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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NYC Hospitals Face Massive Problems With Epic Install

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

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.

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.!

Adopting Physicians

Adopting Physicians | EHR and Health IT Consulting |

I have been going to my family practitioner for years. During these visits I have been able to witness the devolution of the EMR. One thing I really enjoyed about him when we first met was how excited he was about his home grown EMR. He navigated quickly through it and dictated his notes. Then a few years later his affiliated hospital decided to standardize on an EMR. He had to give up his system and adopt to a new one. It was not ideal, and he would tell me all about his challenges, but he was able to use dictation and he completed his notes efficiently. Over time I noticed that his office fell into a nice routine and he could retrieve all the information he needed and dictate notes and orders quickly.  

It had been a year since I had seen him and I called for an appointment. I had to provide all my information and none of my insurance information was in the system. You guessed it, they updated their practice management system and EMR. My patient experience went downhill from there. My previous clinical history was archived and not incorporated into the new EMR. So no trending, no real history. Years of electronic, discrete data now converted to a static view only. It is like having your EMR converted to paper, then scanned.

My provider was frazzled, I could tell the way he focused on my encounter and then had to “hunt and pick” his way around the new EMR. No microphone, no dictation, and no customized templates. He confided to me how the hospital system decided to migrate all their physicians to this new ASP platform and they all had to use the same templates. There was no dictation and even if he could, his old profiles were gone, meaning that he would have to retrain the system to recognize special words and speech patterns. Something that he had spent years investing in. Here he was working for a large healthcare organization and they would not use time proven physician adoption strategies. Instead they adopted physicians into whatever their leadership felt was needed.   

My scenario is being played out through many healthcare organizations. EMR’s are being replaced because of vendor problems, healthcare acquisitions or just because they have outgrown the capabilities of the existing systems. So why are CIO’s allowing their organizations to use a “slash and burn” technique for system replacement? An even more alarming question is; why are CMIO’s not making a stand against it?   

During the sales process EHR vendors focus on their ability to quickly install and train employees on the new system. Organizational leadership views this as an opportunity to get this “information technology” project out of the way so they can move on to the next thing. They might even have this labeled as a Strategic Initiative, tied to bonuses for on time completion.

 The thought of having to deal with all the physician requirements and pay for the process of converting all the old data into the new system, is too daunting. Especially when you have software vendors telling them how difficult and costly it will be. Keep in mind that they have a vested interest in getting the system installed as quickly as possible.

I am certainly not going to talk about physician adoption. This has been the topic of just about every HIMSS conference. It also has been at the core of every EMR adoption strategy. So why are we having to visit this again? Because:

  • Organizations are focused on project life cycles and fail to factor impact to productivity.
  • Hospital leaders often do not understand ambulatory practice operations.
  • Leadership incentives are designed to accomplish quick wins.
  • CEO’s still do not understand the value of discrete data.

As my family physician entered information into my problem list, medication history (which I had to bring with me from Walgreens for my visit) and reviewed my labs (toggling back and forth trying to find scanned images of my previous lab values) I started to get annoyed. Not at him, but at the hospital leadership that placed more importance on their performance appraisals and ignored the impact they would have on thousands of patients. My data which my healthcare provider and I built for years was now relegated to view only files which could now be printed like a pdf. I am sure on a macro level they could trend on the population as a whole, but I have to rebuild my record, history and trends all over again.   

Hospitals focus on episodes of care. Billing is all about the bed stay and the admission timeframe. For ambulatory care it is a longitudinal record. It is all about establishing that long term relationship with the patient. Providers can go months or years without seeing a patient, but are expected to jump into the exam room with a smile, a look of recognition, and an understanding of the patient’s history without having to ask all the same questions all over again.

As an industry we need to do a better job at safeguarding our patient’s records in a way that will allow them to have seamless transitions from one system to the next. Converting data to static views is not only counterproductive, but borderline irresponsible. My personal physician was an EMR champion that loved the technology because of what he could do for his patients. At the end of the day, that’s how it should be for all of us.

No comment yet.!

Solving Medical Practice Problems Post-Tech Adoption

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

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.


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.


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. 


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."


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. 


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."


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

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

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector!

ICD-10: CMS won't deny claims for first year

ICD-10: CMS won't deny claims for first year | EHR and Health IT Consulting |

In a surprise concession, the Centers for Medicare & Medicaid Services announced Monday that it would work with the American Medical Association on four steps designed to ease the transition to ICD-10.

Despite longtime disagreements on the topic, CMS will now adopt suggestions made by none other than the AMA with regard to the code set conversion. Those changes concern:

1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family," CMS officials wrote in a guidance document.

2. Quality reporting and other penalties. "For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."

3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.

4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, "to help receive and triage physician and provider issues." The center will also "identify and initiate"resolution of issues caused by the new code sets, officials added. 

"These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change," wrote Stack.

While AMA played a pivotal role in bringing about these CMS concessions, it was not the only party calling for a smoother conversion to the new code set.

Some members of the U.S. Congress have publicly suggested a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that "a valid ICD-10 code will be required on all claims starting Oct. 1, 2015."

So as things stand today, providers have to use ICD-10 come October – but CMS will be more flexible about denials and payments than it has previously suggested it would be.

