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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Analyzing the Alleged Death of Meaningful Use

Analyzing the Alleged Death of Meaningful Use | EHR and Health IT Consulting |

Earlier this week, Andy Slavitt, Acting Administrator for CMS, told a group of attendees at the J.P. Morgan Annual Health Care Conference that meaningful use is on its way out.

“Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending meaningful use and moving to a new regime culminating with the [Medicare Access and CHIP Reauthorization Act of 2015] (MACRA) implementation,” Slavitt told attendees. “The meaningful use program as it has existed, will now be effectively over and replaced with something better.”

The idea that meaningful use, a program which began in 2011 and aimed to incentivize or penalize physicians for adopting an EHR system, would be over, naturally caused many physicians to celebrate. Melissa Young, an endocrinologist in Freehold, N.J., and a member of the Physicians Practice Editorial Board, e-mailed a three word reaction to the news: “Hooray! ‘Nuff said.”

The AMA had a more formal way of celebrating this news. Of Slavitt, AMA President and CEO, Steven Stack, an emergency physician, told Beckers Hospitals Review in a statement: "He listened to working physicians who said the meaningful use program made them choose between following Byzantine technological requirements and spending more time with their patients. This is a win for patients, physicians and common sense."

In his speech, Slavitt talked about winning the “hearts and minds” of physicians back. Getting rid of meaningful use would undoubtedly help the federal agency achieve that goal, as evidenced by the rising number of docs who opted out of the program due to its stringent requirements.  “The concept of meaningful use was always doomed to failure and it has been proven that there is no improvement in the quality of our healthcare delivery system and it has not reduced the costs of the provision of medical care,” Jeffrey Blank, a podiatric physician in Loxahatchee, Fla., and a member of the Physicians Practice Editorial Board, said via email.

Hold that Thought

Despite the excitement, Robert Tennant, health information technology policy director for the Medical Group Management Association (MGMA), says physicians should keep the champagne on ice. For one thing, they will still be judged on EHR and technical capability.

At the conference, Slavitt talked about MACRA, which authorized the creation of the Merit-Based Incentive Payment System (MIPS). MIPS will measure and compensate physicians on quality, practice improvement, cost, and use of technology. Within MIPS will be elements of meaningful use. Rather than rewarding physicians for using technology, MIPS will aim to pay them on using it towards improving their outcomes.

While Tennant says a reworked meaningful use is “potentially very positive,” the guidelines for MIPS are supposed to be released and finalized this year, which he notes could be a problem for physicians. “Payment under MIPS is supposed to take effect in 2019. If the traditional approach of using a two-year look back [to make those adjustments] is in place, it would mean reporting would begin in 2017,” he says. “If you look at the timing from a regulatory process, we’re concerned with how this would be accomplished.”

In essence, vendors would have to redevelop software around the guidelines, train customers, and practices would have to go live within the space of a year. Moreover, Tennant says if MIPS regulations are finalized in December of this year, they’d likely overlap with a new presidential administration.

“Any new administration, the first thing they do is typically put all pending regulations on hold and review them before they approve,” he says.  Tennant also notes practices still have to be concerned over meaningful use regulations for 2016, including a full-year reporting period and the fact that Stage 3 of meaningful use is technically supposed to be mandatory in 2018.

“We don’t know what we are moving ahead to,” Tennant says. For practices, he advises to select software that fits their clinical needs and to not worry about “arbitrary and potentially changing” regulations. “Don’t focus on 2017 or beyond. We don’t know. The vendor doesn’t know.”

Even still, he is “cautiously optimistic” about Slavitt’s remarks. “We’re hoping CMS takes this opportunity to leverage MACRA to develop a program that is achievable and clinically relevant,” he says.

Blank is interested to see what lies ahead with government regulations, but is not as optimistic as Tennant. “I'm sure that many interest groups and the insurance industry will profit and doctors like me will continue to struggle,” he says.

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Will AAFP Agreement Help Facilitate EHR Vendor Selection?

Will AAFP Agreement Help Facilitate EHR Vendor Selection? | EHR and Health IT Consulting |

Only time will tell whether the endorsement by the American Academy of Family Physicians (AAFP) of a particular EHR technology will translate into increased EHR adoption among these providers.

Late last week, AAFP struck an agreement with EHR company, HealthFusion, to promote its MediTouch EHR technology among its members.

"MediTouch offers the specifications AAFP members need," HealthFusion Chairman Sol Lizerbram, RPH, DO, said in a public statement. "The system was founded and created by family physicians with the goal of enhancing the practice of medicine and improving provider workflows. The quality of the system has been recognized by numerous organizations and health systems. We are honored that we now have the opportunity to associate with AAFP and its membership."

