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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AHA Explains Industry Challenges for EHR Interoperability

AHA Explains Industry Challenges for EHR Interoperability | EHR and Health IT Consulting | Scoop.it

EHR use presents many healthcare benefits, including coordination of care and increased patient engagement. However, , the lack of EHR and health IT interoperability is posing a serious threat to other healthcare initiatives, according to a recent report published by the American Hospital Association.

The report, entitled Why Interoperability Matters, discusses the various aspects of the healthcare industry and care delivery that are negatively impacted by a lack of interoperability. Among those aspects include care coordination, patient engagement, and public health and quality measures reporting.


Care coordination


The exchange of health information is critical for the coordination of care, according to AHA. When patients receive care from multiple different providers, physicians should be able to securely send relevant patient information to the practicing physician. However, that tends not to be the case because EHR systems are not interoperable and cannot exchange information.


Furthermore, care coordination and successful interoperability are vital for provider finances. As accountable care organizations and bundled payments continue to grow more prevalent, the AHA maintains that interoperability and the ability to see all of the care a patient in receiving is crucial in preventing unnecessary treatment.


Patient Engagement


Patient engagement and the shared decision-making between providers and patients is critical in achieving the aims of the healthcare industry, the authors of AHA report maintain. Further, patient engagement is a central part of federal regulations on using an EHR. However, the agency states that many patients are unable to access their electronic health information, hindering the practice of patient engagement.


“The real problem is that the vast majority of patients cannot access their health information in a holistic, meaningful way. Instead, they must go to each of their providers’ patient portals and download unintegrated data. Making sense of this, particularly for patients with multiple chronic conditions who frequently have many health encounters a year, is difficult,” the report states.


Public Health and Quality Measures Reporting


EHR use also provides the opportunity for enhanced public health reporting. Because patient data is aggregated on one, electronic system, healthcare professionals can track healthcare trends and analyze information about population health. But without adequately interoperable systems, that process is significantly hampered.

“Hospitals are happy to report this data to improve public health but must contend with a wide variety of reporting formats and transmission technologies to do so, including faxing, mailing, e-mailing, web forms and secure file transfer protocols,” report reads.


This cumbersome process results in wasted time and resources. Similarly, practices face issues with quality measure reporting. Quality measures reporting is another federally mandated practice for EHR use, however without properly interoperable systems, health systems face challenges.


Interfaces and HIEs as solutions


Healthcare providers have created a few solutions to this interoperability problem, including interfaces and health information exchanges.


Interfaces are programs that allow a facility’s EHR to pass along information from one system to another, yet practices face challenges when using interfaces for more than one provider.


“...in health care, each interface currently is like a snowflake: it must be built to meet the unique requirements between two providers and cannot be reused,” the authors explain.


Because practices would need to adopt multiple interfaces, they are not always a financially stable solution to interoperability.


Like interfaces, health information exchanges (HIEs) have presented themselves as potential solutions to interoperability problems. Although HIEs can be successful in securely transmitting health information between providers, they too are quite costly. Furthermore, AHA explains that many HIEs are installed via federal grants, and that when the grants run out, many practices are unable to maintain their HIEs.


Health IT standards need more specificity


Although there are a set of standards identified for the use of EHRs and other health IT, they are not specific enough to be effective, the authors note. Creating uniformity in how data is collected and stored on an EHR, however, would be a drastic step forward for interoperability, the report states. Increased health IT standards would cause data to be input in the same way across the healthcare delivery spectrum, making information sharing more feasible.


Although the authors acknowledges the potential that health IT standards have in increasing interoperability, the agency maintains that much work in defining those standards and developing other platforms needs to be done before the industry can achieve nationwide interoperability.

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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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New Grant Program Advances Health Information Exchange

New Grant Program Advances Health Information Exchange | EHR and Health IT Consulting | Scoop.it

The development of health information exchange institutions is aimed at advancing coordinated care, delivering superior quality of medical services, and improving public health outcomes. Certified EHR technology and health IT systems can enhance the communication channels and connections between different coordinated care settings, which is why EHR interoperability and health information exchange is so important.


In Massachusetts, the Massachusetts eHealth Institute at MassTech (MEHI) announced that a new grant program is available to strengthen technologies and communication channels among various medical facilities in varying regions across the state, according to the public entity’s press release.


The grant program called Connected Communities Implementation Grant Program is currently accepting proposals from groups that are working together to develop effective health information exchange and utilize health IT systems in an effort to advance coordinated care. The grant is meant for improving workflows and giving providers an opportunity to solve the many challenges of coordinated care and transitions of care within their communities.


