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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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EXTREME essentials for interoperability

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

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

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

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


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

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

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

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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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Are Policies, Standards Enough to Boost EHR Interoperability?

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

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


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


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


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

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


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


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


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


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


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


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

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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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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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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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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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Do Health IT Systems Need Greater Interoperability?

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

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


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


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


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


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


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

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


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


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EHR Interoperability Stressed in DeSalvo’s Keynote Address

EHR Interoperability Stressed in DeSalvo’s Keynote Address | EHR and Health IT Consulting | Scoop.it

To conclude the 2015 HIMSS Annual Conference and Exhibition in Chicago that brought in 35,000 healthcare IT professionals, providers, and other key stakeholders, Dr. Karen B. DeSalvo, National Coordinator for Health IT, delivered a keynote address. EHR interoperability was a major topic of DeSalvo’s speech.

“It has been a great week here at HIMSS,” DeSalvo starts. “I’m so optimistic about the bright future that we have ahead to leverage health information technology and enable better health for everyone in this country.”


“Last year, I stood before you as a brand new National Coordinator and shared what I saw as the need to move our focus beyond adoption and focus on interoperability,” she said. “Unlocking the data can [put it] to many important uses demanded by consumers, hospitals, doctors, and others who are part of our learning health system. We’ve had a very busy year. We took the time to listen, to understand, and to shift our strategic focus to see that we can built upon the strong foundation that we all have built.”


“I personally had the chance to participate in or host two dozen listening sessions across the country. In those sessions, I was able to hear from people on the front lines about what matters most to them,” DeSalvo stated. “I became more and more optimistic as I heard how people are committed to see that we would leverage health IT to the advancement of everyone’s health.”


“In Alabama, adoption can still be a debate in some circles. They have challenges like lack of broadband access in rural communities. In New Jersey, the close proximity to other states and differing state privacy laws when crossing state lines has become an increasing challenge,” DeSalvo continued.


“In the Silicon Valley, the entrepreneurial community is moving past the notion of an electronic health record and is thinking about the next phase – the person-centered health records and the Internet. In places like Chicago and Minnesota, a history of collaboration showed me that when we let go of our own interests, communities move further when they work together instead of against each other and we can put priorities like the public’s health at the top of the agenda.”

DeSalvo also acknowledged her team who have attended HIMSS and spent time listening and discussing the challenges of EHR interoperability as well as the solutions that can improve nationwide data exchange.


“We [need to] continue the great progress and get to a place where every American has access to their electronic health information,” DeSalvo continued. “They, like me, remain steady and unwavering in that vision. Indeed, that was the vision more than a decade ago when President Bush signed an executive order and asked David Brailer to stand in the Office for the National Coordinator for Health Information Technology. In 2009, Congress codified the role and we carry out those responsibilities every day on behalf of the people in this country.”

“The flurry of work in the five years since the HITECH Act, through a set of grant programs, certification programs, the EHR Incentive Programs, has brought us all to a tipping point. Today we know that adoption is strong.”


“We have much work to do to digitize the care experience across the entire care continuum. We also have to see that we achieve true interoperability – not only exchange,” DeSalvo said. “What became clear quickly is that we need to develop a strategic approach that would leverage health IT beyond electronic health records using levers beyond meaningful use to bring not only better healthcare but better health.”


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The Dire Need for Healthcare Interoperability

The Dire Need for Healthcare Interoperability | EHR and Health IT Consulting | Scoop.it

In a recently published study, "Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging," physician Hemal Kanzaria and co-authors uncovered that 97 percent of the over 700 responding ED physicians admit that nearly one in four advanced diagnostic imaging studies they personally order are "medically unnecessary." Worse yet, most in-hospital diagnostic imaging studies cost about five times more than their independent counterparts for the same work.

"The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation," according to the study abstract. The real contributor is that emergency physicians, and virtually every other consulting physician, is being forced to treat immediate crisis in the blind under looming threat of litigation, a callously perverse system that costs Medicare and Medicaid hundreds of billions of dollars each year, and the overall healthcare system arguably close to a trillion dollars per year in waste.


Emergency physicians, hospitalists, specialists, and even primary-care doctors, which pretty much covers anyone with a prescription pad, order lots of unnecessary or redundant tests not because the vast majority are intentionally wasteful but, because they, with rare exceptions, have no idea of what has or has not been done before them and must treat patients in the moment of crisis, not in the continuum of care.


This does not mean that ED doctors are bad at their jobs. It's just that doctors working in teams are proven to provide better care at lower cost. Much lower cost. As much as 30 percent.


Doctors work best if they can work in teams using the same information. Unfortunately, EHRs do not provide the kind of information that doctors need to be effective. They need information that helps them make informed decisions and they need to be responsible for all care and costs. When this happens, the quality of care improves. People get and stay healthier, and, costs go down.

