EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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The Evolution of Enterprise Databases and EHR Interoperability

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

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

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

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

Dr. Donald Voltz

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

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

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

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

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

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

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

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

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



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Can True EHR Customization Help Physician Practices Survive?

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

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

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

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

Capable and cost-effective?

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

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

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

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

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

Diversity and true EHR customization rule

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Epic Systems Wins Big in “Best of KLAS” EHR Rankings

Epic Systems Wins Big in “Best of KLAS” EHR Rankings | EHR and Health IT Consulting | Scoop.it

Epic Systems Wins Big in “Best of KLAS” EHR Rankings

A number of Epic Systems products have achieved top marks in the annual Best of KLAS health IT and EHR rankings, including best overall physician practice vendor and best overall software suite in addition to other awards for acute care, ambulatory care, health information exchange (HIE) and patient portals.  The recognition signals a return to dominance for the health IT giant, which temporarily lost its top title to athenahealth in 2013.

“We are honored to be able to continue to work with talented healthcare providers to create the annual Best in KLAS report. Their feedback is beneficial as vendors strive for excellence,” said Adam Gale, CEO and president of KLAS Research in a news release announcing another winner, Phytel, which was named the top population heath management vendor. “We also look forward to expanding our global research initiative to evaluate additional products/services that impact both provider and vendor success.”

Other familiar names featured frequently in the latest report, including Impact Advisors, winner of the overall IT services firm category, Cerner Corporation for best small ambulatory EHR, and athenahealth for small and mid-sized practice management.  Epic, however, snagged the ribbon for large ambulatory practice management.

Accenture Health may be getting a few more phone calls in the next few months after being named best ICD-10 consulting firm, while Optum’s computer assisted coding (CAC) expertise won the category for the in-demand technology.  For clinical documentation improvement (CDI), another critical ICD-10 competency, KLAS awarded first prize to Navigant.

Overall, Epic received eleven recognitions from the independent research company, which indicates how deeply and widely the company has been able to integrate itself into the healthcare industry’s IT needs.  In contrast, Cerner received three nods and athenahealth bagged two, while McKesson and MEDITECH had one apiece.  Last year, athenahealth had five honors to its name, with Chairman and CEO Jonathan Bush claiming that his company’s victory over Epic for ultimate prize was a triumph of “nimble, innovative models” over the “old guard of HIT leaders.”

Putting aside Epic’s runaway dominance – and athenahealth’s slip from the spotlight this year – Bush may have been correct in saying that new contenders are challenging the big names that seemed so solidified in the early days of the EHR Incentive Programs.  The large number and diversity of winners shows that the marketplace continues to be fragmented, giving new companies a chance to offer the intuitive, user-friendly, feature-rich EHRs that healthcare organizations are clambering for.

With EHR replacement still a very strong force in the marketplace, vendors have a strong incentive to claw their way past their competitors onto EHR ranking lists that give them visibility and credibility in an environment of weary mistrust.

“We are all part of a community of care,” Gale said of the 2013 winners list. “From the vendors that provide services and advance healthcare technology, to KLAS, who produces insights on vendor performance, to the providers who administer care, our joint efforts can make a difference in the lives of the patients.”

“To the healthcare providers, your effort to be heard and counted is critical. It is your voice, amplified by KLAS, that can drive improvements to healthcare technology and services. To the healthcare vendors who diligently seek to align with provider needs, we thank you for your unwavering determination to deliver excellence with passion. We commend your efforts to truly be Best in KLAS.”


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