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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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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What does Stage 3 Meaningful Use Mean to Your Organization?

What does Stage 3 Meaningful Use Mean to Your Organization? | EHR and Health IT Consulting | Scoop.it

March 2015 saw the 3rd stage of Meaningful Use incentives come into effect. We take a look at what is included and how it will affect your organization’s efforts to seek these incentives.


As part of the HITECH Act passed by the Obama administration in 2009, electronic health records (EHR) were mandated for health care providers to provide a superior health experience with an electronic records system delivered more efficiently. Eligible providers (EP) are required to meet certification for each EHR stage in order to qualify for Centers of Medicare and Medicaid Services (CMS) Incentive Programs. The last stage of this Act was implemented in March 2015 as the Stage 3 Meaningful Use (MU) portion.

What is Stage 3 Meaningful Use?

Stage 3 Meaningful Use is the final implementation program to ensure that all direct care health providers are utilizing EHRs to effectively improve their delivery of health services. Within this stage there is greater flexibility and simplification for health care providers easing late adopters into HITECH and making those already apart of HITECH the ability to further develop their EHR programs. Requirements to meet the incentives given by the government as part of this program include several specific targets to be met in order to receive the incentives for joining the program.


The purpose of stage 3 is no longer just data capture, EHR adoption or improved information processes but focuses on improved outcomes. 25% of patients must be engaged in secure private messaging with their provider, 25% must be able to view or transmit data from their own records, 60% of lab work requests including imaging must be sent electronically, 80% of drug prescriptions must be sent electronically and lastly 15% of patients must generate health data using applications or health devices. These requirements differ depending on your health care institution’s choices for menu set objectives as opposed to core objectives.

Differences between Stages 1,2,3


Stage 1 focused on data capture and sharing information between the EP and the patient. It focused on ensuring data capture was in a standardized format. Then using that information to track key clinical conditions to enable effective communication for care coordination and using that to engage patients and their families in their care. Stage 2 focused on advanced clinical processes and the exchange of information. This stage dealt mainly with increasing information transfer electronically.


Stage 3 Meaningful Use focuses on taking the benefits from Stage 1 and 2 in order to improve safety, quality, efficiency of processes and information to affect an improved health outcome for patients.

Bottom Line for Your Health Organization

Although there is not a legislated mandatory adoption of EHRs for EPs, there are still consequences. The two most relevant are the loss of sizable incentives for developing your EHR program from the government. These incentives depend on whether you apply under Medicare or Medicaid. If you do not implement EHRs and certify under the MU program, you will lose 1% of the reimbursement under Medicare and Medicaid physician fee schedule covered amount per year to a maximum of 5% after five years.


Remember that your EHR programs still need to be HIPAA compliant for secure data collection, storage and transmission and require that a risk analysis assessment has been conducted for the MU programs.

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Do Certified EHR Technology, Alerts Risk Patient Safety?

Do Certified EHR Technology, Alerts Risk Patient Safety? | EHR and Health IT Consulting | Scoop.it

After the HITECH Act was passed and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers began computerizing their patient records and adopting certified EHR technology in an effort to promote care. However, integrating electronic records into the physician workflow has led to a variety of issues, according to the Agency for Healthcare Research and Quality (AHRQ).


While certified EHR technology has been considered a surefire way to improve patient safety, there are many examples proving the opposite and finding that these health IT systems may lead to medical errors that threaten patients’ lives.


The majority of medical technologies – whether infusion pumps, cardiac monitoring devices, or certified EHR technology – have warnings that tell physicians when an action is unsafe for the patient. Through these alerts, clinicians are expected to stop a prescription or a medical procedure deemed dangerous for a particular patient. In particular, some important alerts are meant to notify a doctor whether a patient will have an allergy or negative drug reaction.


However, the widespread computerization throughout the clinical setting has brought an enormous number of alerts among different medical devices, which physicians manage every day. A study conducted last year shows that monitoring devices across 66 patient beds in an academic hospital generated at least 2 million alerts throughout a single month.


In another study surrounding ambulatory care, computerized provider order entry (CPOE) systems generated alerts for as much as 6 percent of all orders entered, which means doctors dealt with dozens of warnings per day.


When it comes to managing these large amounts of warnings, many clinicians experience alert fatigue and become desensitized to the safety alerts. This could be a major problem for the healthcare sector, as physicians may ignore some warnings due to alert fatigue and cause serious medical errors within the clinical setting. The results show that many physicians override most CPOE warnings.


With more exposure to these warnings and additional use of health IT systems, physicians become even more prone to alert fatigue. This problem is also due to the mere fact that many of these alerts generated via CPOE systems are often “clinically inconsequential,” AHRQ reports. The problem with ignoring certain alerts that do not pose harm is that clinicians will also bypass any warnings that could lead to a serious safety issue for a patient.


Essentially, alert fatigue and the high number of warnings may be leading to additional medical errors and patient safety issues throughout the healthcare industry. The widespread use of certified EHR technology may not have the intended consequences once hoped for with regard to quality care improvements.


