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 | Scoop.it

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


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


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


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


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


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


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


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


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


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


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

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Burke Autrey's curator insight, September 21, 2016 10:56 AM
Tracking companies who bring in Interim executive talent when it counts... Congratulations to Clinovations and HHC who clearly see the value of tapping into interim executives.
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Are Physicians Making the Most of Mobile Devices?

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

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


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


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


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


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

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Have you hugged your EMR lately?

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

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

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


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


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


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

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


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


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


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


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


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

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

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

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

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


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


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


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

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


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


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

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A better road to information interoperability?

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

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


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

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


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


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


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

Eclectic collective

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


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


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

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


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


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

An industry misguided?

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

  

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

Baxley didn't pull punches either.


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

Inching closer

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


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


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

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

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Hiring Health IT Professionals and Consultants

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

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

Five questions to ask a potential healthcare IT consultant:

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

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

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

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

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

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

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

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

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

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

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

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The Dawn of The Community EMR

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

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

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


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


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


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


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

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

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


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


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

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Study: Scribes Have Positive Financial Impact

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

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

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


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


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


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

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


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


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

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


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


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


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EHR Interoperability Stalled Due to Information Blocking

EHR Interoperability Stalled Due to Information Blocking | EHR and Health IT Consulting | Scoop.it

When it comes to the practice of medicine and drug discovery, the federal government plays a role in supporting these sectors and developing legislation that opens up avenues for healthcare professionals and scientific researchers. The House Committee on Energy and Commerce has gone forward with creating legislation called 21st Century Cures that delves directly into stimulating the discovery and development of new treatments and medications for patients across the nation. The legislation also impacts the expansion of EHR interoperability.

While the intentions of the 21st Century Cures legislation is beneficial for drug discovery, the American Hospital Association (AHA) finds that the enforcement strategies under the proposed rules could have negative consequences for providers, particularly in its aim to expand EHR interoperability.

AHA Executive Vice President Rick Pollack stated in a letter to the House Committee on Energy and Commerce that, which the organization appreciates the inclusion of EHR interoperability expansion, the “enforcement mechanisms” could lead to issues for healthcare providers such as putting together an ecosystem in which doctors may be significantly penalized for minor errors.

AHA does support health information exchange and EHR interoperability in pursuit of improving patient outcomes and incorporating new models of care. Nonetheless, AHA finds some issues with the enforcement related to vendors participating in information blocking problematic.

“The bill includes a number of enforcement mechanisms against those who engage in information blocking,” wrote AHA Executive Vice President Rick Pollack in the letter. “On the provider side, we believe that the use of Medicare fraud and abuse mechanisms, such as investigations by the Office of the Inspector General, imposition of civil monetary penalties or exclusion from the Medicare program, is unnecessary and inappropriate to address the concerns that the legislation seeks to remedy. We recommend that you use the existing structures of the meaningful use program to promote information sharing.”

On behalf of AHA, Pollack mentions that the organization appreciates the committee’s aim to ensure EHR vendors are responsible for creating interoperable health IT products. However, Pollack also stated that the committee should instruct the Federal Trade Commission to analyze any anti-competitive behavior among EHR vendors. In particular, Pollack finds the decertification of EHR systems among vendors that participated in information blocking objectionable, as it would affect healthcare providers and disrupt patient care.

“The language also includes decertification as a sanction for vendors that engage in information blocking. Decertification would be disruptive to hospitals and physicians that have invested in and deployed an EHR that is later decertified,” Pollack explained. “However, the inclusion of provider protections against meaningful use penalties if their EHR is decertified makes it more reasonable.”

The protections against payment penalties under the Medicare and Medicaid EHR Incentive Programs would last for more than one year, which would give providers ample time to find a new vendor, develop a suitable contract, install another EHR system, and attest to relevant meaningful use requirements.

Additionally, AHA would like the definition of information blocking to become narrower in order to avoid charges of fraud to be dealt due to standard business practices. Essentially, AHA would like to reduce some of the punitive approaches the committee set forth and develop more positive approaches to expanding health information exchange.