The hopes behind these type of grant programs and healthcare reforms is that it will achieve better patient outcomes, quality of care, and lower healthcare costs through efficient health information exchange.


“The Connected Communities Grant Program provides us with an opportunity to support impactful health IT programs driven by the priorities in individual communities,” Laurance Stuntz, Director of MeHI, stated in the press release. “Through this approach, our hope is to receive proposals that identify region-specific roadblocks to sharing information, engage a broad cross-section of healthcare stakeholders, and address the unique needs of patients in that community through the use of technology.”


The cooperation and coordination among multiple medical facilities remains a key focus of the healthcare industry especially in terms of long-term and acute care as well as behavioral health services. This particular grant program asks for one or more specialty providers in these areas to send a proposal in order to help further strengthen important partnerships.


Those who receive the grant will initially obtain up to $25,000 from MeHI. The grantees will need to develop a strong action plan, detail health information exchange pathways in a diagram, outline a ‘use case,’ and provide a budget for the anticipated costs.


“Finding ways to improve information sharing and real-time data capabilities, while enhancing providers’ ability to treat patients at the community level, will go a long way toward helping the Commonwealth meet its healthcare cost reduction goals,” David Seltz, Executive Director of the Health Policy Commission, said in a public statement. “We look forward to continuing our work with MeHI and other stakeholders to build a stronger healthcare system.”


The grant program is looking to push forward provider access to clinically important data including laboratory results and discharge plans, better healthcare outcomes, and reduced hospital readmissions along with duplicative tests. Massachusetts medical providers and groups who are interested in expanding their health information exchange capabilities would be wise to send a proposal to MeHI in order to advance the quality of their patient care services.

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Will Altering EHR Incentive Programs Raise EHR Implementation?

Will Altering EHR Incentive Programs Raise EHR Implementation? | EHR and Health IT Consulting | Scoop.it

While the HITECH Act and meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have truly increased the number of healthcare providers implementing and utilizing EHR systems, new research suggests that these federal regulations may have also led to specific disparities in patient care. A study stemming from Weill Cornell Medical College found “systematic differences” between doctors who were avid participants in the EHR Incentive Programs versus those who did not invest as much time and resources into meeting meaningful use requirements.


The study was published in the June edition of Health Affairs and analyzed more than 26,000 doctors across the state of New York. Additionally, the researchers looked at payment data from the Centers for Medicare & Medicaid Services (CMS) and the state Department of Health.


The payment data analyzed in the study stemmed from the years 2011 to 2012. The results show that participation in the Medicaid EHR Incentive Program increased by 2.4 percent during those two years. However, participation in the Medicare EHR Incentive Program rose much more quickly, showing a 15.8 percent increase in the number of providers taking part in the program and implementing certified EHR technology.


The results show that early and consistent provider participants in the EHR Incentive Programs have more financial capacity, better organization and resources for supporting EHR implementation, and previous experience using health information technology.

While meaningful use requirements pushed EHR adoption forward, the process of using the systems on a constant basis had a new set of challenges that some providers were unable to attain, the researchers said. However, the differing rates of participation in the EHR Incentive Programs is leading to higher quality care at some physician offices while others are lacking and administering lower quality healthcare services.


“The expectation is that physicians and hospitals should be electronic,” senior author Dr. Joshua Vest, an Assistant Professor of Healthcare Policy and Research at Weill Cornell Medical College, said in a public statement. “How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don’t have the resources or capability to adopt EHRs.”


The researchers explained that there is a “digital divide” among different healthcare providers due to the participation in the EHR Incentive Programs. These results may play a role in the future of healthcare policy. Since there are certain providers who dropped out of the Medicaid EHR Incentive Program, it may behoove federal agencies to make some significant changes to the objectives within this particular program in order to keep providers participating.


“Electronic health records are vital not only because of their ability to efficiently provide physicians with a comprehensive portrait of and decision support for their patients, but also to drive new healthcare delivery models that can improve the value and quality of clinical care,” Dr. Rainu Kaushal, Chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell, said in a public statement.

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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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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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The Tower of EMR Babel

The Tower of EMR Babel | EHR and Health IT Consulting | Scoop.it

It’s the sad state of interoperability. This week when I was teaching an EHR workshop I asked for those attending to define what an Electronic Health Record was in their own words. I’d say 90% of them said something about making the healthcare data available to be shared or some variation on that idea. This wasn’t surprising for me since I’ve heard hundreds and possibly thousands of doctors say the same thing. EHR is suppose to make it so we can share data.