In fact, a Boston Globe investigation from 2011 shows that alert fatigue and the failure to respond to critical warnings via medical devices led to more than 200 fatalities across a five-year period.


AHRQ gave some recommendations to prevent some of the issues associated with alert fatigue. Increasing alert specificity and eliminating inconsequential alerts, customizing alerts to each individual patient, providing tiers for alerts with regard to severity, and using human factors strategies when designing the warning systems may all lead to greater patient safety and a reduction in medical errors associated with alert fatigue.


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Medical Data Exchange, Cloud Solutions Impact EHR Design

Medical Data Exchange, Cloud Solutions Impact EHR Design | EHR and Health IT Consulting | Scoop.it

Over the last two decades, the medical industry has changed drastically in terms of patient care and access to medical records. It was nearly impossible to obtain one’s own health record 20 years ago. Forbes reports that patients had little choice but to press legal action if they wished to access their own medical data.


In 1996, however, the Health Insurance Portability and Accountability Act (HIPAA) was passed, which did offer legal protections to patients who needed to see their health records. Nonetheless, there was still significant difficulty in accessing this information and most people never went through the challenging process.


Today, these problems are slowly disappearing, as patients have more ability to readily view their medical history and test results via patient portals and through other electronic means.


A study published earlier this year shows that after three hospital systems in separate states offered their patients the ability to view their health records and physician notes, nearly 70 percent of patients reported understanding their conditions better and taking better care of themselves including remaining vigilant about taking their medications on time. The results from the study also showed that providing patients with this ability did not majorly impact the physician workflow.


The design and evolution of certified EHR technology and health IT systems that held medical data are now changing toward a more cloud-based and mobile platform. This leads to more digitizing of medical records and providing more flexible solutions for healthcare professionals within the clinical setting.


Both mobile health and wearables are also impacting the design of certified EHR technology. The Apple watch, for instance, could potentially hold relevant medical data for physicians to view and patients to access. Additionally, mobile apps on smartphones or tablets could be used by patients to request drug refills and securely message doctors or nurse practitioners.


In a new report from market research firm IDC, Judy Hanover, Research Director at IDC, explains, “The new concept of flexible, mobile, cloud-based acute care EHR supports digitizing paper workflow and reengineering processes … 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.”


According to the report, it is expected that over the next few years, providers will begin to replace their current certified EHR technology with cloud-based solutions instead. Greater investment will continue to be poured into the health IT industry as providers move onto meeting Stage 3 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs.


Additionally, the future of EHRs will continue to depend on EHR interoperability and the ready access of medical data across the healthcare industry. Forbes states that many within the medical sector believe EHR interoperability will be the “biggest game changer.” However, it may take longer than expected for interoperability and medical data exchange to expand across multiple healthcare settings, as this industry “moves slowly.”


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Modifications to Meaningful Use Requirements Find Backing

Modifications to Meaningful Use Requirements Find Backing | EHR and Health IT Consulting | Scoop.it

Last month, the Centers for Medicare & Medicaid Services (CMS) released a new proposed rule with several key modifications to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. The general public has until June 15 to submit comments to this particular proposed ruling.


The changes are meant to modify the EHR reporting periods from 2015 to 2017. The new reporting period was transitioned to a 90-day period that would line up with the calendar year. Additionally, patient engagement measures under the Stage 2 Meaningful Use requirements were changed.


If the ruling is passed, no longer will providers have to ensure that 5 percent of their patients download, view, and transmit their health information over the next couple of years. According to the proposed rule, only one patient will need to utilize a portal to view, download, or share their medical data.


The American Medical Association (AMA) recently announced their support of the proposed modifications to the meaningful use requirements. In a press release, the AMA stated their prior advocating of offering more flexibility under the EHR Incentive Programs so that providers and healthcare professionals may adopt and utilize health IT systems in a way that benefits their practice and workflow.


“Physicians want to use new technologies that help strengthen physician-patient relationships, improve health outcomes and make them more efficient,” AMA President-elect Steven J. Stack, MD, said in a public statement. “About 80 percent of physicians have already incorporated electronic health records (EHRs) into their practices, but they have faced significant barriers in participating in the Meaningful Use program and many are receiving penalties despite their investments in EHRs. We believe CMS’ proposal offers common sense solutions that, if finalized quickly, will help more physicians use EHRs in a truly meaningful way while supporting patient engagement.”


Within the letter sent to CMS for public comment, the AMA offered additional advice to the organization that could improve attestation to meaningful use requirements. The suggestions revolve around quality measure reporting and removing the overall “pass-fail structure” so that physicians and hospitals that attempted to meet meaningful use requirements and show positive results are not penalized.


Stack continued by discussing the importance of providing patients with secure messaging tools and patient portals and encouraging their consumers to utilize these platforms. At the same time, Stack mentioned that different physicians and healthcare providers have varying circumstances that may impact their ability to have a high percentage of patients viewing their medical information electronically.

