abdomen that’s trapped in scar tissue and the operative note concludes that the patient performed a “laparoscopic lysis of adhesions in the peritoneum,” that would be enough information to use ICD-9 code 54.51. But there is no direct equivalent for this in ICD-10, no code that is as vague as the one in ICD-9. Instead, the surgeon needs to describe exactly what organ or organs were “released” or freed up during the procedure. If it was a loop of small bowel caught up in adhesions, then the appropriate ICD-10 code would 0DN84ZZ (release small intestine, percutaneous endoscopic approach). It would require specific mention of the small bowel in order to be coded.

So where does the problem or uncertainty come into play with this?

Well, let’s suppose (as is likely to happen) that the surgeon writes his or her usual comprehensive operative note that describes the procedure that includes a description of the dissection that was done around the small intestine. But the note itself simply states in the closing summary that the operation was a “laparoscopic lysis of adhesions in the peritoneum.” Can the coder use the description of the dissection around the small bowl to go ahead and code 0DN84ZZ? This seems to still be open to interpretation, and the last thing coding managers want as we prepare to enter the ICD-10 era is uncertainty.

As I have traveled around the country speaking with various professional groups including national and local AHIMA chapters, ACDIS chapters and coding societies, the opinions on this subject vary. Many boldly state that they would be comfortable coding from this scenario, while others want the physician to be responsible for stating the details explicitly.

Where does this leave the clinical documentation specialist? Will they be left with the responsibility for creating and managing the thousands and thousands of queries that are going to be needed to get the necessary clarification from the surgeons?

We don’t yet know.

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iPad & iPhone EHR Medical Records Apple Touch ID

iPad & iPhone EHR Medical Records Apple Touch ID | EHR and Health IT Consulting |

Apple now introduced the biometric “Touch ID” onto the new iPad, latest iPad Air 2 and the iPad Mini 3.  Touch ID is also on the iPhone 5s, iPhone 6 and iPhone 6 Plus.

What is Touch ID? Touch ID is a little biometric finger print reader on the new iOS devices:

  • iPad Air 2
  • iPad Mini 3
  • iPhone 5S
  • iPhone 6
  • iPhone 6 Plus

With Touch ID, you can now do more with just the touch of a finger, you can log in and verify identity in logging into apps. Touch ID is that little metal ring around the home button on the new iOS devices.

With the introduction of “Touch ID” onto the new iPad we have added something amazing. With three taps you can get into a medical record. You will touch once with Touch ID to get into the iPad, tap the drchrono EHR app, once the app is launched, then with Touch ID, get into their EHR. Only three taps, no typing a passcode.

This video show off Touch ID in action:

This feature was also added to the onpatient Personal Health Record.

This video shows off Touch ID on the PHR in action


The great thing about Touch ID is that it only takes a few minutes to setup. To setup Touch ID EHR follow this video, this video applies to all iOS devices with Touch ID, in the video I am showing how you can use an iPhone 6 to setup Touch ID EHR, it is the same for the new iPad Air 2 and iPad Mini 3:

I spoke about Touch ID a number of months ago, it is now a reality and changing the world.

The amazing thing about Touch ID is that people sometimes forget password and pin codes. This changes the game even more of touch technology in healthcare.

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