While people pay lip service to this idea and just assume that somehow EHR would make data sharing possible, that’s far from the reality today. This is true even in some organizations where they own both the hospital and the ambulatory provider. How sad is this? Extremely sad in my book.


I’ve often wondered what would change the tide. I’ve been long hopeful that ACOs and value based care would help to push the data sharing forward, but that’s going to be a long process. The private HIEs are working the best of any HIEs I’ve seen, so maybe the trend of hospitals acquiring small practices and hospital systems acquiring hospital systems will get us to EHR data sharing nirvana. Although, I don’t think it’s going to make it there in most communities. Instead it’s just going to have a number of large organizations not wanting to share data as opposed to some large and some small ones.

Do people really have much hope for true EHR data sharing? Does FHIR give you this hope? I’m personally not all that optimistic. We all know it’s the right thing to do, but there are some powerful forces fighting against us.

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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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Avoiding Legal Troubles Stemming from EHR Liabilities

Avoiding Legal Troubles Stemming from EHR Liabilities | EHR and Health IT Consulting | Scoop.it

I'm a big supporter of the EHR and its promise to make documenting patient care more accurate, easier, and clear. I also have a healthy respect for the dangers of the EHR — and see new dangers pop up constantly.

With all good technological tools, there are hazards that need to be recognized. The EHR can pose a liability for providers and institutions, and the legal profession is beginning to exploit this weakness in malpractice actions against providers and institutions.


Modern EHRs have a significant learning curve, and require a complete change in the process of documenting patient care. Many functions are a double-edged sword; including record cloning, automated dictation, medication dose checking, documentation templates, automatic record population, etc. The functionality of the EHR can make the job of providers much easier in generating a record, but this same functionality can introduce bad data, wrong dosages, and other errors that can harm patients.


The bottom line is that providers are ultimately responsible for what is charted in the EHR. Here are just a few examples of these new liabilities and how to avoid them.


• Scribes. Much of the charting that is done on the front end of a hospital admission is performed by the nursing and ancillary staff, or in the ER, scribes. This is very helpful in a busy inpatient and/or outpatient department, and speeds patient care and documentation. However, unless the provider verifies the accuracy and completeness of the record, significant errors can made.


• Cut and paste. The "cut and paste" function is one that is familiar to anyone using a computer in the modern age. This can interject errors, and propagate them when one does not exercise due diligence in making sure that the final record reflects the actual encounter. There are tools available which make searching for repetitive text in a record very easy. Obvious propagation of narratives and erroneous data, over and over again, is hard to defend in a court of law, and demonstrates that care was not taken. It also introduces doubt into all areas of the records being scrutinized.


• Note cloning. "Cloning" is another issue that works much like cutting and pasting. Cloning is the practice of copying an entire previous record into a new, editable record. The hazard here is obvious, and similar to the previously discussed practice of cut and paste. It goes without saying the more information and data that you "clone," the greater the risk you are going to miss something, and propagate erroneous data.


• Use of templates and macros. Macros for things such as review of systems and physical examination can really make you look bad when another provider or lawyer is reviewing your record. It is easy to miss that you called a positive physical finding negative, if you don't carefully review the record prior to finalizing it.


• Pull-down menus. Finally, clickable pre-populated components and pull-down menus can be hazardous in that it is sometimes easier to choose the wrong thing than it is to use "free text" to customize the finding or information.


On the bright side, templates for procedures help providers quickly and accurately document informed consent, indications for the procedure, the actual procedure, and the post procedure care by giving the provider a concise and complete format for documentation. The other benefit of the EHR from the provider standpoint is allowing the provider to make a more complete record in support of the level of care that is being billed.


I have to admit that in the past, I have used all the functionality of the EHR, and have made mistakes in my documentation. After studying these issues, and becoming aware of the hazards to patient safety and care, I'm much more sophisticated in my use of the functionality of the EHR. I still use macros and auto-text, but my use of cut and paste is limited to including diagnostic test reports that don't auto-populate. I never use cloning even though the functionality is still allowed in our EHR.


One of the big changes for me has been the deployment of enterprise level dictation in our EHR. Now, even though I can type 60 WPMs, I can much more rapidly and accurately dictate a unique HPI, PE, and plan, and better ensure that the record is accurate.