For example, providers serving the elderly population or Medicaid-based patients in underserved areas may not have the key demographic that utilizes the Internet, smartphones, or even computers.


The AMA includes guidelines on its website for physicians looking to better engage their patients in their healthcare and the use of the patient portal. The organization is looking to work with physician groups to further patient education regarding accessing health information digitally.


Through these proposed modifications to the meaningful use requirements, CMS will be able to give providers the flexibility needed to successfully attest to the objectives and bring the healthcare industry into the 21st century.


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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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Adoption Still a Problem for Organizations Swapping EHRs

Adoption Still a Problem for Organizations Swapping EHRs | EHR and Health IT Consulting | Scoop.it

Each year the Health Information and Management Systems Society’s (HIMSS) annual conference is the Super Bowl of health IT. No other conference boasts more attendees ranging from health IT innovators and collaborators to pioneers. This year 40,000 plus participants descended on Chicago, all eager to learn about the new direction, trends, and solutions of the industry.


As always, buzzwords were aplenty—interoperability, care coordination, patient experience, and value-based care, to mention a few. During her keynote address on April 16, Karen DeSalvo, National Coordinator for the ONC, called the current state of health IT the “tipping point.” In 2011 the ONC released its four-year strategic plan focused on implementing and adopting electronic health records (EHRs). Now, DeSalvo says the industry is changed and ready to move beyond EHRs to technologies that will create “true interoperability.”


Enlightening conversations were happening among the crowded booths, hallways, and meeting rooms between organizations looking to ‘rip and replace’ their current EHR for a new one. While some organizations are struggling to unlock data across disparate systems, others are looking to upgrade their current system for one compatible with ICD-10, Meaningful Use, analytics solutions, or a combination of these. Still others are looking to replace systems they dislike for lack of functionality, vendor relationships, etc. In many cases, replacing an EHR is needed to ensure interoperability is at the very least viable. This buzz at HIMSS is a strong indicator that EHRs are still an important and essential part of health IT, and perhaps some organizations have not reached the tipping point.


In addition to the many challenges these organizations are facing—from data portability, an issue John Lynn wrote about in August 2012, to the cost of replacing the system—leaders are agonizing over the resistance they are facing from clinician end users. How can these organizations force clinicians to give up systems they once resisted, then embraced and worked so hard to adopt? How can leadership inspire the same level of engagement needed for adoption? The challenge is similar to transitioning from paper to an EHR, only more significant. Whereas the reasons for switching from paper were straightforward—patient safety, efficiency, interoperability, etc.—they are not so clear when switching applications.


Clinicians are also making harsher comparisons between applications—from every drop-down list, to icon, to keyboard shortcut. These comparisons are occurring at drastically different phases in the adoption lifecycle. Consider the example of an end user needing to document a progress note. In the old EHR, this user knew how to copy forward previous documentation, but in the new system she doesn’t know if this functionality even exists. Already the end user is viewing the new system as cumbersome and inefficient compared to the old application. Multiply this comparison by each of the various tasks she completes throughout her day, and the end user is strongly questioning her organization’s decision to make the change.


This highlights an important point: Swapping one EHR for another will take more planning, effort, and strategy than a first-ever implementation. The methods for achieving adoption are the same, but the degree to which they are employed is not. Leadership will not only have to re-engage end users and facilitate buy-in, they will have to address the loss of efficiency and optimization by replacing the old application.


Leadership should start by clearly outlining the reasons for change, a long-term strategy, as well frustrations end users can expect. They should establish a strong governance and support structure to ensure end users adhere to policies, procedures, and best practices for using the application. The organizations that will succeed will provide end users with role-based education complete with hands-on experience completing best practice workflows in the application. Education should include competency tests that assess end users’ ability to complete key components of their workflow. Additionally, organizations must capture and track performance measurements to ensure optimized use of the system and identify areas of need. And because adoption recedes after application upgrades and workflow enhancements, all efforts should be sustained and modified as needed.


While HIMSS15 brought to the stage a wealth of new ideas, solutions, and visions for the future of health IT, the struggle to adopt an EHR has not completely gone away. Many organizations are grappling with their current EHR and choosing to replace it in hopes of meeting the triple aim of improving care, costs, and population health. For these organizations to be prepared for true interoperability, they must overcome challenges unseen in paper to electronic implementations. And if done successfully, only then will our industry uniformly reach the tipping point, a point where we can begin to put buzzwords into practice.


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Meaningful Use Stage 3 Success Could Rely On Vendors

Meaningful Use Stage 3 Success Could Rely On Vendors | EHR and Health IT Consulting | Scoop.it

Today I was reading a report on the Health IT Policy Committee’s review of pending Meaningful Use Stage 3 rules — which would ordinarily be as about as exciting as watching rocks erode — when something leapt out at me which I wanted to share with you, dear readers.


