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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Switching EHRs - leaving the frying pan for the fire?

Switching EHRs - leaving the frying pan for the fire? | EHR and Health IT Consulting | Scoop.it

Thinking about switching EHRs? This is a really big decision. Much bigger than choosing between the red patent pumps and snakeskin peep-toes, or your salsa selection at Chipotle. So before you rush into making a move, consider the following:


  1. Why am I even considering switching in the first place?
    Is the vendor sunsetting your product or not keeping up with ONC (Office of National Coordinator) certification?
    Or does your staff report that it is no good (probably using much stronger language), that there are too many clicks, or can’t get desired reports?
  2. Analyze your needs
    Map your workflow. Carefully consider WHY each step occurs – is there a clinical or regulatory reason? If not, get rid of it. Taking bad processes into a new system will not make you any happier with the new technology than the old. Sometimes an outside set of eyes can help shed light on these waste points. There is a pretty forest out there if you stop looking at the beetle-infested trees. You may not even need the following steps if you can improve how you use your current system.
  3. Assess your infrastructure and security
    Along with mapping processes, you should also have an inventory and map of hardware and networks. Assuming you are maintaining an up-to-date security risk assessment, this may be a good place to start.
  4. Do your research
    I know, many of us do not want to re-live college research projects without the reward of more letters after our name, but you will not regret this. Resources include the ONC, HIT.gov, and KLAS. You may also consider a consultant who is familiar with many EHRs and regulations.
  5. Make a comprehensive list of your needs and shop
    A key step that is often not given enough attention is to delineate your requirements in complete detail. These requirements can then be used to create a Request for Information (RFI) or Request for Proposal (RFP) to any potential software vendor. There are hundreds of products out there and they all may dazzle you with a demo. Get under the hood and test drive when possible. Seek out as many organizations that you can who use the product for a balanced opinion.
  6. The price tag is not always straightforward
    Sure, the monthly subscription, setup fees, yearly fees, may be clearly spelled out in the contract, but what about internal costs or future upgrades? Ask the vendor about their upgrades and additional modules processes, as these items will be inevitable with changes in technology and regulation. Are these generally associated with additional fees? Will your current hardware be sufficient or do you need to purchase new? Costs of servers, tablets, and wireless networks should be factored in to your overall cost. What about training for staff or additional IT resources to manage the application? And, as with everything, cheaper is not always the way to go. It may save you a few dollars now but the long range price may be high.
  7. Due diligence complete. I am ready to switch
    Read your contract carefully. Make sure you know your level of support as to the hours, turnaround time, and go-live. Make sure they were clear with an implementation schedule and assumptions.
    Server, web, yearly/monthly fees
  8. They can just move all my current patient information into the new system, right?
    Um, not so much. Data mapping and migration is difficult, time consuming and costly.
    There is no 1 to 1 map from any system to each other. If you choose to migrate data, consider only active patients with a critical subset of their information, such as medications, problems, diagnoses, etc. Another alternative is a data archiving service where you can have access to view your data at any time.
  9. Many perfectly good EHRs have failed due to bad implementations
    The vendor will have a project manager and an implementation plan. However, you need to have both of your own as they will not account for every aspect of your workflow and organizational needs. If you have not implemented a technology solution before, it is highly suggested you get help from an experienced implementation specialist or project manager. Planning and detailed checklists should be a critical part of your implementation. During the design and build process try to customize as little as possible. It will take several months to know what the system can do and is best optimized at a later date. You can also not have too much training or at-the-elbow support for weeks after go-live. These are often the highest complaints heard.


Now, given all that, is it still feeling hot in the kitchen or are you using your frying pan for the best meal you have ever had?

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Interoperability, Usability, and Meaningful Use Stage 3

Interoperability, Usability, and Meaningful Use Stage 3 | EHR and Health IT Consulting | Scoop.it

Satisfaction and usability ratings for certified electronic health records (EHRs) have decreased since 2010 among clinicians across a range of indicators.” This announcement was made two years ago the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition by Michael S. Barr, MD, MBA, FACP. His presentation highlighted “ the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability.


The Electronic Health Record Association (EHR Association), a non-profit association of more than 40 EHR companies, created an electronic health record (EHR) Developer Code of Conduct, which aims to encourage transparency and collaboration among EHR developers, as well as developers, providers, and industry stakeholders.

On the first page of the EHRA code of conduct, the very first item (after a general statement) is Patient Safety. The code says:


Recognizing that patient safety is a shared responsibility among all stakeholders in an increasingly health IT-enabled, learning healthcare system: We are committed to product design, development, and deployment in support of patient safety. We will utilize such approaches as quality management systems (QMS) and user-centered design methodologies, and use recognized standards and guidelines.


The terms User-centered design (UCD), Usability, and User eXperience (UX) have been used over the years to describe the work of the software professionals that specialize in the human-computer interaction. “Software Human Factors” is the field of study that applies the methodologies of Human performance and ergonomics to software. Instead of trying to design objects that work with the physical attributes of the human body, experts in Usability and User-centered design virtual interactions that work with the mental capabilities of human minds.


They were great for mathematicians, but the general public was really confused about how they worked. They were confused because in order to perform even the most basic mathematical functions people had to think differently. They had to think like the mathematicians.

Adding up a series of numbers was simple. All one had to do is key in a number, press , key in the next number, press , and then press the plus key to calculate the sum of all the numbers entered. As Easy as π!

The problem with these calculators was that the design of the user interface focused exclusively on expert users and these experts were a very limited sample size. The answer to fixing the calculators was User-Centered design. UCD is a design philosophy that creates a culture of understanding and enabling end users to perform their tasks using an information architecture and taxonomy that matches their mental model.


After changing the user experience to match a more common understanding of arithmetic, e.g. key in a number, press plus, key in another number, then press equal, the market for desktop calculators exploded.


The HITECH Act


The Health Information Technology for Economic and Clinical Health Act (HITECH Act ) is part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA contains incentives related to health care information technology and contains specific incentives designed to accelerate the adoption of electronic health record (EHR) systems among providers. The Office of the National Coordinator for Health Information Technology (ONC) released a set of Safety-enhanced Design §170.314(g)(3) certification and meaningful use requirements for Electronic Health Records (EHRs). In stage 2 of these certification requirements EHR vendors must include evidence of user-centered design and summative usability test results in their submission.