Take the time to understand EHR technology, and avoid the pitfalls that can be expected to increase your liability in the delivery of patient care.


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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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Value-based Interoperability: Less is more

Value-based Interoperability: Less is more | EHR and Health IT Consulting | Scoop.it

Interoperability in health care is all the rage now. After publishing a ten year interoperability plan, which according to the Federal Trade Commission (FTC) is well positioned to protect us from wanton market competition and heretic innovations, the Office of the National Coordinator for Health Information Technology (ONC) published the obligatory J’accuse report on information blocking, chockfull of vague anecdotal innuendos and not much else. Nowadays, every health care conversation with every expert, every representative, every lobbyist and every stakeholder, is bound to turn to the lamentable lack of interoperability, which is single handedly responsible for killing people, escalating costs of care, physician burnout, poverty, inequality, disparities, and whatever else seems inadequate in our Babylonian health care system.


When you ask the people genuinely upset at this utter lack of interoperability, what exactly they feel is lacking, the answer is invariably that EHRs should be able to talk to each other, and there is no excuse in this 21st iCentury for such massive failure in communications. The whole thing needs to be rebooted, it seems. After pouring tens of billions of dollars into building the infrastructure for interoperability, we are discovering to our dismay that those pesky EHRs are basically antisocial and are totally incapable or unwilling to engage in interoperability. The suggested solutions range from beating the EHRs into submission to just throwing the whole lackluster lot out and starting fresh to the tune of hundreds of billions of dollars more. When it comes to sacred interoperability, money is not an object. It’s about saving lives.


Every EHR vendor flush with cash from the Meaningful Use bonanza is preparing to take its unusable product to the next level, machine interoperability is shaping up to be the belle of the ball. A simple minded person may be tempted to wonder why people who, for decades, manufactured and sold EHRs that don’t talk to each other, are all of a sudden possessed by interoperability fever. The answer is deceptively simple. After exhausting the artificially created market for EHRs, these powerful captains of industry figured out that extracting rents for machine interoperability is the next big thing.


The initial pocket change comes from selling machine interoperability to their current bewildered (or stupefied) clients, and to less fortunate EHR vendors. But the eventual windfall will not come from the health care delivery system or the hapless patients caught in its web. How much do you think access to a national and hopefully global network of just-in-time medical and personal data is worth to, say, a pharmaceutical company giant? How about life insurance, auto insurance, mortgage, agribusiness, cosmetics, homeland security, retail, transportation? Google built an empire by piecing together disjointed bits of personal data flowing through its electronic spider webs. What do you think can be built by combining everything Google knows with everything your doctor knows and everything you know about yourself?


Machine interoperability is not about patient care in the here and now. Interoperability is not about ensuring that all clinicians have the information they need to treat their patients, or that patients have all the information they need to properly care for themselves. Interoperability is about enriching a set of interoperability infrastructure and service providers and about electronic surveillance of both doctors and their patients. Machine interoperability is about control, power and boatloads of hard cash.


For example, if you are hospitalized, it makes sense that your primary care doctor should know that you are (not in the past tense), and when you are discharged, he or she should be appraised of what transpired during your hospital stay. In the old days, before the advent of hospitalists, this could be assumed. Today, thanks to more efficient division of labor, not so much. If the government was genuinely concerned about smooth transitions of care, it would mandate that upon discharge, hospitals must provide all pertinent information to the primary care doctor, and the patient, by any means necessary. If this meant that a piece of paper is stapled to the patient’s robe, and that the hospital employs an army of delivery drones for the purpose, so be it. Eventually, hospitals, which are big businesses, would come up with the most cost effective and efficient way to be compliant with the law.

That’s not how things currently work or how they are envisioned to work. Discharge summaries have a mandated format of structured data elements, complete with metadata, based on government approved standards that change with frightening regularity. Furthermore, to satisfy regulations, the summaries must be generated and transmitted electronically from one “certified” EHR to another, allowing for a host of intermediaries to access and collect said data or at the very least its metadata. Consulting with the PCP by phone for an hour doesn’t count. Sending the information from a non-certified software package doesn’t count. Printing and sending over information by special courier doesn’t even begin to count. Attempting to build a device that streams the information as it happens directly into the PCP medical record will get you excommunicated or burned at the stake.


