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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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NYC Hospitals Face Massive Problems With Epic Install

NYC Hospitals Face Massive Problems With Epic Install | EHR and Health IT Consulting | Scoop.it

A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.


In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.


The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.


Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.


With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.


The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York PostHHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.


So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.


The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.


HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.


What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.


On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

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Burke Autrey's curator insight, September 21, 2016 10:56 AM
Tracking companies who bring in Interim executive talent when it counts... Congratulations to Clinovations and HHC who clearly see the value of tapping into interim executives.
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CMS Chief to Address ICD-10 Implementation in National Call

CMS Chief to Address ICD-10 Implementation in National Call | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) continues gearing up for the October 1 ICD-10 compliance deadline with Acting Administrator Andy Slavitt scheduled to address the ICD-10 transition during a national provider call later this month.


On August 27, Slavitt will provide a national implementation update as the nation reaches the five-week countdown to October 1. Also scheduled to speak are American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman and American Hospital Association (AHA) Director of Coding and Classification Nelly Leon-Chisen.


Two recent surveys show industry-wide progress toward a successful ICD-10 transition in October. In July, the 2015 ICD-10 Readiness reportpublished by AHIMA and the eHealth Initiative stated that half of respondents had completed test transactions with payers or claims clearinghouses.


Despite these positive findings, the report also revealed that ICD-10 preparation gaps still remain for many providers in the area of testing and revenue impact assessments. Only 17 percent indicated that they had completed all external testing. Similarly, only a minority of respondents (23%) have contingency plans related to ICD-10 go-live.

More recently, latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI) showed physician practices to be lagging behind their counterparts.


As compared to seven-eighths of hospitals and health systems ready for October 1, less than a half of physician practices indicated they would be ready. This disparity was also evident in the area of provider impact assessments. Only one-sixth of physician practices had undertaken the assessment versus three-fifths of hospitals and health systems. "This lack of progress is cause for concern as it will leave little time for remediation and testing," WEDI reported.


In a letter to Department of Health & Human Services Secretary Sylvia Mathews Burwell, WEDI cautioned that without a concerted effort the ICD-10 transition could lead to negative consequences for the healthcare industry.


"We assert that if the industry, and in particular physician practices, do not make a dedicated and aggressive effort to complete their implementation activities in the time remaining, there is likely to be disruption to industry claims processing on Oct 1, 2015," the organization stated.


Around the same time, CMS provided clarification about ICD-10 flexibilities it make available to providers following a joint statement with the American Medical Association (AMA) in June. The major ICD-10 flexibility is the federal agency's decision not to reject claims coded incorrectly in ICD-10.


"Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code," the federal agency stated. "The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service. Submitters should follow existing procedures for correcting and resubmitting rejected claims."


Here's a quick look at the agenda for the MLN Connects Call:


  • National implementation update, CMS Acting Administrator Andy Slavitt
  • Coding guidance, AHA and AHIMA
  • How to get answers to coding questions
  • Claims that span the implementation date
  • Results from acknowledgement and end-to-end testing weeks
  • Provider resources


As the entire healthcare industry counts down to October 1, CMS appears ready to ramp up its activities.

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Solving Medical Practice Problems Post-Tech Adoption

Solving Medical Practice Problems Post-Tech Adoption | EHR and Health IT Consulting | Scoop.it

Your practice could have all the latest and greatest technologies at its disposal, but that doesn't necessarily mean it's going to be the fastest, most efficient, or highest-quality care provider. The opposite could be true, in fact, if technology is not well incorporated into your practice after it is implemented.


Unfortunately, many practices are struggling with post-implementation challenges, according to our 2015 Technology Survey Sponsored by Kareo, the findings are based on responses from more than 1,100 readers. While most of the respondents said they are using an EHR for instance, they also said their productivity is suffering as a result; and while more than half said they have implemented a patient portal, they also said they are struggling to get patients to use it.


But it's not just using technology post-implementation that is raising problems for practices; it's also protecting information that is stored on those devices after implementing them. While many respondents said they are using mobile devices in their everyday work, for instance, few said their practice has established mobile device security rules.

Here's a look at these post-implementation technology challenges and others reflected in our survey findings, and advice from experts regarding how your practice can adapt.


CHALLENGE #1: POST-EHR PRODUCTIVITY DROP


Each year for the past four years, we asked survey respondents to identify their "most pressing information technology problem." In 2012, 2013, and 2014, the most common response among survey takers was "EHR adoption and implementation." This year, for the first time, "a drop in productivity due to our EHR," and a "lack of interoperability between EHRs," received the highest percentages of responses.


Let's address the productivity challenge first. Medical practice consultant Rosemarie Nelson says practices that are struggling to get back up-to-speed after implementing an EHR should first assess whether "reverse delegation" between the provider and nursing support staff is to blame. "What happens is once we have this EHR in place and people see that they can task or message somebody else in the practice, they suddenly start to maybe put the burden in a place it shouldn't be," says Nelson. "In the paper days ... the nurses would manage all the incoming correspondence for the physician; they would manage the phones, they would manage the fax machine; basically they were managing [the physician's] paper inbox. Now, with the EHR, suddenly everything just goes to the physician's inbox." To get delegation moving back in the proper direction, Nelson recommends practices modify how nurses screen materials coming into the EHR so that physicians only receive information that requires a physician's review. One option, Nelson says, might be to allow a nurse "surrogate" to manage the physician's inbox so that the materials are prescreened appropriately.  


Jeffery Daigrepont, senior vice president of the Coker Group, a healthcare consulting firm, has similar guidance regarding EHR documentation."When we work with clients, if we see or observe a physician doing the vast majority of data entry, then usually that is a sign that the system was implemented incorrectly," he says. "You really want to design your work flow and processes in a way that minimizes the doctors' time to do the data entry part."


He says practices should consider modifying their EHR to better meet physicians' work flow needs and to create a more standardized work flow for common patient complaints. "... One thing that computers are really good at doing is remembering things," says Daigrepont. "So if you know that for every time you have a patient with this particular visit or diagnosis you are going to follow these five or six steps or action items and it's pretty consistent patient after patient after patient, a lot of times [improving productivity] comes down to spending a little bit of extra time to design your [EHR] around your work flow and around the physician's behavior."


Practices should also consider "add-on" tools, such as voice recognition software and shortcut and abbreviation tools, that may help physicians navigate the system more quickly, says Nelson. To identify time-saving tools, she recommends consulting your vendor and engaging with EHR user groups.


CHALLENGE #2: EHR INTEROPERABILITY ISSUES


As noted, another common post-EHR implementation challenge identified by survey respondents was "lack of interoperability between EHRs." For practices struggling in this area, particularly those struggling to meet the transition-of-care requirements in meaningful use due to difficulty exchanging information with other healthcare systems, Nelson advises stepping up communication with those other healthcare systems. Work with them to find a solution, or pool resources to find one.


"Some of that is just pushing your partners," says Nelson. "If it's a hospital [make sure] they get discharge summaries pushed to you; if it's a key referral, then every certified EHR has to have the ability to share what's called a CCD [Continuity of Care Document] or a CCR [Continuity of Care Record]," says Nelson. "That [CCD or CCR] has key elements in it, which is really all we need. We need to have the patient's problem list, we need to have their medication list, we need to have their allergy list, labs would be great ... Some practices may not realize that they could get this [CCR or CCD] from another practice, and/or they may not realize that they are getting it, so they treat it like a fax instead of learning how to import it into their system so they don't have to re-enter data."


Also, consider participating in the Direct Project initiative, which helps support simple electronic exchanges between practices and their healthcare partners, says Nelson. 


CHALLENGE #3: A LACK OF PATIENT PORTAL ENGAGEMENT


It's not just EHRs that are raising problems for practices post-implementation. While 54 percent of our 2015 Technology Survey Sponsored by Kareo respondents said their practice has a patient portal (up from just 20 percent in 2011), many respondents indicated they are struggling to make the most of their portal's capabilities. Sixty-three percent, in fact, said that "getting patients to sign up/use the portal" was their biggest patient portal-related challenge.


For practices struggling in this area, Nelson recommends using "teachable moments" to promote the portal; for example, when physicians and staff are about to share information with patients, or when they plan to share information with patients. A nurse who is following up with a patient after the physician visit might say, "If you go to our website and register for the portal, you'll be informed when your lab results are ready and you'll be able to view them online."


To increase the likelihood patients will follow through with signing up for the portal, send a text message or e-mail with information on how to sign-up for the portal shortly after the patient visit, says Daigrepont. "If you just say, 'Hey go to the portal,' as the patient is leaving, by the time they get in their car they've already forgotten that information."

Also, make sure that the portal offers key features that patients value, such as the ability to:


• Request appointments;

• Get prescriptions renewed;

• Review test results; and

• Look at visit summaries from previous visits.


"We have to offer more on the portal to make it worthwhile for [patients] to come back," says Nelson. "It's just like any website that a physician or nurse would go to, if there isn't anything of value after the second time they go, they're not going to want to go a third time."

Finally, when promoting the portal to patients, reassure them that the portal is secure, says Daigrepont. "I think a lot of times people are reluctant, especially when it comes to their healthcare information to [sign up] if they are not very much reassured that their privacy will be protected."


CHALLENGE #4: MOBILE DEVICE SECURITY


EHRs and patient portals are not the only technologies practices and physicians are implementing. More are also using mobile devices, such as smartphones and laptops, to store and share protected health information (PHI) and to communicate with patients. Sixty-seven percent of our survey respondents said they use mobile communication devices in the performance of their job.


While mobile devices streamline communication, they also raise potential security problems. In fact, the majority of HIPAA breaches occur due to lost or stolen mobile devices. Yet many practices are failing to take the proper precautions to secure the data stored on mobile devices, particularly when it comes to the use of personal mobile devices for work purposes. Only 32 percent of our survey respondents said they have implemented rules regarding this use of technology.