Summative usability testing for safety-enhanced design involves recruiting targeted users as test participants (Doctors, Nurses, and other medical practitioners) and asking these users to complete a set of pre-defined tasks. An expert test facilitator conducts the testing via an established test protocol while the test sessions are recorded and later analyzed.


The summative usability tests for ONC Meaningful Use Stage 2 certified EHRs are all made public on the CHPL site.

A big problem is that many of the EHR vendors didn’t work with medical professionals in their designs. They created what we call Engineering-centric designs, not User-centered Designs. They made HP Calculators. They created systems that are easy to use for engineers and not medical professionals. Complicating matters, a number of EHR vendors took serious end-runs around the regulations and did not conduct nor report on a proper usability test to become certified. It was fairly obvious that some of the Authorized Testing and Certification bodies seem to be rubber-stamping the summative usability reports perhaps without even looking at them.


Think about this: If an EHR vendor took side-steps in preparation of their usability evaluation, what other short-cuts did they take with development of their system? I’m frightened that someone may suffer serious injury because some EHR vendor ignored usability testing so that their clients can get ONC funding.


The U.S. Food and Drug Administration has acknowledged getting hundreds of reports of problems involving health information technology including numerous patient injuries and deaths.

Some examples seen at hospitals across the country:

  • At Marin General Hospital in Northern California, RNs called on the Marin Healthcare District board to delay implementation of their EHR system. “Orders are being inadvertently passed to the wrong patients. People have gotten meds when they’ve been allergic to them. This is dangerous,” Marin RN Barbara Ryan said in comments reported by the Marin Independent Journal.
  • In Chicago, the Chicago Tribune in 2011 reported on a patient death at Advocate Lutheran General hospital after an automated machine prepared an intravenous solution containing a massive overdose of sodium chloride — more than 60 times the amount ordered by a physician.
  • At Affinity Medical Center RNs in Massillon, Oh. RNs in June raised multiple objections to the hurried introduction of an EHR system. Subsequently, they have cited medication errors, delays in care, problems with documentation, computers crashing, and other concerns.


For another example of why usability in healthcare is so important, see “How Bad UX Killed Jenny”.

The office of Rep. Michael C. Burgess, MD (R-Texas) released a draft bill that is designed to fix some of the issues associated with the HITECH Act. The draft bill completely ignores the problems with usability in healthcare IT and continues the policy of excluding caregivers, patient safety and patient rights organizations, and other healthcare organizations, from playing an active role in ONC.


Proposed rules for stage 3


On Friday March 20, 2015 the HHS released their proposed rules for Stage 3 of the meaningful use program. Contained within these new rules was very significant, but under reported, changes in the meaningful use program: An expansion of the Safety-enhanced Design (aka usability) testing portion.

For the complete text of the changes to the Safety-enhanced Design program see pages 191 to 196 of the proposed 2015 ONC certification document.


A Quick summary of the enhancements includes:

  • ONC will requires 17 instead of 7 functional areas to test
  • ONC recommends 15 participants, instead of providing no recommendation (we have seen many certified EHRs that only tested on two people!
  • ONC clarifies the User-centered Design reporting requirements.
  • ONC provides guidance on when an EHR needs to be retested due to changes in the UI


We welcome these changes to the usability testing portion of the Stage 3 criteria as many of these changes are a direct result of suggestions given as public comment on the 2014 certification program by those, including us, in the usability community.


What exactly is usability and user-centered design?


According to the ISO 9241-11 standard usability is defined as “The effectiveness, efficiency, and satisfaction with which specified users achieve specified goals in particular environments (ISO 9241-11).”

Effectiveness – The accuracy and completeness with which specified users can achieve specified goals in particular environments.

Efficiency – The resources expended in relation to the accuracy and completeness of goals achieved.


Satisfaction – The comfort and acceptability of the work system to its users and other people affected by its use.


Usability in healthcare can be difficult to achieve, but it is important to remember that it is not only based upon the aesthetics of the user interface. Good Usability is also not determined by the number of clicks (see The Myth of Too Many Clicks).


A useable healthcare system must be designed to match the mental models and workflow of its users. A usable EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying). The big business interests of the Healthcare industry may cry wolf (and lobby hard) against enhancements to the usability program because they don’t want to spend the extra time and money to provide a healthcare system that truly follows a safety-enhanced design philosophy. They are no better than the automobile industry that fought hard against seatbelts in the late 1960 and against The United States Intermodal Surface Transportation Efficiency Act of 1991 that required airbags in cars.


With Congress working on legislation to fix major healthcare problems caused by the HITECH act, we hope that they will finally address the issue of lack of EHR usability.


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John Vollenbroek's curator insight, April 23, 2015 7:39 AM

Design of the user interface focused exclusively on expert users and these experts were a very limited sample size.

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State Hospitals Go Digital for ICD-10 Compliance Deadline

State Hospitals Go Digital for ICD-10 Compliance Deadline | EHR and Health IT Consulting | Scoop.it
In order to prepare for the ICD-10 compliance deadline by October 1, medical facilities will need to integrate revenue cycle and EHR systems that follow the new coding set. The State of Washington Department of Social and Health Services (DSHS) recently announced their association with health IT supplier Cerner Corporation to revolutionize their revenue cycle systems and EHR technology in order to better align with ICD-10.

Recently Victoria Roberts, Deputy Assistant Secretary at DSHS, and Justin Dickey, Consulting Practice Director at Cerner, spoke with EHRIntelligence.com to discuss their collaboration further and better prepare providers for the ICD-10 compliance deadline. The two individuals began by discussing how the collaboration will lead to better preparedness for the ICD-10 transition.147504495

“In Washington state, we have two state hospitals that are each about 100 years old and a much newer child study and treatment center. Within those 100 years, these facilities have all worked very independently. They are still very dependent on paper systems,” Roberts explained. “This project is allowing us to really look at how to work with continuity between hospitals, develop more consistent policy and practice, and bring the hospitals into the current century.”

Justin Dickey added: “Our teams are coming together to focus on standardizing workflow and developing a standardized tool set with the Cerner Millennium clinical and revenue cycle platform. More than technology, this is a lot about organizational change management and making sure we have the training programs in place to facilitate the use of the tool set we’re delivering.”

The integration of these health IT tools such as the revenue cycle system will play a key role in improving patient safety and quality of care. Victoria Roberts expanded on this goal.

“The biggest [part of this] is how we share information across shifts and across wards about individual patients,” Roberts said. “One of the things that I’ve been pushing forward is finding a way [to help] nurses and mental health technicians immediately see through the Cerner system the alerts they need to pay attention to.”