Interoperability Hurdles


So, has spending $24.6 billion in taxpayer dollars on EHR systems been a bad idea? Not irreversibly. Some conflicts of interest that strongly inhibit the flow of data need to be addressed first:


1. It's good for EHR vendors to make it as hard as possible to move data to a competing system, denying the healthcare system as a whole.


2. It's good business for hospitals and their sub-specialist employees, whose stability relies on a steady stream of people in medical crisis, to keep data within their own walls and away from competitors.


3. It's good business for the industry as a whole because a free-flow of data means price, quality, and effectiveness transparency, forcing healthcare to compete like the rest of the economy.

And, the federal government obliges everyone with a cloak to hide behind: HIPAA.


The public is the only stakeholder in healthcare that restricting access to data is not good for.


The key to saving our healthcare system is to achieve a free flow of data and to convert that data into actionable clinical, price, and quality information for primary-care physicians, called interoperability.

Interoperability is the ability for different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. It solves three of the most vexing problems the healthcare system and its providers face:


1. It unites a fragmented healthcare delivery system;


2. It streamlines and standardizes communication among providers; and,


3. It eliminates duplication of services.


Three Solutions to Move Forward


Karen DeSalvo, a physician and the former national coordinator for health information technology, set a goal to get the basic infrastructure in place by 2017 and to have a fully interoperable national system by 2024. That deadline has since been moved to 2017.


Considering that literally hundreds of thousands of doctors do not have or cannot afford EHR systems, nor can they afford to jump through the annual labyrinth of regulatory hoops to meet the federal government's definition of "meaningful use," and over 150 EHR manufacturers fighting for the only thing that keeps them in business — proprietary data — this goal is not only unrealistic, it is disingenuous.


But, there are companies already operational and their population health, analytics, and quality measurement systems combined with primary-care practice operational transformation, best practices training, and support that unleashes the power of that information, already generating high quality care and superior clinical outcomes at lower cost.


They do this by cutting waste and managing chronic disease effectively, which keeps patients out of the hospital. As a result, they must be independent of hospitals to avoid the conflict of interest.

Hospitals and their unions, whose lament you are already hearing, realize their vulnerability, and will fight unless you change the system to protect them. Hospitals are necessary to the public welfare and our national security.


Three simple actions can accelerate the process:


1. Funding the expansion of our interoperability capabilities and use of a common population health and analytics system with practice transformation, and requiring EHR companies to format their data in the same way and put it in the same place;


2. Limiting "out-of-network" payments to a reasonable percentage of Medicare to protect both patients and providers to protect patients and shared savings and risk programs from predatory practices; and,


3. Indemnifying doctors that use and document best practices from frivolous lawsuits.


With the kind of savings programs like these can deliver, investing the savings from just four or five Medicare beneficiaries per year for each enabled primary-care practice,  the return on investment generates savings of 100 times or more.


The hardest part is mentally disengaging from the misperception that hospitals are healthcare providers. They are not. Hospitals are medical crisis treatment and rehabilitation facilities. Hospitals cannot so much as dispense an aspirin without a doctor's approval, and doctors need to be clear of conflict of interest.


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Managing a Successful EHR Implementation Extension Program

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

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

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


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


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


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


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


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


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


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


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


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


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


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


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

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Top things providers need to know about interoperability

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

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


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


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


Interoperability saves big


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


Congress is interested in interoperability


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


Cloud computing is driving interoperability


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


Experts have broken down five main use cases for interoperability


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

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

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

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

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

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


The ONC's Interoperability Roadmap is a broad vision


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


Organizations pushing for interoperability


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


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

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EHR Data Interoperability Should Meet Five Use Cases

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

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


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


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


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


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


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


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


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

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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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EHR Adoption Challenges Solved through Data Entry Transfer

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

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


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


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


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


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


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


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


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


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

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EHR Interoperability Solutions Progress in Healthcare Sector

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

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


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


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


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


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


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


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


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


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


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

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Tailored Physician EHR Use Necessary for Evolving Industry

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

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


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


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


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

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


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

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


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

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EHR Interoperability Stalled Due to Information Blocking

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

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

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

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

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

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

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

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

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

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


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Senate Scrutinizes EHR Interoperability

Senate Scrutinizes EHR Interoperability | EHR and Health IT Consulting | Scoop.it

Electronic health record interoperability and secure health information exchange have been key areas of focus for federal health IT leaders in recent months. Now these topics are getting even more attention from Congress.

The Senate Committee on Health, Education, Labor and Pensions is launching a working group focused on identifying ways to improve EHRs, including facilitating secure information exchange between EHR systems from disparate vendors and between healthcare providers.

A source in the office of Sen. Patty Murray, D-Wash., tells Information Security Media Group that the goal of the working group is to make some legislative and administrative recommendations by the end of the year.