If your physicians and staff are using mobile devices for professional use, Nelson recommends:


• Requiring all devices to be password protected (and requiring those passwords to be changed every few months);

• Prohibiting staff from downloading PHI to mobile devices;

• Working with vendors to put safeguards in place that prevent staff from downloading PHI to their devices (staff and physicians may be able to view information remotely, but not download it); and

• Encrypting PHI so that the information stored on mobile devices is protected.


Practices should also inform physicians and staff that, in the event of a potential HIPAA breach, the practice may need to access the device, disable it, remotely wipe it, and so on, says Daigrepont. "I think as business owners you just have to be upfront with your employees," he says. "Say, 'We're happy to give you the convenience of using your personal device, but there's a little bit of a trade-off and here's what you need to know.'"


To ensure all staff and physicians are on board with your mobile device security rules, consider requiring them to sign a mobile device security agreement. 


CHALLENGE #5: OVERALL TECH SECURITY


The increasing use of mobile devices for work-related purposes is not the only new technology that is raising security problems for practices. When acquiring a new piece of technology, whether it is an EHR, patient portal, or mobile device, the practice needs to assess how the use of that technology might raise security risks, and act accordingly to address and reduce those risks.


One of the best ways to do this is by conducting a security risk analysis, during which practices analyze the potential risks and vulnerabilities to the confidentiality, integrity, and availability of their electronic PHI.


Despite the fact that conducting a risk analysis is required under both HIPAA and meaningful use, only 36 percent of our survey respondents said they have conducted one.


That's a troubling statistic, says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC. "We really try to get organizations to not think of the risk analysis as this sort of draconian regulation that [HHS'] Office of Civil Rights (OCR) is putting down on them," says Caswell, who formerly worked at the OCR. "We always say that if you do not conduct a risk analysis, you do not know what risks there are to your organization."


IN SUMMARY


Practices have rapidly implemented new technologies over the past few years, but that is only half the battle when it comes to using that technology effectively. Here are some of the common post-implementation challenges practices face:


• Productivity losses

• Interoperability problems

• Lack of patient engagement with new technologies

• Communication work flow problems

• New security risks

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Gerard Dab's curator insight, July 16, 2015 8:19 PM

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector 

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How health systems can help physician practices prepare for ICD-10

How health systems can help physician practices prepare for ICD-10 | EHR and Health IT Consulting | Scoop.it

Many physician practices are ill-prepared for ICD-10, and health systems must ensure the right tools are in the hands of those who need them most, according to Bill Reid, senior vice president of product management and partners at SCI Solutions.


"Hospitals risk unsuccessful transitions if physician offices in their communities aren't ready," Reid writes for ICD10Monitor.com. Recent studies show that many still are not, despite the Oct. 1 implementation deadline looming.


For instance, a survey unveiled by the eHealth Initiative earlier this month showed that of 271 providers, half said they have conducted test transactions using ICD-10 codes with payers and clearinghouses. Only 34 percent said they have completed internal testing, while 17 percent have completed external testing.


Eighty-eight percent of test claims were accepted during the Centers for Medicare & Medicaid's second round of ICD-10 testing in April.

There are tools that health systems can use to ensure their "healthcare brethren" are moving forward with ICD-10, according to Reid. A cloud-based business management tool can help create a "crosswalk" to convert the ICD-9 code used most often to ICD-10 equivalents. The business management tools help ensure incidents are coded correctly, he says.


"These electronic bridges help ... make it as easy as possible for community physicians to send in accurate orders and referrals, with the correct codes being used from the start of that workflow," Reid says.


One scenario where this works includes if a patient needs to be scheduled for a CT scan. While the patient is at the practice, staff can use the management tool to schedule the order and while doing so select the prognosis which the program will then autopopulate the correct ICD-9 and ICD-10 codes.

The Workgroup for Electronic Data Interchange has warned that unless all industry segments move forward with implementation of ICD-10, "there will be significant disruption on Oct. 1, 2015."

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Top things providers need to know about interoperability

Top things providers need to know about interoperability | EHR and Health IT Consulting | Scoop.it

It seems that interoperability is the biggest buzzword in health IT right now, and for good reason. Too much money is lost by both providers and patients due to a lack of data sharing and communication between doctors. However, with optimized medical software and implementation and standards outlined by the meaningful use program, nationwide interoperability is a goal that could actually be met in U.S. health care over the next few years.


If you're unsure about what interoperability means, or want to know how you can bring data sharing to your health system, here are some of the top facts you'll need to know:


"The U.S. could save around $30 billion annually with interoperability."


Interoperability saves big


According to an analysis by the West Health Institute, the U.S. health care system has the potential to save more than $30 billion each year with an interoperable platform. Having an electronic health record that travels with the patient not only prevents readmissions and duplicate treatments, but it also saves precious time and resources.


Congress is interested in interoperability


Another story making headlines is interoperability on Capitol Hill. For the past several months, Congress has been taking a serious look at interoperability and the way that organizations and legislation can work together to make this happen.


Cloud computing is driving interoperability


Medical devices are growing increasingly sophisticated in the health care environment, and doctors are relying on smartphones and tablets for diagnoses and treatments more than ever before. In busy medical settings, having cloud access to patient information alongside interoperable systems could make these clinical tasks even easier.


Experts have broken down five main use cases for interoperability


According to a recent study published in the Journal of the American Medical Informatics Association, there are five main use cases that make up an interoperable EHR. They are as follows:

1. Organizations must be able to extract patient data while still maintaining their own structured data.

2. Users must have the ability to transmit the entirety of a patient's EHR, or portions of the EHR, to another doctor.

3. The organization's health information exchange can receive requests for copies of a patient's EHR from providers outside of their system in a standard format.

4. Providers must have the ability to move all patient data from an old EHR into a new EHR.

5. Organizations must have the tools to embed EHR data into a health care system's operating API. This increases the value of data capture and transmission.


The ONC's Interoperability Roadmap is a broad vision


Perhaps the biggest revelation about interoperability is the Office of the National Coordinator for Health Information Technology's Interoperability Roadmap, which outlines a long-term, 10-year plan for the future of interoperability in the U.S. Not only does the roadmap address barriers to interoperability, but it also shows how optimized EHR systems can push interoperability toward patient-centered care over the next decade.


Organizations pushing for interoperability


There are several leading nonprofits you might want to be aware of that are making interoperability a priority, according to Becker's Hospital Review. Some of these include the Argonaut Project, IHE USA (which is partly responsible for ConCert, an interoperability testing program), JASON (a group of independent scientists that advises lawmakers and other government officials about health IT) and the CommonWell Health Alliance. Many of these stakeholders are some of the most influential in health IT, so it's clear that interoperability is a major goal moving forward.


As interoperability becomes more of a focus in health care, providers need to think about ways that they can promote data sharing and health information exchange. With Intelligent Medical Software, clinicians can worry less about whether the health data is accurate on the EHR, and can instead focus more on their patients and save resources.

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Final Steps to Take Before the ICD-10 Implementation Deadline

Final Steps to Take Before the ICD-10 Implementation Deadline | EHR and Health IT Consulting | Scoop.it

As the countdown to the ICD-10 implementation deadline continues and the healthcare industry gets closer to October 1, those ready for the new diagnostic coding set will stand out from the rest of the crowd. An article by Pam Jodock, Senior Director at the Healthcare Information and Management Systems Society (HIMSS), describes three types of medical organizations that are either moving forward with the ICD-10 implementation deadline or are behind in their ICD-10 preparations.


The healthcare entities that have implemented new system upgrades and trained their staff on the ICD-10 coding set while ignoring any ICD-10 delays should be more ready than others once October 1, 2015 hits.


The second type of provider likely stopped his or her ICD-10 preparationsonce the 2014 ICD-10 delay was announced but resumed at the beginning of this year. Those who began in January or February should still be in good shape to meeting the ICD-10 implementation deadline. The third type of provider, however, may have difficulty being completely prepared for the new coding set by October 1 if they postponed all plans in hopes of another ICD-10 delay.


Jodock continued to explain that there are a number of steps that well-prepared healthcare providers should have already completed. These include:


  • Remediating systems to identify ICD-10 codes for any services performed on October 1, 2015 and after
  • Completed or undergoing testing with partners and payers
  • Coding staff trained and tested on the ICD-10 codes
  • Contingency plans developed to prepare for any potential reimbursement delays
  • Reassurance from payers, clearinghouses, and other partner entities that they are prepared for the ICD-10 implementation deadline
  • Full training of the medical team on any new clinical documentation procedures


Following these steps among others will ensure greater success among healthcare providers in being well-prepared for the ICD-10 implementation deadline. However, any medical organizations that are behind in their ICD-10 preparation efforts should not worry, Jodock explains.


The Centers for Medicare & Medicaid Services (CMS) offers a variety of services to help providers better prepare for the new diagnostic and procedural coding set. For example, Medicare Adminstrative Contractors (MACs) are offering free billing software to providers and more than 50 percent of MACs are providing physicians and healthcare professionals the ability to submit ICD-10 claims via their provider portals upon the ICD-10 implementation deadline.


A presentation offered by CMS called “ICD-10: Preparing for Implementation and New ICD-10-PCS Section X” discussed further steps on moving forward with ICD-10 preparation.


 “ICD-10 is really foundational to our nation’s healthcare. We really want to make sure everyone is prepared,” Denisia Green, Deputy Director of the National Standards Group, said during the presentation. “We have free resources, tools, and testing available to everyone.”


“ICD-10 is set. The date is set for October 1, 2015. What we want you to understand is that there are not that many codes,” Green explained. “Yes, you have to take a look at the codes that you use. Over half of the codes are laterality. If you look at the code set by category, some of the codes have actually been streamlined in ICD-10. I think one of the things that we have to keep in mind is who are the patients that we take care of and that will help to dictate what codes you’re going to be using.”

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EHR Data Interoperability Should Meet Five Use Cases

EHR Data Interoperability Should Meet Five Use Cases | EHR and Health IT Consulting | Scoop.it

EHR data interoperability remains a top priority for the healthcare industry as well as the federal government. In order to ensure the financial investments the government put into spreading EHR adoption and meaningful use requirements are worthwhile, connectivity between health IT systemsand medical devices throughout a healthcare facility will need to be achieved. However, one question that two scientists posed is: “What makes an EHR ‘open’ or interoperable?”