The overview, brought to us courtesy of Medical Practice Insider, noted that proposed plans for the Stage 3 rule would allow providers to attest in 2017, though attesting wouldn’t be mandatory until 2018. What this means, editor Frank Irving notes, is that it would be up to EMR vendors to be ready for providers wishing to attest a year early.


The folks overseeing this discussion, the Advanced Health Models and Meaningful Use Workgroup, seem (wisely) to have had their doubts that vendors could be relied upon to meet the 2017 deadline. At the session, workgroup members proposed a couple of alternative ways of addressing this timeline. One was to make the 2017 deadline go away, requiring instead that EMRs have full 2015 certification by 2018. Another was to allow optional attestation in 2017, but if need be, with 2014 EMR certification.


I don’t know about you, but this whole thing makes me nervous. By “whole thing,” I mean adjusting the rules to deal with the likely resistance vendors will exhibit to keeping their roadmap in synch with federal requirements.


After all, consider the history of EMR vendors’ relationship with providers. As we’ve noted, HHS has paid out about $30B in Meaningful Use incentives under HITECH without insisting that vendors provide interoperability. And what have EMR vendors done?  They’ve avoided developing shared standards for interoperability with an alacrity which amazes the eye.


In fact, some EMR vendors — including top contender Epic Systems — have been slapping providers with fees for data sharing (even if they’ve kind of dropped them for now), at prices which could leave them millions in the hole. If that isn’t dead opposite to what those in public policy hope to see happen, I don’t know what is.

Bottom line, if the good people overseeing Meaningful Use want to see Stage 3 accomplish good things, they’ll need to see to it that the new rules give regulators some leverage when it comes to controlling vendors.


As the whole sad interoperability saga has demonstrated, vendors will not take actions that advance health IT on their own. Unlike in other IT markets, where interoperability and meeting regulatory deadlines have been the signs of a winner, EMR vendors actually have strong incentives to ignore providers’ business imperatives.


With any luck, however, between tougher rules on Stage 3 and public pressure to achieve interoperability, EMR vendors will do the right thing.  They’ve certainly had long enough.


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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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Future of Health IT: “It’s Time to Build Something Magnificent”

Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?

Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?


I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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Flash storage poised to benefit healthcare IT

Flash storage poised to benefit healthcare IT | EHR and Health IT Consulting | Scoop.it

The economics of flash storage are changing, and the healthcare industry is in a perfect position to take advantage of these changes to solve multiple challenges.


Healthcare has an exploding data storage problem. Increased use of electronic health records (EHRs) and digital images (among other issues) has healthcare CIOs struggling for cost-effective storage solutions, including the cloud and aggressive data-tiering.


The issue with these solutions is that the Health Insurance Portability and Accountability Act (HIPAA) is very specific and rigorous about putting data in the cloud. Choosing the wrong partner could expose you to risk and fines. And, surprisingly, with the exception of “cold” data — which is usually held on tape and other cheap storage solutions — flash storage is starting to be more economically viable for tier 1 storage, and possibly for lower tiers as well.


It isn’t just that flash storage is getting cheaper (though it is). It’s also that flash storage lets you save money on the surrounding infrastructure. On a pure GB/dollar point of view, spinning disks are still cheaper than flash storage, but that’s not the right way to look at it anymore.


Flash storage lowers your storage footprint by 84 percent, saving you money both in terms of physical space and environmental costs. Because of its 90 percent lower latency, flash allows you to run more virtual machines and fewer physical servers, further reducing costs. Flash storage also allows better storage utilization and better scalability.


And perhaps the most overlooked part of all of this is that, because of all the savings above, you often lower licensing costs because you are running less hardware. Add it all up, and the case for flash improves significantly.

Benefits of using flash storage in healthcare

The obvious first benefit of using flash storage in healthcare is that it gives you the opportunity to make more data readily available with low latency and at lower costs than other solutions. This is not merely a matter of convenience, it is an actual necessity in healthcare.


Reforms around the Affordable Care Act put more emphasis than ever on preventive care. The emphasis for health professionals is on follow-up care to prevent patient re-hospitalizations and on intervening with chronic diseases before they become acute. In other words, more data will be “hot” and an increasing number of departments within a healthcare organization will be accessing that hot data. Flash is a good way to respond to these changing methods of accessing your data.


Another major benefit to bringing more flash into healthcare is its advantages to virtual desktop infrastructure (VDI). Virtual desktops are an attractive solution in a healthcare environment, and flash’s low latency is ideal for it. VDI allows use of EHRs in a much more secure environment. Terminals throughout the hospital (sometimes left unattended by necessity) are no longer physical points of access to privileged data and sensitive networks. Administrators can manage access and permissions better with VDI, and more easily update terminals. This is especially valuable for remote clinics, where IT professionals are not always available to easily secure and update remote terminals. A secure virtual desktop makes HIPAA violations far less likely.