According to the EHR vendor, its EHR technology is a means for family physicians to keep pace with federal regulation and industry standards for health IT use:

Family Medicine is finally being recognized for its critical contribution to the healthcare delivery system and we expect the role of Family Physicians to become even more prominent in the coming years as the nation transitions to alternative payment models. With our easy to use interface that assists with government compliance programs such as Meaningful Use and PQRS and our NCQA Pre-Validated Patient Centered Medial Home module, the MediTouch system is already prepared to work closely with AAFP members to meet the challenges of our ever changing delivery system.

For its part, AAFP has said little about the agreement. Its website includes details about HealthFusion/MediTouch EHR and practice management technology as part of discounts and services to members, with the following preface: "Help lower everyday practice costs and save time doing it. AAFP has done the research for you and negotiated the deal."

As for EHR adoption and use, AAFP has remained largely supportive of the EHR Incentive Programs, most recently in welcoming changes to meaningful use requirements proposed by the Centers for Medicare & Medicaid Services (CMS) earlier this year (although still awaiting finalization).

"Family physicians are among the earliest adopters of certified electronic health record technology and remain committed to the promise of delivering better health care with interoperable electronic health records," the organization said in February. "As health providers across the United States build out the EHR infrastructure over the coming years, family medicine will continue to play a central role, and CMS's announcement demonstrates that it is listening to our concerns. We’re gratified to see that our collective voice has been heard and needed change is coming."

As for billing and claims management, AAFP joined its voice with those of other provider associations in supporting additional ICD-10 flexibilities following the ICD-10 compliance deadline set for October 1.

The agreement between AAFP and HealthFusion is no guarantee of increased EHR adoption of a particular technology, but it does steer family physicians in an obvious direction when considering a specific health IT platform.

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The 'fatal cost' of poor IT rollouts

The 'fatal cost' of poor IT rollouts | EHR and Health IT Consulting |

Too often, health organizations "make rookie mistakes" in their technology implementations, writes Leapfrog President and CEO Leah Binder. And too often, these rollouts leave hospitals vulnerable to serious patient safety risks.

"They assume everything is plug-and-play, then panic when things go wrong. They set unrealistic timelines that demoralize staff. They rely too much on vendors. And they expect technology to somehow electronically solve complex human and managerial issues."

Beyond causing "widespread dissatisfaction – sometimes outright revolt" – from clinicians and nurses, Binder shows how poorly-considered implementations have the potential to be fatal.

Leapfrog offers hospitals a test to assess the efficacy of their order entry systems, for instance, she notes.

One-third of the orders tested each year at more than 1,000 hospitals "don’t properly alert to errors," Binder writes. "Worse, one in six of the orders we test that would have killed the patients don’t get stopped by the systems."

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

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

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

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

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

Wearable technology

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

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


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

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

Medical device information system

Recording, Merging and analyzing medical data.

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

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

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

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

Intelligent Hygiene Systems

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

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


IoT has already changed healthcare

But that is just the beginning.

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

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Some Methods For Improving EMR Alerts

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

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

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

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

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

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

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

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

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

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

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

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

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

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Final Steps to Take Before the ICD-10 Implementation Deadline

Final Steps to Take Before the ICD-10 Implementation Deadline | EHR and Health IT Consulting |

As the countdown to the ICD-10 implementation deadline continues and the healthcare industry gets closer to October 1, those ready for the new diagnostic coding set will stand out from the rest of the crowd. An article by Pam Jodock, Senior Director at the Healthcare Information and Management Systems Society (HIMSS), describes three types of medical organizations that are either moving forward with the ICD-10 implementation deadline or are behind in their ICD-10 preparations.

The healthcare entities that have implemented new system upgrades and trained their staff on the ICD-10 coding set while ignoring any ICD-10 delays should be more ready than others once October 1, 2015 hits.

The second type of provider likely stopped his or her ICD-10 preparationsonce the 2014 ICD-10 delay was announced but resumed at the beginning of this year. Those who began in January or February should still be in good shape to meeting the ICD-10 implementation deadline. The third type of provider, however, may have difficulty being completely prepared for the new coding set by October 1 if they postponed all plans in hopes of another ICD-10 delay.

Jodock continued to explain that there are a number of steps that well-prepared healthcare providers should have already completed. These include:

  • Remediating systems to identify ICD-10 codes for any services performed on October 1, 2015 and after
  • Completed or undergoing testing with partners and payers
  • Coding staff trained and tested on the ICD-10 codes
  • Contingency plans developed to prepare for any potential reimbursement delays
  • Reassurance from payers, clearinghouses, and other partner entities that they are prepared for the ICD-10 implementation deadline
  • Full training of the medical team on any new clinical documentation procedures

Following these steps among others will ensure greater success among healthcare providers in being well-prepared for the ICD-10 implementation deadline. However, any medical organizations that are behind in their ICD-10 preparation efforts should not worry, Jodock explains.