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Meaningful Use Program: Why it failed and how to save it

Meaningful Use Program: Why it failed and how to save it | EHR and Health IT Consulting |

Given the "epidemic of waste [that] blights the U.S. health care delivery system," investment in health care information technology systems is a no-brainer. After all, doesn't the magic wand of IT improve the efficiency of every industry it touches? Congress thought so, and, as a result, in 2009, it allocated $20.6 billion as part of the American Recovery and Reinvestment Act to encourage doctors and hospitals to adopt and use IT systems and migrate from their old paper records to the new electronic health record systems. 

Meaningful Use program

To decide who qualifies for these generous incentives, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services, designed a set of criteria called meaningful use, a three-stage compliance program that requires providers show they're using electronic health records in measurable ways. To receive the financial incentives, doctors and hospitals must attest to reaching different stages of meaningful use.

The first stage of the program was designed to drive medical providers to adopt the records. As long as the government was willing to pick up the tab, doctors were willing to buy fancy electronic health record software and not worry about using it. Electronic health record vendors enjoyed an artificial market created by the billions of dollars of incentives included in the Recovery Act's Health Information Technology for Economic and Clinical Health Act. The majority of providers successfully attested to this first stage and as a result, record adoption rates skyrocketed.

Why the second stage failed

Now that everyone had electronic records, the next stage of the program had to logically focus on using this technology. Unsurprisingly, the second stage was not welcomed in the medical community. As of February 2015, roughly a quarter of physicians had complied with the requirements of this stage. Despite the lackluster results of the second stage of the program, HHS has already proposed the rules for the third stage, which is primarily focused on health information exchange among providers. While my own research documents huge benefits of exchanging health information, I believe that before implementing more complicated rules and regulations, we should have a clear understanding of the reasons for which the second stage of the program has failed. Without learning from the past, the future will not be brighter.

Although policymakers' hunch about the benefits of IT was correct, it failed to understand a nuanced condition under which this magic wand works: organic and voluntary adoption. Imposing these records on the medical community and forcing them to adopt and use this technology was destined to fail. Meaningful use is focused on adoption and use of electronic records as the final goal, which misses the whole point: that IT in health care, just like in any other industry, is a means to achieve the actual goal of efficiency. More importantly, meaningful use considers electronic health records as the only type of IT solution and ignores the fact that there are many other IT services that can help medical providers much more. The "one-size-fits-all approach," as American Medical Association President Steven Stack put it, of meaningful use ignores the differences between physicians and incorrectly assumes that medical care is mass-produced in the same way by all physicians and thus only one IT solution best addresses the unique needs of many different types of medical providers.

Policy recommendations

Meaningful use should have been integrated with the capitated payment models, in which the medical providers are paid a fixed amount per patient and are rather encouraged to provide the best care at the lowest cost. The need to cut costs and increase quality would have driven medical providers to adopt a wide variety of IT solutions that specifically address their unique needs. HHS should have set efficiency as a goal and let medical practices to find out the best way to achieve it through health care IT of their choosing. Instead of mandating physicians to record the smoking statuses and vital signs of all patients, send them reminders about their follow-up visits, and communicate with them through secure electronic messages, meaningful use incentives could have been allocated to fund a wide variety of different IT solutions suggested by medical providers.

Using a small part of the incentives now used for meaningful use compliance, we can run a pilot project and test this idea. HHS should call for proposals for IT projects that each provider, based on its own unique characteristics, deems the best way to cut costs and increase quality. Just like research grants, these proposals can then be evaluated by a panel of experts and funded only if approved. This approach will open up the market for meaningful and innovative IT solutions that actually help medical providers improve their efficiency.

Rather than being stuck with electronic health records as the only IT solution, we can have a national lab in which the performance of many different IT solutions will be tested. Medical providers will find their best way to be more efficient and will adopt the IT solutions that best fits their needs organically and voluntarily. Only then IT will work its magic in the health care sector.

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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 |

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 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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4 Signs Your Agency Needs EHR Software

4 Signs Your Agency Needs EHR Software | EHR and Health IT Consulting |

Tens years ago, electronic health records seemed like a luxury for medical practices, but today, making the leap to EHR is more of a necessity. Healthcare reform is changing the way the medical community does business and switching to digital records is part of the process. The first generation of EHR software was problematic and cumbersome, but the modern versions offer real advantages to both patients and staff. Consider four reasons it is past time to get EHR software.

1. Inefficient Audit Trails

Whether you are attesting for meaningful use incentives and Medicare payments or going through a routine accounting audit, proper EHR software makes the process that much cleaner. Without EHR, there is no possibility of getting federal incentives, but the auditing benefits do not stop there.

Electronic record systems automate everything from billing to scheduling to general accounting processes. This means more accurate billing with proper coding – with ICD-10 on the horizon, coding will only get more complex, too. When tax time comes around, you have all the documentation necessary to file effortlessly.

EHR opens the lines of communication with insurance companies and federal agencies. When filing a claim or facing a request for repayment, you have a digital record necessary to prove your case.

2. Poor Productivity

EHR software is critical to improving staff performance, as well as the patient’s view of the medical service. A national survey of doctors found that after implementing EHR:

  • The practice functioned more efficiently
  • They could improve staff and stakeholder recruiting
  • It fostered better patient relationships

The little things like not having to hand write notes or prescriptions add up to more time with patients.

EHR improves scheduling by linking appointments directly to patient records and creates communication shortcuts for labs and consultations. Essentially, the workflow of the practice was better with electronic health records.

3. Wasted Space

Physical record storage wastes space that could be used for more practical and revenue-generating purposes. With EHR, you eliminate the need for paper records, opening up that storage area for new exam rooms, imaging equipment or to add another specialty to the practice.

