EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Do Health IT Systems Need Greater Interoperability?

Do Health IT Systems Need Greater Interoperability? | EHR and Health IT Consulting | Scoop.it

The medical sector is aimed at reaching the triple aim of healthcare by incorporating health IT systems and EHR technology. The triple aim focuses on improving patient care, lowering medical costs, and boosting population health outcomes.


In a Health Affairs Blog, National Coordinator for Health IT Karen B. DeSalvo discusses the landscape of information technology in the medical space.  DeSalvo emphasizes the need for interoperability among health IT systems and mentioned how the Office of the National Coordinator for Health IT (ONC) is developing new implementation standards. Additionally, the need for privacy and security of patient data is also asserted by DeSalvo.


The sharing of patient data through health IT systems has been a major focus for the healthcare industry over the last year. To improve EHR interoperability, ONC has listened to the health IT community to develop a roadmap for establishing strategies and opportunities to move the country toward greater health data exchange.


DeSalvo has participated in many listening sessions across the country and learned about certain issues that harm the interoperability of health IT systems and plague hospitals and providers. Rural communities in Alabama, for instance, do not have full broadband access while bordering state privacy laws in New Jersey block medical data exchange. The overall essence of DeSalvo’s discussion revolves around the importance of interoperability among health IT systems.


“I also listened to my own experiences — as a doctor, as a daughter, and as a consumer,” DeSalvo stated. “I thought of countless patients whom I have seen and those I continue to see when I am in clinic. Of visits where I did not have the information needed to make a decision that day, requiring patients to return and miss work, school, or other obligations. Of patients who want to engage and feel empowered but need not only data, but information, to help them level the playing field, to allow them to meaningfully engage.”


“Of being a caregiver for a mother dying of dementia and being frustrated at just how hard it was to get access to the information I needed to help her. And, as a public health advocate and official, needing information about my community to prioritize resources to help them address the broad determinants of health,” said DeSalvo.

Over the last six years since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, the healthcare industry has gone forward with meeting many of the goals ONC established such as widespread implementation of EHRs and health IT systems. More and more eligible providers began meeting meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs.


While these achievements are impressive, DeSalvo mentions the need to digitalize “the care experience across the entire care continuum” and gain “true interoperability.” ONC is currently working on a plan for both public and private sectors to gain interoperability. The next step for ONC and the healthcare industry is to go beyond meaningful use and EHR implementation in order to truly bring better health for patients across the country.


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The Evolution of Enterprise Databases and EHR Interoperability

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

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

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

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

Dr. Donald Voltz

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

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

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

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

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

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

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

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

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



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Important Features For Your Practice Computers

Important Features For Your Practice Computers | EHR and Health IT Consulting | Scoop.it

Medical computers are an essential element of the modern health care system. They help increase efficiency in every setting from the front office to exam rooms, surgery, and radiology departments. Choosing computers for your practice is an important task, so here are some features to look for:


Sanitation Promoting Features


A clean environment is indisputable in health care facilities, and a critical component of a medical grade computer is their ability to support one. Hygiene-promoting features on your practice computers should include the following:


  • Sealed enclosure resistant to liquid and can be cleaned with disinfectant.
  • Antimicrobial coating on keyboards and monitors or all-in-one computers.
  • Fanless design to reduce dirt accumulation in the system and dust from circulating.
  • Minimal crevices that are potential homes for bacteria.


Mobility and Accessibility


When medical computers are mobile and accessible, health care organizations can save time, money and improve patient care. Nurses and doctors can bring computers with them on patient rounds or during check-in. This accessibility in medical computers lets doctors and nurses focus on patients, not hardware, during appointments. Look for computers that fit into a variety of settings, whether they can be placed on wall mounts, medical carts or nursing stations. VESA mountable computers are the preferred industry standard. The medical computer supplier you choose should offer assistance in installing your computers where you need them. Also, check for an internal lithium battery that allows for mobility without interrupting data management.

Touchscreens are another significant option that lets caregivers focus on patients. When they are easy to use, caregivers can easily enter data and interact with the computer, while still giving attention to patients. Medical Computer touchscreens are also more hygienic since they can come with an antibacterial coating.


Administrative Tools


A high performing and efficient hospital or clinic has central coordination, and medical grade computers reinforce this. With medical grade computers, administrative staff can enter and edit a patient’s medical, insurance and billing information in a patient environment. Each computer on the network should have access to this information, with a setup that allows for HIPAA compliance. Elimination of redundant inputs, reduction of errors and the switch to electronic rather than paper billings all save costs.


Low-Cost Installation


While changing to a medical computer system or getting an overhaul of your current system will undoubtedly involve some expense, you can minimize it in a few ways. One is by choosing a system compatible with as much of your existing systems as possible. For example, inquire about the extent of inputs and outputs that would be necessary with a new system; you may be able to make use of parts of your current system and thus save trouble and money from redundant equipment purchases.


Another way to reduce the initial investment cost is to consider the time and resources required to get doctors and other employees able to operate the system. First, software should be easy to use. Look for medical grade computers that support your preferred software programs or that come with new software that is simple to learn. Insist on getting a free trial before committing to a purchase.

Second, be sure to train employees before your upgrade is complete. Extra time from tutorials is expensive to a hospital or clinic, so find out how long it typically takes for users to master the system. If possible, purchase your medical computers from a company that provides follow-up support..


Cloud-Based Systems


Your practice computers need to be compatible with the cloud. As recently explained on this site, 96 percent of health care organizations are using or considering the cloud. Those who do can hope for average cost savings of 20 percent each year.


Using the cloud has additional advantages over cost savings. It allows for unlimited storage and frequent backups. Also, storage on a remote server rather than a large server on site prevents the risk of losing data in case of a flood, fire, etc. Check for a computer with EN/UL 60601 medical certification with which protects against power surges, failures and improves on-site safety.


A quality medical grade computer has a number of important characteristics that allow for reduced costs and upgraded patient care. Keep a list of necessary features in mind when you shop for your new computer or system, and your health care organization may soon see benefits.


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