The Centers for Medicare & Medicaid Services (CMS) offers a variety of services to help providers better prepare for the new diagnostic and procedural coding set. For example, Medicare Adminstrative Contractors (MACs) are offering free billing software to providers and more than 50 percent of MACs are providing physicians and healthcare professionals the ability to submit ICD-10 claims via their provider portals upon the ICD-10 implementation deadline.

A presentation offered by CMS called “ICD-10: Preparing for Implementation and New ICD-10-PCS Section X” discussed further steps on moving forward with ICD-10 preparation.

 “ICD-10 is really foundational to our nation’s healthcare. We really want to make sure everyone is prepared,” Denisia Green, Deputy Director of the National Standards Group, said during the presentation. “We have free resources, tools, and testing available to everyone.”

“ICD-10 is set. The date is set for October 1, 2015. What we want you to understand is that there are not that many codes,” Green explained. “Yes, you have to take a look at the codes that you use. Over half of the codes are laterality. If you look at the code set by category, some of the codes have actually been streamlined in ICD-10. I think one of the things that we have to keep in mind is who are the patients that we take care of and that will help to dictate what codes you’re going to be using.”

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Work-Life Integration for Physicians

Work-Life Integration for Physicians | EHR and Health IT Consulting |

While I was preparing a talk on work-life balance, I stumbled across a 2014 article in Harvard Business Review by Stewart Friedman. It is worth reading for all those in search of work-life balance, although he argues that the whole idea of balance is the wrong way to approach the issue. Mr. Friedman articulates the concept of work-life integration: instead of viewing yourself being pulled in different directions (work, family, self), you consider how the various parts of your life overlap and integrate.

In the article, he describes several different exercises that can help you consider your own ability to integrate the personal and professional arenas, as well as identifying the skills you will need to achieve improved integration. What I like about his method is that there is not a "one size fits all" approach in which it is verboten to check e-mail at the dinner table or zone out on your morning commute. Instead, he challenges his readers to experiment, test, and explore what works best for each individual.

So, over the past week, I've been considering my own work-life integration. Truthfully, it still feels like a balancing act rather than a friendly merger. However, by using some of his exercises, I can report a recent success. In January, I changed from a primarily clinical to a primarily administrative/leadership role in my organization. One thing I failed to consider as carefully as I should have was the time demands for "after-hours" meetings and events. With young children at home, I am fiercely protective of the dinner time to bed time window. As a physician, I am used to being at work late or being called back to the hospital, but these demands somehow feel better than skipping dinner just to attend a meeting. Patient care can occur at all hours, meetings shouldn't.

My promise to my family and myself was to limit my late evenings to once a week. However, I started the month of April with seven or eight requests already and became concerned about my ability to be professionally and personally successful. I started with a heart-to-heart with myself. Truthfully, my amazing stay-at-home husband could handle it if I was away from home more often than just once per week. While I was concerned about childcare/homework/bedtime items, I knew that it was more than that. The fact is, I love my family and enjoy spending time with them. Even if it is just being silly around the dinner table or watching DVDs of old 80s sitcoms that my kids love now as much as I did then, that time can be the best part of my day. I am not willing to give it up, even for career advancement.

I concluded that my first resolution was the right approach — a maximum of four evenings per month. Next, I reviewed the invitations and requests on my time and determined that I needed to both prioritize and strategize, first on my own, and then with my boss. I am happy to say I was successful on both fronts, and now feel that I am achieving a balance between professional and family demands.

Desire to succeed at work can easily eclipse family obligations. But this physician found a way to integrate both goals into her life.
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Physician Job Satisfaction on the Decline

Physician Job Satisfaction on the Decline | EHR and Health IT Consulting |

Healthcare bureaucracy and greater focus on data entry may be negatively influencing the physician profession including physician job satisfaction, according to a recent survey from the healthcare solutions group Geneia. The company polled 416 doctors in January 2015 and found that 84 percent claim the amount of quality time with patients has decreased over the last ten years.

Physician burnout is also on the rise, as 67 percent of respondents said they know a doctor who will likely stop practicing medicine within five years. Most respondents were unhappy with the work-life balance aspects of their profession. Only 25 percent surveyed stated they were “very satisfied with the work itself.”

Even though the Department of Health & Human Services (HHS) focused on improving patient engagement through Stage 2 Meaningful Use requirements, it seems that the patient-doctor relationship is actually floundering. A total of 78 percent of respondents said they feel rushed when speaking with patients.