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Just Say It, a solution to your EMR data entry dilemma

Just Say It, a solution to your EMR data entry dilemma | EHR and Health IT Consulting | Scoop.it

For as long as I can remember (and that’s a very long time), clinicians have been complaining about the burden of entering data into the EMR. For most of us who started practice when medical records were primarily on paper there were basically two modalities for documenting our work. One was the pen. It worked pretty well for SOAP notes and brief encounters. I even recall documenting full physical exams on paper. The problem with writing things down on paper was that my hand would get tired, and my handwriting was awful. Sometimes after a long day of patient care, even I couldn’t read my notes.


For longer or complicated patient exams we had the luxury of dictation. In fact, I worked in several organizations where all of my notes were dictated and later transcribed by professional transcriptionists. Then along came the EMR, and the expectation that our clinical notes would be entered using keyboard and computer. Thank goodness my mother made me take touch typing in high school. None-the-less, compared to the speed of dictation, typing patient data into the computer was a burden and a significant time sink to my productivity.


Of course, for many years there have been software solutions for voice recognition and today they are substantially better and more accurate than they used to be. They work best when the user “trains” the software to understand his or her own voice, and even the best software will miss words now and then. Also, because medicine has its own language you generally cant’ use just any old software for voice recognition. You must buy speech recognition software written specifically for medical professionals, and it was usually quite expensive.


When I went to work for Microsoft, it always bugged me that our own very robust speech recognition engine, the one that comes free with Windows, couldn’t easily be used for medical dictation. Therefore, clinicians had to install expensive software that used an entirely different speech engine. Because Windows didn’t have a lexicon for medical terminology that worked with our Windows speech engine, that’s just the way it was. That is not the case anymore. Thanks to some innovative partners and the advent of cloud computing, there are now some excellent, cost-effective solutions for clinicians who are ready to ditch the keyboard and start using their voice to enter EMR data. One of those solutions is SayIt, by nVOQ.


This year at HIMSS we demonstrated the nVOQ SayIt solution on our Surface Pro 3 tablets. This marriage of a great, clinical grade device connected to a robust, cloud-based medical speech recognition solution is  guaranteed to delight clinical end-users.


I’ve gotten to know the crew at nVOQ over the past few years. In fact, one of their executives is a former colleague of mine here at Microsoft. nVOQ has been working tirelessly to bring forward and continuously improve a medical, speech recognition solution that is suddenly gaining a lot of traction in the market.  


SayIt is a cloud-based speech recognition solution that converts spoken words into text within seconds. It can be used for free-form dictation, front-end transcription and for navigating EMRs using voice commands or shortcuts. SayIt supports 35+ medical specialties and works with virtually any EMR (PC and Mac-based). The solution enables healthcare providers to:

Work more quickly and effectively in the EMR

Spend less time on clinical documentation, more time with patients

Take more detailed notes for clearer assessments

Document care in their own words for improved patient outcomes

Simplify clinical workflow for time and cost savings 

If it has been awhile since you tried speech recognition for data entry into your EMR, and particularly if you haven’t tried a cloud-based solution, I’d urge you to take another look. I think you’ll be surprised by how much the technology has improved. I also think if you treat yourself to a “clinical grade” device like our Surface Pro 3 that you just might begin to love, rather than loathe, your EMR.


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Getting Started with mHealth at Your Medical Practice

Getting Started with mHealth at Your Medical Practice | EHR and Health IT Consulting | Scoop.it

While mHealth presents great opportunities for physicians and patients, conduct your due diligence before jumping full speed ahead into a complex mHealth venture. Here are a few important considerations:

1. Reimbursement. Incorporating mHealth into your practice takes time — time that you may not always get paid for. Before embarking on any mHealth initiative, evaluate whether it makes sense for your practice reimbursement-wise. Keep in mind that payers vary when it comes to reimbursement for care to remote patients. 


2. Legal guidelines. Prior to incorporating mHealth into your practice, consult a healthcare attorney to ensure compliance with federal and state laws, guidelines issued by your state medical association, and the HIPAA Privacy and Security Rules. For more on laws related to telemedicine, visit bit.ly/mhealth-legal. Also, familiarize yourself with any liability risks that the mHealth approach may raise. In fact, The Doctors Company, a medical malpractice insurer, recently highlighted some of the risks posed by remote health monitoring at bit.ly/remote-risks.