With EHR, physicians can access patient information remotely, as well, making telemedicine a practical option. A doctor is available to answer staff or patient questions whether standing in line at the grocery store or doing rounds at the hospital, because he or she can see the patient records outside of the central storage area. That type of flexibility translates to better patient service and care.

4. Excessive Operating Expenses

An EHR system adds to the bottom line. Paper-driven systems are labor intensive. With the implementation of electronic health records, the agency no longer needs to pay filing clerks to pull and store charts, for example. There is no need to purchase or maintain elaborate retention and retrieval systems.

Other cost saving benefits of EHR include:

  • Reduced transcription costs – physicians and staff do updates as they go instead of dictating notes to be transcribed later
  • Improved reimbursements due to more accurate coding and better documentation
  • Lower risk of medical errors due to missing chart information – with a paper chart critical information like allergies can be misfiled
  • Enhanced wellness care and patient education opportunities – this is especially critical with the new healthcare reform practices focusing on quality not quantity. Practices are not getting paid for services rendered anymore, but for better patient outcomes. This is a factor for patients with chronic illnesses like heart disease or diabetes.

What does EHR bring to the table? Efficiency, productivity, better patient care and cost savings – all essential for agency success.

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Some Methods For Improving EMR Alerts

Some Methods For Improving EMR Alerts | EHR and Health IT Consulting |

A new study appearing in the Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.

Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.

Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.

The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.

For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.

While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:

  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.

The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.

When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.

The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.

But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

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Navigating the Complex Translations from ICD-9 to ICD-10

Navigating the Complex Translations from ICD-9 to ICD-10 | EHR and Health IT Consulting |

Changes in how medical diagnoses are coded under ICD-10 may complicate the financial analysis, research projects and training programs that depend on look-back comparisons of healthcare data, according to researchers at the University of Illinois at Chicago (UIC). The report, a collaboration of researchers at UIC and at the University of Arizona, is also online in the Journal of the American Medical Informatics Association (JAMIA).

To this end, Andrew Boyd, M.D., assistant professor of biomedical and health information sciences at UIC and first author of the paper, and his health information science colleagues, have been looking at issues that could come up as physicians and hospitals change from one system to the other. Previously they found that some ICD-9 codes map well to ICD-10, but many more have highly convoluted mappings, and some don’t map at all. This forward-mapping is needed for continuing payments of ongoing medical conditions, Boyd says.

Boyd has been leading the charge in tackling this mapping issue for the last few years. In 2013, UIC researchers found that 60 percent of the ICD-9 codes are “non-entangled motifs,” which would map without discontinuity and should be immediately interpretable. However, it’s those remaining convoluted codes, which accounted for 36 percent of the codes the researchers looked at, which could cause problems.  In one study, where the researchers looked at 24,008 clinical encounters in 217 emergency departments, 27 percent of the costs were associated with convoluted diagnoses.

And last year, Boyd and other UIC researchers looked at the coding ambiguity for hematology-oncology diagnoses to anticipate the challenges all providers may face during the transition from ICD-9 to ICD-10. The researchers used a web-based tool, developed in house, to input the ICD-9 codes and translated them into ICD-10 codes. They looked at whether the translation made sense; whether a loss of clinical information occurred; and whether a loss of information had financial implications.

“Now, we are taking the same methodology and looking backward,” Boyd says. Reverse-mapping from ICD-10 back to ICD-9 will be important for all sorts of retrospective analyses, he says, “because we have 30 years of data that we want. We don’t want to lose all this information.” Clinical researchers and analysts conducting studies across datasets—and hospital administrators who manage growth and watch trends for strategic planning—will need to pull data under both the new and the old codes, he notes.

Boyd says while there is a huge educational burden on the industry in preparing for ICD-10, memorizing codes, and understanding what documentations are necessary for the new codes, his focus is on is what ICD-9 codes are currently used for in healthcare. “There are plenty of consultants and other companies for that other stuff. We have tried to focus on what reports can you run in ICD-10, and after you code, can you map backwards and run old reports in ICD-9 until you have enough ICD-9 data to make clinical decisions?” he says.  As such, Boyd says that organizations might not be able to run all of their reports meaningfully in ICD-10 until 2018. “Our focus has thus been on using the science of the network, the mathematical theories designed to help connecting networks to help find the hard parts or find the areas where the reports might not make sense. And you have to engage the clinicians to figure it out,” he says.

The aforementioned web portal tool and translation tables were created to provide guidance on ambiguous and complex translations and to reveal where analyses may be challenging or impossible. The tool lists all ICD-9-CM diagnosis codes related to the input of ICD-10-CM codes and classifies their level of complexity, which can be: one-to-one “identity,” or reciprocal, the simplest (28 percent of ICD-9 codes fall under this category); class-to-subclass (12 percent); subclass-to-class (22 percent); “convoluted” (36 percent); or “no mapping” (1 percent). “The healthcare system runs on data,” Boyd says. “We are fundamentally changing the way we record the data.” Although the new system will improve the way the data is sorted and recorded, he says integrating it with the last 30 years of information will be difficult.

