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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Managing a Successful EHR Implementation Extension Program

Managing a Successful EHR Implementation Extension Program | EHR and Health IT Consulting | Scoop.it

Extending your healthcare organization's EHR technology to community physicians and hospitals can prove to be life saving for the patients of your community. This, in turn, dramatically increases patient safety and continuity of care. Sharing known allergies, current medications, and saving time on reviewing lab and radiology results are all examples of how a patient’s healthcare can be greatly affected.

Your organization has decided to increase the footprint within the community by offering availability to your EHR technology. Now what?


The first steps in developing the EHR implementation extension program can feel a bit daunting to those involved, seemingly like taking a road trip without a map or a compass or a smart phone. These days many of us would be completely lost without these tools to guide us. In planning a road trip, typically milestones are planned along the way to the final destination. Having a clear vision of the whole picture will help you and your organization to determine the milestones and plan for success.


The healthcare community is a small one within every region. And when things go well, it will be talked about. However, if an EHR implementation go-live turns south, the word spreads like wildfire within the local healthcare community, potentially harming the success of your healthcare organization's EHR implementation extension program.


Here are a few wrong turns to avoid in helping to ensure a successful EHR implementation extension program.


Navigating without a compass: When starting a successful EHR implementation extension program, develop a strong steering committee that knows and is behind the overall strategy. Develop a roadmap of healthcare sites that will be successful and have similar goals to your organization. Determine those sites by considering the following


  • Financial stability – a thriving practice usually reflects the success of the practice.
  • Similar goals and standards to your organization – a practice that aligns similar to your organization will ensure a cleaner patient record.
  • Amount of referrals to and from your organization – the amount of the referrals between your organization and the potential site can indicate a larger common patient base, affecting a greater patient population.


Fast and furious: Understand the time requirements of the development of the contract and all third-party contracts prior to scheduling your first EHR implementation go-live. Generally, the development of the contract between your organization and your customer can take six to nine months, being generous. Before the finalization of the contract many decisions have to be mad (e.g., what will the package offered include, negation of third-party contracts for additional licensing, service level agreements). Additionally, your legal team will want and need to be involved to fully understand what is being offered, how Stark antikickback laws can affect the contract, and the agreements for allowing users outside of your organization to use the system. Having a plan to potentially separate from a potential client is also a necessity within the contract.


Selecting an EHR system including add-ons, options, and fine print: Developing a solid and clear marketing package will help to set expectations from the beginning. During the initial conversations, it is vital for the package and its contents established. Clearly communicate what is included with the actual implementation of their site and what is a chargeable add-on. For example, custom reports or custom build that can take costly resources can potentially be an add-on package with a set price. Having a clear understanding for both your organization and your potential client will help to provide a solid foundation of the relationship.


Avoid sticker shock. Be clear about what goes into the pricing that is presented in the contract. When developing the pricing portion of the EHR contract, break down what’s included, such as training, go-live support, and help desk for post-go-live process.


The vehicle has all the bells and whistles, but no gas in the tank: There are two parts to this potential blunder to consider. First consider the state of your current health IT infrastructure and setting expectations of what is required for hardware/software/connectivity for your future customer. A full evaluation of your current state of your organization's infrastructure is a valuable tool to help develop the costs and plan to fill any necessary gaps to accommodate the additional usage of the system. This also applies to health IT interfaces that will potentially be used for these sites. Another consideration is setting requirements for hardware and software for the incoming customers.


Giving an inadequately educated driver the keys: There are many options for how to provide education to your in-coming customers, and knowing them may determine the success of your go-live. Some organizations choose web-based training, some classroom training, and some a mixture. Knowing your clientele can help you make this decision. If your organization is looking to bring on smaller ambulatory clinics, they may not have the resources to attend 20+ hours of training. Providing the intro related workflows via the web-based training and offering minimized classroom training may be a good alternative for your organization. If your organization can only offer web-based training, consider providing practice environment an extended go-live support to accommodate the needs of your soon-to-be customer.


Caution about overload: When development of the overall strategy is taking place, consider the amount of resources required to make your strategy a success. Your timeline may include several back-to-back EHR implementations. Consider a team large enough to rotate the discovery, data collection, build, and go-live duties. The question is: to have a separate build team or envelope it into the current build team? The timing of your project plan in conjunction with other organizational initiatives will play a part of how to proceed. If there are other large projects or your organization is new to the system themselves, then it might not be feasible for the current staff to take on. Consider forming a team specific to this project with members being liaisons to the project team. Extending your organization's EMR generally is a long-term initiative and often includes time away from the office for discovery, meetings, go-live prep, and go-live support. 


Being successful is not only important to your organization, but also to your customers and most importantly, the patients. While there are many opportunities for failure, there are also many opportunities for success when it comes to extending your EHR technology. A solid roadmap (clear strategy), a navigation system (project plan), and clear communication will help to build a solid roadmap, guiding your organization to its destination, with the windows down, the radio up, and singing at the top of the lungs.

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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 | Scoop.it

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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EHR Data Interoperability Should Meet Five Use Cases

EHR Data Interoperability Should Meet Five Use Cases | EHR and Health IT Consulting | Scoop.it

EHR data interoperability remains a top priority for the healthcare industry as well as the federal government. In order to ensure the financial investments the government put into spreading EHR adoption and meaningful use requirements are worthwhile, connectivity between health IT systemsand medical devices throughout a healthcare facility will need to be achieved. However, one question that two scientists posed is: “What makes an EHR ‘open’ or interoperable?”