Additionally, many physicians are feeling overwhelmed by the large amount of paperwork and regulations of the healthcare market. The majority of survey takers – 87 percent – felt that the federal regulations in the medical field are impacting “the practice of medicine for the worse.”

In order to counter the negative effects of the business side of medicine on physicians’ career outlooks, Geneia has implemented the Geneia Joy of Medicine Challenge. This will be a web-based event in which the organization will seek ideas from doctors about the best ways to restore the meaning of practicing medicine.

In an interview with, Heather Lavoie, Chief Operating Officer of Geneia, has said that an excess of information has come from the business and technology side on ways to improve the patient-doctor relationship and that it is time for physicians themselves to come forward with creative solutions. This is why Geneia is holding the Joy of Medicine Challenge.

“They’re [physicians] are in a much better position now to design what will work for them,” Lavoie said in the interview. “Some of what you hear from physicians about what they really need is less data entry and less time in the office clicking away.”

Geneia has already seen some doctors submit ideas for improving the practice of medicine. Some suggestions include hanging EHRs on the wall and limiting the direct interaction necessary with the systems while enabling the tools to capture more data automatically. Additionally, one idea on improving population health management includes leveraging the broader care team, and not just physicians, to categorize patients who are at highest risk, who have missed important preventive services,  as well as those with less serious conditions.

While the survey did not directly ask about how meaningful use stages are affecting the practice of medicine, the takeaway shows doctors are unhappy with the bureaucracy and high amount of data entry required through recent regulations.

Despite the dissatisfaction with data entry, EHR systems are here to stay, Lavoie mentioned. Physicians are not asking to go back to paper-based charting and in general going backwards would not work for the medical industry. For example, there are many medical school graduates getting into the field today who have never used paper charts.

However, Lavoie does say that EHR systems may need better design and improved implementation in order to give physicians more time for direct patient care. Both meaningful use and the Affordable Care Act were “a good shot in the arm” in the move from paper-based to electronic systems, “but with any shot in the arm, there may be side effects,” Lavoie infers.

Currently, there are too many “business burdens” for clinicians. The implementation of EHRs may have occurred too rapidly, which puts the systems at a disadvantage for being instrumental or meaningful in the healthcare system. Many medical facilities have felt rushed when implementing health IT tools, which often translates to less training for staff members. The deadlines of federal regulations have also put a time constraint on the design of EHRs, which may benefit from better construct.

“We jumped into implementation very rapidly in some cases and when you do that, you might shortcut design and you might not efficiently implement them… or adequately train the staff,” Lavoie explained.

The talent and the skill of physicians are not being used effectively if they spend more time with data entry than direct patient care. Freeing up physicians from the administrative tasks of their job may improve their career satisfaction.

One solution that Lavoie proposed involves greater data capture and automating data entry. For instance, when a patient’s blood pressure is measured, it would be useful to have a system that incorporates automatic uploading instead of manual recording.

Some supplementary solutions to these issues could come from dictated notes and natural language processing tools. Bringing physicians back to connecting with patients is important for both the satisfaction of practicing medicine and patient participation. Additionally, patient portals that are designed well and have greater usability do improve the patient experience, according to Lavoie.

“Access to information about an individual’s health status… [and] their full medical history has the potential … to improve the physician-patient relationship ultimately and improve satisfaction. That said, we can implement things well or we can implement them poorly.  It isn’t necessarily a limitation of the system itself, rather, so much of it is in how we implement it, how we communicate about it, and how we use it as a tool,” Lavoie spoke on the benefits of patient portals.

Even though two-thirds of doctors know someone who is considering leaving the occupation, Lavoie says most doctors are problem-solvers and optimists who would rather heal the profession rather than leave it. By incorporating the suggestions from the Joy in Medicine Challenge, job satisfaction among those practicing medicine may be restored.

Kush Pathak's curator insight, March 11, 2015 6:00 PM

The bureaucracy that is being discussed in this article is the Department of Health and Human services. I did not realize that they spend so much of their time and resources on petty data entry and statistics. These things may be important, but what is more important is to ensure that those in the healthcare field and satisfies, and are protected under the law. I do not agree with what this bureaucracy is doing because it just goes to show that these governmental and restrictive bodies are not always here to show protect us, sometimes they are more focused on their their own public image and less on the well being of their actual members and the people that rely on them.!

Changing the Culture of Healthcare

Changing the Culture of Healthcare | EHR and Health IT Consulting |

Why is it that patients are slow to take charge of their health records? Some articles suggest that management of health information should be a patient-driven initiative and the points that are used to propagate this idea are not without merit. However, the primary reason is a lack of a collaborative effort among patients and providers. It is the responsibility of healthcare professionals – who bear more accountability than ever – to make a concerted effort to drive this change. And, since the technology is available to support this effort, the first step for providers is to embrace their influential role in educating patients on the importance of managing life-long health and wellness.