Dean F. Sittig, PhD, from the University of Texas and Adam Wright, PhD, from Boston-based Brigham and Women’s Hospital determined five use cases which identify the definition of EHR data interoperability. Their findings are published in the Journal of the American Medical Informatics Association (JAMIA).


These five use cases include (1) clinicians for provision of more robust and safer care, (2) researchers who can assist in improving knowledge of medical conditions and healthcare workflow processes, (3) administrators who will no longer be reliant on only one EHR vendor, (4) software designers and developers who will benefit by being able to create innovative products and address EHR user interface issues, and (5) patients in order to receive their pertinent medical data regardless of where they obtained healthcare services.


Currently, EHR data interoperability between multiple electronic patient record systems is lacking across the medical care industry. With more than $26 billion invested by the federal government in ensuring EHR implementation boosts patient care processes, it may be for naught if EHR data interoperability is not achieved.


Another major problem that has been perceived in the healthcare sphere is the potential forinformation blocking. A variety of EHR vendors as well as providers have been implicated in the blocking of effective health information exchange. The researchers state that, while many in the healthcare industry understand the need for effective EHR data interoperability, few comprehend the specific definition of the term.


“Many commentators assume that an open EHR shares some of the qualities of ‘open-source’ software, which usually implies that the application’s source code is available, often free of charge, for review, use, and even modification,” the published report stated. “While we support the open-source concept, it has no bearing on whether an EHR satisfies the definition we propose below. On the other hand, we strongly believe that EHR developers should provide customers with access to an ‘escrowed’ copy of their current source code to help mitigate health care business continuity problems in the event the developer goes out of business.”


One use case the researchers point out is the ability of an authorized user to share either an entire patient record or a portion of the record with another physician who utilizes a separate EHR system developed by another vendor.


By focusing on the five use cases the researchers uncovered, vendors and providers could move forward with achieving EHR data interoperability and health information exchange. EHR vendors and developers will need to commit to providing EHR capabilities that can effectively share and exchange data among clinicians and larger healthcare organizations or public health agencies.

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Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls

Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls | EHR and Health IT Consulting | Scoop.it

With the ICD-10 implementation deadline only three and a half months away, it is beneficial for healthcare providers to continue their last-minute preparations for the coming ICD-10 transition. The Centers for Medicare & Medicaid Services (CMS) includes a variety of tools and resources for providers to utilize when getting ready for the ICD-10 implementation deadline.


From the Road to 10 website to videos and expert columns, CMS is working toward preparing healthcare providers for the coming ICD-10 implementation deadline on October 1, 2015. In a video called “ICD-10: Getting from Here to There – Navigating the Road Ahead,” Dr. Ricardo Martinez, Fellow of the American College of American Physicians, discussed how the International Classification of Diseases (ICD) version 10 is a significant improvement over the more outdated ICD-9 codes being utilized across healthcare facilities today.


The video also went over key steps that small medical practices should incorporate when preparing for the ICD-10 implementation deadline. In particular, providers will need to understand how the new codes will differ from the older ICD-9 codes.


“As a practicing physician, I see the limitations of ICD-9 every day and why input from the medical community into the development of ICD-10 has been so valuable,” Martinez explained. “ICD-9 is outdated – even antiquated by today’s practice standards – and it limits the speed and accuracy with which I can gather information, gain insights, and, more importantly, care for my patients.”


“Today, ICD-9 doesn’t even address laterality, which signifies if a condition affects the left or the right limb,” continued Martinez. “On a professional note, when recently faced with a complex patient who had an acute stroke in history of a previous stroke, we had to search through many old records to determine whether that old stroke was left or right side, wasting valuable time that could have been dedicated to patient treatment. With a single code, ICD-10 will provide us with more detail. Better data makes better care possible.”


“To help small provider practices and other healthcare professionals with the transition to ICD-10, the Centers for Medicare & Medicaid Services is actively working with physicians, industry leaders, and others,” Martinez mentioned. “Healthcare has been using the international classification of diseases for over a century to identify and track diseases and help us improve our care for our patients.”


“Although most of the world transitioned to ICD-10 years ago, the currently used version of ICD-9 is fundamentally unchanged since its implementation in the United States in 1979,” Martinez stated. “One major limitation of ICD-9 is that it predates many modern technological advances and clinical terminology reflecting the use of CT scans, for example, which were also invented in 1979. Therefore, an update was necessary to account for these innovations in medicine.”


“For years, practitioners noted the need for increased specificity within clinical terminology, documentation, and coding to accurately represent the care provided to their patients,” Martinez clarified. “Under sponsorship of the World Health Organization (WHO), a group of physicians developed the basic structure for ICD-10. Then, each specialty provided input on the subset of procedure or diagnosis code needed. Addressing both the changes in medicine and the need for increased specificity, ICD-10 will capture greater detail in the clinical encounter for each patient.”

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Examine Your Medical Billing Process for Improvement

Examine Your Medical Billing Process for Improvement | EHR and Health IT Consulting | Scoop.it

I met with a medical practice owner yesterday who was looking for some help and feedback on her business. She says she believes they are "doing fine," but she senses there are areas that could be improved upon. This is a great first step in making some simple changes that can yield amazing results.


Back in 2008, when I first wrote "The Lifecycle of a Single Claim," I was feeling quite overwhelmed and wondered where I should start to fix my medical billing problems. By creating this document, it allowed me to break down what appeared to be such a huge task and challenge, to a much more manageable one. The concept is simple, really. Just write down every single step that a patient's medical claim travels through at your medical practice.


When I initially performed this task, I counted 60 different steps through our billing process. Sixty may sound like a lot, but when you write down each step and carefully look at each one — and your practice's policies and procedures for that step — you will be able to identify areas of improvement. Start with the first area that needs attention, modify your process, and move to the next step. This may take several months to a year to get everything squared away, depending on how easy it is to make changes at your practice. Some people have a harder time reaching out of their comfort zone, than others.


Here are four strategies to help you tackle this challenge:


1. Include staff.

The key to making this first step a success is to include your staff members in making these changes. Ask them how they might perform a task more efficiently and get them to become part of the solution, instead of part of the problem. You will move much more easily through this process.


2. Tackle one item at a time.

Think of it as a science experiment. It is very important to make one change at a time and then give it a few weeks to see what the results are. You may end up with another task to manage, or it may result in several tasks being combined into just one step.


3. Give yourself a break.

As you move through this process of identifying areas of improvement, you may be wondering, "How the heck did I get in this mess?" Try to avoid this type of thinking, and instead look at this experience thinking, "Wow! Another area I can improve!" Your attitude is infectious and should spread through your team in a positive way.


4. Plan for the long haul.

Know this is a long-term project and plan accordingly. Areas that need improving will not be fixed overnight or even in a month. This change process should take several months if you're doing it right. By taking the time required, those big changes are introduced slowly, and by doing one at a time it's much less painful for staff to accept those changes.


Once you have managed your way through this journey, and are confident with it, know that this has become a living and breathing document. It should change as your practice grows and modifies its policies and procedures. Assign each section to the appropriate employee to manage and set some guidelines for updating. You want to make sure you or a supervisor is approving any updates and changes, and that they correlate with your overall company culture. Most importantly, have patience. This might be a little painful, but the results will surprise you, and make your practice much more manageable.

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Superbill and Forms Revision for ICD-10

Superbill and Forms Revision for ICD-10 | EHR and Health IT Consulting | Scoop.it

The ICD-10 implementation date is just four short months away. Physicians must ensure that their forms, including their superbills, are ready for the conversion on Oct. 1, 2015.

Superbill Revision


Many physician practices use a superbill to account for the services rendered (CPT codes) and patients' diagnoses (ICD-9 and ICD-10 codes). These forms must be updated on a regular basis to reflect any code changes. The conversion to ICD-10 will require a major overhaul of the superbill. Each ICD-9 code that is listed on the existing superbill will need to be converted to the related ICD-10 code. There is not always a 1:1 match when translating an ICD-9 code to an ICD-10 code. In fact, due to the greater specificity in most areas of ICD-10, there could be several ICD-10 codes that map back to just one ICD-9 code.


CMS' website provides a list of the mappings of ICD-9 to ICD-10 codes called the General Equivalence Mappings (GEMs); view it here: bit.ly/CMS-GEMs. This tool is helpful as a first step for practices to compare the commonly used ICD-9 codes to the related ICD-10 codes. However, the user must keep in mind that these GEMs are not a crosswalk. The full list of ICD-10 codes, including coding guidelines and conventions, must be reviewed to determine the appropriate code assignment.


Since the list of ICD-10 diagnosis codes a practice utilizes could be quite extensive, the use of a superbill for diagnosis coding might need to be reevaluated. There are other solutions, such as the use of EHR, which would better assist physicians in selecting appropriate codes.

It's also important to remember that the physician documentation within the record (outside of the superbill), must justify the services provided and fully describe the patient's diagnoses. The superbill does not stand on its own for coding and billing purposes.


Other Forms Revision


Besides the superbill, there may be other forms that will need to be revised in anticipation of ICD-10. Physician practices should take an inventory of all forms currently used, whether paper or electronic, and review them for ICD-9 codes. Any forms that currently include ICD-9 codes will need to be refreshed with ICD-10 codes.


Some areas that may currently include ICD-9 codes are patient scheduling and registration, documentation templates within the EHR, coding and billing forms, and external reporting/databases. Once these impacted areas are identified, it's essential to communicate any required changes to the forms with the affected parties to ensure readiness for the ICD-10 conversion.


EHR Readiness


Most physicians use some type of EHR within their practice. It is essential that the EHR is ready for the conversion to ICD-10. If the practice has purchased an EHR from a vendor, a readiness assessment should have already been completed several months ago for ICD-10. However, if this process has not been done, practices should contact their EHR vendor immediately to ensure that it will be compliant with ICD-10 on Oct. 1, 2015.