3. Take time to test the waters. Getting involved in mHealth may take a toll on physician and staff time, and it may cost a significant amount of money. For that reason, Robert Tennant, an executive consultant at healthcare management firm Beacon Partners, recommends starting out slowly with mHealth initiatives. For instance, prior to taking on a more complex mHealth initiative, such as remote health monitoring, open it to a small group of patients, such as those with a particular chronic illness. "Make sure that [you] can make it work on a small scale before going too far with it," he says. "It might be a situation where you have to evaluate a number of scenarios before you finally reach one that makes sense."


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How Electronic Health Records Will Be More Helpful To Doctors And Patients

How Electronic Health Records Will Be More Helpful To Doctors And Patients | EHR and Health IT Consulting | Scoop.it

Twenty years ago, if patients wanted to read their own medical records, they likely had to sue their healthcare provider for access. Even after the Health Insurance Portability and Accountability Act was passed in 1996, legally guaranteeing patients the right to their medical information, the process to obtain records was so arduous that few people bothered.


Today, the picture is different. Not only do patients have the right to view their records, technology is improving their ability to access them.

When three hospital systems in Massachusetts, Pennsylvania and Washington took the step of offering patients online access to their health records and physicians’ notes, more than two-thirds of the patients reported positive results: having a better understanding of their health and medical conditions, taking better care of themselves and becoming more regular with their medications. Encouragingly, this did not significantly add to physicians’ workloads: Only 3 percent spent more time answering patients’ questions outside of visits, and 11 percent spent more time writing or editing notes.


Tapping New Models


These hospitals are not alone. Several healthcare executives are experimenting with similar models and a new generation of electronic health records (EHRs) is on its way.


The legacy EHR systems, rooted in PCs tethered to server computers and built primarily to meet regulatory requirements, have become unwieldy and expensive for most healthcare organizations to support, according to the latest report from market research firm IDC. It predicts a massive structural shift to web-native technologies like cloud, allowing organizations to store and access data and programs over the Internet and pay a fee based on how much computing power is used.

“The new concept of flexible, mobile, cloud-based acute care EHR supports digitizing paper workflow and reengineering processes, ” explains IDC research director Judy Hanover. It also enables better integration with analytics, big data, mobile and social tools.

Wearable health records are knocking on doctors’ doors too. Drchrono, for instance, has made patient-facing and provider-facing Apple Watch apps to complement its iPhone and tablet versions. Using the app, a physician can view a patient’s information, respond to patient messages using quick text and assess a patient’s refill requests as well as lab results without taking out his or her iPhone or iPad.

Others in the industry seem to agree that there is demand for such seamless connectivity. The 2015 Middle Market Healthcare Outlook, conducted online by the Harris Poll on behalf of CIT, confirms that the benefits of technology are clear to most healthcare executives. According to this study, about 3 in 4 recognize the positive impact of technology in reducing costs for consumers. However, a majority of those surveyed also feel that the stakes are higher for the healthcare industry with respect to technology, and they struggle to figure out which technological advances will be most relevant.


Moving Beyond Regulation


According to Hanover, there is an acute innovation gap in EHR. Her studies indicate that doctors see fewer patients today and spend more time on documentation than they did when using paper charts in 2009. She believes that the healthcare industry has been so focused on meeting regulatory mandates like Meaningful Use — policy designed to ensure that clinicians and hospitals actually use the computers they bought through government subsidies — that there was no real push for innovative, flexible software.


But business needs are now overtaking regulatory mandates and several healthcare executives are exploring the next generation of medical records software, built on cloud as a foundation. These cloud-based systems offer lower up-front capital expenses, predictable maintenance costs and flexibility to scale up or down based on requirements. They will make it easier to access patient data from multiple endpoint devices and analytics services to understand it better.

EHRs of the Future


“There’s a huge appetite for getting better workflows into healthcare, looking at department specific and mobile apps. I would see an environment where hospitals and health systems would perhaps rip out and replace in some cases,” says Hanover. The Harris Poll study also predicts higher investments in IT. The study found that IT was the third most likely reason for healthcare executives to seek financing in 2015 after “new hires” and “new construction.”

Is it time for healthcare providers to swap their current EHR and upgrade to the new cloud-based software? Hanover expects investments to flow into this next generation of EHRs in the next one to two years. The industry will see several EHR systems move to the cloud within three to five years, she believes.