A Culture of Connectivity:

The healthcare industry is becoming increasingly decentralized and engagement through health monitoring among patients and providers is more possible today than ever. In an article in the Wall Street Journal (“Staying Connected Is Crucial to Staying Healthy”), reporter Laura Landro interviewed Dr. Joseph Kvedar, vice president of Connected Health at Boston-based nonprofit health system Partners Healthcare, about the increasing decentralization of care, as well as the spread of health apps and trackers.

Dr. Kvedar confirmed how, in the new network-based model of healthcare, connectivity is critical to providing the highest level of care, by saying “the ideal way to keep you focused on improving your health is through connectivity and in-the-moment, contextual messaging – messages directed at your specific health needs at the moment you need them.” The result of greater connectivity is higher engagement, but providers must actively pursue initiatives centered around leveraging filtered, personal health data from patients. Health providers need to have an influential role in closing the loop of contextual messages by responding on priority, as demanded by the condition at hand.

A Culture of Convenience:

Platforms that monitor individual patients for ongoing prevention and large populations with multiple chronic conditions, while managing exceptions, can do so with greater coordination. This will also have a positive impact on internal operations by minimizing errors in data as it is exchanged through faster, more secure channels. In turn, this increases staff productivity, minimizes intervention and streamlines patient processing and the overall patient experience within and independent of the clinical environment.

New breakthroughs in technology have helped overcome the traditional challenges of interoperability, making diagnosis and ongoing care more convenient than ever. Portable devices and clingy fitness trackers have contributed to having health vitals available at your fingertips; data that has now become easy to upload and analyze on any platform for possible conditions. And, as a recent article in The Economist states, “…computing power is now being applied successfully in countless small ways, using smartphone and other diminutive devices, to make a big difference to the effectiveness of treatments,” (“Bedside Manners”).

A Culture of Change:

It is up to providers to facilitate this change in the culture, from one of episodic care to an ongoing healthy lifestyle with a “coaching” approach. While it is true that families should manage their own medical records and data, providers should take the lead. Combining live interactions and virtual online coaches as needed, the exchange and use of data will bring significant and actionable insights that are applicable in the daily lives of individuals everywhere.

Taking it one step further, healthy lifestyles within various segments of the population can be promoted by developing and implementing community wide initiatives that leverage vital data monitoring. These efforts can impact greater health issues such as diabetes, blood pressure, early child birth, obesity and other conditions. By adopting a consistent and motivating approach toward shared data exchange processes, providers will be able to better manage and motivate patients, while driving positive, ongoing change at the fraction of the cost of live interactions.

In healthcare, proper use of medical data is critical to optimizing outcomes and lowering costs, but the absence of a truly collaborative effort among patients and providers remains as a barrier to success.

Drivers of Change

is the fact that no simple solution is available and no national initiative – legislative or otherwise – exists to helps fill this engagement void in healthcare. Just as providers are responsible for patient care and satisfaction, so too should they serve as facilitators of patient engagement. By taking this approach, new age health initiatives will reshape the culture of healthcare and lead the industry to a truly preventative system.

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CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 | EHR and Health IT Consulting |

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.

“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”

“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD.  “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to   physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.  The actions CMS is initiating today can help to mitigate potential problems.  We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms.

The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.

CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.

The AMA also has a broad range of materials available to help physicians prepare for theOctober 1 deadline.  To learn more and stay apprised on developments, visit AMA Wire.

CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:

  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30th.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27th.

In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.

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At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability

At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability | EHR and Health IT Consulting |

On June 24, Doug Fridsma, M.D., Ph.D., in a presentation to the AMDIS Physician-Computer Connection Symposium being held at the Ojai Valley Inn and Spa in Ojai, Calif., shared with CMIO attendees some of the latest activity going on with regard to the American Medical Informatics Association (AMIA), the association of which Fridsma became president and CEO last fall, after having served as chief science officer in the Office of the National Coordinator for Health IT.

Fridsma shared with his CMIO colleagues some of the highlights of the recently released “Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs,” referred to in shorthand as “EHR 2020.”

As part of the opening of that report, published online on May 29 in the Journal of AMIA (JAMIA), notes, “Over the last five years, stimulated by the changing healthcare environment and the HITECH Meaningful Use (MU) EHR Incentive program, EHR adoption has grown remarkably, and there is early evidence of benefits in safety and quality as a result. However, with this broad adoption many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, transferred new and burdensome data entry tasks to front-line clinicians, and lengthened workdays.” Further, the report’s introduction stated that “Interoperability between different EHR systems has languished despite large efforts. These frustrations are contributing to a decreased satisfaction with professional work life. In professional journals, press reports, on wards and in clinics, we have heard of the difficulties that the transition to EHRs has created.”