“Right now in our facilities, we continue to use white boards and white boards aren’t always updated as they should be. Sometimes things happen at 10 o’clock in the morning that don’t get communicated to the shift that comes at 3 o’clock in the afternoon. The hope is that through the Cerner system that information can be entered into the EHR and then communicated out through the alert board.”

Roberts went on to explain how allergy and medication alerts play a role in helping physicians provide safe care. Cerner representative Justin Dickey mentioned that “a task-driven clinical workflow allows [Cerner] to ensure they’re leading clinicians down the right path and also to have a mechanism that measures the quality of documentation as care is progressing through the organization.”

While the health IT tools are used in collaboration to increase the quality of care, they are also impacting the revenue cycle and ensuring that the document quality of claims are up to high standards. The two individuals went on to speak about solutions they’re incorporating to prevent any issues once the ICD-10 compliance deadline takes hold.

“One of the [solutions] we’re dependent on is the dashboard report,” Roberts said. “This allows us to understand the workflow and how well different staff are adopting to the model.”

“Our toolset has a physician dashboard that allows us to zero in on clinicians’ usability experience,” said Justin Dickey. “It identifies the areas where we may need to increase training and assist [promoting] workflow. The dashboard helps track problem areas and gives a tool set that shows what to focus on and issue remediation.”

While incorporating new health IT systems is necessary for the ICD-10 transition, providers are also concerned about other areas with regard to the upcoming ICD-10 compliance deadline. Many fear delayed payments and claim rejections from the Centers for Medicare & Medicaid Services (CMS). Victoria Roberts and Justin Dickey spoke about best practices to follow in order to avoid these issues during the ICD-10 compliance deadline.

“From the state perspective, it’s really anticipating and planning for the training curve that will take for the staff to support the implementation. We’re going from a primarily paper system to an electronic system with staff who rarely have need to even check e-mail,” Roberts explained. “It’s figuring out how to invest and support the staff during the transition.”

Justin Dickey added that Cerner is “helping define those workflows and giving the tools necessary to manage denials and throughput [as well as] giving a visual of what’s happening through the care process and payment process.”

The new EHR systems that DSHS will be using include a diagnostic assistance tool that includes natural language clinicians can easily understand. It provides a simple way to find the right diagnostic coding at the needed specificity instead of forcing physicians to search through a large variety of codes.

“The natural language helps clinicians choose and navigate down to the appropriate level of specificity within the ICD-10 code set,” Justin Dickey mentioned.
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Breaking Down the Health IT Impacts of Stage 3 Meaningful Use

Breaking Down the Health IT Impacts of Stage 3 Meaningful Use | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare and Medicaid Services (CMS) released its proposed rule for Stage 3 meaningful use on March 20, revealing the hotly anticipated provisions for the final phase of the EHR Incentive Programs.


Raising the bar on some of the toughest aspects of Stage 2 while requiring healthcare providers to make some significant leaps in EHR adoption and care delivery by 2018, the Stage 3 meaningful use framework poses some difficult questions for eligible providers and hospitals struggling with interoperability and the burdens of leveraging EHRs for patient care.


From health IT interoperability to privacy and security to big data analytics, the impacts of Stage 3 will touch nearly every aspect of the healthcare industry in the next few years.

What are some of the key issues providers must keep in mind as 2018 approaches and the EHR Incentive Programs eventually come to an end?


Top 8 goals of the Stage 3 meaningful use proposed rule


The objectives and thresholds in Stage 3 urge providers to new heights in patient care by encouraging more extensive use of health information exchange, e-prescribing, clinical decision support, and computerized provider order entry (CPOE).  CMS also hopes to increase patient engagement substantially over Stage 2 levels and promote the coordination of care through expanding access to personal health information.  Read a summary of the eight major objectives included in CMS’ plan for the industry.


Interoperability key to Stage 3 meaningful use requirements


Industry-wide EHR interoperability is the ultimate goal of the EHR Incentive Programs, and Stage 3 hopes to bring providers closer to widespread health information exchange than ever before.  “The flow of information is fundamental” to better care, healthier patients, and reduced costs, says HHS Secretary Sylvia Burwell, but the path towards meaningful interoperability has been a difficult one.  Stage 3 intends to address some of the major barriers to interoperability by raising thresholds and benchmarks for health information exchange.


Can Stage 3 meaningful use CEHRT bring on big data analytics?


Stage 3 brings some major changes to the way EHR technology is certified and designed in accordance with the EHR Incentive Programs’ growing emphasis on healthcare analytics and population health management.  With the newly-named “health IT modules” presenting opportunities and challenges for providers seeking to gear up for the optional 2015 Edition Certified EHR Technology (CEHRT) criteria, how will the new provisions for EHR development allow the technology evolve into meaningful tools for big data analytics and effective care coordination?


How does Stage 3 meaningful use affect health data privacy?


As CMS turns its attention to interoperability and increased data exchange, patient privacy and security measures will become ever more important to the industry.  Continued confusion over meaningful use and the HIPAA Security Rule has left many providers asking questions about how they can protect their patients’ electronic personal health information (ePHI) in the face of data breach after data breach.  Learn how Stage 3 hopes to simplify patient data privacy and security measures for providers in this breakdown of the Stage 3 proposal from HealthITSecurity.com.


What does the Stage 3 meaningful use rule mean for analytics?


How will Stage 3 build on existing infrastructure to encourage healthcare analytics to thrive?  By leveling the playing field and requiring providers to meet all the same measures in 2018.  This controversial proposal may leave some lagging organizations in the lurch, but with the help of the ONC’s Common Clinical Data Set, it would create rich opportunities for informaticist and population health managers.  Will Stage 3 be the push the industry needs to expand its budding analytics capabilities?


ONC proposes 2015 health IT certification criteria rules


The 2015 CEHRT criteria, released in conjunction with the Stage 3 rule, have significant implications for healthcare privacy and security.  By opening up the certification program to include new types of health IT, and therefore new types of patient data, the ONC plans to achieve widespread interoperability.  How will federal rule makers ensure that personal health information is sufficiently protected without overburdening providers and EHR developers?