Dean F. Sittig, PhD, from the University of Texas and Adam Wright, PhD, from Boston-based Brigham and Women’s Hospital determined five use cases which identify the definition of EHR data interoperability. Their findings are published in the Journal of the American Medical Informatics Association (JAMIA).


These five use cases include (1) clinicians for provision of more robust and safer care, (2) researchers who can assist in improving knowledge of medical conditions and healthcare workflow processes, (3) administrators who will no longer be reliant on only one EHR vendor, (4) software designers and developers who will benefit by being able to create innovative products and address EHR user interface issues, and (5) patients in order to receive their pertinent medical data regardless of where they obtained healthcare services.


Currently, EHR data interoperability between multiple electronic patient record systems is lacking across the medical care industry. With more than $26 billion invested by the federal government in ensuring EHR implementation boosts patient care processes, it may be for naught if EHR data interoperability is not achieved.


Another major problem that has been perceived in the healthcare sphere is the potential forinformation blocking. A variety of EHR vendors as well as providers have been implicated in the blocking of effective health information exchange. The researchers state that, while many in the healthcare industry understand the need for effective EHR data interoperability, few comprehend the specific definition of the term.


“Many commentators assume that an open EHR shares some of the qualities of ‘open-source’ software, which usually implies that the application’s source code is available, often free of charge, for review, use, and even modification,” the published report stated. “While we support the open-source concept, it has no bearing on whether an EHR satisfies the definition we propose below. On the other hand, we strongly believe that EHR developers should provide customers with access to an ‘escrowed’ copy of their current source code to help mitigate health care business continuity problems in the event the developer goes out of business.”


One use case the researchers point out is the ability of an authorized user to share either an entire patient record or a portion of the record with another physician who utilizes a separate EHR system developed by another vendor.


By focusing on the five use cases the researchers uncovered, vendors and providers could move forward with achieving EHR data interoperability and health information exchange. EHR vendors and developers will need to commit to providing EHR capabilities that can effectively share and exchange data among clinicians and larger healthcare organizations or public health agencies.

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86% of Providers Aim for Integrated EHR, Practice Management

86% of Providers Aim for Integrated EHR, Practice Management | EHR and Health IT Consulting | Scoop.it

EHR replacement continues to be a major force in the health IT market, finds Black Book Rankings in its latest industry survey, as providers attempt to retool their infrastructure to meet the data-heavy demands of value-based reimbursement and accountable care.  The main concern?  For the 86 percent of providers seeking to deploy an integrated EHR and practice management solution, it’s ensuring that clinical data and revenue cycle management are aligned in order to support improved operational efficiencies and broad initiatives like population health management and quality reporting.


More robust revenue cycle management remains at the heart of organizational efforts to fully leverage health IT infrastructure, yet only 22 percent of small practices believe they are currently getting the most out of their practice management software suites, Black Book says in its full report. 


The market for replacement software remains fluid and lucrative, adds Managing Partner Doug Brown, as dissatisfied providers continue to define their own needs and seek health IT products that will help them accomplishtheir financial goals.


"Revenue cycle management and integrated EHR vendor loyalty among small practice EHR physician practices is still on a significant upward trajectory,” said Brown. "The EHR/practice billing vendor's abilities to meetthe evolving demands of interoperability, networking, mobile devices, accountable care, patient accessibility, customization for specialty workflow, and reimbursement are the main factors that the replacement mentality and late adoption remain volatile especially among solo and small practices.”


"High performing vendors have emerged from the pack as practice implementations succeed and fail, meaningful use attestations are reviewed, and users assess their vendor’s capabilities to meet their individual practice needs, particularly managed care reimbursement and ACO billing ," he added.


“The majority (70%) of smaller and solo practice physicians have still not settled on a technology suite or set of products that delivers to their expectations on meaningful use, clinician usability, and coordinated billing and claims, hence, the relentlessly moving EHR marketplace.”

Over the past year, 13 percent of small providers participating in the survey upgraded or outsourced their billings and collections processes and systems.  Eighty-four percent still believe that there is work to do in order to develop a comprehensive health IT infrastructure that meets their practice management needs – and those upgrades must integrate clinical and financial data into one seamless system in order to support the clinical analytics, patient management, and big data competenciesrequired for successful participation in accountable care.


Ninety-two percent of providers looking for a revenue cycle or practice management upgrade are only targeting systems that revolve tightly around the EHR in an effort to create a more complete portrait of patient populations and activities as providers seek to stem the outgoing tide of reimbursement. 


The vast majority of healthcare providers, including those practicing through hospital systems, or larger networks, believe that they will see declining or negative profitability over the next two years due to declining revenues if they do not make more of an effort to develop integrated EHRs and more capable practice management technology systems.


In order to forestall a headlong tumble into the red, eighty-five percent of solo practitioners and small practices are considering outsourcing their billing processes, with 48 percent of those providers with in-house billing staff hoping to engage a third-party service over the next eighteen months.  The increasing popularity of high-deductible health plans is bringing an untenable degree of complexity to the billings and collections process, these providers say, which may be better handled by a dedicated service.