“There’s an opportunity for healthcare technology suppliers to really innovate and offer a compelling option,” she says.


Early Days for Data Sharing


The latest guidelines released by the Centers for Medicare & Medicaid Services require healthcare providers to share data with other providers and patients, without compromising on security. Many in the industry expect data sharing capability to be the biggest game changer. Will this mean a doctor can pull a new patient’s medical history — blood work, blood pressure and medication details — from another hospital? “Not so fast. Healthcare moves slowly,” warns Hanover.

It’s early days yet for opening up access to patient data, and the new generation of EHRs might begin with better workflow, improved productivity and tighter integration with analytics of patient data.


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Laurie Bolick Wolf's curator insight, June 17, 2015 2:46 PM

This article specifically focuses on the changes expected in healthcare as technology improves and changes.  The expectation is that care will  improve as providers are able to access information from multiple facilities and locations easily and immediately.  While this does increase productivity and the ability to see more patients, the downside is the documentation within the EMR itself.  The shear volume of data that must be entered with EMR is much higher than when documentation was done on paper.  In the end, the time saving with technology advancements may be lost in the extra time spent on documentation.

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Important Features For Your Practice Computers

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

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


Sanitation Promoting Features


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


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


Mobility and Accessibility


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

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


Administrative Tools


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


Low-Cost Installation


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


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

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


Cloud-Based Systems


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


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


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


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How cloud computing enables interoperability

How cloud computing enables interoperability | EHR and Health IT Consulting | Scoop.it

CMS has signaled a renewed focus on interoperability, a welcome development for healthcare professionals anxious to more easily exchange insightful data. But there’s still the matter of how well the people involved in various collaborative “Big Data in Healthcare” initiatives operate together.

At some point for most of us in our careers – usually early on – we’ve encountered a project that was initially heralded with a great deal of fanfare, only to ultimately fizzle out after failing to gain enough buy-in. For all the excitement surrounding Big Data projects, many are at similar risk of a premature end if stakeholder concerns aren’t addressed at the outset:

  • Who will host the data?
  • How will data privacy concerns be handled?
  • How have restrictions on data use been addressed?
  • Do existing consents allow for data sharing?
  • Will the data need to be de-identified? If so, using which methodology?
  • Who will be responsible for acquiring, maintaining and distributing it?
  • How will the data be protected as it’s routed to its new home?
  • How well will it be protected in its new home? Who will have access to it?

For this to work, a neutral ground is usually needed, offered by a trusted third party.

The cloud: breaking down barriers to data exchange
In healthcare, massive amounts of data are not stored in pre-defined, structured tables. Instead, they are often composed of text, notes, numbers, images, formulas, dates, and other facts that are inherently unstructured. In fact, certain kinds of data sources are being created so quickly that there is no time to store it before the need to analyze it.

Savvy healthcare executives see Big Data as an opportunity to break down the paradigm of siloed data. They know that isolated data can be inefficient. Yet even while supporting the vision of Big Data, many healthcare leaders are traditionally reluctant to share data outside their own firewalls. Due to competitive considerations and confidentiality risks, there must be a level of trust in the quality and security of the receiving organization’s health data management systems for the data owner to be willing to share it. No one wants to risk a HIPAA privacy or security violation at the hands of another entity.

'Dirty' data can yield hidden treasures
To make an effective Big Data play, data sharing arrangements must be made, data flows defined, data analytics engines and the underlying infrastructure created, and the proper data governance must be agreed upon by all relevant stakeholders. It is at this stage that a trusted third party data warehouse environment is critical for success.

Conventional wisdom leads many to believe that data must be scrubbed, normalized and aggregated into a standard format in order to gain key insights. In fact, for Big Data in Healthcare, the time-tested principle of “garbage in, garbage out” actually may not apply.

Using the right data analytics tools can reveal unexpected insights from unstructured or “dirty” data as some call it.