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Unlocking EHR Data to Accelerate Clinical Quality Reporting & Enhance Renal Care Management

Unlocking EHR Data to Accelerate Clinical Quality Reporting & Enhance Renal Care Management | EHR and Health IT Consulting | Scoop.it

When healthcare providers began achieving Meaningful Use (MU) — the set of standards, defined by CMS, that allows for providers to earn incentive dollars by complying with a set of specific criteria — a health IT paradox emerged. The reports required for incentive payments are built on data the EHR captures, however, EHRs don’t typically have built-in support for automated reporting. This places a time-intensive manual burden on physicians as they report for MU quality measures. In other words, a program intended to increase the use of technology inadvertently created a new, non-technical, burden. The need to manually assemble information for reports also extended to the CMS Physician Quality Reporting System (PQRS) incentive program. As with many providers, EHR reporting shortcomings for these CMS programs severely impacted the kidney care provider, DaVita Healthcare Partners, Inc. (DaVita).

As one of the largest and most successful kidney care companies in the United States, DaVita has constantly focused on clinical outcomes to enhance the quality of care that it provides to its patients. In its U.S. operations that include 550 physicians, DaVita provides dialysis services to over 163,000 patients each year at more than 2,000 outpatient dialysis centers. These centers run Falcon Physician, DaVita’s nephrology-focused solution that largely eliminates paper charting by capturing data electronically and providing a shared patient view to caregivers within the DaVita network.

Falcon Physician serves DaVita very well in its design: renal-care specific EHR capabilities and workflows to support patients with chronic kidney disease (CKD). However, federal incentive programs like MU and Physician Quality Reporting System posed their own challenges. Falcon, like most EHRs, did not have the sophisticated data processing and analytics capabilities needed to meet the complex clinical quality reporting mandated by these programs. With limited built-in support for automated reporting, DaVita physicians had to manually calculate denominators and complete forms for submission to CMS for quality measures reporting, typically taking five to six days per report. With the organization averaging 800 encounters per physician each month, this placed a highly time-intensive and manual burden on physician offices. In addition, manual reporting often resulted in errors, since physician offices had to manage ten or more pieces of data to arrive at a single measure calculation, and do that over and over again.

The Need to Automate Reporting – But How?

To address the time and accuracy issues, DaVita recognized it would need to unlock the data captured by the EHR and use an effective data analytics and reporting tool. To begin evaluating options, the organization put together a team to explore two potential paths: creating a proprietary reporting capability within the EHR, or integrating a third-party solution.

It became clear that proprietary development would be challenging, mainly because of the technological expertise that would be needed to build and maintain sufficiently advanced analytics capabilities. It would require special skillsets to build the rules engine, the data mapping tools, and the visualizations for reporting. In addition, DaVita would need to maintain a clinical informatics and data validation team to assess the complex clinical quality measures, develop these measures, and test the overall application on an ongoing basis. Further, DaVita would also need to get this functionality certified by CMS and other regulatory agencies on a periodic basis.

While looking for a third-party solution that could easily integrate with Falcon, DaVita came across CitiusTech, whose offerings include the BI-Clinical healthcare business intelligence and analytics platform. This platform comes with pre-built apps for multiple reporting functions, including MU and PQRS. Its application programming interface (API) simplifies integration into software like Falcon. The platform aligned closely with DaVita’s needs, and with a high interest in avoiding the expense, time and skillset hiring needed to build a proprietary reporting function, the organization decided to move forward with third-party integration.

Accelerated Implementation and Integration

Implementation began with a small proof of concept that delivered a readily scalable integration in fewer than six weeks. DaVita provided the database views and related data according to the third-party solution’s specifications. This freed DaVita not just from development, but also from testing, installation, and configuration of the platform; thereby, saving time and money, and creating a more robust analytics platform for DaVita’s physicians. In the end, going with an off-the-shelf solution reduced implementation time and cost by as much as two-thirds.

Integration with the third-party platform enabled DaVita’s Falcon EHR system to completely automate the collection and reporting of clinical quality measures, freeing up tremendous physician time while improving report accuracy. With additional capabilities that go beyond solving the reporting problem, the new solution translates EHR data into meaning performance dashboards that assist DaVita physicians in the transition to pay-for-performance medicine.

The platform with which DaVita integrated is ONC-certified for all MU measures for eligible professionals (EPs) and eligible hospitals (EHs). Falcon was able to leverage these certifications and achieve both MU Stage 1 and Stage 2 certification in record time. This also enabled Falcon to accelerate its PQRS program and offer PQRS reporting and data submission capabilities.

Automated Reporting and Dashboards in Action        

Today, hundreds of DaVita physicians use the upgraded EHR, and the integrated business intelligence and analytics function eliminates the need for these doctors to perform manual calculations for MU and PQRS measures. Where manually creating reports used to take five to six days, pre-defined measure sets now complete reports and submit data almost instantly.

With the manual reporting problem solved, DaVita’s physicians now take automation for granted. What they see on a daily basis are the quality-performance dashboards. These dashboards give them a visual, easily understood picture of how they’re doing relative to quality measures, and the feedback has been extremely positive. Many powerful reporting features are highly appreciated, such as key measurements appearing in red when it’s time to change course in care provision to meet a particular measure. Such information, provided in real-time with updates on a daily basis, has led to very strong adoption of the new reporting capabilities among physicians.

Currently, DaVita is working to develop a benchmarking tool that can rate all physicians within a location. The focus on quality-measurement rankings relative to their peers, with drill-downs to specific indicators such as hypertension and chronic kidney disease progression, will allow physicians to focus on enhancing care delivery.

Unlocking data located in the EHR has helped DaVita comply with MU and PQRS. In the coming years, the upgraded EHR will help physicians comply with evidence-based guidelines and optimize increasingly complex reimbursement requirements.


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ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption

ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption | EHR and Health IT Consulting | Scoop.it
The healthcare industry is on track for spending billions of dollars on health IT products throughout 2015. With the ICD-10 compliance deadline looming in October, most providers are looking to adopt advanced IT systems that incorporate the new ICD-10 coding set.

Almost 60 percent of polled hospitals leaders stated they will be focusing on transitioning to ICD-10 compliance throughout 2015, according to a report from peer60. Some typical IT products many may be purchasing include revenue cycle management, population health management, patient engagement, EHR, and ICD-10 migration systems.147504495

The researchers also broke down the surveyed hospitals by size and found that the bigger organizations are more likely to invest in health IT technology over the next year due to having more resources to spend. However, the report also discovered that very small hospitals are more likely to purchase an EHR system when compared to larger medical facilities.

It is likely that larger hospitals already have EHR systems set up and are looking toward health IT than can better coordinate care, engage patients, and provide analytics. Additionally, every hospital with over 1,000 patient beds was planning on purchasing a major IT solution in 2015.