The alternative to forward mapping, Boyd says, is to dually code in ICD-9 and ICD-10, a process that he says would double the cost of professional coding and double the time of physicians. “We have a $3 trillion dollar healthcare system, so not even all the big organizations will be able to code everything,” Boyd says. “Some will for internal purposes, but the cost is so huge to have everyone in the country do that.” As such, in the sense of mapping forward, Boyd says that it’s easier because you can map to the same general concepts. “Right now, for example, we say ‘ear infection’ in ICD-9,” he says. “You’ll have to specify right, left, or unspecified in the future. And if you map backwards you’re losing data. If you map forward, it maps forward to ‘unspecified ear infection,’ so at least you get the idea,” Boyd explains.

Boyd says that everything his team has done in this arena has been published online and is available for free use. They have created a tool where the user can create either the organization’s top 25 codes or 100 codes used in practice, and then the tool will give them a graphical output so the user can see how the codes are interrelated.

“Besides that, we also generate an online table so you can take that an incorporate it into your own reports,” Boyd says. “We also label the list of your own codes that you provide us into one of those five complexity categories. We have additionally created a separate online tool for when you’re in ICD-10; we provide the network backwards and we indentify the same categories,” he says. “All of this helps you understand the robust network in a comprehensive manner. We’re all in this together.  The idea is to reduce the costs and burden for everyone.”

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Three ICD-10 Work Flow Changes to Consider

Three ICD-10 Work Flow Changes to Consider | EHR and Health IT Consulting |

The first few months on the ICD-10 coding system are expected to cost both money and time. We all know how to prepare for the possible financial hit — be in as good financial shape as possible going in and have some money saved to cover any shortfalls. That might be a challenge, but at least you know what you need to do.

But you can't just put extra time in a savings account to tide you over when things get messy in October. Or can you? Actually, with a little creative scheduling and work flow management, you might be able to do just that.

Here are a few ideas to help you get started.

• During the first few months of ICD-10, your coders and the people in the business office are going to have all that they can handle getting used to the new coding system and dealing with the inevitable snafus. So, as best you can, arrange for them to have as little as possible to deal with that doesn't involve making the ICD-10 transition run smoothly. "Verify insurance and benefits eligibility at the scheduling call when at all possible, and also let the front office work the exceptions," recommended Elizabeth Woodcock, president of Woodcock and Associates practice management consulting firm. "If you aren't already doing this in the front office, this is a good time to start. Let the business office focus on billing and getting paid."

• Woodcock also recommended that you consider staffing up in preparation for the transition to ICD-10. "You may be able to delay a retirement or ask a previous employee to do some contract work for the few months surrounding ICD-10. And be prepared for some overtime," she said. Christine Lee, manager of provider practice services with Care Communications, a health information management consulting firm, suggested trying to shift to other employees anything billing staff normally does that doesn't relate directly to ICD-10. "In smaller organizations, people wear a lot of hats, so it might be feasible to switch responsibilities around a little bit. You might even consider hiring temporary outside help," she said. "It might mean spending more money, but the revenue saved by getting claims out faster and with fewer errors might make up for that."

• You might also be able to increase your coding efficiency (and success rate) by having what Lee calls "a designated clean up crew" to deal with lingering ICD-9 claims —depending on your turnaround time, this could take a couple of months. Not only would this be a more efficient way to structure the work flow, it could reduce errors as well. Lee recommended that even if you don't go as far as to have a team just for ICD-9 claims, you organize things so that coders don't have to switch codes sets more than once a day.

The transition to the ICD-10 coding system is "kind of like Y2K," joked Woodcock. And if you do a good job organizing your work flow before ICD-10 becomes a reality, it might be just as anticlimactic.

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Four Ways to Increase Patient Portal Engagement

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

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.

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.!

Clinical Quality Reporting Vital for Improved Patient Care

Clinical Quality Reporting Vital for Improved Patient Care | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) have announced that the 2015 annual updates to last year’s electronic clinical quality measures (eCQMs) have now been released. To view the latest version of the eCQMs and participate in clinical quality reporting, visit the electronic Clinical Quality Improvement (eCQI) Resource Center available through the ONC website.

Currently, there are 64 updated measures for eligible healthcare professionals and 29 updated measures for eligible hospitals. The National Quality Strategy (NQS) along with CMS and the Department of Health and Human Services (HHS) have developed these clinical quality measuresbased around six priorities. These are:

1) Patient and Family Engagement

2) Care Coordination

3) Patient Safety

4) Clinical Processes and Effectiveness

5) Population and Public Health

6) Efficient Utilization of Medical Resources

For eligible hospitals, the updated standards revolve around hearing screening, statin prescription during the discharge process, timeliness of hospital and emergency care, anticoagulation treatment for atrial fibrillation, rehabilitation, and thrombolytic therapy.

Healthcare providers will need to use these updated measures to electronically report data to CMS and its clinical quality reporting programs. These updated eCQMs will be part of the standards for reporting under the Medicare and Medicaid EHR Incentive Programs, Physician Quality Reporting System (PQRS), and the Inpatient Quality Reporting Program (IQR).

The Resource Center offers healthcare providers specification tables, documentation on Measure Logic Guidance, and resources for increasing quality improvements and supporting eCQMs. Via the CMS eCQM Library page, eligible professionals and hospital providers can view previously published specifications for 2014 eCQMs.

The reason eCQMs and clinical quality reporting is so important to healthcare providers is due to the impact it bears on financial reimbursement from either Medicare or Medicaid programs. According to aCMS brief about clinical quality reporting, providers who do not satisfactorily meet data reporting requirements on quality measures for Medicare Physician Fee Schedule (MPFS) will have negative payment adjustments put toward their medical practice.