If you refer a patient to cardiology service, and in a misguided senior moment decide to pick up the phone and talk to the cardiologist at length about this patient, it doesn’t count. If the cardiologist pens a concise and beautiful letter to you after she sees your patient, thanking you for the referral and summarizing her impressions and plan of care in proper English, it doesn’t count. The only thing that counts is a lengthy clinical summary containing all the sanctioned data elements sent from you to the cardiologist, copied in its entirety and returned from the cardiologist to you, hopefully with some indication about what happened during the consult. Having your EHRs talk to each other this way is considered interoperability. Whether you actually read the interoperated information is irrelevant. As long as the contents are captured by the network for other uses, it’s all good.


But wait, there is more. If you practice, say, in St. Louis, Missouri and work for a huge health system or somehow managed to string together a machine interoperable network with the twenty or so specialists you use on a regular basis and the four hospitals where you have admitting privileges, that’s not good enough. Nothing is good enough unless any research lab in Hopewell, New Jersey or Bangalore, India can discover you on the (inter)national interoperability network and request data about a patient you may have treated five years ago, and nothing will be good enough unless any app store developer in Cupertino, California can discover your patient and subsequently obtain her medical data once she downloads a free diet app from iTunes.

Are you “just” a patient eager to be “engaged” in your own care? Picking a doctor who will spend two hours with you listening carefully and explaining things you don’t understand, and who will give you his cellphone number in case you have more questions, doesn’t count. Getting a team of physicians together on a conference call to brainstorm about your mom’s options, doesn’t count. Building a long term relationship with your pediatrician and having her come see your sick kid at home because your car is in the shop and your toddler can’t keep any food down, and now the baby won’t stop crying, doesn’t even register on the interoperability radar. Nothing counts unless you log into a website or an app, accept the cookies, the tracking beacons, the small print, and then click on some buttons to verify that you are a “Never smoker”, or to peruse machine generated visit notes that even your doctors don’t read anymore.


Perhaps machine interoperability on a national scale is a wonderful thing, but so is having arugula in every fridge. There is absolutely no evidence that either one will improve health and/or reduce the price of care. Every dollar spent on national machine interoperability is a dollar that was previously used, or could be used, to provide medical care. Where did we find the moral fortitude to demand that people experience adverse outcomes at least three times before letting them have a slightly more expensive pill, while spending billions of dollars to incentivize the purchase of unproven and often failing technologies? If we are supposed to be parsimonious in our use of health care resources, if we are supposed to choose wisely in all other areas, where is the comparative effectiveness research showing that expensive machine interoperability on a grandiose global scale provides more value than cheaper and simpler localized or human mediated communications?


  • Add one doctor visit for every Medicare beneficiary for the next 8 years
  • Give primary care a 20% raise for the next 4 years
  • Double the number of residencies for the next 3 years
  • Educate 60,000 new primary care doctors from scratch
  • Buy an iPhone glucose monitor for every diabetic patient and an iPhone BP monitor for every hypertensive patient (no, I’m not a “technophobe”)
  • Put a brand new playground, a gym teacher and a home economics teacher in every elementary school in the U.S.
  • End homelessness in America


These are some of the things we could do with the billions of dollars spent on machine interoperability. Which has more value for our collective health? How did health care become a fully owned subsidiary of the computer industry? Who authorized this unholy acquisition and how much were those brokers paid? Have we forfeited our right to choose, or even know, how endless fortunes are steadily interoperating out of our treasury and into the hands of global technology firms? Publishing fuzzy ten year plans on obscure websites, so the Technorati can tweak them, doesn’t count. Publishing thousands of pages of regulations in the federal register, so interest groups can preview the fruits of their labor, doesn’t count either. Raiding public coffers to please friends and family and to curry political favors is hardly a disruptive innovation, so let’s just call it what it is.


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Innovative Health IT Products Sought Through ONC Challenge

Innovative Health IT Products Sought Through ONC Challenge | EHR and Health IT Consulting | Scoop.it

Ever since the Medicare and Medicaid EHR Incentive Programs have been established, the adoption and implementation of EHR systems and other health IT products has been tremendous. The health IT sector in general has been expanding greatly over the last several years.

The Office of the National Coordinator for Health IT (ONC) reports that almost $700 million was invested in medical technologies during the first quarter of 2014, which shows an 87 percent growth when compared to the first quarter of 2013. Health IT products and mobile health applications are all leading the way in changing the way doctors and consumers interact across the healthcare continuum.Health IT Products

Nonetheless, ONC explains that even with the evident growth in the health IT sector, many startups are still challenged in acquiring pilot partners that will help develop their health IT systems and show that their product is effective for the industry. These pilot partners are necessary for acquiring the data needed to establish a health IT product as successful among potential investors and customers including healthcare systems, payers, and the patient community.