Another reason flash storage is beneficial for healthcare environments is because it scales fast. Mass casualty and trauma events can tax systems and quickly use up system resources. Flash, with its low latency and ease of use with virtual machines, allows hospitals to spin up storage quickly in response to emergencies.

Future potential for flash storage in healthcare

In the near future, you will also see flash storage used in medical research, as well as in the growing field of personalized medicine. Particularly resource-intensive functions, such as genome mapping, will become more common in both research and personalized medicine. These advances will mean that medicine will be prescribed, in part, based on a patient’s genetic makeup. For instance, some medication has been known to work on some people and blocked in other people with certain inhibiting genes. Previously, this medication would fail to be approved by governing bodies.


However, personalized medicine and big data might soon be giving a new lease on life to these drugs. The data storage needs to accommodate these advances will increase exponentially, and Flash will serve as a major component in meeting the challenge. Now is the time to build your internal capabilities and infrastructure in preparation for the future data storage needs of healthcare.


How much you use flash depends partially on your type of environment. Some healthcare enterprises will be able to use cheaper options for some or all of their storage needs. But the economics of flash are changing. Less hardware, less physical space, less latency, combined with more scalability and power means flash, and even all-flash storage arrays, may be the right solution for a healthcare CIOs needs.

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Linking EHRs with medication cabinets for improved safety

Linking EHRs with medication cabinets for improved safety | EHR and Health IT Consulting | Scoop.it

Increasingly hospitals are recognizing the value of interoperabilitybetween electronic health records and automated dispensing cabinets, or ADCs. In addition to eliminating redundancies during the medication ordering process, linking them helps to reduce medication errors at the point-of-care.


Hackensack University Medical Center recently unveiled this interoperability between its ADC from Omnicell and its Epic EHR.

Now nurses are able to easily interface with the complete medication management system within one application at the patient's bedside, said Nilesh Desai, director of pharmacy at HackensackUMC.


"With the addition of the interoperability piece, it is now embedded directly into Epic and as you open a patient's chart, automatically you can launch and schedule the medications and view if the medication has been delivered by pharmacy or not," said Desai.


With this interoperability, he said, that there's not a separate login and the nurse doesn't have to remember another password: It's connected to the EHR and it directly opens up to the patient's chart.


Normally when there is a medication that has to be delivered from the pharmacy, the nurse has to go back to the cabinet or look into the cabinet to see if pharmacy delivered it or not.


"If the medication is not delivered the medication is grayed out and the nurse will be unable to remove it," said Desai. "As soon as a pharmacy technician delivers a medication, it lights up. As a nurse, you don't have to go to the cabinet to find out if the medication has been delivered. A nurse can do it directly from a computer from anywhere in the nursing unit. It saves quite a few steps and time."


Shafiq Rab, MD, vice president and chief information officer at HackensackUMC, points out that there are other benefits of interoperability between EHRs and ADCs. One is that while the drug is being procured from the pharmacy system, it also checks for allergies, drug-to-drug interaction, and drug-to-food interaction.


Clinical inefficiencies raise red flag for hospitals


A benefit analysis extrapolated from a 2013 white paper prepared by Cerner, "The Clinical Benefits of CareAware Enhanced Dispensing," revealed that prior to interoperability between EHRs and ADCs, nurses at Penn State Milton Hershey Medical Center were spending on average of 8.5 minutes on a single patient's medication pass resulting in clinical inefficiencies within the medication administration and reconciliation process. Post-implementation they spend on average 5.8 minutes, a 32 percent improvement.


To address the inefficiencies due to disparate clinical information systems, Penn State Hershey partnered with CareAware, Cerner's device connectivity architecture that provides interoperability between CareFusion's Pyxis MedStation ADC and Cerner's Millennium EHR.  

According to the white paper, CareAware "allows clinical information to be shared seamlessly between the two systems improving workflow and patient safety," while allowing the nurse to view the same information in both systems.


Flip Groves, vice president of business development in the Medication Management Solutions Group at CareFusion/Pyxis, said such interoperability extends not only to the EHRs, but also into the entire, end-to-end, medication-management process.  


"Interoperability means connecting the automated dispensing cabinets into enterprise-wide pharmaceutical resource inventory management system, to IV prep check systems, to microbial surveillance systems, bringing together oversight and optimization of the end-to-end management of medication processes and resources," said Groves.

He added that interoperability also enhances patient safety and clinical workflow by eliminating opportunities to introduce errors, and by providing the users with the right information, through the right application, in the right place, at the right time.


Dan Pettus, vice president for IT in the Medication Management Solutions group at CareFusion/Pyxis, said that interoperability is significant not only for EHRs and ADCs but also for other devices including IV pumps and ventilators.


That capability, said Pettus, is the tie-in to all of the necessary connections that you need to make these applications from products interoperable.


"It's beneficial to our customers to have one-stop shopping when it comes to those technology platforms," said Pettus. "Less interfaces, less complexity, it reduces to maintain these things over time."