“The quality programs grew out of two realizations: Health care is unsafe and outcomes are poor,” Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine, told The Wall Street Journal. “But there is no single measure of a doctor’s or hospital’s quality that will fix those problems. Instead, we’re measuring processes. Of the 123 different metrics in the government’s Hospital Compare website, 102 measure processes. That’s important, but it has become too burdensome for the benefit it delivers.”

“Quality should focus on the functional outcomes that mean the most to patients,” Wallace continued. “For a patient who got a knee replacement, can she walk and climb steps? For a man having prostate surgery, can we operate without causing incontinence and impotence?”

Essentially, quality metrics are important toward improving patient care and tracking patient health and functional outcomes across healthcare facilities and hospitals. In order to avoid negative payment adjustments from CMS and ensure quality improvements toward better care at one’s practice, providers are encouraged to follow the most updated eCQMs and participate in quality reporting programs.

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Seven ICD-10 Transition Steps Medical Coders Should Follow

Seven ICD-10 Transition Steps Medical Coders Should Follow | EHR and Health IT Consulting |

With only four months to go until October 1, healthcare providers who are behind in their implementation of the new diagnostic coding set need to follow specific ICD-10 transition steps to ensure success by the compliance deadline. From integrating new systems and upgrading technological processes to training staff on the new codes and testing the systems, providers will need to be ready by October 1 to ensure their healthcare reimbursement and revenue remains stable.

According to the Journal of AHIMA, coders especially have had difficulty moving toward the new ICD-10 codes, as the amount of responsibilities on their shoulders has risen drastically. When it comes to training and learning about the necessary ICD-10 transition steps, the funding for such activities is low and few resources are being put toward it within the healthcare industry at large, the Journal ofAHIMA reports.

“The budget is the paramount issue,” Anita C. Archer, CPC, Director of Regulatory and Compliance at Hayes Management Consulting, told the news source. “Providing funding for [physician practice] coders to attend training is a problem. There is a much better infrastructure on the HIM side.”

MeShawn Foster, another consultant on ICD-10 implementation, stated, “Based on what I’ve heard, some coders have had to use their own money for training and even their own paid time off to attend the training. With hospital coders, the training is available, and they don’t need to pay out of pocket. Justifying the cost of some of these conferences is hard for the physician coder.”

As the ICD-10 transition deadline comes near and providers only have four months to finish their preparation, physician practice coders are experiencing significant challenges in ensuring they can properly utilize ICD-10 codes in time, especially when it comes to their training.

Another complex challenge that physician practice coders will need to overcome is the management of the practice’s superbill, which requires patient demographics to be evaluated. Additionally, EHR templates will need to be updated as part of the key ICD-10 transition steps.

The Journal of AHIMA offered seven practical tips for providers to follow as they adhere to some common ICD-10 transition steps on their path toward the October 1 deadline. These tips are:

1) Become an expert on using the ICD-10 diagnostic codes.

2) Start at the beginning and convert only the top 20 ICD-9 codes to the new ICD-10 codes. This will prevent coders from becoming overwhelmed.

3) Set aside one to two hours for practicing dual-coding per week.

4) Network with other physician practice coders to reduce the costs of ICD-10 training.

5) Find a physician leader in larger medical practices to advocate for ICD-10 training and preparation on the coders’ behalf.

6) Offer ideas and opinions on template design along with template updating.

7) Schedule weekly meetings in order to discuss any and all ICD-10 implementation issues.

By following the seven tips above, physician practice coders will be on their way toward successfully transitioning toward the ICD-10 code set.

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How Should DoD Secure Health Records?

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

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 |

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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Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline?

Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline? | EHR and Health IT Consulting |

As the ICD-10 implementation deadline drew closer, more lawmakers began attempting to develop a different type of transition period in which healthcare providers would not be penalized for reporting inaccurate ICD-10 codes. For example, HR 2247, the ICD-TEN Act, would create a “safe harbor” for providers in which they wouldn’t be denied reimbursement “due solely to the use of an unspecified or inaccurate sub-code.” 

The Coalition for ICD-10 states that the Centers for Medicare & Medicaid Services (CMS) has often accepted less specific codes under ICD-9 and, when the ICD-10 implementation deadline hits, the new reporting requirements will have no difference in level of specificity.

“CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition,” the Coalition for ICD-10 explains. “Furthermore, it would be inappropriate and a violation of coding rules to require a level of specificity that is not documented in the medical record. Indeed, CMS has made it abundantly clear that it would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.”

Essentially, the ICD-TEN Act was proposed due to physician fears that there may be a significant increase in the number of claim denials once the ICD-10 implementation deadline takes effect.

However, the latest CMS end-to-end testing results show that there is only a 2 percent denial rate of claims due to ICD-10 errors. This shows that the physician fears may be unfounded.

According to the Coalition for ICD-10, a “safe harbor” transition period is not necessary and the current status of the ICD-10 implementation deadline should take effect on October 1 as is.

Additionally, CMS released its acknowledgement testing results taking place between June 1 and June 5. CMS accepted a total of 90 percent of claims submitted across the nation during this time period.

While a 10 percent denial rate is significant, CMS holds that the majority of claim rejections were due to submission errors within the testing environment that won’t affect the processing of claims when real claims are submitted after the ICD-10 implementation deadline.

It is time for providers to be ready for the ICD-10 implementation deadline or else risk having their claims rejected once October 1 hits. Any provider who submits ICD-9 codes after the deadline risks having the claims returned to their facility, returned as unprocessable, or rejected, according to apamphlet from CMS.