As such, ONC is looking to create stronger relationships to help innovators bring new health IT products to the market. ONC has announced a new challenge program: the Market Research and Development Pilot Challenge.

To participate in the challenge, health IT developers will need to work with host sites like hospitals, clinics, pharmacies, or laboratories to create pilot proposals. ONC will be offering $300,000 through a year-long commitment to truly develop new and revolutionary health IT products for the medical sector.

The funding will be distributed among six teams who will then initiate the pilot, collect a variety of data, evaluate the product, and distribute the results with ONC’s assistance. After six months, the teams will be expected to return an evaluation report about their findings. The very first steps to take, however, is to select the right team, create an overall plan, and prepare the pilot proposal.

For each team, ONC will first award $25,000 when the pilot teams are selected and then another $25,000 after the pilot development and evaluation period is completed. In addition to this challenge, ONC will also be initiating sessions around the nation to train the health IT startup community on federal regulations, privacy and security standards, payment reforms, and funding opportunities that will affect the outcome of their services or health IT products.

The forward push for increasing the number of health IT solutions among providers and medical systems leads a pathway toward sharing patient data quickly and efficiently across the healthcare continuum. The National Coordinator for Health IT Karen B. DeSalvo has spoken about the need for EHR interoperability and helped develop the ONC roadmap to reach this goal.

“We heard loudly and clearly that it was time to focus on interoperability as a priority and we articulated why the time is now to achieve the vision.  First, as a nation, we have made significant progress in digitizing the care experience such that there is now data to be shared.  Second, consumers increasingly expect and demand real-time access to their electronic health information,” DeSalvo stated. “Informed by your input and feedback we acted on this opportunity.”



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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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EHR Data Interoperability Needs Strong Security Platforms

EHR Data Interoperability Needs Strong Security Platforms | EHR and Health IT Consulting | Scoop.it

Within the healthcare industry, EHR data interoperability has become all the rage, as medical providers, the federal government, media, and health IT vendors continue discussing the impact and benefits of interoperable, electronic patient records. In fact, more EHR vendors and developers are starting to bring interoperable products in front of providers.


For example, the medical device manufacturer Smiths Medical will be revealing its management software with an interoperability platform at the Association for the Advancement of Medical Instrumentation (AAMI) Conference taking place between June 5 and June 8 in Denver, Colorado, according to a company press release.


In addition to the new developments within the health IT field regarding EHR data interoperability, the Office of the National Coordinator for Health IT (ONC) has published public commentsto its nationwide interoperability roadmap.


“I am very opposed to this,” one respondent stated. “It proposes to repeal federal law that allows state legislatures to enact true medical privacy laws for citizens. It views patient data as public property rather than personal property. It has uses of data that many patients will not accept.”


The comments show how controversial EHR data interoperability is currently among consumers across the nation. Patient data privacy and security is, as always, at the forefront of the discussion and federal agencies continue to address its importance.


As ONC along with the Centers for Medicare & Medicaid Services (CMS) release proposed meaningful use requirements, there are some entities that have found EHR data interoperability stressed under the Stage 3 Meaningful Use proposed rule to be overly complex to implement among the industry.


Recently, the American Medical Association (AMA) has sent a letter to both CMS and ONC expressing its concerns over the complexity within Stage 3 Meaningful Use requirements that may impair EHR data interoperability. The inadequacies in building up sufficient health information exchange systems throughout the nation could lead to negative impacts on population health management efforts as well as overall quality of patient care.


As privacy and security continue to impact the ongoing reforms toward effective EHR data interoperability and health information exchange, the AMA underscored the security risks that EHR technology poses on the medical sector and patient safety.


“Another area where attention is lacking is how to address the growing privacy and security risks related to EHRs and other technology. Between 2010-2013 there were almost a 1,000 significant data breaches affecting 29 million patients, two-thirds of which involved electronic data. Moving to an electronic environment has greatly increased the probability of cybersecurity threats and breaches of patient data. Already, we have seen major institutions experience large data breaches that affect thousands of patients, as well as new cyber-attacks that cause EHRs to go dark literally for days,” theAMA letter stated before CMS and ONC rule makers.


“Rather than address these concerns, the proposed rule tries to highlight the numerous technology advancements that can be used and added to EHRs. It, however, fails to address how this may increase the risk for privacy and security problems… Before expanding the program to include additional technology and other requirements, we believe that the immediate need for greater protection of patient information must first be addressed.”

