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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Electronic Data Key for Patient Engagement Initiatives

Electronic Data Key for Patient Engagement Initiatives | EHR and Health IT Consulting |

Patient engagement initiatives within the healthcare industry are moving past the patient portal, as pilot programs called OpenNotes allow patients to view their medical doctor’s notes taken during the visit. The latest version of the initiative even allows patients to comment and correct any information available in the physician records.

The New York Times reported on one patient that followed his own medical records and healthcare data with rigor. Steven Keating, a young doctoral student from the Massachusetts Institute of Technology’s Media Lab, had a brain scan eight years ago that found an anomaly and required monitoring over the years.

In a follow-up scan three years later, no issues were uncovered. However, based on his own research, Keating knew the problem was located near the olfactory center of the brain and, when he began smelling vinegar, he knew these were “smell seizures.” Three weeks after conducting an MRI, surgeons removed a cancerous tumor from his brain.

Medical experts believe this type of patient engagement and self-education can be gained when patients have full access to their own healthcare records. These type of patients are thought to be better able to stick to their prescription drug regimen and even identify early symptoms of disease.

Today, more and more hospitals and physician practices are adopting patient portals to meet Stage 2 Meaningful Use requirements as well as offer patients easy access to their medical information. Through the OpenNotes program, more patients are integrating wellness goals in their everyday life, taking their medications on time, and gaining a better understanding of their chronic diseases.

Currently, more than 5 million patients have received open access to their physician notes through these pilot programs. Nonetheless, Keating told the news source that obtaining one’s own medical information still has its share of barriers.

“You can get (access to data), but the burden is always on the patient. And it is scattered across many different silos of patient data,” Keating said.

Federal agencies are providing policies to support patient engagement initiatives and access to medical data in order to overcome these barriers. For instance, the Stage 3 Meaningful Use proposed rule sets forward a key objective for boosting patient engagement initiatives.

Health IT Now, a coalition of physician and patient groups that advocates health information technology, finds the Stage 3 proposed rule and the 2015 edition health IT certification criteria favorable, especially regarding its patient engagement initiatives.

“These changes are important steps forward. The Patient API change in and of itself is elegant. It allows patients to control more of their information while expanding interoperability,” Joel White, Executive Director of Health IT Now, stated in a press release. “We also support reducing burdens on healthcare providers, the folks who have to implement these changes. We believe HHS could go one step further and only approve measures that can be reported electronically. We need to scrap paper and pen in the health IT program.”

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Can EHRs Be Secure and Fast?

Can EHRs Be Secure and Fast? | EHR and Health IT Consulting |

Are we ready to replace passwords with biometrics for access to our facilities' networks and EHRs? I know that I'm ready for something easier and more secure than my ever-changing facility login, a byproduct of being forced by the system to change my password every couple of months.

In its current iteration, the EHR at my facility takes three separate login steps to get into the record to document a patient encounter or retrieve information. This doesn't seem like much, but multiply it by 20 or 30 patients and it becomes burdensome and a significant time waster.

If a terminal is locked, I have to enter my credentials to access the system and from there, I have to enter my credentials to open the EHR. Then if I want to dictate any notes, I have to again enter my credentials to open the dictation software. It gets old in a hurry, and is a major complaint among members of the medical staff at my community hospital.

The IT team in our organization is experimenting with using the embedded "near field" chip in our ID cards as a way in which to log in to the EHR. It would be a big step forward and would eliminate the majority of authentication to access our EHR. It would also have the added advantage of encouraging all members of the medical staff to carry their hospital IDs, but not all software needed for charting supports this mode of authentication.

Fast Identity Online (FIDO) is the current buzz phrase that refers to all of the biometric authentication technology currently available or planned. We are already using our fingerprints in a variety of ways to unlock our phones and doors, and there are readily available technologies that rely on retinas, irises, face recognition, or voice recognition that are being developed to solve authentication and security problems. We have seen the future in a variety of science fiction films, and much of it is working and available technology.

While there is a tremendous upside to FIDO technology, there are also significant downsides in the form of privacy. We constantly see that passwords are not 100 percent secure, and companies tasked with protecting our personal data stored on their servers also fail. It is not too much of a stretch to raise concerns about personal biometric data being stored on vulnerable servers, and the privacy vulnerability that this represents to us all as individuals.

There should be similar concerns with biometric security data. My fingerprints are stored on my phone as a security measure, but could an enterprising criminal find a way to use that data to reconstruct my fingerprints?

As always, computer technology and software are well ahead of privacy protections and personal security, and will remain so for some time, possibly forever.