“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) stated at the end of 2014. ““This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS.”

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OIG Found Inaccurate EHR Incentive Payments in Arkansas

OIG Found Inaccurate EHR Incentive Payments in Arkansas | EHR and Health IT Consulting |

The Medicare and Medicaid EHR Incentive Programs were established to improve the quality of care, boost population health management initiatives, and reduce overall healthcare costs, which is known as the Triple Aim of Healthcare. With these goals in mind, it is important to track the progress of meaningful use requirements and EHR incentive payments throughout the healthcare industry.

The Office of the Inspector General (OIG) found a major flaw in the EHR incentive payments completed by the Arkansas Department of Human Services. A total of 14 hospitals received incorrect EHR incentive payments, which resulted in an overpayment of $1.2 million.

An OIG report states that the organization looked at EHR incentive payments among 20 of the highest paid hospitals from November 1, 2011 to June 30, 2013. It was found that the Arkansas Department of Human Services paid 20 hospitals more than $19 million, which covered 65 percent of the total amount paid between the time period of the audit.

“The State agency did not always pay EHR incentive program payments in accordance with Federal and State requirements,” the report stated. “The State agency made incorrect EHR incentive payments to 14 hospitals. Specifically, for 13 hospitals, the State agency made incorrect payments totaling $1,225,734.”

The Arkansas Department of Human Services caused these errors because the agency had foregone following federal requirements with regard to cost report data elements concerning EHR incentive payments. Additionally, the organization failed to review supporting documentation for figures available in the reports.

The OIG recommends several measures that the Arkansas Department of Human Services will need to follow. First, it is important to refund $79,428 to the federal government. Also, the agency will need to modify the EHR incentive payments across the hospitals that received incorrectly calculated disbursement.

Additionally, it is suggested that the Arkansas Department of Human Services review all payment calculations given to hospitals that were not part of the 20 hospitals within the audit. The organization will need to determine whether payment adjustments are needed.

“The State agency did not concur with the recommendation to refund the net overpayment of $79,428 but stated that the incentive payments for 8 of the 13 hospitals had already been adjusted in accordance with our finding,” the report states. “The State agency also stated that it expected the incentive payments for the other five hospitals to be adjusted in accordance with our findings. The State agency also did not concur with our recommendation to work with the one hospital for which the total incentive amount was set aside to recalculate the incentive payment using the June 2009 cost report data.”

The Office of the Inspector General plays a major role in ensuring that various medical organizations are sticking to federal and state mandates. Hospitals and other providers attesting to meaningful use requirements under the EHR Incentive Programs will also need to ensure all information submitted to federal and state agencies are accurate in order to receive EHR incentive payments.

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Have you hugged your EMR lately?

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

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 |

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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The Internet of Things: a $117B opportunity for Healthcare

The Internet of Things: a $117B opportunity for Healthcare | EHR and Health IT Consulting |

The Internet of Things, also known as IoT, will radically change the appearance of several industries, above all the healthcare. According to a recent post“The use of IoT is expected to grow fastest in healthcare over the next five years, to the tune of $117 billion by 2020”.

As we already noticed ‘New wearables are emerging rapidly This revolution is likely to create a huge impact on mhealth’.

Which are the areas where the use of IoT will reshape medical care?

Wearable technology

The easiest way of patient monitoring. Wearable technology gadgets are very popular at the time. They are able to monitor a vast range of health markers, such as brainwaves, breathing patterns, blood pressure, calories burned, footsteps, heart rhythms, physical position and balance, and temperature, to name just a few.

Wearables can also remind you, or you family, to take medication.


All you need is a mobile device. The Internet of Things, through the advancements in telemedicine, let healthcare professionals (HCPs) interact with patients virtually. In other words, physicians can ‘visit’ their patients always and everywhere, avoiding the travel time required to meet faraway patients.

According to Wired, “There are a lot of pros to telemedicine. Convenience is one. Access is another. Then there’s the immediacy of it, too.”

Medical device information system

Recording, Merging and analyzing medical data.

Traditionally HCPs have to record a large quantity of data about their patients.

It takes a long time, and what is worse, it could generate errors. Thanks to IoT, patient data is automatically transmitted to electronic health record (EHR) systems. This will increase accuracy and further will allow caregivers to spend more time providing care.

Doctors still have to analyze all that data, but the Internet of Things allows them to merge digital medical data from vastly different medical devices.

Medical device information system will help improving the delivery of patient care.

Intelligent Hygiene Systems

Hospitals are going to be healthier places. The Internet of Things is going also to increase the quality of care hospitals provide. Even if (public or private) hospitals are the place where you should cure you of a disease, it is a fact that each year more than 2 million patients catch infections during hospital stays!

Recent studies as already proved that Hospitals using the system had an average 105.6% increase in hand hygiene solution dispenses and a decrease in healthcare associated infections (HAI) by more than 24%.


IoT has already changed healthcare

But that is just the beginning.

Thanks to the Internet of things Doctors and patients already feel closer than ever. On the other hand, IoT represents also a not to be missed opportunity for Pharma industry. An opportunity that in only five years will make Pharma gain over $117 billion.