Some practices have created their own "home-grown" EHR which will also need to be evaluated for ICD-10 readiness. Physicians and their coding staff should practice assigning ICD-10 codes within their EHR system to ensure that the system is capable of accepting these codes. It's important to remember that the current ICD-9 codes are between three digits and five digits, whereas the ICD-10 codes are between three characters and seven characters.


Many EHRs have built-in documentation templates that physicians use to assist with capturing the complete clinical picture of the patient. These templates may need to be revised for ICD-10 as well.


Next Steps


Leading up to ICD-10 implementation, a physician practice should have already created an ICD-10 communication plan, developed a budget, completed staff and physician education, performed readiness testing, analyzed documentation, reviewed quality reporting requirements, and revised superbills and other forms. Use these remaining four months wisely to ensure a smooth transition on Oct. 1, 2015.

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The Dawn of The Community EMR

The Dawn of The Community EMR | EHR and Health IT Consulting | Scoop.it

While many healthcare stakeholders would like to see clinical data shared freely, the models we have in place simply can’t get this done.

Take private HIEs, for example. Some of them have been quite successful at fostering data sharing between different parts of a health system, but the higher clinical functions aren’t integrated — just the data.


Another dead end comes when a health system uses a single EMR across its entire line of properties. That may integrate clinical workflow to some degree, but far too often, the different instances of the EMR can’t share data directly.


If healthcare is to transform itself, a new platform will be necessary which can be both the data-sharing and clinical tool needed for every healthcare player in a community. Consider the vision laid out by Forbes contributor Dave Chase:


Just as the previous wars impacted which countries would lead the world in prosperity, the “war” we are in will dictate the communities that get the lion’s share of the jobs (and thus prosperity). Smart economic development directors and mayors will stake their claim to be the place where healthcare gets reinvented.


In Chase’s column, he notes that companies like IBM have begun to base their decisions about where to locate new technology centers partly on how efficiently, effectively and affordably care can be delivered in that community. For example, the tech giant recently decided to locate 4,000 new jobs in Dubuque, Iowa after concluding that the region offered the best value for their healthcare dollar.

To compete with the Dubuques of the world, Chase says, communities will need to pool their existing healthcare spending — ideally $1B or more — and use it to transform how their entire region delivers care.

While Chase doesn’t mention this, one element which will be critical in building smart healthcare communities is an EMR that works as both a workflow and care coordination tool AND a platform for sharing data. I can’t imagine how entire communities can rebuild their care without sharing a single tool like this.


A few years ago I wrote about how the next generation of  EMRs would probably be architected as a platform with a stack of apps built over it that suit individual organizations. The idea doesn’t seem to have gained a lot of traction in the U.S. since 2012, but the approach is very much alive outside the country, with vendors like Australia’s Ocean Informatics selling this type of technology to government entities around the world. And maybe it can bring cities and regions together too.


For the short term, getting a community of providers to go all in on such an architecture doesn’t seem too likely. Instead, they’ll cling to ACO models which offer at least an illusion of independence. But when communities that offer good healthcare value start to steal their patients and corporate customers, they may think again.

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AMIA Issues Report on Electronic Health Records

AMIA Issues Report on Electronic Health Records | EHR and Health IT Consulting | Scoop.it

Today AMIA released the results of a task force report on Electronic Health Records (EHR).  The Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs was released in the Journal of the American Medical Informatics Association (JAMIA) jamia.org  and represents an evolutionary approach in the management of patient medical data.  EHRs allow health-care providers and clinicians to record patient information electronically instead of using paper records.


The EHR-2020 Task Force is comprised of a distinguished group of 15 experts. The findings are being presented publicly today at the AMIA iHealth 2015 Clinical Informatics Conference in Boston, Massachusetts. The report recommends changes that will support patient engagement, improve provider workflow, support innovation, and set the stage for future improvements that will improve patient’s health and healthcare.


AMIA is at the forefront of using EHRs and information technology to enhance medical care and advance the functionality of EHRs.  The EHR-2020 Task Force report represents practical solutions to the concerns members have about the challenges of EHR adoption. AMIA worked with many groups, government agencies and professional organizations to determine methods to solve EHR challenges that providers encounter, and to further create a sustainable framework for innovation in EHRs.


“Health information technology is a key part of enhancing health and health care, and empowering patients to be first-order participants in their care.  As part of this report, we listened to our members who work closely with EHRs to understand the current challenges. We think these recommendations will improve the value that EHRs will provide to patients, and set the stage for more significant benefit in the future“, said Douglas B. Fridsma, MD, President and Chief Executive Officer, AMIA.


Security and confidentiality are at the heart of EHR planning since its inception and AMIA is acutely aware of the concerns of the general public as well as the medical community.  As the professional home of health informatics professionals, AMIA’s members —multidisciplinary and interprofessional—address many of the EHR problems from a wide range of perspectives:  as informaticians, clinicians, scientists, vendors, innovation and implementation scientists, change agents, and people who cross all these boundaries.


“While we recognize that there are challenges with implementing and using EHR technology, this report is aimed at practical solutions that we believe will improve health and health care for patients and their caregivers. We are hopeful that it will generate the thoughtful conversations and innovations that will make what is possible, real for all patients,” said Thomas Payne, MD, Chair, AMIA EHR 2020 Task Force. Dr. Payne is the Medical Director, IT Services, University of Washington (UW) Medicine and Associate Director, UW Medicine Center for Scholarship in Patient Care Quality and Safety.


There is an urgency to act on behalf of patients and the individuals who care for them. AMIA will continue to work with policy makers on their critical role in moving our nation toward better use of EHRs to better serve medical providers and the general public.

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Study: Scribes Have Positive Financial Impact

Study: Scribes Have Positive Financial Impact | EHR and Health IT Consulting | Scoop.it

Many hospitals, and some larger medical practices, have been using scribes to capture medical documentation within EMRs — leaving the provider free to make old-fashioned eye contact with patients.

Using the scribe might sound like a crude workaround to techies, but it’s been a hit with emergency department doctors, who prefer to focus on their brief, critical encounters with patients rather than the hospital’s expensive toy.


While it was clear from the outset that doctors loved having a scribe to support them, there’s been scant evidence that the scribe was anything other than an added cost.


A recent study, however, has concluded that at least from a Case Mix Index standpoint, scribes can have a meaningful impact on a hospital’s revenue.  The study, which evaluated the use of scribes between 2012 and 2014 across a group of hospitals, concluded thatthe scribes save money and boost patient-doctor communication.


The study, which was designed to capture the impact of medical scribes on a hospital’s CMI, linked Best Practices Inpatient Care Ltd. with Advocate Good Shepherd Hospital, Advocate Condell Medical Center and hospitalist-specific medical scribes from ScribeAmerica LLC.

Kicking things off to a good start, ScribeAmerica and Best Practices put scribes through a jointly-developed course that emphasized workflow, productivity and accurate inpatient documentation. The researchers then tallied the results of using trained scribes over a two-year period in the two hospitals.


From 2012 to 2014, researchers found that for both Advocate Condell Medical Center and Advocate Good Shepherd Hospital, CMI values climbed after medical scribes came on board.  Advocate Good Shepherd’s CMI grew by .26 and Condell Medical’s CMI rose .28. These are pretty significant numbers given that a CMI growth of 0.1% typically translates to a gain of about $4,500 per patient. In this case, the hospitals gained roughly $12,000 per patient.


These findings make sense when you consider that using scribes seems to have served its purpose, which is to be extenders for providers who’d otherwise be hunched over an EMR screen.

Researchers found that inpatient physicians at the two hospitals studied were able to cut time spent on chart updates by about 10 minutes per patient on average. This profit-building effect is enhanced by the fact that scribes often get discharge summaries prepared immediately, rather than within 72 hours as is often the case in other hospitals.


That being said, it should be noted that the study we’ve summarized here was co-written by the CEO of Best Practices, which clearly invested a lot of time and effort training the scribes for the specific tasks important to the study.


Still, the study does suggest, at minimum, that scribes need not necessarily be written off as an expense, given their capacity for freeing providers for billable clinical activity. Ideally, IT vendors will develop an EMR that doctors actually want to use and don’t need an intermediary to work with effectively.  But until that happy day arrives, scribes seem like they can make a difference.


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How Should DoD Secure Health Records?

How Should DoD Secure Health Records? | EHR and Health IT Consulting | Scoop.it

The Department of Defense is about to move forward with its multi-billion dollar plan to overhaul its electronic health records system. But when you're an organization such as DoD, supporting 9.5 million active and retired military personnel and their beneficiaries, there are variety of important privacy and security challenges that must be prioritized and tackled, privacy and security experts caution.


In late July, the DoD awarded a $4.3 billion, 10-year contract to Leidos Partnership for Defense Health, a group of three main vendors that include EHR provider Cerner and consulting firms Accenture and Leidos Inc. The contract, which has the potential to be worth $9 billion if DoD exercises all its options over 18 years, involves the Leidos Partnership team transitioning the Pentagon's existing proprietary EHR system onto a Cerner off-the-shelf EHR at about 1,000 DoD sites worldwide, including military hospitals in the U.S., as well as health clinics in remote places such as Afghanistan.


However, as the Leidos partnership embarks on the massive overhaul, there are several critical privacy and security issues that need to be addressed to safeguard patient data throughout the plan.


Additionally, many of the challenges faced by the DoD in its EHR project are also similar - but much larger in scope - to the privacy and security concerns that healthcare organizations in the private sector face when undertaking their own EHR system migrations.


Those issues range from protecting patient data as its moved from one platform to the next, to thoroughly vetting the consultants involved with the EHR work.

Migrating Data

"Several security and privacy challenges exist as the DoD transitions from its old EHR to the new system," says Keith Fricke, principal consultant at consulting firm, tw-Security.


"Migrating from one EHR to another often involves importing historical data from the old system to the new one. The data set may be rather large," he notes. "Extracting data from the old EHR will likely result in a large interim database or data file. The database may need to be sent to the new vendor for data field mapping or importing."