To make it work on an EHR, we need enterprise level solutions, as the thought of customizing my FIDO login separately at each terminal in the hospital, defeats the purpose and intent of making this simultaneously easier and more secure.

It seems that an enterprising technology company would see the opportunity in allowing medical providers to quickly and securely sign into an EHR. I know that there are a lot of smart people working on this problem in an attempt to make this both easier and more secure for those of us in the trenches.

As the pace of technology development and implementation becomes more rapid, so does the need for increasing security and privacy, as well as reducing the technological burden on the healthcare providers who daily have the use this technology in the performance of their jobs. These competing trends get more important everyday as the penetration of the EHR becomes more ubiquitous.

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Electronic Health Record Vendors Take Patient Data Hostage: What Should We Do?

Electronic Health Record Vendors Take Patient Data Hostage: What Should We Do? | EHR and Health IT Consulting |

In today’s interconnected world it seems intuitively true that instant access to comprehensive medical patient histories will help physicians to provide better care at a lower cost. This simple argument was persuasive enough for the federal government to spend $26 billion to incent medical providers to adopt electronic health records (EHR) systems so that they can electronically share medical records. The initial investment appeared to be large, but it was an economically sound solution to control the rising healthcare expenditure. The resulting HITECH act is one of the few healthcare laws that maintains bipartisan support. To establish a nationwide health information exchange network, officials designed a two-stage plan. First, incent every medical provider to create an electronic archive of their patients’ medical records. Second, connect these electronic archives together so that the providers can share their patients’ records. The $26 billion in federal incentives was a lucrative source of revenue for hundreds of different software vendors to develop and aggressively market their own type of EHR products in a medical market that knew little about information technology. According to the Office of National Coordinator for Health IT, in 2008, less than 10 percent of hospitals had basic EHR systems, and a mere five years after, 94 percent of the hospitals use a certified EHR system.

The next step forward is to connect these electronic silos together so that physicians can share their patients’ records. The billions of dollars in federal spending will only have any tangible benefit if this is done successfully. EHR vendors have taken patient data hostage and are not willing to release it unless they receive a big ransom. They typically claim that technical problems limit the interoperability of their products. This prevents physicians from sharing their patient records with other doctors. This is like T-Mobile claiming that its users cannot make calls to AT&T customers. The claimed interoperability limitation does not end here. The vendors are proposing hefty charges to allow data sharing between their own customers.

As I have discussed in detail before, this a hole that the government has dug for itself. A nationwide health information exchange network sounds great, but it is not possible to achieve this goal without the proper alignment of economic benefits for every player in the healthcare market. In the face of this problem, the government has three choices:

  1. Pay EHR vendors the ransom that they are asking to release their hostage and allow sharing of the patient data among medical providers.
  2. Regulate the industry and force the EHR vendors to allow sharing of patient data among medical providers.
  3. Do nothing.

The government appears to be following the first plan. Officials had not anticipated interoperability challenges and assumed that all of the providers with EHR systems would have the capacity to exchange records. Based on this assumption, the third stage of the EHR incentives program was designed to encourage physicians to actively engage in the exchange of medical records. Today nearly every physician has an EHR system and although many of them also want to exchange information, the EHR vendors do not allow them. The incentives, which were initially planned to encourage physicians, will end up with EHR vendors and help drive future profits. As Rep. Phil Gingrey (R-GA) put it, "we have been subsidizing systems that block information instead of allowing for information transfers, which was never the intent of the [HITECH] statute.”

Regulating the industry seems like the only feasible solution to this problem. Rep. Michael Burgess (R-TX), the leader of the House Energy and Commerce trade subcommittee is drawing up a bill to enforce data sharing. The benefits of regulating the EHR industry, if any, will take a very long time to become tangible. The EHR vendors will furiously push back against any kind of regulation and will insist that technical challenges are a real barrier to interoperability. Congress is poorly situated to adjudicate this claim. Time is a critical factor in the long term success of HITECH plans, which threatens the viability of this strategy.

The best solution for the government is to do nothing. The new pay for performance payment methods in which the medical providers are being paid a fixed amount for treating patients would drive them to become more efficient and increase their profit margin by seeking solutions such as health information exchange to cut costs. Because the market for new EHR products is now saturated, the only revenue source for EHR vendors are charges for data exchange. Currently, they can get away with outlandish charges because they know the incentives from the federal government allow doctors to cover their costs. But if the free money from the government were to stop, then EHR vendors would have to persuade the physicians to pay for the exchange fees. Just like any other service, the highest price that the medical providers would pay is equal to the value of the service for them. If the electronic exchange of information helps medical providers to cut back on their costs and save some money they will be willing to pay a fair price for it. EHR vendors will end up lowering their fees to a reasonable level or will eventually go out of business.