In addition to enabling insights from disparate data sources, storing and protecting data, data management services are now available that alleviate the need for healthcare organizations to hire additional experts in meaningful use or cloud technology, including:

  • Pulling data from different sources into a single cloud-based repository for collaborative use
  • De-identifying the data and stripping it of identifiable information
  • Data visualization with dashboards and reports
  • Audit trails of who accessed what, when and from where
  • Dynamically scaling the infrastructure as the data volume increases

Cloud for collaborative care
Entities that are members of an accountable care organization or other coordinated care programs also benefit from the neutrality of the cloud for a variety of functions, from the day-to-day, such as claims and billing, to more analytic reporting and collaboration. The cloud provider can host the data along with any other number of data management services that the healthcare organization can’t, or just doesn’t want to take on.

Can you blame them? Healthcare organizations need all of their IT staff on deck for analytics and other data projects. And as we move to a more coordinated and shared model for healthcare, all stakeholders need a neutral and trusted environment that fosters collaboration. And based on the potential for infinite computing power and storage on the cloud, the sky’s the limit for interoperability.


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How Should DoD Secure Health Records?

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

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


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


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


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


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

Migrating Data

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


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


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


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


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

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


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

Long Haul

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

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


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

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


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


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


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


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


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

User Access

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


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


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


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


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

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

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Solving Medical Practice Problems Post-Tech Adoption

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

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


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


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

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


CHALLENGE #1: POST-EHR PRODUCTIVITY DROP


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


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


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


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


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


CHALLENGE #2: EHR INTEROPERABILITY ISSUES


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


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


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


CHALLENGE #3: A LACK OF PATIENT PORTAL ENGAGEMENT


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


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


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

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


• Request appointments;

• Get prescriptions renewed;

• Review test results; and

• Look at visit summaries from previous visits.


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

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


CHALLENGE #4: MOBILE DEVICE SECURITY


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


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


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


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

• Prohibiting staff from downloading PHI to mobile devices;

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

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


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


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


CHALLENGE #5: OVERALL TECH SECURITY


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


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


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


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


IN SUMMARY


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


• Productivity losses

• Interoperability problems

• Lack of patient engagement with new technologies

• Communication work flow problems

• New security risks

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

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector 

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

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

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


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


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


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

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


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


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

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

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

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

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


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


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


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


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


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


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


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

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Four Ways to Increase Patient Portal Engagement

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

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


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


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

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


2. Get tablets and train on-site.

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


3. Promote it.

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


4. Get the doctors in on it.

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

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

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

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EHR Adoption Challenges Solved through Data Entry Transfer

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

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


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


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


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


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


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


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


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


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

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Get Your Medical Practice Paid: 4 Revenue Tips

Get Your Medical Practice Paid: 4 Revenue Tips | EHR and Health IT Consulting | Scoop.it

It seems pretty obvious: You do the work, you get paid. But unfortunately for many in the healthcare business, it’s not always that black and white.

There are so many obstacles to proper payment, including: complex and confusing billing systems; patients unable to pay their office copay, co-insurance, or deductibles; high outstanding accounts receivable; improper coding vs. documentation; etc. All this and more can lead to outstanding bills and ultimately low cash flow for the practice.

Here are some tips to make sure your practice gets the compensation it deserves:


The Right Code: ICD-10


With the new ICD-10 rules taking effect Oct. 1, it’s imperative that your practice management software and EHR are up to date and that the billers in your practice are trained and ready to go. Improper documentation at some point in the chain of work can lead to a deficit in your bottom line. Make sure that your software is ICD-10-ready.


Ignorance Is Not Bliss: Pay Attention to the Details


Doctors, office managers, and certain staff should be able to access at-a-glance details and have the ability to generate reports if they are employing an efficient billing system. Every doctor should be able to easily access the following data:


• Average daily and monthly revenue categorized by HCPCs and insurance

• Number of outstanding accounts receivable

• Cash value of outstanding accounts receivable

• Number of audits paid/failed status

• Payment and claim status

• Outstanding revenue by HCPCs and insurance

• Monthly adjustment reports


If you are a doctor in a private practice and can’t access this critical information, then at a minimum, you should require a weekly billing report from billing staff or your outsourced billing service. This weekly report should cover the items listed above and will allow you great insight into the "health" of your practice.


Verify Patients’ Benefits Before Their Visit


At the very least, verify patient's benefits before they leave your office. It sounds fairly obvious, but many practices don’t get the patients’ copay before they see the doctor. This could be rectified as easily as keeping patients’ credit cards on file, so it can be the default if the patient fails to bring cash to their visit. Better yet, utilize a practice management system that seamlessly updates you with this information so that you can easily charge in the office. You’d be surprised how something so simple can increase practice cash flow.