Yet, it is not practical to send data extracts this large over a data connection. "Instead, it is better to send the data sets on an encrypted external hard drive, tracked via shipping provider," he says.


Data integrity issues are among the biggest challenges involved with such massive EHR undertakings, says Tom Walsh, founder of tw-Security. "Often times, the data mapping between an old system and new systems misses something. The only thing worse than no patient data is the wrong patient data."


To counter those problems, the data extraction process must include mechanisms to validate the data ultimately imported into the new EHR exactly matches the data stored in the old EHR, Fricke advises.

Another factor that needs close oversight is ensuring that role-based access controls to patient data are maintained from the old system to the new, especially where highly sensitive information, such as behavioral health data, is involved, Fricke says.


Privacy and security expert Kate Borten, founder of consulting firm The Marblehead Group, says it's equally important to ensure that the consultants working with or accessing the sensitive data are scrutinized. "I expect that many contractors will have access to PHI throughout this major project," she says. "It is very important that they be thoroughly vetted, that they be given the minimum necessary access permissions, and that they be monitored."

Long Haul

Because the DoD project will last several years, it's important to have measures in place to safeguard data during the various project stages.

"Workers should use simulated PHI rather than actual PHI as much as possible," Borten says. "Too often, PHI access is granted for development, testing, and training purposes, when simulated PHI could and should be used instead."


However, often a test environment must have real patient data in order to perform a true functional test, Walsh notes. "Security controls for test environments can often be less stringent. People using the test environment may forget that the data they are working with represents a real patient. Generic user accounts with easy to remember

passwords may be set up to help facilitate functional testing."


So, to avoid possible breaches or unauthorized access to PHI, the test environment needs to have security controls set to the same level as the production environment, Walsh recommends.


Because there will be thousands of people involved with the project - including individuals working for contractors and subcontractors - another danger is a watering down of security measures and practices that should be in place throughout the project, at all locations, for all personnel involved with the work.


"A front line worker may honestly say, 'I didn't know,' and it is a true statement," Walsh says. "Privacy and security education must be conducted for everyone involved."


As for securing data during project stages, Fricke recommends that data be stored on servers located in a secure data center and accessed via virtual desktops. "Doing so significantly reduces the likelihood that data is being stored on contractors' laptops or hard drives of workstations," he says.


"If storing data locally on laptops and desktops is required, these devices must be usingencryption."

User Access

In addition, Fricke suggests that two-factor authentication be used for any remote access to the data being worked on for the migration. "We've seen news stories in the past year about foreign countries targeting US government systems for hacking and exfiltration of data," he says. "The vendors involved in this EHR migration must ensure that all systems involved in the process have proper security patching levels, well-maintained malware protection, and 24x7 audit log monitoring."


Also, if any of the individuals working on this project had their information compromised in the Office of Personnel Management breach, extra care must be exercised to avoid becoming a victim of a spear-phishing attacks.


Because the DoD EHR systems contain healthcare data for U.S. military personnel, then the information potentially could be a hot target of the most devious cyberattackers, Walsh notes.


"The data in these systems are not just any patient. This is the patient data of the men and women who willing chose to serve our country," he says. "Our military personnel are prime targets for domestic and foreign terrorists. Workforce clearance will have to be strongly enforced for anyone involved, but especially far more rigid for any person with elevated privileges, such as system administrator, super user, etc."


Finally, because the DoD project will last at least a decade, maybe two, it's vital that all project work is thoroughly documented, Fricke says.

"It is important that from a project management perspective, the project managers ensure all project documentation is kept very current," he says. "There is always staffing turnover of project managers and contractors in a project this large and with the long timelines expected. Gaps in documentation will cause potential delays, potential rework and possible lapses in security practices as turnover occurs."

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Are Physicians Making the Most of Mobile Devices?

Are Physicians Making the Most of Mobile Devices? | EHR and Health IT Consulting | Scoop.it

As smartphones and tablets become more accessible to consumers, and as their capabilities expand, nearly every industry is incorporating mobile technology into their business models. Banks, for instance, are creating apps to help customers monitor their finances from mobile devices, retailers are rushing to make their websites "mobile-friendly," and schools are budgeting to add tablets to classrooms.


Healthcare should be no exception, but surveys indicate that many practices and physicians are lagging when it comes to fully utilizing mobile devices in patient care. While most physicians are using mobile devices such as smartphones and tablets, at work, according to our 2014 Technology Survey, Sponsored by Kareo, few are using them to assist with direct patient care. For instance, the majority said they use their mobile devices to look up drug information, read journal articles, and access CME opportunities, but only 10 percent said they are using them to remotely monitor patients' health information, such as their vital signs.


Still, family physician Linda Girgis, who is on the advisory board for physician social networking site SERMO, predicts that physician use of mobile devices in patient care will pick up traction. More and more physicians on SERMO, Girgis says, are beginning to participate in discussions about mHealth, ask questions, and share ideas. "We're talking about it more and it's something that more are going to be incorporating into their practice," she says.


Jonathan Linkous, CEO of the American Telemedicine Association, agrees that use of mobile devices in patient care is gaining momentum. One reason is that the administration of healthcare through a mobile device does not cost a lot of money for patients and physicians, as mobile devices are something that most are already using anyway. "A mobile device is not necessarily a healthcare device, it can be anything that people use for communicating, and then it can also be used for healthcare, and that's why it's been very useful," says Linkous. "You're not always having to invent new technology, or always having to invent new ways of connecting people, you're just adding on to technology that's already been deployed."


Another factor leading to mHealth popularity is that more patients are expressing interest in it, says Linkous. You may already be experiencing this in your practice. "... I think they're coming to the doctor and asking them, 'I have a heart condition,' 'I have high blood pressure,' 'I have —whatever else it might be — are there any applications on the cell phone I can use?' And so now the doctors are being asked questions by their patients about what applications can I download, or what types of devices can I use to help me take better care of myself."

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Have you hugged your EMR lately?

Have you hugged your EMR lately? | EHR and Health IT Consulting | Scoop.it

Seeking to provide balanced discourse and to recognize marginalized voices at the gooey center of health care, I kindly ask that you find a seat in the Captain’s Room of the Hilltop Motor Lodge for the inaugural meeting of Physicians for the Liberty of the Electronic Health Record, where founder and president Dr. IM Klickhffor starts the proceedings with this plenary talk.

Thank you, thank you. Many of you are using this weekend to catch up on your charting. To raise your hands from the keyboard and clap so generously fills my heart with a JOY template. This weekend wouldn’t be possible without the generosity of the IT companies crowding the exhibit hall, the motel gym, and the less humid corners of the indoor pool. But any conflicts of interest on my part are entangled more with the contradictions that make us human.


Why are we here? I’d argue it’s because medicine is in desperate need of a new orderset, and it’s called EMRpathy. Physicians must value electronic medical records, EMRs, and the larger enterprise of electronic health records, because they possess intrinsic worth. This complex, vulnerable and sensitive software shouldn’t be tolerated for their financial incentives and then insulted for destroying the doctor-patient relationship.


We must stop treating the unexpected screen, dialogue box or pop-up menu as an uninvited guest and instead embrace the opportunity to be questioned by these beneficent and diligent systems. In this way, our colleagues might discover what we’ve known all along — the meaning at the heart of “meaningful use.”


But such radical ideas tug at the roots of precepts that anchor the medical profession, namely the Hippocratic writings. We’ve all been to medical school. We’re familiar with aphorisms such as, “it is more important to know the patient who has the disease than the disease the patient has.” I dare not contradict Hippocrates, but medicine has advanced over the past 2,500 years. An ICD-10 diagnostic code exists for the craziest stuff, like “Spacecraft crash injuring occupant, initial encounter,” but you won’t find a code for restoring the imbalance of the four humors.

No disrespect to Hippocrates, after all, he’s famously the father of western medicine. But when it comes to the challenges in our modern age, he risks appearing as a deadbeat dad.


The most important element in the care of our patients in 2015 is documentation. If we don’t represent the patient in the EMR, the patient doesn’t exist. If not documented appropriately, a skilled and expert physical exam never happened, and intimate conversations with a patient or family become figments of our imaginations. We don’t get paid if the coders can’t play the coding game, and where do they play that game — on the field of the EMR.


The EMR holds the heart, lungs and soul of medicine. In a better world, we wouldn’t need lobbyists to fight for EMRpathy, but my own story speaks to the challenges before us.


My personal journey almost ended at the login page. Ten hours of formal training outside of my hectic clinical schedule, followed by thirty hours on my own time practicing and cursing the system. Like you, I screamed in my sleep, woke up dripping in sweat. I went to a dark place, seriously chewed on the idea of a professional reboot out of clinical medicine, the profession I loved.


But during one ER shift, I asked the EMR representative why most EMRs seemed designed by medical students who graduated last in their class. Why couldn’t the EMR be more user-friendly, intuitive and ready to go out of the box? She listened with unflappable calm, blew a thread of chestnut hair that had drifted over her eye. “Let’s explore,” she said, beaming, and clicked through each busy screen like an astronomer canvassing a night sky. “Take a seat,” she said. “But before logging in, I want you to contemplate the important relationships in your life, your family, and close friends. Were they always smooth sailing? Of course not. If marriage requires work, why wouldn’t your relationship with the EMR, who you’ll be spending more time with than your wife, be any different?”


“But isn’t empathy with the user a fundamental principle of design thinking?” I said. “Because I don’t feel the love.”

“Didn’t Hippocrates say the patient comes first?” she said.

“But this system doesn’t put the patient first, either.”

“It puts their chart first,” she said. “If Hippocrates had to document on his patients, he wouldn’t have had time to write what he did.”

That revelation struck me in the head like a dropdown menu. Resentment won’t make the EMR better, only patience and EMRpathy.  Imagine Hippocrates working as an ER physician in 2015. He would be stomping around the trauma room in clogs, grumbling and scratching under the collar of his scrub top. Why? His Press Ganey surveys were riddled with patient comments about his sandals and tunic.