EHR vendors are likely to remain busy throughout this year, as 27 percent of surveyed hospitals are looking to either replace a current EHR system or install a new one in the ambulatory care setting. Additionally, 31 percent of those looking to replace a system are undecided on whether to purchase from their previous vendor. This means that around one in ten hospitals will be changing their EHR vendor.

The data analytics market is also emerging among health IT systems. Despite it being a new avenue, 26 percent of hospital leaders said they are planning to buy an enterprise analytics suite in 2015, with 30 percent of these tools being first time purchases. Chief Information Officers (CIOs) were the key positions that were looking to incorporate analytics systems in their healthcare facilities. Additionally, 25 percent of those who already have analytics products are looking to update and replace their systems with more enhanced features. Nonetheless, 40 percent of the survey takers are unsure whether they will be renewing their data analytics software.

With Stage 2 Meaningful Use requirements calling for greater patient engagement and the creation of patient portals among medical facilities, the healthcare sector is poised to incorporate more patient-centric solutions. However, the report found that 40 percent of hospital leaders have not picked a patient engagement strategy as of yet. Regardless, 48 percent of hospitals will be addressing patient engagement in 2015.

Others in the industry are already choosing replacement products to increase patient engagement at their facilities. With many looking to leave their current health IT vendor, there is definitely a market for product replacement aimed toward improving the patient-doctor relationship. Smaller hospitals are still considering their options.

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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Role of Integrated EHR Technology in Solving Fragmented Care | EHRintelligence.com

Role of Integrated EHR Technology in Solving Fragmented Care | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Authors of a recent Harvard Business Review article claim that integrated care hold the key to resolving fragmented healthcare in the United States.

Pioneering healthcare organizations demonstrate that it is now possible “the integrated-care model and accelerate its adoption more broadly and deeply across the American health care system.” This according to the Institute for Healthcare Improvement and Weill Cornell Medical College’s Kedar S. Mate, MD, and the Permanente Federation’s Amy L. Compton-Phillips, MD. Kaiser Permanente just so happens to be one of them.

Along with aligning payment with integrated care and other measures, the authors of “The Antidote to Fragmented Health Care” identify the creation of universal EHRs a means of achieving an end to fragmented care:

The lack of a single health record for each patient that clinicians from all specialties can access in both inpatient and outpatient settings is an obstacle to integrating care. In addition, patient privacy protections inhibit the sharing of health information, creating both perceived and real hurdles. Back in the 1990s, the U.S. Veterans Administration developed an electronic health record (EHR) that linked information across venues of care and provider specialties. This early work showed that linking clinicians electronically was transformational.

In addition to the example of the VA and its Veterans Health Information Systems and Technology Architecture (VistA) EHR, the authors highlight the positive experiences of EHR end-users at Kaiser Permanente:

Kaiser Permanente has an EHR that is shared by primary care doctors and specialists who work in hospitals and offices and is also used by nurses, pharmacists, physical therapists, and nutritionists. Their ability to collaborate electronically with patients in their homes and with each other using tools such as electronic consultation has fundamentally changed the way medicine is practiced at KP.

While these examples do make a case for integrated EHR technology, they are short on details about the two EHR technologies being used by providers at the VA and Kaiser Permanente.

Kaiser Permanente is using an Epic EHR although it is one that bears the marks of its own optimizations and enhancements. As noted in a report earlier today, the costs of implementing and maintaining an Epic EHR “are significantly higher than comparable competitor products, and, in at least one study, did not produce savings for payers” based on research published in the Journal of the American Medical Informatics Association. Not all healthcare organizations have these kinds of financial resources at their disposal or the expertise necessary for running this EHR technology effectively.

The example of the VA should raise additional doubts about the concept of a universal EHR. Without taking the Phoenix scheduling fiasco into account, the VA is facing significant pressure from Congress to modernize its EHR platform and achieve interoperability with the Department of Defense’s platform, when one is finally chosen.

The longstanding lack of interoperability between the two departments continues to be an obstacle preventing the records of DoD patients moving seamlessly into the VA’s EHR platform. And even with billions of dollars in funding from the federal government, no solution is in sight.

The EHR marketplace is full of players with products capable of supporting a provider’s pursuit of meaningful use and other financial incentives and still health information exchange varies by region and interoperability remains elusive. Technology is only one component of the authors’ vision of integrated care, but it is much more complicated than they demonstrate.



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Concerns on Proposed Meaningful Use Requirements Abound

Concerns on Proposed Meaningful Use Requirements Abound | EHR and Health IT Consulting | Scoop.it

With the deadline for public comments regarding the proposed Stage 3 Meaningful Use requirements at an end, various healthcare groups and medical providers submitted their opinions on the regulations in the nick of time. The American Hospital Association (AHA) urges the Centers for Medicare & Medicaid Services (CMS) to delay the finalization of Stage 3 Meaningful Use until providers are more prepared to meet its demands.


In a letter to the Secretary of the Department of Health and Human Services (HHS) Sylvia Burwell, the AHA along with other healthcare organizations stated their preference of delaying the finalization ofStage 3 Meaningful Use requirements. Essentially, a handful of medical organizations, from the AHA to America’s Essential Hospitals and the Children’s Hospital Association, are concerned about the capability of current health IT infrastructure to support the objectives under the last stage of the Medicare and Medicaid EHR Incentive Programs by 2018.


Additionally, the letter asks for HHS to work toward speeding up the process of health information exchange and developing an effective health IT infrastructure that would be able to meet the requirements under the Stage 3 Meaningful Use rule.


“We have learned from early experience in Stage 2 that it is unwise to finalize requirements based on untested standards, such as the Direct protocol for sending summary of care documents. We need testing and refinement of standards, as well as time to work through implementation issues, before a standard becomes a regulatory requirement. Indeed, we still have many lessons to learn from Stage 2, given that 2015 is the first year that most providers will be meeting the Stage 2 requirements,” the letter stated. “We believe that Stage 3 requirements, including the higher thresholds and more robust requirements for technology should be built on evaluation of experience in Stage 2 by all providers, and not just those that are among the first adopters.”


With regard to the proposed modifications to Stage 2 Meaningful Use requirements, it seems that the majority of stakeholders approve of the objective to reduce the reporting period to 90 consecutive days. Dr. Reid Blackwelder, Board Chair of the American Academy of Family Physicians (AAFP), was one proponent of the decrease in the reporting period.