Point-of-care medication errors averted


Mark Neuenschwander says that for years he has tried to draw attention to the gap between the point-of-dispensing and the point of administering medications.


"It is possible for nurses to get the right medications for the right patients at dispensing cabinets and then to administer them to the wrong patients," said Neuenschwander, a Bellevue, Wash.-based consultant on bar code-enabled medication dispensing, preparation and administration.


Bar code medication administration, Neuenschwander says, has matured and become commonplace in today's hospitals to verify patients and medications to address this problem, but be noted that in addition to verification, a sound medication use process requires information.


"In addition to verifying that they have the correct medications for a particular patient, they also need to have access to information about medications both when they come from dispensing cabinets and when they are at the point-of-care."


Neuenschwander, cofounder of the unSUMMIT for Bedside Barcoding, asserted that nurses must document what is administered and that this must occur at the point of care, not at the point of dispensing.

"It is critical that what the nurse sees at any point is up to date. I am thrilled with the ongoing efforts and success in integration information with information systems, dispensing cabinets, and point of care technologies," he said.

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Laurie Bolick Wolf's curator insight, June 19, 2015 12:37 PM

This article summarizes the link between medication dispensing cabinets and EMR.  The current systems in place require bar code scanning of the patient and the medication to ensure the right drug is going to the right patient.  New technology will also allow the nurse to view if the medication is available at the dispensing cabinet from any computer on the unit.  This would definitely be a time saving improvement.  Currently, I sometimes will walk back and forth numerous times to the dispensing cabinet to see if my drug has arrived yet.  With this new innovation, I could avoid this and use my time more effectively.

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EMRs Should Include Telemedicine Capabilities

The volume of telemedicine visits is growing at a staggering pace, and they seem to have nowhere to go but up. In fact, a study released by Deloitte last August predicted that there would be 75 million virtual visits in 2014 and that there was room for 300 million visits a year going forward.


These telemedicine visits are generating a flood of medical data, some in familiar text formats and some in voice and video form. But since the entire encounter takes place outside of any EMR environment, huge volumes of such data are being left on the table.


Given the growing importance of telemedicine, the time has come for telemedicine providers to begin integrating virtual visit results into EMRs.  This might involve adopting specialized EMRs designed to capture video and voice, or EMR vendors might go with the times and develop ways of categorizing and integrating the full spectrum of telemedical contacts.


And as virtual visit data becomes increasingly important, providers and health plans will begin to demand that they get copies of telemedical encounter data.  It may not be clear yet how a provider or payer can effectively leverage video or voice content, which they’ve never had to do before, but if enough care is taking place in virtual environments they’ll have to figure out how to do so.


Ultimately, both enterprise and ambulatory EMRs will include technology allowing providers to search video, voice and text records from virtual consults.  These newest-gen EMRs may include software which can identify critical words spoken during a telemedical visit, such as “pain,” or “chest” which could be correlated with specific conditions.

It may be years before data gathered during virtual visits will stand on equal footing with traditional text-based EMR data and digital laboratory results.  As things stand today, telemedicine consults are used as a cheaper form of urgent care, and like an urgent care visit, the results are not usually considered a critical part of the patient’s long-term history.


But the more time patients spend getting their treatment from digital doctors on a screen, the more important the mass of medical data generated becomes. Now is the time to develop data structures and tools allowing clinicians and facilities to mine virtual visit data.  We’re entering a new era of medicine, one in which patients get better even when they can’t make it to a doctor’s office, so it’s critical that we develop the tools to learn from such encounters.


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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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ICD-10 Implementation Vital for Value-based Care Payments

ICD-10 Implementation Vital for Value-based Care Payments | EHR and Health IT Consulting | Scoop.it

When the SGR bill was passed by the Senate without any ICD-10 implementation delays, the proponents of the new coding set rejoiced. Not only did passage of this bill bring about a stronger formula for Medicare reimbursements but it also meant that the ICD-10 implementation would most likely take place by the scheduled deadline of October 1, 2015.


When President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on April 16, the legislation moved American physicians away from fee-for-service payments toward value-based care and accountable care delivery, according to the Healthcare Information and Management Systems Society (HIMSS).

Additionally, the new SGR bill includes innovative objectives for establishing the meaningful use of certified EHR technology. These payment models will be key for improving population health outcomes throughout the country. The volume-based payment reductions under the prior sustainable growth rate formula will now be altered with a new annual payment update of 0.5 percent through 2019.


By 2019, doctors will be able to choose their reimbursement method among two options: the Merit-Based Incentive Payment System or the Alternative Payment Model. While the Merit-Based Incentive Payment System will depend upon the performance of physicians, doctors who choose the Alternative Payment Model must utilize certified EHR technology standards and authorized quality measures as well as assume financial risk.


The overall push toward value-based care among the federal government, patient advocacy groups, and healthcare providers will require the medical industry to quickly and efficiently transition to the ICD-10 coding set. Documenting patients’ medical histories as well as accurately reporting and coding diagnoses and treatments is vital in the quest to pay for value and enhance population health outcomes across the sector.