Claim Denied? Don’t Let It Go


Make sure your billing staff is diligent about following up on denied claims. Making sure your billing staff or billing service has the right codes can significantly improve this denial rate, but when it does happen, don’t let it go. There should always be follow up on denied claims, but ideally, your billing staff or service should try to catch coding errors before they’re made. Catching coding errors is often better handled by a sophisticated, outsourced billing service — just make sure it offers a transparent view into billing success.


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Six Ways to Improve Patient Satisfaction Scores

Six Ways to Improve Patient Satisfaction Scores | EHR and Health IT Consulting | Scoop.it

Large physician practices and hospitals already have a portion of their payments linked to patient satisfaction. Over the next few years, it will be an integral portion of physician payment, including penalties possibly dwarfing those under meaningful use. More about this program, known as the Clinician & Group Consumer Assessment of Health Providers and Systems (CG-CAHPS) can be found on the Agency for Healthcare Research and Quality's website.

Here's the government's hypothesis in a nutshell:


• Patients who like their doctors are more likely to be compliant patients;

• Compliant patients are healthier patients;

• Healthier patients are less expensive; so

• Physicians with satisfied patients should be paid more than physicians with dissatisfied patients.


The Affordable Care Act introduced a different set of quality metrics than used by the Institute of Medicine (IOM): quality, patient satisfaction, and payment. Quality is a key element with both programs, but there's an important difference with the reform law: your patients are the arbiters of quality. Quality more or less equals patient satisfaction.


What's being measured?


CG-CAHPS measures the patient experience, an expansive proxy for quality that takes into account the following:


• Timely appointments

• Timely care (refills, callbacks, etc.)

• Your communication skills

• What your patient thinks about you

• What your patient thinks about your staff

• Your office running on schedule


I have been in enough medical practices — both as a patient and as an administrator — to know there's a method to this madness. It's less about the care and more about the caring. Here's what I suggest for improving your quality measures via these proxies.


1. Hire sunshine.


I can train anyone* to do anything in our office, but I can't train sunshine.  Look to hire positive and happy people, particularly for roles with lots of patient interaction. Your patient satisfaction — and thus, your "quality" — will improve. You'll also find a cost-saving benefit to this hiring tactic: employee turnover will shrink.


2. Start on time.


CG-CAHPS asks patients whether they were seen within 15 minutes of their appointment times; it's even underlined for emphasis. Physicians who start on time are more likely to run on time, so have your feet set before you start running.


3. Set patient expectations.


It's helpful to share with patients the FAQs about your practice so that they know what to do for refills, after-hour needs, appointment scheduling, etc. By making these answers available on your website, on your patient portal, and in your print materials, you'll better align patient expectations with patient experiences and thereby score better on quality surveys.


Some patients gauge quality by whether or not they get the antibiotic they think they need. It's helpful for primary-care physicians to include education on antibiotic overuse in their patient education materials.

Along these lines, it is important for your patient to know what to expect after their visit in terms of test results, follow-up visits, etc. I receive more complaints about the back end of our patients' experiences than anything else. Make sure you and your staff do not drop the ball as you near the goal line.


4. Listen with your eyes.


Nothing says "I don't care" like having your physician focus on a computer screen rather than on the patient. This is particularly true in the first couple of minutes of each visit, and especially important with new patients. One virtue of using medical scribes is that you can listen with your eyes a whole lot more.


5. Put your staff in their place.


Your staff has an important bearing on the patient experience. I'm a big fan of letting them know their actions influence quality. It's pretty cool, for me as a mere bureaucrat, to know that I can improve quality simply by being friendly and helpful to our patients. Make sure your staff knows that making a patient's day is a beautiful act.


6. Monkey see, monkey do.


Staff will follow your lead. If your thoughts and actions emphasize running on schedule, being kind to patients and their families, and not dropping balls, they'll be stronger teammates for you.

Patient satisfaction has always been a gauge of quality, just as patient referrals remain the lifeblood of most practices. Treat this next wave as an opportunity to show off the caring that has always been a big part of the medical care you offer your patients.