Black Book ranks Kareo, Inc. as the top-performing electronic health record and billing software and service vendor for 2015, tapping the company for the honor for the third year in a row.  Other highly-rated vendors include ADP AdvancedMD, athenahealth, Greenway, HealthFusion, McKesson, and NexTech, the report adds.

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Increasing Productivity with Your EHR: 5 Strategies

Increasing Productivity with Your EHR: 5 Strategies | EHR and Health IT Consulting | Scoop.it

With the passage of the HITECH Act in 2009, the federal government began requiring physicians to adopt EHR technology. The act mandates "meaningful use" of EHRs by providing incentivized Medicare and Medicaid payments to physicians who use the technology and imposing Medicare penalties on non-adopters. Since then, physicians have voiced concern about decreased productivity and revenue with EHR implementation.

Study results have been mixed, with some studies showing decreased productivity and others showing stable or increased productivity after implementation. Given these inconsistent results, it's reasonable to conclude that success varies among practices with respect to EHR adoption.


So how do you implement an EHR and maintain or improve your productivity? Here are five strategies to consider.


1. Provide Quality Training

Some people in your practice may be technical whizzes. Most are probably not and will require in-depth training to begin feeling comfortable and efficient using an EHR. Successful training requires an initial assessment of physician and staff computer skills, several days of individualized in-house training, as well as ongoing feedback sessions and tutorials. One training technique that has been shown to be effective is to create peer "super users" within the practice who can help others get up to speed with the new system.


2. Delegate Tasks to Your Staff

The work flow of your practice will change as you adapt to using an EHR. One way to improve the new work flow and increase efficiency is to delegate certain data entry tasks to support staff. You can enable medical assistants and nurses to enter vital signs, social and family histories, problem lists, and medical reconciliation into the electronic chart. You can even grant certain staff the ability to enter orders that are later electronically co-signed by you. Each task you delegate is less time that you spend at the computer and more time available for your patients.


3. Customize Your EHR

Do you like your notes and charts formatted a certain way? Do you order certain tests frequently? Almost all EHRs allow for customizable templates as well as ways to create lists of "favorite" or frequently used orders and order sets. Customizing your EHR can significantly decrease the number of "clicks" you need to make for each patient encounter.


4. Decrease Your Typing

For years, physicians used paper charts and transcription services, so it's not surprising many of them feel that typing slows them down. Consider working with a medical scribe who not only is a speedy typist but who is also trained in medical terminology as well as effective and thorough charting. If hiring a scribe seems like it would be too much of an expense, consider purchasing voice recognition software to decrease your burden of typing and boost your productivity.


5. Implement a Patient Portal

Patient portals are convenient for your patients because they allow people access to their health information online. But patient portals can also be convenient for your practice and can even improve your office's efficiency. Ask your patients to fill out new health information, issues, and concerns from home a day to two before coming in to see you, thus allowing you to have access to patient questions in advance and to save time during appointments. Encourage patients to use the portal to request and "pick up" prescription refills, referrals, and lab test orders, as well as to schedule office visits — all of which will free up your support staff to attend to other duties.


Since the passage of the HITECH Act, medical practices have been mandated to adopt EHRs. While the transition to new EHR technology can be challenging, various strategies can be used to enable a practice to quickly increase productivity and revenue.

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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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Health Information Blocking Continues to Plague Data Exchange

Health Information Blocking Continues to Plague Data Exchange | EHR and Health IT Consulting | Scoop.it

Ever since the HITECH Act was passed and the Medicare and Medicaid EHR Incentive Programs were established, more than $29 billion was put toward expanding EHR implementation and health information exchange. Eligible physicians and hospitals were encouraged to adopt EHR systems and health IT platforms by offering financial incentives to those that do. Additionally, under the EHR Incentive Programs, reimbursement penalties would be given to those that have not met meaningful use requirements by a certain period. Despite the clear pathway toward medical data exchange, various stakeholders have participated in health information blocking, which impedes the goals of the healthcare IT industry for improved access to key data.


The New York Times reported that administration officials have found hospitals and laboratories along with EHR vendors participating in health information blocking in order to keep their consumer base from jumping toward a competing healthcare provider.


The federal government is currently attempting to create an environment across the healthcare industry in which medical information will flow freely from one facility to the next. The Obama Administration continues to make it a priority for hospitals and clinics to adopt EHRs and computerize patient records.


President Obama signed a stimulus bill upon taking office that gives hospitals and doctors incentives for implementing certified EHR technology. While large numbers of healthcare providers have adopted electronic records systems, the problem at hand is that few are able to share patient data across platforms designed by different vendors. Essentially, health information blocking delays the progress of EHR interoperability.


“We have electronic records at our clinic, but the hospital, which I can see from my window, has a separate system from a different vendor,” Dr. Reid B. Blackwelder, chairman of the American Academy of Family Physicians, told the news source. “The two don’t communicate. When I admit patients to the hospital, I have to print out my notes and send a copy to the hospital so they can be incorporated into the hospital’s electronic records.”


Another pediatrician from Massachusetts also lamented that he has tried and failed to connect medical records with a hospital’s EHR system in order to better coordinate care with his patients. Not long ago, the Office of the National Coordinator for Health IT (ONC) sent a report to Congress expressing the need to put an end to health information blocking.