With regard to the way forward, the authors of the report said in their introduction, “Ultimately, our goal is to create a robust, integrated, inter-operable health system that includes patients, physician practices, public health and population management, and support for clinical and basic sciences research. EHRs are an important part of this ecosystem, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the ecosystem working together. This ecosystem has been referred to as the ‘learning health system.’”

What’s more, the report’s authors noted, “Potentially every patient encounter could present an opportunity for patients and clinicians alike to contribute to our understanding of health care and participate in research and clinical trials. As part of the learning health system, EHRs have long been touted as beneficial to the safety and quality of health care, and studies have shown potential benefits related to information accessibility, decision support, medication safety, test result management, and many other areas. However, implementation of any new technology leads to new risks and unintended consequences; these too have been well documented.”

Speaking of the release of “EHR 2020,” Fridsma told the AMDIS audience on Wednesday that Senator Lamar Alexander, chair of the Senate HELP Committee, “was running around at Vanderbilt, saying, ‘This is something that addresses a lot of the concerns we have.’”

Fridsma noted in his comments that the effort that led to the “EHR 2020” report predated his tenure at AMIA, but reflects the broad focus of the association at this point in time. “We brought together experts to say, what will the EHR look like in the next few years, and what kinds of things could we discuss? And then the Senat HELP Committee testimony that occurred ten days after this was done” created results. “Lamar Alexander took the five principles and said, ‘I’m going to have five hearings on those principles.’” And that, Fridsma said, is what is expected to happen.

Fridsma summarized the learnings shared in the report by noting four main areas of focus. “The first thing we had in the report,” he said, “was that we need to simplify documentation. We went through a series of discussions on why documentation is so complex. We are accelerating to the next stage, but we’re not necessarily getting to the end goal. So we create a whole series of activities” around physician documentation, as a health system, he said, “one set around what is required by regulation, and the other necessary for patient care. Some of this is tied to how our reimbursement works. But the most important development at ONC was the CMS [Centers for Medicare & Medicaid Services] targets for alternative payment models, because that gives physicians and other providers financial incentives to move forward in this area. That will be more of an incentive than Stage 3 of meaningful use, which was really front-loaded.”

The other areas of focus of the report were the need to make regulation more focused; the need to increase transparency around EHR functions; and the need to encourage innovation. As for encouraging innovation, Fridsma told his audience, “That really speaks to a lot of the work going on at ONC right now around FHIR, etc. We’re moving from document-centered ways of viewing information to data-centered ways of viewing information. The EHRs we are using today are not the EHRs that the people we are training today are going to be using. And the way we’ll get there is to encourage APIs and other solutions.”

And he added that, with regard to the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.” He added that “Our plan is to pick themes like these over the next year, and to focus on those themes” at AMIA, in a strategic way intended to help guide healthcare industry thinking on EHR development and evolution.

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Top things providers need to know about interoperability

Top things providers need to know about interoperability | EHR and Health IT Consulting |

It seems that interoperability is the biggest buzzword in health IT right now, and for good reason. Too much money is lost by both providers and patients due to a lack of data sharing and communication between doctors. However, with optimized medical software and implementation and standards outlined by the meaningful use program, nationwide interoperability is a goal that could actually be met in U.S. health care over the next few years.

If you're unsure about what interoperability means, or want to know how you can bring data sharing to your health system, here are some of the top facts you'll need to know:

"The U.S. could save around $30 billion annually with interoperability."

Interoperability saves big

According to an analysis by the West Health Institute, the U.S. health care system has the potential to save more than $30 billion each year with an interoperable platform. Having an electronic health record that travels with the patient not only prevents readmissions and duplicate treatments, but it also saves precious time and resources.

Congress is interested in interoperability

Another story making headlines is interoperability on Capitol Hill. For the past several months, Congress has been taking a serious look at interoperability and the way that organizations and legislation can work together to make this happen.

Cloud computing is driving interoperability

Medical devices are growing increasingly sophisticated in the health care environment, and doctors are relying on smartphones and tablets for diagnoses and treatments more than ever before. In busy medical settings, having cloud access to patient information alongside interoperable systems could make these clinical tasks even easier.

Experts have broken down five main use cases for interoperability

According to a recent study published in the Journal of the American Medical Informatics Association, there are five main use cases that make up an interoperable EHR. They are as follows:

1. Organizations must be able to extract patient data while still maintaining their own structured data.

2. Users must have the ability to transmit the entirety of a patient's EHR, or portions of the EHR, to another doctor.

3. The organization's health information exchange can receive requests for copies of a patient's EHR from providers outside of their system in a standard format.