Physicians complain about the utility of such patient satisfaction scores, especially when it’s tied to their reimbursement, and I must confess that I agree with them on this point. Does it make sense to evaluate and compensate physicians on our interactions with patients when medical practice is now about the Doctor-EMR relationship? Studies show that ER physicians spend twice as much time with the EMR than with their patients, and that’s high touch intimacy, with over 4,000 mouse clicks in a busy 10-hour shift. Who touches patients 4,000 times in a shift?


Physicians lament how EMRs keep them away from the bedside of their patients. But the bedside is vanishing, too. Through telemedicine, patients  exist on the screen, not sitting on a stretcher before us. No bedside to sit at. Nobody to examine. And with no body to examine, we point to the physical exam, and it looks very different. Despite the evolving state of the clinical encounter — bedside or screen — our patients’ digital symptoms are seamlessly melded with orders and decision-making and preserved as one in the EMR.


Hippocrates still breathes, only it’s Hippocrates 2.0. We’re creating a digital life. Physicians must turn their gaze to the EMR with eyes wide open and appreciate the EMR as another respected colleague.

Corporations are considered people, so why not EMRs? The EMRpathy orderset asks physicians to be sensitive to the EMR’s feelings and point of view. Medical schools must recognize EMR disparities and develop curricula in EMR cultural competency. Reading literature that ventures beyond the people-centric canon would mark a solid first step in changing the culture. It will take time. But if we teach and champion effectively, the next generation of physicians won’t flinch at each honk and hard stop, or respond rudely to the dialogue boxes insisting on conversation. They’ll accept documentation as a quest. They’ll understand that our response to obstacles defines our character as individuals and physicians.


What can you do right now? Acknowledge our keyboard intimacy, that our fingertips know the personality of each key better than it ever recognized an enlarged spleen or an S3 heart sound. Tenderly welcome each click and greet each drop down menu as an invitation for friendship. Slow down and click. And click again. And click some more. Be present in the moment, these endless moments of great meaning.


I’m happy to take questions. But if you want to take the next ten minutes to catch up on the charts, honor them with my blessing.

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A better road to information interoperability?

A better road to information interoperability? | EHR and Health IT Consulting | Scoop.it

In the national discourse about interoperability, much of the focus is on enabling a doctor using one electronic health record to access patient information residing in a different hospital’s EHR, even when another vendor built it.


But is that really the best way to give doctors the data they need?

"Having the government mandate interoperability is completely wrong," JaeLynn Williams, president of 3M Health Information Systems, told me. "I think we should let the market drive it – and the market says physicians want a single workflow."


That workflow does not have to be directly in an electronic health record, either, and in all likelihood it won't be as the industry moves beyond its initial digitization and into what many are hailing as the post-EHR era, wherein new platforms come to market that enable clinicians to more effectively follow their patients.


If you picture the EHR as one piece of a software stack, rather than the entire application, these technologies are a layer of abstraction above the EHR and essentially reach down to get that data.


"That's what clinicians want. They don't care about interoperability," said Stuart Hochron, MD, chief medical officer at mobile collaboration platform maker Practice Unite. "They want the information."

Eclectic collective

I'm going to group a bunch of tools together, for simplicity's sake, and christen them as part of a new breed of software delivering that patient data. 


Practice Unite and 3M, with its workflow tools, are in there. Others include par8o, with its boldly-marketed "operating system for the entire healthcare industry," ExamMed's newly-minted "universal healthcare technology platform" and the TapCloud smartphone app, which the company calls "a powerful overlay to an EHR."


Overlay. That's the operative word and, indeed, while ExamMed and par8o are more about reaching and tracking patients they also, for lack of a better term, overlay EHRs and other software systems.

It's important to explain that, rather than being direct competitors, these vendors are a representation of emerging technologies that more closely tie clinicians with patients in a way where all parties have access to relevant data. Hospitals could implement and use two or more of them. And they are just a few of the countless innovators coming to market.


Make no mistake: None of these are going to take over the world and solve today's existing interoperability issues alone. Instead, what they have the potential to do is create pockets of interoperability that might not get us to the Holy Grail of any doctor being able to see all the records of any patient – but might land us somewhere close enough. 


Take par8o, for instance. Lancaster Regional Medical Center is using the platform on top of multiple vendors' EHRs from triage to tracking patients' next steps in care outside its own facilities, according to Lancaster Regional CEO Russell Baxley, to essentially tie together various providers in the area with specialists, patients and payers. Other par8o customers such as MGM Resorts and Mt. Sinai in New York also have the potential to enable wide regions of information interoperability.

An industry misguided?

The Office of the National Coordinator for Health IT is at the epicenter of all this. Its 10-year roadmap to interoperability ambitiously aims for the end point of a learning health system – which is, in my opinion, a noble goal and one worthy of the federal government's efforts.

  

But not everyone will agree with me on that, of course. When I asked Williams if she thinks that the government should back off its efforts to drive standards that fuel interoperability, she cut to the chase: "I would say 'yes.' We're relying too much on standards."

Baxley didn't pull punches either.


"I think we played it out all wrong to get to where we need to be. There's nothing pushing anybody toward true interoperability," he said. "The incentives and the penalties are placed on the wrong people. The only way we'll have true interoperability is when the penalties are placed on the EHR providers and bonuses offered for those vendors to make their systems interoperable."

Inching closer

This new crop of platforms won't supplant ONC's work, of course, but they could soar right on by.


"The ability to capture data selectively and share it opportunistically in ways that empower the clinician will surpass any plans to create huge data warehouses and EHR-to-EHR interoperability," predicted par8o co-founder Adam Sharp, MD. 


Indeed, as more and more pockets of interoperability expand outward, we inch ever closer to that broad-accessibility of data that so-called interoperability promises. But will that be close enough to nationwide interoperability to affect the care delivery improvements we all want?

"I think regions are good enough," 3M's Williams said. "We have pieces of interoperability that exist right now. I believe that we are a lot closer than we think."

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Health and Electronic Security

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

The rapid adoption of electronic health records (“EHR”) and other new technology in healthcare has resulted in the introduction of serious security threats. Numerous stories and reports have made it clear that hackers, criminals and others view the healthcare industry as a ripe target due to security vulnerabilities. This issue is exacerbated by the high value placed upon medical records in the black market.


The question that many are asking is was all of the money spent on acquiring EHRs misspent now that security flaws or issues are popping up with such frequency. Namely is healthcare throwing good money after bad. To some degree it may be a misplaced accusation. Any adoption of newer technologies will lead to issues, including exploitation of flaws that may not be expected. Unfortunately, it is also likely that bad actors will be ahead of the field when it comes to finding weaknesses or ways to get at data. Such a scenario should be viewed as an inherent risk in implementing technology. That being said, it is likely an unavoidable risk in this day and age. It is simply too difficult and against expectations to remain on the digital sidelines.


The increase in attacks against healthcare entities should appropriately raise alarm bells and spur action. Medical information is very sensitive on many levels and needs to be protected. One place to look for a solution is HIPAA. As is well-known, the HIPAA Security Rule sets standards for protecting health information. The technical, physical, and administrative safeguards define certain minimum standards to follow. In the current day and age though, the HIPAA standards by themselves are probably not enough. From this perspective, it is important to remember that HIPAA only sets a floor, not a ceiling. Best practices may well require actions beyond those proscribed by HIPAA. The healthcare industry needs to evolve and adapt to new realities.


The speed with which adaptation can occur will dictate how secure medical information remains. While much money was and is being spent in connection with new digital and technological solutions, the expense is not going to end as long as threats remain. Technology takes investment, time and attention, all of which are ongoing and recurring obligations.

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Preventing Physician Burnout

Preventing Physician Burnout | EHR and Health IT Consulting | Scoop.it

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).


Follow these five steps to significantly improve your work-life imbalance:


1. Identify the five to eight most important aspects of your life (what you value most).


2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).


3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.


4. Plan your time so that you are focused on what you value most.


5. Determine what can be delegated to others.


Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.


So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).


Follow these simple brain-training steps to increase your positivity:


1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.


2. Challenge your negative (typically distorted) thinking, the most common of which are:


• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.


• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.


• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.


• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.


• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.


Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

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Complete independence for a small practice today is unwise

Complete independence for a small practice today is unwise | EHR and Health IT Consulting | Scoop.it

Momentum remains in favor the flow of physicians to employed positions. Is this wisest path for physicians? That is unknown and likely depends upon the particular circumstance. Either way, independent physicians are an increasingly shrinking, yet curiously heterogeneous group. Independent practices vary in size, composition and philosophy. The impact of size (from solo to very large) and composition (primary or specialty care, single or multispecialty and physician demographics) is relatively straightforward, but the consequence of the practice philosophy may be a less obvious and more critical. Practices that wish to remain independent may need to reflect on what it means to be independent today.


Although the composition of the independent practice can cause some complexity, size may be an absolute barrier to survival. Small independent physician groups are quickly becoming an endangered species whereas larger independent practices may be better positioned to navigate the waters of health care today. Being completely independent may simply not possible for small groups (less than four physicians) and is becoming increasingly challenging for mid-size groups (4 to 8 physicians). Why is this the case? Here are a few reasons:

  • Inability to contract with managed care payors on own.
  • Inability to negotiate with vendors to keep expenses down.
  • Insufficient care management and care coordination infrastructure.
  • Inability to compete on convenience or patient experience.
  • Challenges relating to reporting and regulatory requirements.
  • High upfront and ongoing technology expenses.


Complete independence for a small practice dealing with the challenges today is at best, unwise. More strongly, one could conceivably argue that it is bordering on negligence. How can a solo practitioner for instance responsibly compete with sophisticated, well-funded, integrated systems in delivering the high quality, comprehensive patient care that is expected today? What about customer service? How loyal will their patients remain? Can the small independents stave off the convenience and access the retail clinics are offering? Single provider practices and small independents who are continuing to hold on to hope that they will survive, and health care reform will not affect them do so at their peril.


To weather the storm of health care reform and remain independent many small private practices have banded together to form independent practice associations (IPAs). Many successful IPAs have developed infrastructure for value-based contracting and have transformed into accountable care organizations (ACOs). But, what do we know about the independent practices that join these IPAs to maintain and maximize their autonomy? Will this strategy yield the outcome they seek? Are they really, truly independent? In many ways, yes.