Additionally, the costs of sharing data among medical practices are creating barriers and essentially showing that various providers decline to share key data that is needed to treat a patient regardless of their condition.


Certain companiesare also making it more difficult for hospitals to connect to multiple laboratories and technology services while others have customers sign strict contracts that prohibit them from easily choosing a different EHR platform.


Recently, a House Committee passed a bill that states health information blocking is a federal offense. It is also against the law for doctors and hospitals to deliberately take part in health information blocking if they are receiving federal incentives from the Centers for Medicare & Medicaid Services (CMS) for adopting certified EHR technology, according to a bill passed in Congress last month.

Through federal regulations, it is possible that health information blocking could become a problem of the past.

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ICD-10 Implementation Vital for Value-based Care Payments

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

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


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

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


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


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


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


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


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


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


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EHR Interoperability Imperative for Care Coordination

EHR Interoperability Imperative for Care Coordination | EHR and Health IT Consulting | Scoop.it

The medical industry is incorporating stronger strategies for care coordination to reform the sector and improve quality of care.  One major aspect of improving care coordination stemming from the Patient Protection and Affordable Care Act is the integration of Accountable Care Organizations (ACOs), which focus on a team of healthcare professionals working together to improve patients’ health across different specialties and varying facilities.


Nicole Beagin, Associate Editorial Director at The American Journal of Managed Care, and Mary Caffrey, Managing Editor of Evidence-Based Oncology and Evidence-Based Diabetes Management at The American Journal of Managed Care, spoke with EHRIntelligence.com to discuss the ACO Coalition their organization has created and how health IT systems and electronic patient records could be used to improve care coordination.


“The ACO Coalition is an initiative of AJMC,” Beagin stated. “Our ACO members are made up of payers, providers, patient advocates, those who work in health IT, and specialty-pharmacy. We put on two meetings per year and have four web-based events per year [for the ACO Coalition]. Various stakeholders and our members present on case studies and best practices.”


“[Our last meeting] had a lot of information about patient engagement. A lot of speakers were talking about patient engagement,” Caffrey explained. “[Some key questions formed were] how do you really define patient satisfaction and how to achieve population health measures with hard-to-reach populations.”


With the Centers for Medicare & Medicaid Services (CMS) focused on bringing the healthcare system toward value-based care, it grows more imperative than ever before to improve care coordination and the quality of services among ACOs and other entities, AJMC reports. At one meeting of the ACO Coalition, Jonathan Hare, CEO of WebShield Inc., addressed the need to share information quickly and effectively among medical organizations.


The sharing of payment models and emphasis of quality measures are key for better coordination while patient privacy and data security remains vital for healthcare organizations as well, said Hare at the meeting.


“Our meeting that we held in Miami last October, from Geisinger, Dr. Thomas Graff and Dr. Eric Newman both touched upon EHR use within the Geisinger health system,” Beagin continued. “[They discussed] how they were using EHRs within a group to specifically address specialty providers and specialty care coordination.”


When discussing providers’ feedback on ACO development, Caffrey mentioned, “Different health systems folks presented the data they’ve collected from the providers and will show where they started and what kind of challenges they’ve had to overcome in moving their system forward. We’ll see a lot of screens that move from red to green. When they started up with the ACO, they had a lot of patient data that was off the mark from where they needed to be in terms of health measurements. They had to make many changes in terms of how they were delivering care but also system changes in how they were communicating adequately and collecting data.”


When asked what objectives under meaningful use stages may be the most difficult to achieve for healthcare providers, Beagin stated, “Our members have been discussing the issue of interoperability when implementing EHR systems within their practices. Data technology is a hot button issue for our members.”


Clinical quality measures under Stage 2 Meaningful Use requirements as well as patient and family engagement have been major discussions as well,” Beagin concluded.


“With hard-to-reach populations, there’s a need for the use of technologies for the interface with community organizations such as churches or civic organizations,” said Caffrey. “Healthcare organizations are realizing that population health will occur outside the walls of the clinic and outside the walls of the hospital. If they’re taking responsibility for the population, they will need to meet the population where they are. A lot of our discussion has been about how to use technology to engage the community organizations and how to partner with these organizations.”


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Do Health IT Systems Need Greater Interoperability?

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

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


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


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


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


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


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

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


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


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Few Physicians Think EHR Technology Improves Outcomes

Few Physicians Think EHR Technology Improves Outcomes | EHR and Health IT Consulting | Scoop.it

The adoption of EHR technology was expected to improve patient health outcomes and quality of care. To determine whether EHR systems have truly helped with these healthcare objectives, who would be the most trustworthy professional to ask? Physicians and other medical professionals are the ones working directly with patients and utilizing the systems to store and access relevant data.


This is why a new survey from Accenture is concerning, as it shows that only some doctors actually believe EHR technology improves health outcomes or reduces medical errors. The survey polled 2,600 physicians around the globe with 600 doctors from the US and found that health IT use has grown significantly since a similar survey was administered in 2012.


The majority of US healthcare providers are proficient at incorporating EHR technology in their practice but few believe that it has actually improved treatment decisions. In 2015, only 46 percent of polled physicians feel that EHR technology improves treatment decisions, which decreased from the 2012 survey by 16 percent.