This particular change would allow more medical practices to successfully attest to Stage 2 Meaningful Use requirements in 2015.  Additionally, the AAFP is pleased with the removal of the 5 percent threshold requiring patients to view, download, and transmit their healthcare data in place of having just one patient who accomplishes this.


One issue that Blackwelder did find is that essentially the proposed modified rule eliminates Stage 1 Meaningful Use and fuses it into a combination with Stage 2 Meaningful Use requirements. This is certain to “cause significant confusion,” Blackwelder said.


Additionally, the AAFP encourages CMS to address the problems of meaningful use audits, which are putting “undue hardship” on physicians across the nation. As the comment period for these proposed rulings has come to a close, CMS will work toward addressing the many concerns among the healthcare industry.

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Meaningful Use Requirements Impact Adoption of EHR Functions

Meaningful Use Requirements Impact Adoption of EHR Functions | EHR and Health IT Consulting | Scoop.it

As healthcare providers continue to upgrade EHR systems and achieve meaningful use requirements under the EHR Incentive Programs, federal agencies put forward additional mandates like the Meaningful Use Stage 3 proposed rule to advance health IT initiatives within this sector.

Once the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the implementation of health IT systems spread across hospitals and physician practices. After the HITECH Act was established, the federal government developed meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs to encourage physicians to adopt EHR systems.EHRIncentiveLogoweb

The adoption of EHR technology has been steadily rising over the last decade and researchers from the University of Michigan conducted a study to analyze EHR adoption in hospitals across the country.

The study was published in the Journal of the American Medical Informatics Association and used 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data to analyze the rise in adoption rates of EHR functionalities among hospitals.

The researchers looked at whether Stage 1 Meaningful Use requirements pushed forward the earlier rates of EHR adoption. Essentially, the study looked at whether there was a common sequence for adopting EHR functionalities and whether the location or size of a hospital affected this.

The researchers surveyed almost 3,000 hospitals in all 50 states. The results show a similarity in the sequence of EHR adoption across hospitals. The homogeneity score was 0.48, which illustrates moderate-to-strong evidence for similarity among hospital adoption of EHR functionalities.

Patient demographic data, radiology reports, and laboratory reports are some of the first functions implemented in the EHR system while clinical reminders, guidelines, and physician notes were adopted in later years. The EHR functions analyzed include clinical documentation, results management, computer provider order entry (CPOE), barcode, and decision support.

Some other items that had strong homogeneity in the study include medication lists, drug-allergy alerts and drug-drug interactions, nursing assessments, and discharge summaries.

Smaller hospitals were more homogenous when it came to their adoption of EHR functionalities while larger health systems as well as urban and teaching hospitals displayed more diversity.

The researchers also predict that Stage 1 Meaningful Use requirements are leading the adoption of certain EHR functions over others. For instance, incorporating clinical guidelines and medication computerized provider order entry in EHR systems is a key part of the federal rulings, which has increased the adoption of these particular EHR processes.

The study also indicated that meaningful use requirements caused hospitals to adopt clinical guidelines, medication CPOE, clinical documentation functions, and decision support tools earlier than other EHR functions. Meaningful use requirements may have also affected the decisions of smaller hospitals more than larger health systems.

The results show that healthcare providers are putting their resources into meeting meaningful use requirements and earning financial incentives under the EHR Incentive Programs. While this is positive news, it is also important to address the individual needs of each hospital.


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How Stage 3 MU Concerns Impact EHR Incentive Programs

How Stage 3 MU Concerns Impact EHR Incentive Programs | EHR and Health IT Consulting | Scoop.it

The Medicare and Medicaid EHR Incentive Programs will be impacted by the latest Stage 3 Meaningful Use proposed rule. The proposed ruling calls for stricter security measures for protecting patient health information, increasing the amount of electronic prescribing and computerized order entry conducted in hospitals and physician practices, and pushing forth patient engagement efforts.

“Transmitting the prescription electronically promotes efficiency and patient safety through reduced communication errors,” the Stage 3 Meaningful Use proposed ruling states. “It also allows the pharmacy or a third party to automatically compare the medication order to others they have received for the patient that works in conjunction with clinical decision support interventions enabled at the generation of the prescription.”

Currently, there is a comment period in which providers, vendors, and other stakeholders can offer their perspective on some of these meaningful use requirements and state which objectives are not achievable.

Once the final ruling for Stage 3 Meaningful Use requirements is established, however, providers who are unable to meet the objectives will need to file a hardship exemption and ensure there is evidence of their burden. Otherwise, these healthcare providers will receive a payment penalty from the Centers for Medicare & Medicaid Services (CMS).

The healthcare providers who do meet Stage 3 Meaningful Use objectives, on the other hand, will receive payment incentives from CMS. While some hospitals and practices have seen financial incentives from the Medicare and Medicaid EHR Incentive Programs, others have been burdened with payment penalties as well as the major financial investment from implementing EHR systems, according to the JD Supra publication.

With around half of healthcare providers not meeting Stage 2 Meaningful Use requirements, it remains to be seen whether the federal government will ease its restrictions and allow more time for struggling healthcare professionals to catch up.

Some are concerned over the set objectives in the Stage 3 Meaningful Use proposed ruling such as the goal of ensuring 25 percent of patients view and download their health information through portals.

Another major complication that CMS set forth is the requirement of all eligible hospitals and providers to attest to Stage 3 Meaningful Use by 2018 regardless of prior attainments. There will also be an optional period in 2017 to attest to Stage 3 Meaningful Use requirements. Those who feel incapable of meeting Stage 3 within the next three years should send comments to CMS and the Office of the National Coordinator for Health IT (ONC) before the May 29 deadline.

Others are concerned with the EHR reporting period beginning in 2017, which will require providers to report on a full calendar year. However, this system is meant to align the Medicare and Medicaid EHR Incentive Programs with other CMS initiatives such as the Physician Quality Reporting System.

Even with the many issues surrounding reaching Stage 3 Meaningful Use requirements, the proposed ruling aims to improve quality of care by expanding health information exchange, EHR interoperability, and patient engagement efforts.

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Healthcare Industry Reacts to Stage 3 MU Proposed Rule

Healthcare Industry Reacts to Stage 3 MU Proposed Rule | EHR and Health IT Consulting | Scoop.it
On March 20, the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health IT (ONC), and the U.S. Department of Health and Human Services (HHS) announced that the latest proposed ruling on Stage 3 Meaningful Use requirements have been released for public comment.

