EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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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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86% of Providers Aim for Integrated EHR, Practice Management

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

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


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


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


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


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


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

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


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


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


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


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

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EHR Adoption Challenges Solved through Data Entry Transfer

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

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


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


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


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


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


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


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


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


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

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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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Do Health IT Systems Need Greater Interoperability?

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

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


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


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


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


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


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

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


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


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Few Physicians Think EHR Technology Improves Outcomes

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

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


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


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

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


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


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


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

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


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


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


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State Hospitals Go Digital for ICD-10 Compliance Deadline

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“The natural language helps clinicians choose and navigate down to the appropriate level of specificity within the ICD-10 code set,” Justin Dickey mentioned.
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New Medical Tech Not Hard to Swallow, Just to Implement

New Medical Tech Not Hard to Swallow, Just to Implement | EHR and Health IT Consulting | Scoop.it

The "always on" smartphone world of today matched with personal digital diagnostic technologies in development by the likes of Microsoft, Apple, Google, and other digital powerhouses promise to revolutionize chronic disease management and empower population health to stratospheric levels.

The development initiatives using data created and transmitted via smartphones using wearable, clothing embedded, ingestible, and other personal sensors are limited more by imagination than technology.

Just one little problem: The ability to convert another tsunami of new patient data into usable and actionable information for physicians using existing EHR technology is more than a decade in the rearview. The existing system platforms are static warehouses, not digital highways.

Further, each EHR's warehouse is an island unto itself because it uses a different layout, nomenclature, and even language designed to make changing to a competitor as difficult as possible by making data migration to a new system an expensive and daunting process. Until Congress stepped in, exorbitant ransoms imposed by some EHR companies to translate the data into the standard language are effectively bad memories.

The Wall of Interoperability

Still, federal law, which prescribes that all EHR data is to be contained in a standard format called a CCDA (Consolidated Clinical Document Architecture, if you must know), to be certified. The law, however, has more loopholes than grandma's knitting.

That makes the new healthcare information highways, population health, and similar programs that convert EHR warehoused data into usable information for physicians and other healthcare providers (among a host of other enabling and time-saving features), the ultimate solution hobbled by that EHR industry manufactured wall to data called "interoperability."

Circumventing EHR companies by automating removal of the CCDAs out of EHR systems has been solved by a very clever few, as has even making them interactive, but it comes at a cost because each version of each EHR has to be done separately.

To achieve a single-keystroke model (inputting data only one time), which is not only desirable but the only way to get people to use it, tons of EHR data has to be machine translated into a common language, delimited, mapped, parsed, validated, and, finally, populated into a common platform so that it can be made into something useful for providers. Every day. That takes lots of time, money, and skill, which can be undone by EHR companies at will every time they issue an upgrade, new version, or even a simple update — and expensively redone.

In return, providers get useful, time-saving tools that can allow them to do much more in much less time, which is the key to a reasonable quality of life for physicians.

That makes effective population health, let alone enhancing it by new wireless, personal smartphone app-enabled diagnostics, equivalent to baking a cake by having to get and process the raw ingredients from farmers and dairies instead of a cake mix from the supermarket.

The obvious solution, of course, is to pull the data directly into the information manufacturers' systems, circumventing the EHR warehouses, which will be hoisted by their own petard in the open ocean without a paddle because information systems cannot be EHR-specific to be effective.

In the end, there is a bright future for developers, physicians, healthcare providers and, especially, patients.

EHR companies? They took a different road. The survivors will join the program, and the time to do so is so very close.


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Physician Job Satisfaction on the Decline

Physician Job Satisfaction on the Decline | EHR and Health IT Consulting | Scoop.it

Healthcare bureaucracy and greater focus on data entry may be negatively influencing the physician profession including physician job satisfaction, according to a recent survey from the healthcare solutions group Geneia. The company polled 416 doctors in January 2015 and found that 84 percent claim the amount of quality time with patients has decreased over the last ten years.

Physician burnout is also on the rise, as 67 percent of respondents said they know a doctor who will likely stop practicing medicine within five years. Most respondents were unhappy with the work-life balance aspects of their profession. Only 25 percent surveyed stated they were “very satisfied with the work itself.”

Even though the Department of Health & Human Services (HHS) focused on improving patient engagement through Stage 2 Meaningful Use requirements, it seems that the patient-doctor relationship is actually floundering. A total of 78 percent of respondents said they feel rushed when speaking with patients.