Small independent practices may remain in charge of their own billing; they set their own compensation and benefit packages; have autonomy with human resources; flexibility around strategic practice decisions; and can more easily leave an IPA than they could an employed position. But, there are no free lunches. Independent practices that seek the shelter of an IPA must accept the movement towards value-based care. All physicians who wish to remain in practice must embrace the triple aim and endeavor to improve quality, enhance the patient experience and eliminate unnecessary cost from the system. Today physicians must grapple with reporting requirements related to quality measures, closing clinical care gaps, implementing and maintaining baseline IT connectivity for data exchange and working with other actors in the health care neighborhood in a more collaborative manner than ever before.


Physicians who believe they can opt into value-based contracts in order to realize value to their practice without a more significant, philosophical alignment with the triple aim and simply fly under the radar are sadly mistaken. This is a misconception that cannot be tolerated by a high achieving health care organization. Especially if the organization is looking to bring together disparate independent practices where an even higher bar of clinical integration is sought to satisfy the payers.


Participation in population health management through value-based contracts necessitates accountability that is shared by all stakeholders. Physicians must understand that they are accountable to the patients they serve; they are accountable the managed care payer partners, and they are accountable to each other. Poor performers, naysayers or laggards who underperform cannot be accepted if networks of independent physicians are going to be successful. Moreover, this will be counterproductive to their goal of realizing the positive returns successful performance can bring to their own practice and maintaining independence.


Networks all over the country have formed with the goal of bringing these remaining independent practices together for a shared purpose. Many of the independent networks will continue to do everything possible to educate and assist in facilitating successful behavioral and operational changes that yield positive results towards the collective best interest… but, in the end it is up to the individual physician practice to make a choice. What is more important, complete independence or survival?


Teamwork has become a common core value for successful health care organizations, and it is increasingly clear that health care is a team sport. The time has come for independent practices to embrace this, pick a partner and join a team. Many physician networks offer a great value proposition for independent practices that are realistic with their expectations. While physicians may no longer be able to achieve complete independence, as a sensible, viable path, with the right mindset there is still great opportunity in private practice if physicians can accept being almost independent.

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Hiring Health IT Professionals and Consultants

Hiring Health IT Professionals and Consultants | EHR and Health IT Consulting | Scoop.it

An ambulatory medical practice is a unique environment for information and technology. Several factors inherent in the health care community call for a specific level of competency in order to accurately install, maintain, and support technology. Where a standard small business or residential client might easily call in a local tech group or geek squad, the small to medium sized healthcare client should seek out professionals with specific knowledge of their unique needs. The following are tips to assist in hiring someone for your practice.

Five questions to ask a potential healthcare IT consultant:

Look for thoughtful and detailed answers to each of these questions. This quick evaluation will help identify which tech groups can provide knowledgeable guidance as you move your facility to a more technical infrastructure.

1) Do you have any certifications or support experience in healthcare specific technology?
2) What do you know about HIPAA compliance?
3) How familiar are you with EHR, EMR, or PM solutions?
4) Do you have any experience with or access to Medical Device connectivity?
5) What do you know about electronic vs. paper medical workflow?

Which specific Health IT skillsets do you really need to get started?

Not every practice needs the expertise of a high-level HIT consulting firm. Many agencies identifying themselves as "HIT Proficient" will provide services which exceed your immediate needs. In this case you may find that prices per hour or contract requirements are higher than expected.

To create your initial IT environment, you should seek out a group or individuals who identify themselves as providing technical expertise. Determine what areas you will need help such as:

  • Skilled IT Assessments - Assess what the practice has in place and what may be needed to be ready for an EHR.
  • Technology Consulting – Assisting in all aspects of implementation?
  • Hardware Selection – Assess what you have and what you will need to purchase or upgrade.
  • Hardware Quotes and Purchasing – Do you need help?
  • Hardware/Software Support and Systems Maintenance – Who will do this?
  • IT Installation and Upgrades – Will your new software require this? Who will do it?
  • Software User Training – Assess all users' basic skills.
  • EHR Solution and Software Selection – Review, demo, and get references on as many systems as you can.
  • Readiness and Workflow Assessments – Once a system has been purchased is you workflow aligned with the new technology?
  • Wired and Wireless Networking – Is your network HIPAA Compliant?
  • Offsite Backup and Storage – Who will do this?
  • Waiting Room/Patient Entertainment, Digital Signage and Media – Review and determine what is the right fit for the practice.
  • Remote Login Assistance and Prompt Phone Support (help desk) Line – Will you need this?

What should you expect from a good Health IT support group?

A good health information technology (HIT) group will focus on the unique needs of your medical environment. They will be tuned into your practice dynamics and look to fit the technology to your specialty, skillsets and personal goals. They should also be your partner in identifying ways to improve efficiencies – both relating to workflow and in terms of your budgeting needs. Any group encouraging you to dramatically change your flow of tasks or to spend more than are practical for your site and size should raise a red flag immediately.

In addition, you should feel that your consultant is your advocate. They should not be pressured by your EHR vendor, hospital, or manufacturers to persuade you in any on direction. Anyone receiving heavy incentives to steer you toward specific solutions, is a reseller, NOT a consultant.

Look for descriptive terms such as independent and agnostic to describe anyone you consider to give you guidance. The independent consultant can engage the services of a reseller, or many resellers, and can monitor the selection of best fit products and services knowledgeably on your behalf.

You should also expect a good consultant to oversee the entire IT infrastructure process. Making sure that all of the identified pieces fall into place at the right times for the right reasons. Ask for a clear project plan and timelines. Look for a checklist of executable goals. Steps identified and outlined with clear objectives will help you feel confident that each step is carefully planned, followed, and achievable.

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Four Ways to Increase Patient Portal Engagement

Four Ways to Increase Patient Portal Engagement | EHR and Health IT Consulting | Scoop.it

I had the pleasure of speaking at the semi-annual Practice Management Institute Conference this May.


Can you guess the biggest hurdle practices in attendance were facing? Patient portal engagement. So we talked, brainstormed, and shared insight on the topic. And here are some of the top ideas that came up with to increase portal engagement:


1. Direct patients to access return to work or school slips on the portal.

This tip even works for say general or orthopedic surgeons that see many patients one time — maybe — for follow up.


2. Get tablets and train on-site.

Have a staff member walk patients through signing into the portal and sending a message to the nursing staff, letting them know why they are in the clinic today. This is a great teaching moment for patients and can be done in the waiting area or exam rooms while patients are waiting to see the provider.


3. Promote it.

Most patients would find a portal quite useful, if they knew it was there, what it was, and how it benefits them. Make sure when marketing your portal that you are letting patients know they can send and receive messages from the staff, check lab results, and request refills without waiting for call backs.


4. Get the doctors in on it.

This works in two ways. First, have doctors talk with patients about it, even if it's simply letting them know when their prescription runs out they can request a refill via the portal or to check for their lab results. You can also have the physician ask patients to check for a message from the clinic to see how they are doing after the visit.

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Laurie Bolick Wolf's curator insight, June 19, 2015 1:29 PM

How to improve patient use of patient portals.  Suggestions listed here are great.  So many patients are not even aware that these portals exist, but would much prefer this kind of contact with their physicians.

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Larger Physician Groups Eye Cloud-Based EHRs

Larger Physician Groups Eye Cloud-Based EHRs | EHR and Health IT Consulting | Scoop.it

In January, the federal Centers for Medicare & Medicaid Services (CMS) rolled out a new fee schedule for providers taking care of patients with two or more chronic conditions. Within weeks, Privia Medical Group, a 310-provider multispecialty medical group based in Arlington, Va., had electronic health record (EHR) templates for the documentation and coding requirements as well as a 20-page tutorial with screen shots.


To Andrew Aronson, M.D., Privia’s chief medical officer, that responsiveness is one of the key reasons the group chose to work with the Watertown, Mass.-based athenahealth for its health information technology needs. “Any update or rollout of new information goes on behind the scenes and is pushed out to all our offices,” Aronson says. “It is released quickly and we are off to the races in implementing the new revenue stream. We are not driving a 4-year-old model car anymore. We are constantly driving the newest and coolest as far as technology goes.” He adds that having each physician office purchase and support its own hardware and EHR software is an “antiquated approach.”


Privia is not alone among midsize and large physician groups and independent practice associations in taking a second look at either an application service provider (ASP) remotely hosted EHR from a vendor such as eClinicalworks or a software-as-a-service (SaaS) model from vendors such as athenahealth or Practice Fusion. (The SaaS model involves a single, integrated database that is delivered as a service to multiple customers simultaneously via the Internet. In an ASP model, the EHR is delivered over a secure Internet connection but involves multiple separate instances of an application, and customers could be on different versions of the software.)


The Orem, Ut.-based KLAS Enterprises has done ambulatory EHR perception reports for almost 10 years, and has seen the pendulum gradually swing from almost no cloud adoption to much stronger interest, notes Erik Bermudez, a KLAS research director. “Ten years ago they would say if they got angry at their EHR, they felt better if they could kick a server in the basement,” he says. “They were at peace knowing it was all behind their four walls.” But that perception has gradually changed. Although many doctors may not understand the distinction between ASP and SaaS models, when KLAS has asked physicians about the umbrella term of remotely hosted EHRs, practices ranging up to 100 physicians are now open to it, he said, “although name recognition and a vendor’s size and reach continue to be important criteria for large practices. Practices with hundreds of physicians that have a CIO tend to have an interest in keeping data in-house,” he adds.


Concerns about data security might be misplaced, Kosiorek added. People tend to correlate moving records to another company as a point of fear. But security in the cloud provider’s environment is most likely better than in your own office, he says. Cloud-based systems have a vested interest in keeping things secure. If they have a breach, it will impact their reputation forever. “Small to medium-size practices have limited means to invest in security, so they are trusting their IT staff to have all the bases covered with security,” he said, “and the smaller the staff, the tougher that is to take on.”