Additionally, while 58 percent believe EHRs reduce medical errors in 2012, today only 46 percent of respondents feel this to be true. Along with these statistics, 36 percent of respondents feel that EHR technology does not reduce medical errors.


Among US physicians, large numbers utilize electronic prescribing (72 percent) and patient notes (82 percent) as well as integrate clinical results into the EHR system (65 percent). There has also been a significant rise in prescription refill request services, patient EHR access capabilities, and remote monitoring for tracking patients’ wellness.


From the 2012 survey to today, prescription refill request services rose by 15 percent, patient access to their medical information rose by 25 percent, and remote monitoring rose by 16 percent. Also, 46 percent of respondents enabled their patients to book appointments online and 14 percent offer videoconferencing consultations. It is likely that patient engagement objectives within meaningful use requirements incentivized healthcare providers to begin offering these services.


“Despite the rapid uptake of electronic medical records, the industry is facing the reality that digital records alone are not sufficient to driving better, more-efficient care in the long-term,” Kaveh Safavi, M.D., J.D., who leads Accenture’s global health business said in the press release.

“The findings underscore the importance of adopting both technology and new care processes, as some leading health systems have already done, while ensuring that existing shortcomings in patient care are not further magnified by digitalization,” Safavi continued. “The US healthcare market has made remarkable progress in EMR adoption, and we believe that as the technology evolves, so too will the benefits to physicians and patient care.”


While many physicians felt that adoption of EHR technology did not boost health outcomes, many do see a benefit to greater patient engagement. For example, 81 percent of polled physicians saw improved patient satisfaction when allowing patients to update their own medical records while 71 percent saw it improve patient-physician communication.


“The industry needs to adapt to a new generation of patients who are taking proactive roles in their healthcare and expect to have real-time data at their fingertips,” Safavi stated. “When patients have a greater role in the record-keeping process, it can increase their understanding of conditions, improve motivation and serve as a clear differentiator for clinical care provided by physicians.”


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How cloud computing enables interoperability

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Fixing What's Wrong with EHRs is Easier Done than Said

Fixing What's Wrong with EHRs is Easier Done than Said | EHR and Health IT Consulting | Scoop.it

Immigration, drought, and EHR are all of great concern. We know people are concerned about immigration because of the daily news. The message is basically, "Solve the immigration crisis." In California, farmers are concerned about the drought as the "Solve the water crisis" billboards in the central valley attest.

It's obvious that physicians are concerned about EHRs. The concern is so great that the AMA convened an advisory committee and has spoken out. In September, they recommended overhauling (their word) the design of EHRs to improve usability and called on EHR vendors and the government, "To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs..." The AMA framework outlines a list of "usability priorities" — things they cannot specify precisely but are easily identified when you haven't got enough. The tip-off that these are "non-functional" requirements lie in the words of the AMA statement: enhance, support, promote, offer, reduce, promote, facilitate, and expedite. The first item on their list is, for example, "Enhance physicians' ability to provide high-quality patient care."

According to the AMA, "these priorities were developed with the support of an external advisory committee comprised of practicing physicians, as well as noted experts, researchers, and executives in the field of health information technology."

To me, their announcement essentially says no more than, "Somebody, please solve the EHR crisis." If this reformulation sounds critical, it is, and I'll explain why.

"Solve the ... crisis" statements do little to advance a solution; they merely express concern, dismay, and helplessness. They lack actionable suggestions for how to solve the crisis. They merely express the hope that someone who is smarter or more knowledgeable will be able to do what they cannot.

This is where the EHR crisis diverges. Immigration and drought are the result of forces beyond the control of policymakers, legislators, vendors, or individual organizations. They are truly complex problems. Immigration and drought cannot be solved, only mitigated or accommodated.

Turning to EHR, let's consider the AMA's priorities. What does it mean, for example, to "Enhance physicians' ability to provide high-quality patient care?" Is there a single enhancement that would work in every EHR? How do you enhance a computer system in a way that will result in predictably higher-quality care? The vendors already claim (or perhaps believe) that their systems are optimal, or at least adequate. Will they have any idea how to make their "practically perfect products" better? Similar questions can, and should, be asked about each of the AMA's eight challenges.

Taking a step back, several points are inescapable:

• The problems with EHR were smoldering for years, but only became a crisis when the federal mandate was imposed.

• The mandate effectively put a stop to the development of new EHRs since, in addition to implementing their new concept, they must replicate everything that is old to get certified or no one would buy them.

• Few comprehend the root causes of the EHR problems about which they complain. The few have an idea, either don't disseminate their knowledge, can't get it published because editors assume that ordinary physicians don't need to know that stuff, or the publications appear in obscure journals that no physician will ever discover. Thus, most physicians, probably including the committee members, have only vague notions of what it might mean for an EHR to be better. They can't have had much experience with one that is significantly better because if there were such a beast, people would be using it instead of complaining. Most notions of what would be better are based on daydreams, not evidence.

• The AMA's contention that EHR just needs a minor overhaul implies that they believe that today's EHRs are basically sound and well-designed. This assumption has no basis in fact. Just because EHRs are bought and used is not evidence that they are well designed, easy to use, or that they do what people expect.

Unlike drought and immigration, there is a solution to the EHR crisis.

It is to abandon mandates, abandon certification, and abandon penalties and incentives. Instead, efforts should be directed toward educating physicians about the information science behind medical records, be they paper or electronic.