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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 |

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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Hiring Health IT Professionals and Consultants

Hiring Health IT Professionals and Consultants | EHR and Health IT Consulting |

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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Kareo, McKesson Lead the Way in EHR and Health IT Systems

Kareo, McKesson Lead the Way in EHR and Health IT Systems | EHR and Health IT Consulting |

When healthcare providers are looking to either implement or upgrade their EHR and health IT systems, there are a wide variety of options to choose from. Ever since the HITECH Act was passed and meaningful use requirements were established under the Medicare and Medicaid EHR Incentive Programs, the number of EHR vendors across the industry has skyrocketed. So what is a physician practice to do? How do they choose the best possible solution?

Luckily, the market research firm Black Book offers a variety of surveys that illustrate which health IT systems vendors are truly successful in providing superior solutions. Recently, Black Book announced the results of its four-month user poll determining the highest-ranked EHR and billing software vendors in 2015, according to a company press release.Health IT Systems

The survey results based on EHR users show industry trends and disclose the health IT systems vendors who scored highest in billing, claims, and practice administration categories when it comes to the providers’ experience.

Kareo Inc. achieved the highest ranking for both its certified EHR technology as well as its billing software in 2015. This marks the third year in a row that Kareo has achieved this honor of best EHR technology among small physician practices.

“Revenue Cycle management and integrated EHR vendor loyalty among small practice EHR physician practices is still on a significant upward trajectory,” Doug Brown, Black Book’s Managing Partner, said in the release. “The EHR/practice billing vendor’s abilities to meet the evolving demands of interoperability, networking, mobile devices, accountable care, patient accessibility, customization for specialty workflow, and reimbursement are the main factors that the replacement mentality and late adoption remain volatile especially among solo and small practices.”

The results from the Black Book survey come from 33,000 ambulatory groups, physician practice administration staff, and medical records professionals. Investors and those looking to purchase or upgrade their EHR and health IT systems can benefit from these type of surveys, as it offers a broad comparison of the different types of healthcare technology vendors in the market.

Some other EHR, practice management, and billing software vendors who gained high ranking in the survey encompass ADP AdvancedMD, athenahealth, Greenway, HealthFusion, McKesson and NexTech.

“High performing vendors have emerged from the pack as practice implementations succeed and fail, meaningful use attestations are reviewed, and users assess their vendor’s capabilities to meet their individual practice needs, particularly managed care reimbursement and ACO billing ,” Brown said in a public statement. “The majority (70 percent) of smaller and solo practice physicians have still not settled on a technology suite or set of products that delivers to their expectations on meaningful use, clinician usability, and coordinated billing and claims, hence, the relentlessly moving EHR marketplace.”

It is likely that polls like this will push forward greater competition among vendors of EHRs and health IT systems. Over time, we many see new leaders emerge within the health IT industry.

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Outcomes after ICD-10 Transition Deadline Look Promising

Outcomes after ICD-10 Transition Deadline Look Promising | EHR and Health IT Consulting |

Those who have had concerns about the coming ICD-10 transition deadline may have less to worry about now that the latest batch of ICD-10 end-to-end testing from the Centers for Medicare & Medicaid Services (CMS) has been successful. The acceptance rates of the ICD-10 claims during the April end-to-end testing has been higher than the prior round of end-to-end testing from January, according tothe Journal of AHIMA.

Essentially, there has been more test claims sent to CMS as well as fewer errors found after submitting the ICD-10 claims. This points the way toward a more successful ICD-10 transition deadline come October, as fewer mistakes would keep financial reimbursement across the healthcare sector more stable. Most importantly, the majority of errors that did occur during the end-to-end testing period were not related to ICD-9 or ICD-10 codes.

“With four months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since half the claims submitted for end-to-testing were professional claims,” theCoalition for ICD-10 stated in an article. “These results indicate that significant progress has been made since the January end-to-end testing with the overall rejection rate dropping from 19 to 12 percent and ICD-10 rejections dropping from 3 to 2 percent.”

Out of the 23,138 test claims that were sent over to CMS, a total of 20,306 ICD-10 end-to-end testing claims were accepted. This shows that as many as 88 percent of claims should be accepted when the ICD-10 transition deadline rolls around. While this is good news, there may be slight problems at a handful of medical facilities as 2 percent of claims submitted were found invalid due to errors in ICD-10 diagnosis or procedure codes.

The Coalition for ICD-10 also explains that there were “zero claims rejected due to front-end CMS system issues for professional and supplier claims.” Since out of the 12 percent of rejected claims only 2 percent were due to actual ICD-9 or ICD-10 coding errors, the healthcare industry seems to be in a stronger position toward successfully submitting their claims after the ICD-10 transition deadline.

The other errors that occurred hold no bearing on ICD-10 and would only be rejected under ICD-9, the Coalition states. Currently, CMS systems are capable of accepting institutional claims as well as professional and supplier claims.

Everyone who participated in ICD-10 end-to-end testing in April received Remittance Advices, which should steer them toward the right direction if any errors occurred on their end. Currently, there is less than four months to fix any issues before the ICD-10 transition deadline takes hold.

CMS will be conducting educational sessions about submitting ICD-10 claims prior to the final end-to-end testing session in July before the ICD-10 transition deadline takes effect on October 1. The federal agency continues to urge medical care providers to prepare for the coming ICD-10 implementation in order to avoid any reimbursement delays or rejections after the ICD-10 transition deadline.

Direct Reimbursement Solutions's curator insight, July 1, 2015 9:03 AM

With only four months to go, it seems that ICD-10 testing is going very well. Good news for providers of care.!

Will Health IT Systems Improve Radiology Reporting?