The announcement emphasizes how the proposed rules will give providers more flexibility under the EHR Incentive Programs and increase EHR interoperability to improve the access and sharing of patient health information.2015-01-12-chime-small

The healthcare industry as a whole is currently processing the proposed ruling and preparing to contribute during the comment period. Some public statements about the Stage 3 Meaningful Use proposed ruling from leading organizations have been released.

A statement from the College of Healthcare Information Management Executives (CHIME) said: “CHIME is closely evaluating both the CMS Meaningful Use rule and the ONC certification rule. Based on our initial review, we are pleased to see flexibility built into the Stage 3 proposed objectives. We are still trying to understand the implications of moving all Medicare providers to a single definition of MU by 2018, but are encouraged by the potential for this policy to simplify and streamline the long-term viability of Meaningful Use. While we and other stakeholders have been critical of the program over the last two years, we have always underscored how vital Meaningful Use is to modernizing our nation’s healthcare system. We look forward to digging further into the rule, looking for elements that will allow providers to build on their IT investments, specifically in the areas of care coordination, patient engagement and interoperability.”

“We do, however, urge CMS to quickly publish the proposed rule alluded to in Dr. Conway’s January 29 announcement. We were encouraged by the signals to shorten the 2015 EHR reporting period from 365 to 90 days and make other program improvements through a follow-on rule. We call on CMS to propose policy changes to the ‘all-or-nothing’ construct, lengthen timing between required Stage upgrades, and consider much-needed revisions to the hardship exception categories. These changes will enable far better participation among providers, which will in turn, keep them on a path towards improved care through health IT.”

With the inclusion of some more policy changes, CHIME recognizes that Stage 3 Meaningful Use regulations will play a pivotal role in expanding health IT adoption across the country and thereby improving the quality of care. Another statement comes from the American College of Cardiology President Kim Allan Williams Sr., M.D., on the organization’s reaction to the proposed ruling.

“The American College of Cardiology has long supported the adoption of electronic health records (EHRs) as a mechanism for improving patient outcomes,” Williams said. “The EHR Incentive Program as currently structured has been focused more on ‘checking the box’ than changing care delivery to achieve the goal of improved patient care.”

“Although the ACC is still reviewing the proposed regulations, the College is concerned by the proposal to require all providers, even first-time participants, to report for a full calendar year,” the American College of Cardiology President continued. “Implementing an EHR system in a physician practice or a hospital is not as simple as flipping a switch; it takes time, financial investment, careful consideration and planning, as well as education for all staff. The program must take this learning curve into consideration.”

Some players within the healthcare industry find the EHR reporting period of a full calendar year problematic and are urging CMS to transition to a 90-day reporting period instead.

Additionally, there may be too many regulations that are being put forth to advance the meaningful use of health IT systems instead of addressing the various problems in the medical industry today. A statement from the American Hospital Association (AHA) underscores this point.

“Hospitals are implementing electronic health records at a brisk pace in order to improve patient health and health care, but they must do so under the crushing weight of government regulations,” Linda E. Fishman, Senior Vice President of Public Policy Analysis and Development at AHA, said in a public statement. “The release of today’s rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today. In January, CMS promised to provide much-needed flexibility for the 2015 reporting year, which is almost half over. Instead, CMS released Stage 3 rules that pile additional requirements onto providers. It is difficult to understand the rush to raise the bar yet again, when only 35 percent of hospitals and a small fraction of physicians have met the Stage 2 requirements.”

“We urge CMS to release the 2015 flexibility rules immediately. Information technology holds the promise of enhancing care for patients and communities,” Fishman continued. “America’s hospitals are committed to adopting technology but need today’s problems to be addressed to make progress for patients and communities.”
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Why Meaningful Use Should Balance Interoperability With More Immediate Concerns

Why Meaningful Use Should Balance Interoperability With More Immediate Concerns | EHR and Health IT Consulting | Scoop.it

Frustration over the stubborn blockage of patient data sharing is spreading throughout the health care field; I hear it all the time. Many reformers have told me independently that the Office of the National Coordinator should refocus their Meaningful Use incentives totally on interoperability and give up on all the other nice stuff in the current requirements. Complaints have risen so high up that the ONC is now concentrating on interoperability, while a new Congressional bill proposes taking the job out of their hands.

Such a narrow focus would be a mistake. Coming out of the computer field myself and appreciating the importance of frictionless data exchange (which most programmers figured out how to do long ago), I care about interoperability as much as anyone. I have written written about it repeatedly. But we can’t put off other requirements without at least a plan to get them working.

Take measles. Lots of news reports have documented its alarming re-emergence in American life. Wouldn’t you like to know the rates of innoculation in your geographic area? If so, you’ll be glad to know, according to a report just released by the ONC, that 73% of hospitals eligible for MU incentives were able to report vaccinations to their local public health registry electronically (p. 2 of the report). This doesn’t mean other hospitals failed to report vaccinations, but that they used old-fashioned, error-prone manual systems to do so.

And how about epidemics? A few months ago the American public were scared witless that Ebola would spread throughout our cities. That didn’t happen (although two unfortunate victims died of Ebola in the U.S.), but we don’t have to import our epidemics–we have plenty of our own local infections to worry about, from Lyme disease to life-threatening valley fever (coccidioidomycosis).

So you should be happy to hear that 48% of eligible providers met their public health requirements for syndromic surveillance through electronic submissions, a figure that rose to nearly 75% in several states (p. 4 of the report). This data goes directly from emergency rooms and urgent care centers to agencies monitoring this data nationally, such as the Centers for Disease Control.

These advances come directly from the stringent requirements in Stage 2 of Meaningful Use. ONC data shows that few hospitals could do these things electronically in Stage 1.

There’s a general principle of public policy that lies behind my points here: changes to behavior must balance the evolution of our long-range infrastructure with immediate needs.

We all understand that long-range infrastructure changes are important. We need fee-for-value in payments, and interoperability in electronic health records.

But these things take a long time to bend the cost curve and show results. The current slow-down in the growth of U.S. health care cost is a relief to see, but economists can’t decide whether it’s a long-term trend or the a temporary blip. It might be fall-out from the economic slowdown (perhaps people are even delaying treatment they need), so we can’t depend on the positive trend continuing.

Standards bodies and EHR vendors tout improvements in interoperability, but its disappointingly resistant to adoption. As for accountable care, we’re getting more Accountable Care Organizations, but actual costs savings are scattered and slow to come. This is probably because they suffer from the same interoperability gaps as everybody else in health care, in addition to slow advances in the other clinical decision support and analytics they need.