Additionally, many physicians are feeling overwhelmed by the large amount of paperwork and regulations of the healthcare market. The majority of survey takers – 87 percent – felt that the federal regulations in the medical field are impacting “the practice of medicine for the worse.”

In order to counter the negative effects of the business side of medicine on physicians’ career outlooks, Geneia has implemented the Geneia Joy of Medicine Challenge. This will be a web-based event in which the organization will seek ideas from doctors about the best ways to restore the meaning of practicing medicine.

In an interview with EHRIntelligence.com, Heather Lavoie, Chief Operating Officer of Geneia, has said that an excess of information has come from the business and technology side on ways to improve the patient-doctor relationship and that it is time for physicians themselves to come forward with creative solutions. This is why Geneia is holding the Joy of Medicine Challenge.

“They’re [physicians] are in a much better position now to design what will work for them,” Lavoie said in the interview. “Some of what you hear from physicians about what they really need is less data entry and less time in the office clicking away.”

Geneia has already seen some doctors submit ideas for improving the practice of medicine. Some suggestions include hanging EHRs on the wall and limiting the direct interaction necessary with the systems while enabling the tools to capture more data automatically. Additionally, one idea on improving population health management includes leveraging the broader care team, and not just physicians, to categorize patients who are at highest risk, who have missed important preventive services,  as well as those with less serious conditions.

While the survey did not directly ask about how meaningful use stages are affecting the practice of medicine, the takeaway shows doctors are unhappy with the bureaucracy and high amount of data entry required through recent regulations.

Despite the dissatisfaction with data entry, EHR systems are here to stay, Lavoie mentioned. Physicians are not asking to go back to paper-based charting and in general going backwards would not work for the medical industry. For example, there are many medical school graduates getting into the field today who have never used paper charts.

However, Lavoie does say that EHR systems may need better design and improved implementation in order to give physicians more time for direct patient care. Both meaningful use and the Affordable Care Act were “a good shot in the arm” in the move from paper-based to electronic systems, “but with any shot in the arm, there may be side effects,” Lavoie infers.

Currently, there are too many “business burdens” for clinicians. The implementation of EHRs may have occurred too rapidly, which puts the systems at a disadvantage for being instrumental or meaningful in the healthcare system. Many medical facilities have felt rushed when implementing health IT tools, which often translates to less training for staff members. The deadlines of federal regulations have also put a time constraint on the design of EHRs, which may benefit from better construct.

“We jumped into implementation very rapidly in some cases and when you do that, you might shortcut design and you might not efficiently implement them… or adequately train the staff,” Lavoie explained.

The talent and the skill of physicians are not being used effectively if they spend more time with data entry than direct patient care. Freeing up physicians from the administrative tasks of their job may improve their career satisfaction.

One solution that Lavoie proposed involves greater data capture and automating data entry. For instance, when a patient’s blood pressure is measured, it would be useful to have a system that incorporates automatic uploading instead of manual recording.

Some supplementary solutions to these issues could come from dictated notes and natural language processing tools. Bringing physicians back to connecting with patients is important for both the satisfaction of practicing medicine and patient participation. Additionally, patient portals that are designed well and have greater usability do improve the patient experience, according to Lavoie.

“Access to information about an individual’s health status… [and] their full medical history has the potential … to improve the physician-patient relationship ultimately and improve satisfaction. That said, we can implement things well or we can implement them poorly.  It isn’t necessarily a limitation of the system itself, rather, so much of it is in how we implement it, how we communicate about it, and how we use it as a tool,” Lavoie spoke on the benefits of patient portals.

Even though two-thirds of doctors know someone who is considering leaving the occupation, Lavoie says most doctors are problem-solvers and optimists who would rather heal the profession rather than leave it. By incorporating the suggestions from the Joy in Medicine Challenge, job satisfaction among those practicing medicine may be restored.


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Kush Pathak's curator insight, March 11, 2015 6:00 PM

The bureaucracy that is being discussed in this article is the Department of Health and Human services. I did not realize that they spend so much of their time and resources on petty data entry and statistics. These things may be important, but what is more important is to ensure that those in the healthcare field and satisfies, and are protected under the law. I do not agree with what this bureaucracy is doing because it just goes to show that these governmental and restrictive bodies are not always here to show protect us, sometimes they are more focused on their their own public image and less on the well being of their actual members and the people that rely on them. 