The money that is currently being wasted on incentives and bureaucracy should be redirected to fund:

• Research that concentrates on basic science and is not tied to, or conducted using, an existing EHR; and
• Development of completely new EHRs that start with a blank slate and embrace design concepts that put the medical record, not data, at their core.


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A better road to information interoperability?

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

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


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

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


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


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


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

Eclectic collective

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


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


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

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


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


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

An industry misguided?

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

  

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

Baxley didn't pull punches either.


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

Inching closer

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


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


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

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

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EXTREME essentials for interoperability

EXTREME essentials for interoperability | EHR and Health IT Consulting | Scoop.it

Writing in the Journal of the American Medical Informatics Associationthis past week, two health IT researchers put forth five use cases that help define what an "open" electronic health record should really look like.

Dean F. Sittig, professor of biomedical informatics at the University of Texas Health Science Center at Houston, and Adam Wright, medical informatics researcher in the Department of General Internal Medicine, Brigham & Women’s Hospital, use the term EXTREME – it stands for EXtract, TRansmit, Exchange, Move, Embed – to shape a definition of usefulinteroperability.

  • An organization should be able to securely extract patient records while maintaining granularity of structured data.
  • An authorized user can transmit all or a portion of a patient record to another clinician who uses a different EHR or to a personal health record of the patient’s choosing without losing the existing structured data.
  • An organization in a distributed/decentralized health information exchange can accept programmatic requests for copies of a patient record from an external EHR and return records in a standard format.
  • An organization can move all its patient records to a new EHR.
  • An organization can embed encapsulated functionality within their EHR using an application programming interface. Goals: access specific data items, manipulate them, and then store a new value.


The five EHR use cases are similarly meant to help five distinct types of people: clinicians (enabling the delivery of safe and effective health care); researchers (helping advance understanding of disease and healthcare processes); administrators (reducing the need to rely on specific EHR vendors); software developers (so they can develop innovative applications); and patients (so they can access their personal health information anywhere).

Widespread access to EHRs that conform to the five EXTREME use cases "is necessary if we are to realize the enormous potential of an EHR-enabled health care system," Sittig and Wright contend.

"Health care delivery organizations should require these capabilities in their EHRs. EHR developers should commit to providing them," they write. "Health care organizations should commit to implementing and using them. In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers to widespread health information exchange that is required to transform the modern EHR-enabled health care delivery system."

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Are Policies, Standards Enough to Boost EHR Interoperability?

Are Policies, Standards Enough to Boost EHR Interoperability? | EHR and Health IT Consulting | Scoop.it

In order to truly strengthen EHR interoperability and advance health information exchange across the medical care sector, federal regulations and standards may not be enough to make a difference. The meaningful use requirements under the EHR Incentive Programs and the EHR certification program established by the Office of the National Coordinator for Health IT (ONC) are not enough to move forward EHR interoperability.


Despite the issues surrounding EHR interoperability, David McCallie MD, SVP Medical Informatics at Cerner, writes in a guest blog that the healthcare sector should also look at the many achievements and “lasting advances” of the past several years.


For example, electronic prescribing standards have become well-established and e-prescribing has been implemented in large numbers across clinics, hospitals, physician practices, and pharmacies. Additionally, secure messaging and email has become a standard method of communication, which is replacing the older versions of technology like the fax machine.


Another instance of the successful advancements made in the healthcare industry is widespread adoption of “document-centric query exchange,” McCallie explains. Some ongoing developments in healthcare today include encoding complicated clinical information into summary documents and the move toward API-based interoperability.

“Nonetheless, the refrain we hear from Capitol Hill is that we have failed to achieve the seamless interoperability that many had expected.


This has led to numerous legislative attempts to 'fix' the problem by re-thinking government approaches to the standard setting processes authorized by HITECH,” McCallie wrote. “We should be careful not to overreact in light of any disappointments and perceived failures around interoperability.  There are many things we must improve, but we should not inadvertently take steps backwards.”


The issue at hand, McCallie writes, is that Congress feels that developing and initiating standards alone will lead to better EHR interoperability. While standards are needed, they are not sufficient for gaining true EHR interoperability and healthcare data exchange throughout the industry.


In order to create useful EHR interoperability, McCallie outlines several factors necessary for achieving this goal. First, each standardization must co-exist alongside a business process. Secondly, through real-world testing and validating, a standard can be cultivated.


Thirdly, healthcare institutions must choose to incorporate the standard in their workflow in order to serve a “business purpose,” McCallie explained. Some other important tips to consider are developing strong security frameworks amongst data sharing tools, creating a ‘business architecture’ in which legal entities are considered, and incorporating a governance platform that holds oversight of the business frameworks.


As previously reported by EHRIntelligence.com, another important aspect to improving EHR interoperability is impeding information blocking throughout the medical industry. Currently, Congress and ONC have moved forward in addressing information blocking, which occurs when certain vendors or providers charge large fees for sharing data and providing access to key information.


This tends to harm care coordination efforts among accountable care organizations and long-term care facilities. Essentially, health data exchange and EHR interoperability is needed in efforts to improve the quality of patient care. Along with addressing information blocking, the steps outlined by the Cerner representative should help move the healthcare sector toward enhanced EHR interoperability.