"As we focus on making our healthcare system work better for families, the promise of electronic health records could not be more important," Murray said in a statement provided to ISMG. "However, as researchers, providers and patients gather and use more health information, we need to be aware of the cyber-criminals who want to exploit that information. Patients and providers need to know that their information is safe and secure, so I look forward to working with my colleagues to develop strategies to protect privacy and meet today's challenges."


Frustrated by Pace of Change

The new Senate workgroup is the culmination of years of activity by Congressional members, says David Holtzman, vice president of compliance at the security consulting firm CynergisTek. "They are frustrated by the slow pace of change by the Department of Health and Human Services, and the companies that are in the EHR marketplace to address interoperability and patient safety issues," he says.

Holtzman adds that he hopes that the workgroup "can find a path toward restoring balance" between the needs of healthcare providers to have EHR systems that are accessible, yet secure, while facilitating information sharing with other providers - regardless of technology platform.

Because nearly $30 billion has been spent so far on HITECH Act incentives payments to hospitals and physicians for making "meaningful use" of EHRs, Congress is scrutinizing whether taxpayers are getting a return on this investment. EHRs from different vendors, for instance, often don't easily exchange data. By improving EHR interoperability so that patient data can be securely exchanged among healthcare providers nationally, treatment outcomes, as well as patient safety, can potentially be improved.

EHR interoperability is also critical to a "Precision Medicine Initiative" that President Obama unveiled in his State of the Union address (see Precision Medicine: Privacy Issues).

Precision medicine, also known as personalized medicine, involves the use of genomic, environmental, lifestyle and other personal data about patients so that clinicians can better tailor medical treatments that are potentially more effective, based on an individuals' characteristics.

During a May 5 hearing by the Senate committee, Karen DeSalvo, M.D., who heads the Office of the National coordinator for Health IT within HHS, said that the exchange of health data, including for precision medicine efforts, facilitates "more liquidity" of information, but with that, comes risks. "We're ramping up additional security. ... It's a top priority," she said.

DeSalvo told committee members that ONC, which oversees standards and policies of the HITECH Act programs, is ready to collaborate with the working group on EHR interoperability and related issues.
Working Group Goals

In a statement, the Senate committee says the goals of the new bipartisan working group are to help identify ways that Congress and the Obama administration can work together to:

    Help doctors and hospitals improve quality of care and patient safety;
    Facilitate information exchange between different EHR vendors and different health professionals;
    Empower patients to engage in their own healthcare through convenient, user-friendly access to their personal health information;
    Leverage health information technology capabilities to improve patient safety; and
    Protect patient privacy and security of health information.

The working group, which is composed primarily of committee members' staff, will invite participation from health professionals, health information technology developers, relevant government agencies, and other experts specializing in health information technology, according to the committee statement.
HITECH Scrutiny

Sen. Lamar Alexander, R-Tenn., chair of the Senate health committee, said in a statement about the new working group: "After $28 billion in taxpayer dollars spent subsidizing electronic health records, doctors don't like these electronic medical record systems and say they disrupt workflow, interrupt the doctor-patient relationship and haven't been worth the effort.

"The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure."

The scrutiny over EHR interoperability and secure health information exchange also stretches to the House of Representatives. In March, Rep. Michael Burgess, M.D., R-Texas, unveiled legislation that calls for devising new methods for measuring whether EHR vendors are compliant with interoperability standards (see Bill Proposes EHR Interoperability Plan).

That bill proposes establishing a Congressionally appointed committee, to be known as the "Charter Organization," that would recommend methods for measuring whether EHR systems that qualify for the HITECH Act incentive program satisfy key interoperability criteria.
10-Year Vision

Interoperability and secure health information exchange is the focus of ONC's 10-year roadmap. ONC is reviewing public comments it received on its draft roadmap, and hopes to issue its next proposed version of the 10-year plan later this year.

In addition to its 10-year plan, ONC recently issued a report to Congress about information blocking, outlining how the secure exchange of health information is sometimes intentionally and unreasonably blocked by healthcare organizations, technology services providers and electronic health record vendors. In some cases, the players are inappropriately invoking HIPAA privacy and security concerns, ONC says (see Overcoming Health Info Exchange Blocking).

In an interview with Information Security Media Group at the recent HIMSS conference in Chicago, ONC Chief Privacy Officer Lucia Savage said misunderstandings about HIPAA often contribute to healthcare providers not engaging in the exchange of patient electronic health information. "We need to be a lot clearer about what the HIPAA rules are and how they support interoperable exchange," she says.


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Few Physicians Think EHR Technology Improves Outcomes

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

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


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


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

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


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


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


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

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


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


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


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Meaningful Use Requirements Impact Adoption of EHR Functions

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

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

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

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

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

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

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

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

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

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

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

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

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


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