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Can Apple, Others Bring PGHD to the EMR?

Can Apple, Others Bring PGHD to the EMR? | EHR and Health IT Consulting |

Not settled with simply being the dominant device on which clinical data applications are hosted, Apple made another step towards becoming an even more ubiquitous presence at healthcare organizations last week when it launched ResearchKit.

ResearchKit is a platform that allows healthcare organizations to host apps that will get people to participate in clinical trials. During an event for the press, the company announced a few initial partnerships with major healthcare provider organizations to use ResearchKit, including Icahn School of Medicine at Mount Sinai, Penn Medicine, Dana-Farber Cancer Institute, Massachusetts General Hospital, Stanford Hospital, and more.

ResearchKit builds off HealthKit, which was a health platform Apple launched last year that aimed to connect personally-generated health data and clinical data. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.

The Cupertino, Calif.-based company is part of a wider movement in the industry to bring patient-generated health data (PGHD), from various portals and monitoring devices, into clinical data applications like the electronic medical record (EMR). The Office of the National Coordinator for Health IT (ONC), in its proposed rule for Stage 3 of meaningful use, made integrating PGHD into the EHR a requirement for eligible hospitals and providers.

Of course, this integration is easier said than done. Healthcare Informatics Senior Editor Gabriel Perna spoke with Rob Faix, principal advisor at the Naperville, Ill.-based consulting firm, Impact Advisors on the most recent edition of the Healthcare Informatics podcast. Faix discusses the challenges of bringing together patient and clinical data; why Apple has taken the lead in this category with many prominent healthcare organizations; and how ResearchKit can be a game changer.

“Integrating this data will be a significant challenge but I think it’s one that hardware device vendors, software developers, and EMR vendors are up for…it’s the next big opportunity,” Faix says. “

Faix talks about how this integration may happen. He predicts there will be a staging process, where PGHD is graded and reviewed. “Context will be important. The software and EMR vendors and the clinical community are really going have to think about that as we integrate PGHD into the EMR,” he says.

Sifting through a potential avalanche of data will present itself as a challenge, as will having to deal with potential issues of liability. “I have information in front of me that I chose to accept or discard, and therefore, it could be tied back to an adverse event,” Faix says.

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The HealthIT Data Hogs of Healthcare

The HealthIT Data Hogs of Healthcare | EHR and Health IT Consulting |

Keeping data within one's EHR is a great business model for both large-scale users like hospitals and EHR companies alike. You can charge what you want, lock customers in, and keep competitors out. Keeping data within your own software or institution is a huge competitive advantage.

System resident EHR companies are doubling down on this model by acquiring cloud-based EHR companies. Some are moving data out of facilities and into their own cloud-based lockbox. Some are setting their table to be the single click-point as Kayak is to the travel industry.

The winner will become the data supermarket to healthcare.

Except, these strategic movements are mostly about hospital data  (which is crisis data and of very limited use in population health), and has limited value to all of the other health and care things that have to be done to move the quality, health status, and cost dials from fiscal Armageddon to sustainability.

That's where hospital-centric strategy will get hospital-centric companies into the cook pot. Healthy people without medical emergencies or crises and not needing sophisticated diagnostics and invasive procedures is bad for hospital business, so, it is understandable for companies to cater to them. Expecting a voluntary, or even some sort of sincere, attempt, however, at a 180-degree transition from a trillion dollar plus, fee-for-service-dependent medical crisis industry to the physician world of a few bucks for prevention is just, how do I put it delicately — disingenuous.

That's why we should not only be skeptical of the motives of these business models, but physicians should step away carefully and demand EHR companies to serve their needs. And, they can be pigs about it because the company that successfully becomes a data supermarket will feed the entire industry.

In the hospital world, controlling data is a competitive advantage, a point of physician control, and a means to continue to extract trillions from insurers long enough to try to make a transition or just keep the industry anchored in their harbor by their sheer size. Hogs that, when they are fat enough have eaten the economy into starvation, will become food instead.

In the physician world, sharing data is a competitive advantage, a point of hospital control, and a means to actionable information to perform population health and create analytics that will derive and extract their value from insurers by what they save, not consume. Also in the trillions. Warm, pink, fuzzy, cute, and sustainable.

This is where we come full circle to the data collection and warehouse world and the real question for the data collectors of healthcare: Are you the hogs or the pigs?

There may be better metaphors to wrap this argument around, but pigs are just so darn cute.

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