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Are Policies, Standards Enough to Boost EHR Interoperability?

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

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


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


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


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

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


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


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


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


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


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


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

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Health Data Interoperability Needs Information Blocking to End

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

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


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

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


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

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


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

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


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


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


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


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

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Switching EHRs - leaving the frying pan for the fire?

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

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


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


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

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Health Information Blocking Continues to Plague Data Exchange

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

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


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


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


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


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


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


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


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


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

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

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ICD-10 Implementation Vital for Value-based Care Payments

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

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


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

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


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


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


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


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


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


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


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EHR Interoperability Imperative for Care Coordination

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

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


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


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


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


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


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


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


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


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


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


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


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Interoperability, Usability, and Meaningful Use Stage 3

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

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


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

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


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


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


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

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

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


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


The HITECH Act


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

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


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

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


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


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

Some examples seen at hospitals across the country:

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


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

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


Proposed rules for stage 3


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

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


A Quick summary of the enhancements includes:

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


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


What exactly is usability and user-centered design?


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

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

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


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


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


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


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


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John Vollenbroek's curator insight, April 23, 2015 2:39 AM

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

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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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Breaking Down the Health IT Impacts of Stage 3 Meaningful Use

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

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


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


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

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


Top 8 goals of the Stage 3 meaningful use proposed rule


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


Interoperability key to Stage 3 meaningful use requirements


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


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


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


How does Stage 3 meaningful use affect health data privacy?


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


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


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


ONC proposes 2015 health IT certification criteria rules


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



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Nurses Call for Greater Device and EHR Interoperability

Nurses Call for Greater Device and EHR Interoperability | EHR and Health IT Consulting | Scoop.it

Medical professionals throughout the industry have put EHR interoperability into the forefront of healthcare reform. A new survey from West Health Institute shows that nurses are looking for greater medical device integration and more data sharing capabilities among healthcare tools.

The report states that 91 percent of polled nurses would spend more hands-on time with their patients if they could reduce the amount of time spent managing devices. As much as 72 percent of nurses interacted with two or more electronic devices while working. Out of all respondents, 41 percent stated spending three or more hours per shift working with medical devices.

One out of two nurses said they noticed a medical error due to inadequate device integration. Additionally, 74 percent of respondents agreed that it is taxing to coordinate all of the data stored in medical devices.

Improved EHR interoperability and medical device integration could be key for the healthcare sector in order to reduce medical errors and prevent as many as 210,000 deaths occurring in hospitals every year. The most common medical errors include drug prescription inaccuracies, failure to prevent injury, and diagnostic flaws.

If both EHRs and devices could “seamlessly communicate and share data,” patient safety as well as provider satisfaction could be increased. According to a recent study by HIMSS Analytics, more than 90 percent of hospitals use six or more tools that could be integrated with EHRs, but only one out of three hospitals have consolidated these devices with EHR systems.

With the help of Harris Poll, the West Health Institute surveyed 526 nurses about their interaction with technology and medical devices in the healthcare setting. The survey results show that nurses are unhappy with the many uncoordinated devices that they work with when interacting with patients.

The majority of nurses polled feel that EHR interoperability and device integration would significantly add to patient care and decrease medical errors. When it comes to the most difficult aspect of medical devices, 39 percent mentioned their lack of communication or data sharing capabilities.

Almost all respondents – 96 percent – felt that device coordination could at least slightly decrease the number of medical errors within the healthcare system. Essentially, these healthcare professionals are looking for technology that is capable of sharing information automatically in a coordinated manner.

The majority of respondents also stated that, in order to improve patient safety and the quality of care, bedside nurses need to focus on patients’ needs without distraction. About half of nurses felt that at least 10 percent of medical errors responsible for adverse events could be prevented if hospital medical devices could share information seamlessly.

“Devices that are connected to each other – such as a patient chart to vital signs machines, to blood glucose monitors, etc. – would eliminate data entry, which is a huge risk of error,” one registered nurse was quoted in the survey results.

Adopting standards for EHR interoperability and device integration will need to be incorporated into national legislation in order for the US healthcare system to reduce medical errors associated with adverse events and preventable deaths.


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

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

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

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

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

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

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

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

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

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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