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7 conditions necessary for interoperability

7 conditions necessary for interoperability | EHR and Health IT Consulting | Scoop.it

Standards alone are not sufficient to achieve interoperability, according to David McCallie, M.D., senior vice president of medical informatics for Cerner.


McCallie, who also has served as a member of the Health IT Standards Committee since its beginnings in 2009, warns against the notion that nothing has been achieved in a guest post on the blog of Beth Israel Deaconess Medical Center CIO John Halamka.


"In particular, we have mostly settled the vocabulary questions for encoding the record," McCallie says. "We have widely deployed a good e-prescribing standard. We have established a standard for secure email that will eventually replace the fax machine, and we have widely [but not yet universally] deployed a good standard for document-centric query exchange."


At the same time, he cautions against congressional "fixes" that assume that once standards are in place, interoperability will inevitably follow.


To that end, he cites seven conditions required for interoperability. According to McCallie:


  1. A business process must exist for which standardization is needed
  2. A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation
  3. A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose
  4. A "network architecture" must be defined that provides for the identity, trust and security frameworks necessary for data sharing in the complex world of healthcare
  5. A "business architecture" must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur
  6. A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed
  7. All of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard


The JASON Task Force, which McCallie co-chaired, summed up these requirements into Data Sharing Arrangements, which do not just happen, but require the active engagement and collaboration of the various stakeholders in order to enable real-world, widespread use, he says. TheJASON Task Force is an independent group of scientists that advises the government on science and technology.


The task force previously reported that "meaningful interoperability" had not been achieved through Meaningful Use Stage 1 or 2; it later recommended that Stage 3 requirements be narrowed to more closely focus on interoperability.


Interoperability also was one of the main topics of discussion during a Senate Committee on Health, Education, Labor and Pensions hearing Wednesday. It was one in a series the committee set up to seek ways to improve electronic health record exchange and interoperability of health IT systems.

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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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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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Concerns on Proposed Meaningful Use Requirements Abound

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

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


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


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


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


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


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


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


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

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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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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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While EHR Interoperability Remains Vital, Security Fears Abound

While EHR Interoperability Remains Vital, Security Fears Abound | EHR and Health IT Consulting | Scoop.it

The movement toward EHR interoperability is sought by the federal government and certain patient advocacy groups that believe it will lead to improved quality of healthcare, better outcomes, and lower costs. With the Office of the National Coordinator (ONC) releasing an Interoperability Roadmap and issuing a report to Congress addressing the problems of information blocking, it is clear that the healthcare sector will be moving toward greater EHR interoperability and less restrictive health data exchange systems.


After ONC issued its report on information blocking in which EHR vendors were accused of charging additional fees for healthcare providers looking to access patient medical data outside of their facility, Epic Systems was one vendor that decided to drop its fees for exchanging patient data with non-Epic EHR system users. The Milwaukee Business Journal reported Epic System’s fees will be excluded until 2020.


Previously, Epic Systems charged $2.35 for every patient record accessed that wasn’t part of its EHR system. Removing these charges will be a big boost to EHR interoperability. Epic will also be taking part in the Carequality project, which is meant to develop effective health data exchange networks that assist in the sharing of medical information throughout the country.


While EHR interoperability is the name of the game for ONC, other federal agencies, and many healthcare providers, there are certain entities and individuals that do not support the seamless sharing of data. This was clearly seen in the public comments provided to ONC after the release of the Interoperability Roadmap.


“I have many issues with EHRs and interoperability – privacy is one of them. Privacy is a person’s right and this seems to be taken away with EHR interoperability,” wrote one stakeholder. “It allows nationwide access by innumerable people, which is unacceptable.”


Wayne Johnson, a retired Senior Project Manager, wrote to ONC: “I strongly urge you to vote against the proposed implementation of a National Medical Records System, an intrusive, non-secure storage and retrieval system designed to store and track the private medical data of US citizens, citizens who rightfully expect their personal information and effects to be secure from government inspection. I hold a Master’s of Science in software engineering, and I guarantee that the database system you intend to build, regardless of your intentions for security, will be compromised. Unlawful access to the private medical information stored in the system will be achieved. There is no such thing as an absolutely secure networked system.”


Clearly, privacy and security remains a top concern among citizens when it comes to improving EHR interoperability. As such, ONC issued an updated version of its Guide to Privacy and Security of Electronic Health Information in early May.