The Coalition for ICD-10 also reports on the importance of the ICD-10 implementation in the move toward value-based care, as ICD-9 codes do not have the same capabilities as the newer coding set. While the healthcare community supports the SGR reform bill, many physician groups are still against the ICD-10 implementation and are hoping for additional delays.


However, a move toward measuring and paying for value-based care is not possible without transitioning to a modernized form of diagnostic and procedure coding. In order to accurately measure the value of a healthcare service, it is vital to have the detail available in the ICD-10 coding set, the coalition explains.


One example of the subpar quality of ICD-9 codes involves putting two patients with similar conditions but differing symptoms under the same code while ICD-10 accounts for a variety of divergence among patients. Essentially, ICD-10 codes will include key information about patients and record their medical history more accurately with additional detail.


“Despite opposition to ICD-10 by some physician groups and a few isolated state medical societies, there is general recognition in the medical community that a modern and precise coding system like ICD-10 is essential for measuring and paying for value,” the Coalition for ICD-10 stated. “ICD-9 represents medicine of a bygone era. It cannot support a move to measuring and paying for value. To meet the demands of SGR there can be no further delays in the ICD-10 implementation date.”


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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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6.5 Billion Transactions Boost Health Information Exchange

6.5 Billion Transactions Boost Health Information Exchange | EHR and Health IT Consulting | Scoop.it

The quick and efficient access to healthcare data among medical organizations is vital in pursuit of improved quality of care, better patient health outcomes, and lower costs. In general, health information exchange helps reduce hospital readmission rates, target symptoms before a disease progresses, and prevent medical errors across the healthcare continuum.


One announcement from Surescripts – the largest health information network across the country – shows how devoted the medical industry is to advancing health information exchange and quick access to pertinent data in pursuit of better patient care. Last year, Surescripts processed 6.5 billion health data transactions, which was published in the 2014 National Progress Report. The large amount of health information exchange Surescripts conducted amounts to more than either PayPal or American Express handled in 2014.


“Connecting the nation’s healthcare system is a monumental task, and while more work is needed to ensure true interoperability nationwide, there is no question that the Surescripts network is more connected than ever before,” Tom Skelton, Chief Executive Officer of Surescripts, said in a public statement. “Healthcare is evolving and our collective ability to share health information is addressing a major pain point for providers and patients that ultimately saves time and money and improves the quality of care.”


The statistics show it all – Surescripts exchanged data transactions among 900,000 healthcare professionals, 61,000 pharmacies, 3,300 hospitals, 700 EHR systems, 45 immunization registries, and 32 state and regional networks. The health information that Surescripts shared belonged to approximately 230 million patients, which represents seven out of ten US residents.


Through the Surescripts network, 1.2 billion electronic prescriptions were processed by pharmacies and physicians. Additionally, healthcare professionals accessed and shared 764 million medical history transactions and 7.4 million clinical messages.


Throughout 2013, the access of medication history data rose 75 percent in acute care settings like emergency rooms. Some other key information that Surescripts is capable of sharing among healthcare organizations includes patient charts, visit summaries, and referral orders.


When compared with 2013, the amount of clinical messages that were transferred across the Surescripts network rose by 1,300 percent. This type of extensive health information exchange complies with many regulatory policies and raises patient health outcomes across the nation.


Additionally, sharing electronic data access throughout the industry is a major driver toward combatting prescription fraud and drug abuse. Electronic drug prescription plays a huge role in reducing the abuse of prescription painkillers, for example. Paper prescriptions are relatively easy to forge and medical facilities that transfer to electronic prescribing will make it virtually impossible for addicts to transcribe a false prescription.


“I see the physical and emotional toll that opioid abuse takes on patients and their families every day in the emergency room. E-prescribing can be an effective tool in fighting that abuse,” Dr. Sean Kelly, FACEP, CMO, an emergency physician at Beth Israel Deaconess Medical Center, stated in the press release. “Physicians are eager to embrace technology – as long as it is good technology that speeds our workflows and allows us to make better informed decisions that increase patient safety.”


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CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent”

CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?


Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?

I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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Will Hospital EHR Use Help Prevent 1 Million Heart Attacks?

Will Hospital EHR Use Help Prevent 1 Million Heart Attacks? | EHR and Health IT Consulting | Scoop.it

The implementation of health IT systems as well as hospital EHR use could lead to better care and outcomes among patients with heart conditions, reports the Office of the National Coordinator for Health IT (ONC) in the latest HealthITBuzz.


With high blood pressure affecting as many as 67 million people across the US, hospital EHR use will be needed to reduce the risks associated with hypertension including stroke, atrial fibrillation, and heart failure. Providers may be able to help patients with high blood pressure by teaching them how to self-monitor their condition.