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Health Data Interoperability Needs Information Blocking to End

Health Data Interoperability Needs Information Blocking to End | EHR and Health IT Consulting | Scoop.it

From federal government agencies and the medical industry to patient advocate groups and vendor-neutral companies, the push for greater health data interoperability with the healthcare market remains strong.


As seen in the proposed rule for Stage 3 Meaningful Use Requirements, the Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) continue to stress the importance of health data interoperability.

ONC explains on its website that EHR systems will only reach their full promise when they effectively exchange medical data throughout the healthcare continuum. Health data interoperability through health IT systems and certified EHR technology will improve physician workflows and enable betterhealth information exchange.


There are certain health IT interoperability standards that are necessary for improving data exchange and these cover how users interact with a system, the messaging capabilities of differing platforms between each other, the management of health data exchange, and the integration of consumer tools with relevant medical systems.

While the federal government knows the importance of health data interoperability and continues to stress its importance, there may be certain entities including healthcare providers and EHR vendors that have played a role in blocking information flow throughout the healthcare industry.


Entities within the medical sector have charged large interface fees when data access requests were made and Congress is now attempting to put an end to information blocking through these means.

“Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Care business models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records,” stated John D. Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center, in his latest blog post.


Halamka lays out a few key solutions for the problems surrounding health data interoperability and the ongoing issues of information blocking. First, it is important to define the necessities of care coordination and care management. Additionally, Halamka insisted that it’s time to put an end to the meaningful use requirements under the EHR Incentive Programs, explaining that they are no longer necessary.


A few other steps necessary for improving health data interoperability, according to Halamka, are: (1) creating a national provider directory in order to route messages, (2) developing a voluntary national identifier in healthcare, and (3) guiding state privacy laws to break down information blocking.


The American Medical Informatics Association (AMIA) also recently provided recommendations for improving health data interoperability within health IT systems. The organization emphasized the need for EHR certification standards that offer more technical requirements for boosting EHR interoperability and secure medical information exchange.


Additionally, more healthcare providers would benefit from developing a comprehensive healthcare IT roadmap. The latest results from Frost & Sullivan show that approximately half of medical providers worldwide do not have an IT roadmap stressing EHR interoperability. By following the steps set forth among these medical groups, researchers, and experts, the healthcare industry may be able to significantly improve health data interoperability over the next several years.

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EHR Adoption Challenges Solved through Data Entry Transfer

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

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


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


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


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


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


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


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


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


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

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EHR Interoperability Solutions Progress in Healthcare Sector

EHR Interoperability Solutions Progress in Healthcare Sector | EHR and Health IT Consulting | Scoop.it

EHR interoperability is the name of the game, as healthcare providers and health IT vendors begin to realize the importance of connecting systems and medical devices to better communicate and share data throughout a medical organization.


National Coordinator for Health IT Karen B. DeSalvo has mentioned time and time again the need for EHR interoperability throughout the healthcare sector in order to ensure all physicians and healthcare professionals are able to access key data when making vital clinical decisions. Additionally, payers, patients, and hospitals will need the ability to view necessary health information to create a healthier population around the nation.


The Brookings Institution released a policy brief several months ago calling for fixing some of the issues and challenges within the health IT industry including the need for greater EHR interoperability and data exchange. Redundant testing and duplicative data entry would be solved with an increase in medical data sharing.


The Office of the National Coordinator for Health IT (ONC) has gone forward with addressing the challenges and needs of the healthcare community with regard to improving EHR interoperability. From the ONC Nationwide Interoperability Roadmap to the report to Congressaddressing information blocking, this federal agency has put great efforts toward advancing EHR interoperability throughout the country.


Despite ONC’s efforts, according to Chief Informatics Officer Dr. John D. Halamka, there is an access of policy and political barriers to true health information exchange. Halamka states that the Massachusetts State Health Information Exchange (HIE) creates thousands of connections between hospitals and professionals throughout the nation with the help of Health Information Service Providers (HISPs).


The CIO goes on to say the EHR interoperability has a “positive trajectory” and that there is currently sincere progress taking place in boosting health data exchange. More importantly, Halamka states the importance of continuing efforts, identifying gaps in EHR interoperability, and solving these issues. Moving forward is the only real option.


Analysis from the research market firm Frost & Sullivan shows that interoperability and connecting healthcare tools is not uniform around the globe. In order to fix this issue, stakeholders will need to address connectivity standards and create a “digital healthcare strategy” that can connect vital medical devices in efforts to improve care coordination.


“More than 50 percent of healthcare providers do not have a healthcare IT roadmap, although they acknowledge the role of digital health in enhancing healthcare efficiency,” Frost & Sullivan Healthcare Research Analyst Shruthi Parakkal said in a public statement. “Consequently, even the existing interoperability standards such as HL7, DICOM and Direct Project are not being utilized optimally by many providers.”


Instead of requiring upgrading individual systems and investing funds in updating workflows, it would benefit hospitals and clinics if vendors developed products with guaranteed connectivity even when devices are developed by multiple manufacturers.


Parakkal also mentioned the importance of EHR interoperability in healthcare providers’ quest for successfully attesting to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs and qualifying for financial incentives for adopting certified EHR technology. As CIO Dr. John D. Halamka mentioned, we must move forward in order to improve EHR interoperability on a national level.