Will Health IT Systems Improve Radiology Reporting? | EHR and Health IT Consulting |

Within the healthcare industry, there are a wide variety of different professionals who participate in managing patient care including treatment and diagnosis. Health IT systems and EHR technology play a role in every medical providers’ workflow, but do not always assist in streamlining healthcare services. With regard to diagnostics, radiologists have often had difficulty remaining high accuracy rates when determining disease based on test images, particularly with radiology reporting.

However, Nuance Communications has assisted the radiology field by developing the PowerScribe 360® Reporting version 3.0, which offers useful reporting information to radiologists during the clinical documentation process, according to a company press release.

Dr. Lincoln Berland, the Chair of Body Imaging Commission at the American College of Radiology, spoke with EHRIntelligence.comand shared his insights on the radiology field and the technologies including health IT systems that affect it.

When discussing the latest version of the PowerScribe 360 Reporting solution, Berland stated, “I’ve been involved with the development and refinement of this new system and what it’s designed to do is to assist the radiologist at the point of interpretation for making recommendations and describing finding. The way it works is by a radiologist dictating a report and he/she may come upon a finding – for example, an adrenal nodule that they will report. The system will recognize that it’s an adrenal nodule and highlight with a flag in the corner that there is a guidance rule for managing that.”

“A radiologist clicks on that and the algorithm list pops up. Radiologists fill in the blanks of a finding in the dialogue box,” Berland explains. “For example, it could be a two centimeter adrenal nodule that’s less than 10 field units. There may be two to five different features that you fill in. At that point, text appears that indicates how you would say it in the report and how the recommendation would appear in the report. If the radiologist finds it acceptable, he/she clicks accept and it automatically pops into the correct locations in the report.”

“This is revolutionary in the sense that nothing like this has ever been available before,” exclaimed Dr. Berland. “The reason it’s so important is that medicine has become so complex and algorithms for managing different kinds of findings – and particularly incidental findings – have become so confusing that to really make sure the right one is chosen every time, radiologists have to look it up, find an article, read through an algorithm, and follow a chart. This bypasses all of that.”

“In practical reality, the way it worked before this system, is that the radiologist most of the time doesn’t look it up. If they’re a specialist in the area, they’ll remember most of the findings and recommendations, but they won’t do it with complete accuracy. If you’re not a specialist, you may not know where to look it up or that even such a guidance rule exists and you might not get it right,” mentioned the Chair of Body Imaging Commission at the American College of Radiology. “What this provides is efficiency, accuracy, consistency, and the right recommendation every time because it’s appearing right on the screen and all of the potential recommendations have been reviewed before you get to the report.”

When asked what some common challenges in the radiology field are specifically with regard to digital technologies and health IT systems, Berland answered, “One of the main challenges that we deal with is the correlation of information. Radiology requests often have a very rudimentary amount of information that comes with it and the EHR has luminous amounts of information.”

“It’s often in a separate system and radiologists have to open that separate system to review the data, going through reams of pages to find the particular piece of information that’s relevant to the examination that you’re reporting,” he continued. “That is a tremendous challenge. Gathering the right information is one of the most difficult parts about making the correct interpretation, particularly for the increasingly complex radiology procedures that we perform.”

“Another problem is dealing with access to all of the relevant information from patients that are in multiple sites,” he explained. “Nuance now has a system called PowerShare [the Nuance PowerShare Network] so that people can share information and images from other sites very quickly. With something like PowerShare, that information can be shared through the cloud before the patient even arrives at the tertiary care center.”

As a final thought on the challenges within the radiology field, Berland stated, “Accessing the right information at the right time is very difficult. Automating that through a system at the point of interpretation is going to be a game changer in how we manage radiology reporting.”

When asked about some of the benefits and difficulties of implementing the PowerScribe 360 reporting program, Berland answered, “From the standpoint of having worked on the system to try to develop it, the challenges that we’ve had in trying to make sure that all of the answers are correct is that the logic is complex because of the algorithms that follow down multiple different paths and depend on multiple different conditions.”

“One of the advantages of the system is that using the PowerShare method, whenever  an update comes along with a newer algorithm, it can be downloaded through the cloud to all the sites used in the system so that there isn’t a significant delay between the issuance of the new guideline and everyone having access to it,” he explained.

Dr. Berland also discussed the most vital quality check tools that radiologists need to conduct their work.

“The Incidental Findings Committee has devised rules for particular organ systems where incidental findings are discovered. Now we have six papers that cover 11 organ systems. What Nuance and Mass General have done is take five of those rules and one additional guideline from another source and translated them into this computerized system. Specifically, they have a rule for managing renal, liver, adrenal and pulmonary nodules, thyroid, and ovarian cysts incidental findings,” Berland answered.

When asked whether the cloud platform is preferable for storing radiology reports, Berland explained, “I don’t think [the cloud] is a prevalent way of managing information right now. We’re a unified healthcare system with a single computerized system that goes through all of our various physical sites. We manage our data locally with backup.”

“The advantage of the cloud that we see is access to data in other health systems either in our state of Alabama or elsewhere in the region wherever a patient has been seen. The problem is that we don’t currently have standards that are well established enough – patients don’t have a single identifier – so we can’t easily have a unified system over multiple sites. There always has to be some reconciliation locally. I think the cloud will increase in utility because people are now being seen in a broader array of institutions and sites, which is going to require the interconnectivity of data,” Berland concluded.

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