Since May is National High Blood Pressure Education Month, ONC and the Centers for Disease Control and Prevention (CDC) have come together to encourage providers and other healthcare professionals to share blood pressure data and other patient health information through the integration of EHR systems within a hospital or clinic.

The Department of Health and Human Services (HHS) is also working on the Million Hearts® initiative, which is geared toward preventing one million heart attacks or strokes by 2017. Under the Medicare EHR Incentive Program, research regarding the Million Hearts® electronic clinical quality measures was submitted for public viewing in CDC’s Morbidity and Mortality Weekly Report.


The research based on the clinical quality measures shows that data reported under the meaningful use program can possibly lead to more complete and timely information necessary for tracking and analyzing public health issues.


The results from the initiative show that 36 percent of reporting providers attested to the objective requiring 70 percent or more patients effectively managing their hypertension. Nonetheless, hospital EHR use may not be enough to truly make a difference in patient care, as physicians will need to develop patient-centered coordinated care strategies and implement the sharing of data through certified EHR technology.


With both coordinated care efforts and hospital EHR use on the rise, providers will be better able to control patient blood pressures and prevent heart failures and disabilities among their consumers.

Storing electronic health information and using data analytics to track hypertension trends and other patient health criteria can lead to more progress and quality improvements among the healthcare sector. The data collected through the Medicare and Medicaid EHR Incentive Programs could play a key role in tracking success in the national goal of preventing one million heart attacks and strokes by 2017, ONC reports.


Clinical quality measures data can also be used to help physicians find the right treatments or diagnostics for chronically ill patients and better coordinate care among these populations. Additionally, greater EHR interoperability will be key in ensuring that all data is shared efficiently among specialists, primary care doctors, and public health agencies.


“Despite the recent advancements and investments in health IT infrastructure, significant work lies ahead in order to reach the goal of ensuring that the right information arrives in the right format at the right place and time —and ultimately, that the data drive tangible improvements in care and value,” a report from the Workgroup for Electronic Data Interchange (WEDI) stated.


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Laurie Bolick Wolf's curator insight, June 17, 2015 10:15 PM

The article suggests that through the use of EMR, a decrease in strokes and heart attacks may be possible.  While a great idea in concept, I find it lacking in feasibility.  While multiple physicians and specialists can see the trends of health through EMR from other visits, it does not necessarily promote health improvement or change.  The only way I can see this really working is to do a data collection using EMR of those who consistently are documented to display certain health risks and then to individually target these people with specific education.

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Erlanger Health System Takes A Chance On $100M Epic Plunge

Erlanger Health System Takes A Chance On $100M Epic Plunge | EHR and Health IT Consulting | Scoop.it

The seemingly eternal struggle between EMR giants Cerner and Epic Systems has ended in another win for Epic, which was the final choice of Chattanooga, TN-based Erlanger Health System. The health system’s CEO, Kevin Spiegel, who said that Cerner had been its other finalist, announced last week that Erlanger would spend about $100 million over 10 years for the Epic installation.


Erlanger, a four-facility public hospital system with about 800 total beds, is an academic medical system and serves as a campus of the University of Tennessee College of Medicine. The system also partners with UT to operate the UT Erlanger Physicians Group, a 170-member multispecialty practice.


The health system, which fell in financial trouble in 2012, only recently saved itself and positioned itself for the massive Epic investment. It closed out FY 2014 with $618M in total operating revenue and $18M in operating income.


Erlanger’s turnaround is all well and good. But that being said, these numbers suggest that Erlanger is making something of a gamble by agreeing to an approximately $10M a year health IT investment. After all, the health system itself concedes that its return to financial health came in large part due to $20 million in new Medicare and Medicaid funding from CMS, along with new funding from the state’s Public Hospital Supplemental Payment Pool. And politically-obtained funds can disappear with the stroke of a pen.


The risky nature of Erlanger’s investment seems even more apparent when you consider that the system has an aggressive building plan in place, including a new orthopedic center, a $68M expansion of one of its hospitals, a 100,00 square foot children’s & women’s ambulatory center and a new health sciences center. Particularly given that Erlanger just completed its turnaround last year, does it make sense to squeeze in Epic payments alongside of such a large capital investment in infrastructure?


What’s more, the health system has a bond rating to rehabilitate. Faced with financial hardships in 2013, its bond rating was downgraded by Moody’s to a Baa2 and the system’s outlook was rated “negative.” By 2014, Erlanger’s had managed to boost the Moody’s outlook to “stable,” in part due to the influx of state and federal funds obtained by Erlanger execs, but the Baa2 rating on its $148.4 million in bond debt stayed in place.


While I imagine the hospital will realize a return on its Epic spending at some point, it’s hard to see it happening quickly.  In fact, I’d guess that it’ll be years before Erlanger’s Epic install will be mature enough to be evaluated for ROI, given the level of effort it takes to build a mature install.


In the meantime, Erlanger leaders may be left wondering, from time to time at least, whether they really can afford their expensive new EMR.


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