Rodger Prong, executive director of Oakland Physician Network Services (OPNS) Inc., a 425-member Michigan independent physician organization, notes that many of its members are adopting the free (with advertising) or low-cost cloud-based Practice Fusion EHR.

“I had a lot of suspicion of this platform at first,” Prong admits. “I ignored it for two to three years. The old saying is you get what you pay for. But then I saw several positive independent surveys of doctors. What creates traction is what interferes with physicians the least,” he said. Prong said the process of migrating data to Practice Fusion from other EHRs has gone well.


The OPNS doctors using Practice Fusion have interfaces to an organization-wide registry and data warehouse. “We like the fact that they do enterprise-wide changes. It helps us not have downstream problems with interfaces,” he says.


Prong said that with some EHR vendors, interface costs are exorbitant. “If they don’t make enterprise-wide changes, then we have different versions out there and every time they change something for a doctor we wind up incurring additional cost to get the interface operational,” he says. “Practice Fusion gave us one price per interface for our entire group. We only pay them once and it works for everybody.”

You don’t see software in other industries developed in this client/server manner anymore. The mentality that the cloud is a new thing is curiously specific to healthcare. Derek Kosiorek

Some provider organizations decide to subscribe to remotely hosted EHRs to avoid costly hardware upgrades and IT personnel costs.  East Georgia HealthCare Center Inc., a federally qualified health center with nine facilities and 23 physicians, had been a customer of eClinicalWorks (eCW) for several years as part of the Georgia Primary Healthcare Association, which managed the software from an Atlanta data center. “As EHRs became more robust, and contained more information than we originally used them for, we started running out of resources,” says Herb Taylor, East Georgia’s IT director.


“Computing and processing speed started getting slow. So we could either spend a bunch of money on hardware upgrades or evaluate cloud-based options. We went with eCW in the cloud. It was a smart decision for us financially and with the IT staff we have.”


Taylor says that performance has improved dramatically.  “At the time we moved, a year ago, with 130 employees, we were averaging about 20-40 tickets a week about people experiencing slowness,” he says. “Now we get only a few tickets a month, and those are in the more rural sites and have more to do with latency with the Internet service provider.”


Taylor says the cloud offers him better disaster recovery protection than he previously had. “You as an individual provider won’t have funds to truly be redundant in a disaster situation,” he says. eCW is so big on a national scale it has sites in multiple locations, he added. The data is encrypted at rest and in transit. You gain the benefit of a larger-scale organization. He also keeps a storage-area network on site, so if there is a disruption, users could keep working and then upload data to eCW’s site later.


For Taylor, it all comes back to financial security. “You may be able to spend that $300,00 to $400,000 to get where you need to be this year, but where are you going to be in five or six years when it is time to upgrade all that hardware again? That was the big factor for me. No matter what happens, I am paying x amount of dollars to eCW. It was a no-brainer for us with 23 providers to pay the monthly fee,” he says.

Another physician group that recently signed a contract with athenahealth is Healthcare Network of Southwest Florida, which has 25 physicians and 250 staff members. In the next six months it will migrate from a GE Centricity system it has been using for the last several years.


Larry Allen, the organization’s chief information officer and vice president of information technology, was attracted by the fact that athenahealth can do 12 software upgrades a year. Like Privia’s Aronson, Allen talks about some of the advantages of the economies of scale a SaaS vendor can offer on the business side. “Let’s say an insurance carrier requires a modifier on an ICD-9 code. When they make that change, you see claims denied, and you have to go back in and reconcile and resubmit it,” he explains. “With athena, the first time any provider in their cloud has that denial, they flag it and put a business rule in the system so that the next time we code that, we would see an alert that this claim will likely be denied and a modifier code is required. And the claim gets successfully processed the first time.”


Allen said there are pros and cons to consider. “One of the advantages of having your own database is that you can make modifications to it that are unique to your group,” he says. On the other hand, with a cloud-based solution, the vendor can study EHR usability issues across all its practices and then make changes that impact all the practices at once, instead of single install of Epic, for example.


Privia’s Aronson says another advantage is that by studying keystroke click variations among Privia’s providers, athena can help its practices with work flow and train them how to become more efficient in terms of keystrokes. “We have 100 separate practices in our medical group. If they were all on disparate EHRs, we would have no idea what our benchmark was, or be able to compare one to another.”


Users also perceive a mobility benefit because they can access the EHR over the web, whether at home or working away from the office. “I can log onto athenanet anywhere I have web access, Aronson said. I don’t have to be in the office. That is huge for our providers. They want to get out of the office at the end of the day and finish their notes at home at night, and not have to go through virtual private networks,” he said.


MGMA’s Kosiorek says that one key challenge is working through contract language with the cloud service providers. “That is the biggest issue groups are going to have with cloud-based systems,” he says. “Who owns the data and what format you get it back in if the relationship ends? The contract has to be rock-solid about what happens to the data.”

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EHR Adoption Challenges Solved through Data Entry Transfer

EHR Adoption Challenges Solved through Data Entry Transfer | EHR and Health IT Consulting | Scoop.it

Once the HITECH Act was passed in 2009, EHR adoption and implementation of health IT systems grew tremendously over the coming years, as more providers began focusing on obtaining financial incentives from the Centers for Medicare & Medicaid Services (CMS) under the EHR Incentive Programs. While patient safety and quality of care has improved with the integration of computerized records, EHR adoption challenges have led to certain burdens among healthcare professionals.


From the potential for medical errors to a conceivably negative impact on the patient-doctor relationship, EHR adoption challenges will need to be addressed as healthcare facilities continue to implement computerized systems in order to qualify for the Medicare and Medicaid EHR Incentive Programs.


Fourteen experts from a wide background of organizations including Kaiser Permanente, Cerner Corporation, and Nextgen Healthcare put together a report to illustrate the future of EHR technology and how to overcome many common EHR adoption challenges. The report was published on behalf of the American Medical Informatics Association EHR 2020 Task Force.


Some of the “unintended clinical consequences” of EHR implementation has been the longer work hours required from the data entry around computerized patient records  and less time for physicians to communicate directly with their patients. Additionally, EHR interoperability has not grown across the medical sector as quickly as previously hoped. Health data exchange is lacking due to information blocking among providers and vendors alike.


The overall goal of the health IT industry is to develop an effective and interoperable health information exchange platform in which patients, providers, healthcare professionals, and public health agencies have ready access to key data. However, EHR adoption challenges have put up roadblocks toward meeting this goal.


The Task Force offers ten suggestions for improving on health IT systems and overcoming some common EHR adoption challenges. First, it is important to decrease the overall burden from a high amount of data entry on the physician. When it comes to diagnosis and treatment, the process of capturing data has fallen on the physician, but moving the data entry toward other members of the healthcare team or even patients themselves could prove beneficial.


“Clinicians remain uncertain regarding who can and cannot enter data into the record, placing a tremendous data entry burden on providers, the most expensive members of the care team,” the Task Force wrote in the report. “Clinician time is better spent diagnosing and treating the patient rather than charting. Regulatory guidance that stipulates that data may be populated by others on the care team including patients would reduce this burden.”


Another suggestion the Task Force offered is to include sound recording during a patient visit instead of manually entering information into the EHR system. When it comes to discussing medical history, conducting a basic physical exam, and giving patients advice, doctors would benefit from a sound recording instead of pure data entry.


By following the suggestions offered in the Task Force’s report, the healthcare sector should move forward in properly addressing some common EHR adoption challenges and paving the road toward a future of effective and interoperable health IT products.

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Tailored Physician EHR Use Necessary for Evolving Industry

Tailored Physician EHR Use Necessary for Evolving Industry | EHR and Health IT Consulting | Scoop.it

The healthcare industry is changing every day and new, revolutionary processes are continuing to affect patient care and population health outcomes. Whether it’s through patient-centered medical homes, accountable care organizations (ACOs), EHR adoption, or general improved care coordination, the medical sector is making some significant modifications toward better care. However, physician EHR use and implementation of health IT systems will likely depend upon the needs of each disparate medical facility.


Meaningful use requirements, for instance, will need to be flexible enough to ensure health IT platforms are useful and beneficial for differing healthcare providers. When integrating public comments into theStage 3 Meaningful Use final rules and the Stage 2 Meaningful Use modified rules, the Centers for Medicare & Medicaid Services (CMS) should consider the need for adaptable and flexible requirements that providers could customize to their interests.


The American Hospital Association’s President and CEO Rich Umbdenstock wrote in a brief the importance of removing obstacles and developing federal regulations that meet the needs of the healthcare industry. Both care coordination, reducing costs, and investing in physician EHR use are key objectives throughout the medical care market.


“It’s time for regulators to recognize the changing healthcare landscape and remove obstacles on the road to collaboration,” wrote AHA President Rick Umbdenstock. “Healthcare is changing; hospitals are changing; and regulations that block progress toward meeting patient demands and community expectations must change, too.”

Two areas within the healthcare industry that may need health IT customization are public health reporting and chronic disease management. The Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) along with the National Opinion Research Center (NORC) at the University of Chicago released a report titledPublic Health IT to Support Chronic Disease Control.


In efforts to focus more attention on the triple aim of healthcare, NORC determined that chronic diseases are the major medical cost drivers and most common conditions found among patients across the country. The report went over population health interventions and physician EHR use to exchange data with public health agencies in efforts to curb the further deterioration of chronic conditions.

In particular, physician EHR use can be applied toward addressing case management, social services, behavioral health, and public health services. Incorporating EHR systems will also lead to better collaboration and communication among multiple medical facilities and public health agencies.


“The capacity to collaborate and share data across health care, public health and other partners becomes important in the context of supporting public health core functions,” the report stated. “We see great potential for using electronic data shared between health care providers, governmental public health agencies and other community partners. However, our discussion and earlier research points to important barriers to effective coordination and data sharing to promote population health. These challenges range from the limited mandate for governmental public health agencies in relation to chronic disease, limited public health IT infrastructure and historic lack of coordination between governmental public health agencies and health care providers.”

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