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EHR Incentive Programs Sparked Market to Reach $25 Billion

EHR Incentive Programs Sparked Market to Reach $25 Billion | EHR and Health IT Consulting | Scoop.it

The meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have brought forth an era of electronic data access for the healthcare industry. The EHR market has never been stronger and recent findings illustrate that fact. A report from Kalorama Information called EMR 2015: The Market for Electronic Medical Records states that the EHR market reached nearly $25 billion in 2014.


Some of the stimulants that led to this increase for the EHR market come from the payment penalties promised by the Centers for Medicare & Medicaid Services (CMS), the financial boosts assured under the EHR Incentive Programs, vendors upgrading systems, and the search for greater efficiency throughout the healthcare industry.

“There’s still a healthy and competitive market for EMR,” Bruce Carlson, Publisher of Kalorama Information, said in a public statement. “Expect growth this year and next at seven to eight percent and stable growth until 2019. Eventually, there will be market saturation but this is a bit of a way off, especially in emerging markets.”


Between 2012 and 2014, the EHR market grew by 10 percent due to system upgrades and EHR adoption across the healthcare sector. Kalorama predicts that this market will hit $35.2 billion over the next four years.


As more providers and hospitals continue to attest to Stage 2 and Stage 3 Meaningful Use requirements under the EHR Incentive Programs, EHR adoption and upgrades will continue to rise over the coming years. Additionally, the payment reductions stemming from the meaningful use regulations will push more healthcare providers to continue updating their systems and spending more funds on certified EHR technology.


The latest results from CMS show that, last year, more than 80 percent of doctors across the country have utilized an EHR system as compared to 57 percent in 2011. At this point in time, the federal government has distributed more than $28 billion among providers who have successfully attested to meaningful use requirements under the EHR Incentive Programs.


The Kalorama report also found that EHR adoption varies among different parts of the US and different age groups with younger physicians more likely to implement and utilize certified EHR technology. One out of two doctors report having EHR platforms that meet the federal criteria for having a basic system.


The report from Kalorama discusses a variety of issues within the health IT sphere and the stimulants behind the EHR market. These factors include the historic market growth since 2012, regulatory trends, international market sizing, and profiles of various EHR vendors. Additionally, the report covers the status of meaningful use requirements, incentives under the EHR Incentive Programs, and vendor pricing.


Currently, the healthcare IT market is very complex with a wide variety of developments stimulating its growth. From mergers, acquisitions, security developments, and the ICD-10 transition to BYOD, big data, and the rise in electronic prescribing, the health IT market is likely to continue growing and transforming over the coming years.


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Do Health IT Systems Need Greater Interoperability?

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

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


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


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


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


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


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

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


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


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The Status of Medical Errors Among Health IT Systems

The Status of Medical Errors Among Health IT Systems | EHR and Health IT Consulting | Scoop.it

While adoption of EHRs and health IT systems has been stressed among federal agencies and the medical industry in order to improve patient care and health outcomes, some issues within the health IT sector may be actually leading to medical errors among healthcare staff.


For instance, a survey from West Health Institute showed that about 50 percent of polled nurses noticed a medical error because a device or EHR system was not integrated adequately within the hospital or practice. Lack of EHR interoperability or integration may make it more difficult for doctors, nurses, and other healthcare professionals to provide effective care and avoid medical errors.


For example, if at the end of a long shift, a professional has to spend an additional two hours entering in data through an EHR or other system, he or she is more likely to make a mistake. In fact, 74 percent of respondents in the survey claimed that it was troublesome to coordinate data stored in a variety of medical devices.


Another poll of 1,224 Massachusetts residents conducted by the Harvard School of Public Health shows that 23 percent of respondents or one of their close acquaintances were involved in circumstances that led to a preventable medical error, according to The National Law Review. About half of these medical errors led to serious health consequences, the poll shows.


The most common problem that was reported is misdiagnosis of a medical condition. Most people polled in the survey did not seek data on patient safety at the medical facility they chose. Additionally, a smaller percentage – 35 percent – of polled Massachusetts residents believe that medical errors are a serious threat in the state.