The guide has been updated to become more user-friendly and geared toward smaller medical practices and healthcare organizations that are addressing privacy and security measures across their facility, according to The National Law Review. While targeting small providers, the guide is also applicable to organizations of all sizes.


Some of the areas ONC focuses on includes identifying when patient authorizations are needed to disclose protected health data, the key questions providers need to ask their EHR vendors about security, and how to develop a security management program that will cover the privacy and security requirements under the Medicare and Medicaid EHR Incentive Programs.


While EHR interoperability remains vital for strengthening the healthcare industry as a whole, providers will need to focus on privacy and security measures to allay the fears of their patients.


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Health IT Certification Criteria Stresses Interoperability

Health IT Certification Criteria Stresses Interoperability | EHR and Health IT Consulting | Scoop.it

As technology continues to evolve and the federal government pushes forward EHR interoperability and health IT implementation, providers and vendors will need to ensure the systems they adopt adhere to the latest standards. Yesterday, the Department of Health and Human Services (HHS) led a webinar called the “2015 Edition Health IT Certification Criteria Webinar,” which should help the healthcare community learn more about the standards set forth by the Office of the National Coordinator for Health IT (ONC).


The ONC panelists stated the following about the 2015 Health IT Certification Criteria:


“Now as we move towards the care continuum and the larger spectrum of interoperability, we’re thinking about how to support not just the EHR Incentive Programs, not just MU settings, but also those other settings such as long-term and post-acute care or behavioral health. This is a response to the stakeholder feedback we received over the last couple of years via round tables or listening sessions and through our federal advisory committees: the Health Information Policy Committee and the Health Information Standards Committee.”


“So how are we doing that? In the 2015 Edition Proposed Rule, we changed our focus from the EHR module to the health IT module to really think about the broader continuum of health IT and what’s needed to get to interoperability and the key components of health information exchange,” the panelist continued. “The overview of the proposed rule is about better care, smarter spending, and healthier people and that’s something that’s an HHS-wide goal and our goal is through health IT to support those key elements. We’re also building on the foundation that’s already in place – and we’re thinking about interoperability, a key word for the year and highly addressed in terms of our draft roadmap, which was released earlier this year.”


“What are the specific health IT goals that you will see resonate throughout the rule?” the panelist asks. “Improve interoperability, ensure privacy and security… reduce health disparities… data access and exchange, patient safety, reliability and transparency of certified health IT… and support for EHR Incentive Programs as well as the larger care continuum.”


Clearly, ONC has moved forward in expanding the certification criteria to go beyond digital patient records and focus on the health IT spectrum as a whole. As usual, improving health IT interoperability among the medical industry is a major goal of the federal agency as well.


The latest edition of the health IT certification criteria is meant to create more expansion of health information exchange and connect more providers and patients with access to relevant medical data. ONC continues to focus on engaging providers with Stage 3 Meaningful Use requirements, enhancing privacy and security strategies as well as patient safety, and improving data exchange.

The latest health IT certification standards also allow for EHR vendors to design systems based on the unique needs of specialized medical facilities. The changes in the 2015 Edition Health IT Certification Criteria should lead to improved quality of care, better patient outcomes, and lower costs across the healthcare continuum.


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EHR Market Reached $25B in 2014, Likely To Increase

EHR Market Reached $25B in 2014, Likely To Increase | EHR and Health IT Consulting | Scoop.it

The electronic health record market reached nearly $25 billion in 2014 and is likely to continue growing over the next four years, according to a report by Kalorama Information, Healthcare IT News reports.


Report Details

According to the report, EHR sales increased by 10% between 2012 and 2014, reaching $24.9 billion. The report attributes the growth in large part to hospitals and providers acquiring updated EHR systems.

Among physicians, EHR adoption rates increased from 57% in 2011 to 81.4% in 2014.

Meanwhile, the report projected that the EHR market will grow to $35.2 billion by 2019.

The report said the estimated growth likely would be driven by:

 Continued EHR adoption among hospitals;


 Increased adoption to meet meaningful use Stage 3 requirements; and


 Payment reductions under the incentive program for failing to adopt EHRs.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

The report said that "fear of reimbursement loss will end up driving adoption more than incentives for extra reimbursement."

It added, "Growth will continue at approximately 13.4% for 2015-2019 as the 'carrot' of incentives tempts physicians but most importantly as the 'stick' of penalties threaten to impact 2015 revenues".

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