The solution to infrastructure problems is better infrastructure, but we also need advances in health care right now. That’s why I support Meaningful Use requirements for public health reporting. The next step, as Dr. Kenneth Mandl recommends, is for these agencies to package up their knowledge into apps that clinicians can use, completing the circle. Another insight I’ve learned from the computer field applies here: you’ll never get anywhere if you apply all your efforts to developing your infrastructure.


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IOM Panel Recommends Addition to Stage 3 Meaningful Use

IOM Panel Recommends Addition to Stage 3 Meaningful Use | EHR and Health IT Consulting | Scoop.it

A committee from the Institute of Medicine (IOM) has released recommended guidelines urging the federal government to include patient socioeconomic status and behavioral health data in Stage 3 Meaningful Use regulations. The IOM report was published in the New England Journal of Medicine last month.

The committee suggests incorporating a number of social determinants into EHRs and asking patients 12 questions about their socioeconomic status and behavioral health. Out of these 12 measures, four are currently being evaluated within the healthcare industry while eight are original questions. This process may cut costs in the healthcare industry as well as provide patient-centered accountable care.

Using such data could lead to improved diagnoses and treatments as well as strengthened decision making among providers. Clinicians would be able to identify risk factors more quickly by learning about a patient’s social background.

In addition to basic healthcare services, physicians would be able to refer patients to community organizations or public health departments when different issues arise such as domestic abuse. Along with these benefits, this kind of questionnaire would broaden the amount of patient data available and aid population health management strategies.

The recommendations stem from an IOM report released in November that attempted to uncover social and behavioral domains that are directly related to health outcomes, Politico reports. The panel in charge of the paper analyzed the ways to capture this data in EHR systems.

Some criticism from the American Medical Informatics Association claims that adopting this questionnaire will cause physician workflow issues as well as patient privacy complications. Additionally, some experts wondered if patients would provide honest answers to the questions.

The authors of the IOM report, however, hold a different opinion. The authors stated that by having data on socioeconomic status, employment status, and personal relationships, doctors would be able to “better partner with the patient to make informed and realistic medication choices.”

“Any new diagnostic technology or mode of therapy creates added demands and necessitates changes in practice,” William Stead of Vanderbilt University and Nancy Adler of the University of California, San Francisco, wrote in the report. “We believe that the benefits of adopting and using the measurement panel will outweigh these costs.”

Nonetheless, providers would need to take patient privacy and security into account when implementing a socioeconomic and behavioral health questionnaire in their practice. The change in workflow, however, will be minor, as much of the data can be self-reported or recorded during initial medical visits.

The most recent report hopes to expand the number of organizations involved in considering the implementation of this socioeconomic and behavioral health questionnaire. In particular, it asks the U.S. Department of Health & Human Services (HHS) to take part in including the survey within Stage 3 Meaningful Use requirements.

To qualify for the EHR incentive program under Stage 3 Meaningful Use regulations, the panel calls for behavioral health and socioeconomic data to be stored in EHR systems. Time will tell whether the federal government decides to include a behavioral health and socioeconomic survey as part of Stage 3 Meaningful Use.


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Patients want more from their EHRs | Healthcare IT News

Patients want more from their EHRs | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

Having established a level of trust and familiarity with electronic health records over the past few years, increasing numbers of U.S. patients are looking for more advanced features from their EHRs, according to a new survey from the National Partnership for Women & Families.


The study, "Engaging Patients and Families: How Consumers Value and Use Health IT," follows up on a similar 2011 report that assessed consumer views toward EHRs. A lot has changed since then, with more and more patients comfortable with the idea of digitized records, and easier online access to health information spurring more patient engagement in their care.

In the past year, more than four in five patients with online access to their health records (86 percent) used their online records at least once, according to NPWF; more than half (55 percent) used them three or more times a year.


"To date, the public discourse on health IT has largely focused on the views of doctors, hospitals and vendors," said NPWF President Debra L. Ness in a press statement. "It is crucial to hear what patients have to say about how they experience EHRs and health IT as they receive care and manage their health."

By repeating questions from 2011, the new survey – which lays out seven strategies to help engage patients and families more effectively in their care – identifies trends in patient attitudes since meaningful use has helped fuel EHR adoption. Its new questions yield data on new topics in discussion for health IT policies and programs, such as patient-generated health data, patient care plans and mobile access.


"Engaging Patients and Families" is not the only new report being updated for the first time since 2011: It comes close on the heels of the Office of the National Coordinator for Health Information Technology's new 2015 Strategic Plan, which was published on Monday for the first time in four years.

"As the National Partnership's new data show, more consumers are accessing, sharing and using their health information, underlining the importance of interoperability of health data and systems," said National Coordinator for Health IT Karen DeSalvo, MD, in a statement. "We are focusing our efforts in these areas to empower individuals to address not only gaps in information exchange and interoperability, but also enable them to take steps to improve their health and better manage their health needs,"

Among other key points from NPWF's report, which polled more than 2,000 patients: Patients' online access to their health records has nearly doubled – from 26 percent in 2011 to 50 percent in 2014.

Still, they want even more functionality, including the ability to email providers (56 percent), review treatment plans (56 percent), see doctors' notes (58 percent) and test results (75 percent), schedule appointments (64 percent); and submit medication refill requests (59 percent).

Patients' trust in the privacy and security of EHRs has increased since 2011, and patients with online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) than those with EHRs that don't include online access (67 percent).

Different populations prefer and use different health IT functionalities. Hispanic adults were significantly more likely than non-Hispanic Whites (78 percent vs. 55 percent) to say having online access to their EHRs increases their desire to do something about their health. African American adults were among the most likely to say EHRs are helpful in finding and correcting medical errors and keeping up with medications.

NPWF suggests that "specialized strategies" may be necessary to improve health outcomes and reduce disparities in underserved populations.

"The views of patients must be front and center as we take the next steps in implementing health IT," said Sandra R. Hernández, president and CEO of the California HealthCare Foundation, which funded the poll. "As we as a nation become more diverse, the imperative to address disparities grows. We need the kind of robust information EHRs provide and the genuine patient engagement they can facilitate."

"We have made progress in leaps and bounds in just a few short years," said Mark Savage, NPWF's director of health information technology policy and programs, in a statement. "But clearly there are barriers still to overcome, and this report breaks down policy implications for the meaningful use program as well as broader delivery system initiatives that must be carried out. And it's an important reminder that meeting the needs of patients and families must always be at the core of health IT design and implementation."



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