4. Providers must have the ability to move all patient data from an old EHR into a new EHR.

5. Organizations must have the tools to embed EHR data into a health care system's operating API. This increases the value of data capture and transmission.

The ONC's Interoperability Roadmap is a broad vision

Perhaps the biggest revelation about interoperability is the Office of the National Coordinator for Health Information Technology's Interoperability Roadmap, which outlines a long-term, 10-year plan for the future of interoperability in the U.S. Not only does the roadmap address barriers to interoperability, but it also shows how optimized EHR systems can push interoperability toward patient-centered care over the next decade.

Organizations pushing for interoperability

There are several leading nonprofits you might want to be aware of that are making interoperability a priority, according to Becker's Hospital Review. Some of these include the Argonaut Project, IHE USA (which is partly responsible for ConCert, an interoperability testing program), JASON (a group of independent scientists that advises lawmakers and other government officials about health IT) and the CommonWell Health Alliance. Many of these stakeholders are some of the most influential in health IT, so it's clear that interoperability is a major goal moving forward.

As interoperability becomes more of a focus in health care, providers need to think about ways that they can promote data sharing and health information exchange. With Intelligent Medical Software, clinicians can worry less about whether the health data is accurate on the EHR, and can instead focus more on their patients and save resources.

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Staff Training Crucial in ICD-10 Conversion Preparations

Staff Training Crucial in ICD-10 Conversion Preparations | EHR and Health IT Consulting |

Healthcare providers who are behind in their ICD-10 conversion preparations may benefit from following the ICD-10 Quick Start Guide provided by the Centers for Medicare & Medicaid Services (CMS).

The five steps that providers will need to take when it comes to their ICD-10 conversion preparations are the following: (1) developing a plan, (2) training the healthcare staff, (3) updating system processes, (4) working with vendors and health insurers, and (5) testing workflow processes and systems.

When it comes to training the clinical staff (including nurses, doctors, and medical assistants) and moving forward with ICD-10 conversion preparations, it’s vital to focus on new clinical concepts and documentation obtained through ICD-10 codes. When training coding and administrative staff including coders, billers, and practice management employees, the focus should be on ICD-10 fundamentals.

CMS provides a variety of resources including webinars, national provider calls and presentations, the Road to 10 website, and email updates. Physician groups, healthcare organizations, hospitals, payers, and vendors also offer a variety of resources for medical providers who are still behind with some common ICD-10 conversion preparations.

The very first step to take is to identify the top 25 most common ICD-9 codes used in one’s medical facility. Common diagnosis codes are also available on the Road to 10 website and other resources.

Teach your healthcare and coding staff how to code the most common cases using the ICD-10 coding set. Using reports via one’s practice management software and billing documents, providers can better identify the most commonly used ICD-9 codes.

Once the top 25 codes are gathered and there is still time before the ICD-10 implementationdeadline, providers are encouraged to expand ICD-10 coding of typical cases past an additional 50 or more codes. This would ensure the majority of a provider’s cases are managed effectively under ICD-10.

Even though the ICD-10 coding set has expanded to more than 68,000 codes, providers will only need to use a small section of the set. Along with training staff, updating system processes is vital for one’s ICD-10 conversion preparations. All hardcopy and electronic forms need to be updated while information gaps should be resolved before the October 1 deadline.

Clinical documentation will need to include laterality, the number of encounters (initial or subsequent), kinds of fractures, and other information about related complications. It is useful to put together a documentation checklist detailing new concepts that should be captured with ICD-10 codes. Once systems are in place, ICD-10 end-to-end testing is crucial to ensure a healthcare facility is prepared for the October 1 deadline.

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

Direct Reimbursement Solutions's curator insight, July 1, 2015 10:10 AM

Excellent advice for ICD-10 preparedness.!

Preventing Physician Burnout

Preventing Physician Burnout | EHR and Health IT Consulting |

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).

Follow these five steps to significantly improve your work-life imbalance:

1. Identify the five to eight most important aspects of your life (what you value most).

2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).

3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.

4. Plan your time so that you are focused on what you value most.

5. Determine what can be delegated to others.

Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.

So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).

Follow these simple brain-training steps to increase your positivity:

1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.

2. Challenge your negative (typically distorted) thinking, the most common of which are:

• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.

• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.

• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.

• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.

• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.

Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

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Without Obamacare, Jobs Report Might've Been Worse

Without Obamacare, Jobs Report Might've Been Worse | EHR and Health IT Consulting |

The Affordable Care Act, which is infusing millions of new paying customers into the economy who previously couldn’t afford medical care services, continues to boost jobs growth as the health industry emphasizes outpatient care and value-based medicine.