One medical error that took place at Advocate Lutheran General Hospital led to the death of a baby that was born prematurely, the Chicago Tribune reports. A pharmacy technician entered the wrong data in an existing field on his computer screen when prescribing nutritional fluids to Genesis Burkett, an infant born 16 weeks early.

The error led to automated medical technology preparing an intravenous solution that had 60 times more sodium chloride than was ordered by the physician. When the prescription was given to the baby, his heart was stopped, leaving behind two grieving parents. This shows how a medical error when using health IT systems could have grave results.


“(These) technologies can be enormously helpful, but what is emerging is that when implemented poorly, they can be harmful,” Dr. Ashish Jha, associate professor of health policy at Harvard University’s School of Public Health, told the news source.

Greater EHR interoperability, device integration, and health data sharing could potentially lead to fewer medical errors within the healthcare community. The survey from West Health Institute also found that polled nurses prefer medical devices that are better coordinated and EHR systems capable of interoperability. The seamless sharing of data is being called for by many medical professionals.


“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Ross Koppel, a sociologist at the University of Pennsylvania and health IT expert, told the source.


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LISA SHOCK's curator insight, May 6, 2015 5:00 PM

EHRintelligence notes the importance of proper interoperability and integration of EHR systems for clinical application.  .  

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How Patient Access to Doctor Notes Affects Physicians

How Patient Access to Doctor Notes Affects Physicians | EHR and Health IT Consulting | Scoop.it

Releasing physician notes to patients is scary for many doctors. Common concerns include patient misunderstandings regarding the health information included in the note, damaged physician-patient relationships due to the content included, and a flood of questions from patients who are confused about clinical terminology.

But presenters at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago said it's time to put those concerns to rest.


The presenters, Jan Walker, assistant professor at Beth Israel Deaconess Medical Center and codirector of the OpenNotes initiative; Amy Gleason, chief operating officer at CareSync; and internist Susan Woods, director of patient experience and connected health at the Veterans Health Administration, agreed that providing patients secure online access to physician notes is a win-win for all parties.

Here are three key findings they shared during their presentation:


1. More patients want — and expect — access to physician notes.
During the presentation, Walker shared results from a one-year Open Notes demonstration project funded by the Robert Wood Johnson Foundation. About 100 physicians from Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center participated in the project, affecting more than 13,000 patients in multiple locations.


Jan Walker In the demonstration project, patients received an alert that their note was ready to view as soon as the physician signed the note (and they received another alert prior to patient visits).

Walker acknowledged that one big question prior to starting the project was whether patients would be interested. Ultimately, over the course of the 12-months, 82 percent of patients at Geisinger who had a visit to their provider opened at least one note.


Notably, that included older patients, sicker patients, and less educated patients. In fact, patients with no more than a high school education looked at notes at same rate as everyone else, said Walker.

Ninety nine percent of patients said they wanted to continue having access to physician notes, and 85 percent said availability of physician notes would influence their future choice of providers.


2. Patients report positive results when they can view physician notes.
So what effect did that increased access to physician notes have on patients? The study suggests a positive one. About three-quarters of the survey respondents said they take better care of themselves, understand their health better, feel more in control, take their meds as prescribed at greater rates, and feel better prepared for patient visits, said Walker.


Other positive results Walker said patients reported included:

• Improved recall of the patient visit and improved ability to adhere to follow-up recommendations, because looking at the note helped patients refresh their memory.


• Improved trust between patients and their physicians because it removed the "mystery" of what the physician was writing in the record.

 
• Improved ability of patients to be prepared for their next visit and to engage in shared decision making.


3. Physicians report positive results when patients can view their notes.
While many of the physicians reported concerns regarding how patient access to notes would affect their work flow, very few actually saw these concerns come to fruition, according to Walker.


Only 2 percent reported longer visits, 3 percent reported spending more time on patient questions, and 11 percent reported spending more time on documentation. In fact, Walker commented that a common question received from physicians who were participating in the demonstration was whether the access to physician notes feature was on, because they weren't getting questions from patients about the notes. 


And, contrary to the fear that patients might be confused, unnecessarily worried, or offended by the notes, only one percent to eight percent of physicians reported these problems, said Walker.

Perhaps most telling is that, at the end of the 12-month demonstration, none of the participating primary-care physicians stopped participation, even though that was an option. "We really believe this is the right thing to do," said Walker.


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