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Tailored Physician EHR Use Necessary for Evolving Industry

Tailored Physician EHR Use Necessary for Evolving Industry | EHR and Health IT Consulting | Scoop.it

The healthcare industry is changing every day and new, revolutionary processes are continuing to affect patient care and population health outcomes. Whether it’s through patient-centered medical homes, accountable care organizations (ACOs), EHR adoption, or general improved care coordination, the medical sector is making some significant modifications toward better care. However, physician EHR use and implementation of health IT systems will likely depend upon the needs of each disparate medical facility.


Meaningful use requirements, for instance, will need to be flexible enough to ensure health IT platforms are useful and beneficial for differing healthcare providers. When integrating public comments into theStage 3 Meaningful Use final rules and the Stage 2 Meaningful Use modified rules, the Centers for Medicare & Medicaid Services (CMS) should consider the need for adaptable and flexible requirements that providers could customize to their interests.


The American Hospital Association’s President and CEO Rich Umbdenstock wrote in a brief the importance of removing obstacles and developing federal regulations that meet the needs of the healthcare industry. Both care coordination, reducing costs, and investing in physician EHR use are key objectives throughout the medical care market.


“It’s time for regulators to recognize the changing healthcare landscape and remove obstacles on the road to collaboration,” wrote AHA President Rick Umbdenstock. “Healthcare is changing; hospitals are changing; and regulations that block progress toward meeting patient demands and community expectations must change, too.”

Two areas within the healthcare industry that may need health IT customization are public health reporting and chronic disease management. The Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) along with the National Opinion Research Center (NORC) at the University of Chicago released a report titledPublic Health IT to Support Chronic Disease Control.


In efforts to focus more attention on the triple aim of healthcare, NORC determined that chronic diseases are the major medical cost drivers and most common conditions found among patients across the country. The report went over population health interventions and physician EHR use to exchange data with public health agencies in efforts to curb the further deterioration of chronic conditions.

In particular, physician EHR use can be applied toward addressing case management, social services, behavioral health, and public health services. Incorporating EHR systems will also lead to better collaboration and communication among multiple medical facilities and public health agencies.


“The capacity to collaborate and share data across health care, public health and other partners becomes important in the context of supporting public health core functions,” the report stated. “We see great potential for using electronic data shared between health care providers, governmental public health agencies and other community partners. However, our discussion and earlier research points to important barriers to effective coordination and data sharing to promote population health. These challenges range from the limited mandate for governmental public health agencies in relation to chronic disease, limited public health IT infrastructure and historic lack of coordination between governmental public health agencies and health care providers.”

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EHR Interoperability Stalled Due to Information Blocking

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

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

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

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

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

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

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

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

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

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


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ICD-10 Implementation Deadline Causes Concern among Providers

ICD-10 Implementation Deadline Causes Concern among Providers | EHR and Health IT Consulting | Scoop.it

The ICD-10 implementation deadline is set for October 1, 2015 and doesn’t seem to be changing. While previous ICD-10 deadlines have been postponed, the Centers for Medicare & Medicaid Services (CMS) among other federal agencies seem to be focused on sticking to this particular ICD-10 implementation deadline.


For instance, both the House and the Senate passed the H.R. 2, the Medicare Access and CHIP Reauthorization Act, which repeals the Sustainable Growth Rate (SGR) formula but did not include any ICD-10 delays. The Journal of AHIMA reported that the bill was seen as a real challenge by ICD-10 proponents, as previous SGR legislation in 2014 led to a last minute ICD-10 postponement. However, this time, October 1, 2015 still stands as the current ICD-10 implementation deadline.


“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” AMA executive vice president and CEO James L. Madara, MD, said in a statement. “Patients will be able to get the care they need and deserve.”


While the ICD-10 implementation deadline stands still, this does not ensure that all physicians and providers are ready to transition to the new coding set yet. A new survey from NueMD shows that many small medical practices may not be ready to completely move over to the ICD-10 coding system by October, according to a company press release.


NueMD surveyed around 1,000 medical practices, billing firms, and other healthcare industry professionals. Most of the respondents came from small and medium-sized medical practices. The survey results illustrate that only 11 percent of respondents are “highly confident” their staff will be sufficiently trained by October 1 to transition toward the ICD-10 coding set. Also, 35 percent of respondents claimed they were “not at all confident” that their staff will be ready for the ICD-10 transition.


On top of this, only 13 percent stated they are “highly confident” their organization will be equipped to transition to the new coding set. Additionally, about one out of three respondents said they are “not at all confident” that their business will be ready for the coming ICD-10 transition.


About two out of three respondents are either “highly” or “significantly” worried about claims processing after October 1 while 70 percent of those polled feel that their finances as well as their operations will be at least “somewhat” negatively affected after the ICD-10 implementation deadline.


One very interesting finding from the study is that, when asked “Which of the following statements best describes your feelings about the new coding standards for ICD-10?” one out of three respondents said, “There should be no transition to ICD-10.” The type of concerns that more than half of respondents have regarding their business after the ICD-10 implementation deadline include claims processing, software upgrade costs, payer testing, training/education, and the compliance timeline. CMS will need to keep these issues in mind as it continues to prepare the healthcare industry for the coming ICD-10 implementation deadline.


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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 2:39 AM

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

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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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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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