The health care industry added 22,000 jobs last month, which was about on par with February totals for health services jobs, according to the jobs report issued Friday by the U.S. Department of Labor’s Bureau of Labor Statistics.

In the past year alone, 363,000 jobs have been added in the health sector. The entire U.S. economy added 126,000 jobs in March though such totals ended a string of 12 consecutive months when 200,000 jobs or more were added to employment rolls.

The growth in health care continues to come in the ambulatory care sector which is key to the shift away from fee-for-service medicine to value-based care models that emphasize outreach to patients, encouraging them to take their medications and see a primary care provider, typically in a less costly outpatient care setting.

The labor department said there were 19,000 jobs added in the ambulatory care sector. By comparison, hospitals added just 8,000 jobs. And the nursing home sector actually contracted by losing 6,000 jobs.

As an example of the shift going on in health care, technology firms are benefiting as well as hospitals and other traditional medical care providers look to cloud-based platforms to help them manage populations of patients. Value-based care emphasizes health outcomes.

On Friday, Chicago Mayor Rahm Emanuel said health technology company ZirMed, which helps hospitals manage populations of patients in part with predictive analytics and help with claims management, is openings its first Chicago office and would add 200 or more jobs, including “advanced healthcare technologists” to what it calls a “Healthcare Analytics Center of Excellence.”

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Electronic health records and data abuse: it's about more than medical info

Electronic health records and data abuse: it's about more than medical info | EHR and Health IT Consulting |

On the heels of the recent announcement that medical insurance firm Anthem was breached, we look at the nuance and impact of a medical record breach versus a medical data breach. They are certainly related, but digging through troves of data containing primarily identity information is significantly different to an attack that focuses on specific treatment of a specific patient.

If an attacker can harvest name, social security number, phone, address, email and the like, that haul has a much wider potential audience than, say, whether or not a patient underwent a specific medical procedure. A stolen medical record containing a lot of detail may sell for a lot of money, but that market is more specialized than the broader market for general identity data.

To help folks visualize the different levels of data that thieves might want to swipe from a medical facility, and then abuse, my colleague, Stephen Cobb, created this diagram of a generic electronic health record.

Level one is pretty basic info, things that are fairly easily knowable about you without any hacking, normally sourced through Open Source Intelligence (OSINT) gathering. However, grabbing a big fat collection of such data might still earn a bad guy some black market bucks, say if a spammer needed fresh targets.

The illegal earnings potential goes up a notch if you can grab Level 2 data. Scammers can use that to carry out several kinds of identity theft, creating fake IDs, opening credit card accounts, committing tax fraud (filing fake returns to get a refund) or even use it to answer challenge questions to online accounts, thereby pivoting the attack to new digital beachheads. Even Level 2 data is enough to commit some types of medical ID theft, though the bad guys have no clue how healthy or sick you really are (here’s a pretty scary case of what can be done with just a stolen driver’s license).

Level 3 data just makes all of the above that much easier; plus, it enables new forms of badness. Some crooks prefer taking over an established account to opening a (fake) new one. the number of electronic records or EHRs that actually contain financial or payment data is not clear, but obviously a lot of healthcare entities do handle it at some point, making them a target for digital thieves who turn around and sell it on carder forums.

When you get to Level 4 data, the badness takes on a new dimension. If an attacker has a patient’s full (or partial) history, it’s easy to imagine matching up a willing bidder who has a need for a similar medical procedure with a donor record to (roughly) match, in an attempt to get pinpointed specific services they would otherwise have difficulty receiving.

But the options for selling medical history-style Level 4 records may be much narrower in scope than, say, bulk repackaging and resale on the underworld markets of lower levels, appealing to any buyer who wants to assume an identity, spread a wider net and attack other properties, or engage in fraudulent activity which is then blamed on you (if it’s your record that was compromised).

Of course, the threatscape may well change as the EHR becomes more universal. With the proliferation and sprawl of third party providers who are somehow tapped into a cohesive health ecosystem, there will always be various specialized smaller providers whose business is targeted to a specific subset. That’s not bad, it’s just how the health segment does business; in many cases it leverages strengths of one organization to help another. But it does imply a larger potential attack surface, which has implications for security if the data sprawl is not carefully managed. For example, if an attacker can gain a beachhead in one of the providers in the ecosystem, will they then have an elevated trust relationship with other systems within this ecosystem?

And here’s the rub: having instant digital access to all of a patient’s medical data (or other sensitive information) wherever a doctor happens to physically be is a wonderful tool, but now we have many more endpoints in question with security environments to understand and corral. This implies an ongoing need, not just for really smart endpoint protection, but also strong encryption, and authentication, as well as sane network segmentation, vigilant network monitoring and reliable disaster recovery.

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