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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Top things providers need to know about interoperability

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

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


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


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


Interoperability saves big


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


Congress is interested in interoperability


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


Cloud computing is driving interoperability


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


Experts have broken down five main use cases for interoperability


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

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

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

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

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

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


The ONC's Interoperability Roadmap is a broad vision


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


Organizations pushing for interoperability


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


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

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EHR Data Interoperability Needs Strong Security Platforms

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

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


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


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


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


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


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


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


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


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


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

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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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Healthcare Industry Reacts to Stage 3 MU Proposed Rule

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

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

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

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

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

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

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

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

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

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

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

“We urge CMS to release the 2015 flexibility rules immediately. Information technology holds the promise of enhancing care for patients and communities,” Fishman continued. “America’s hospitals are committed to adopting technology but need today’s problems to be addressed to make progress for patients and communities.”
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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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Electronic health records and data abuse: it's about more than medical info

Electronic health records and data abuse: it's about more than medical info | EHR and Health IT Consulting | Scoop.it

On the heels of the recent announcement that medical insurance firm Anthem was breached, we look at the nuance and impact of a medical record breach versus a medical data breach. They are certainly related, but digging through troves of data containing primarily identity information is significantly different to an attack that focuses on specific treatment of a specific patient.

If an attacker can harvest name, social security number, phone, address, email and the like, that haul has a much wider potential audience than, say, whether or not a patient underwent a specific medical procedure. A stolen medical record containing a lot of detail may sell for a lot of money, but that market is more specialized than the broader market for general identity data.

To help folks visualize the different levels of data that thieves might want to swipe from a medical facility, and then abuse, my colleague, Stephen Cobb, created this diagram of a generic electronic health record.

Level one is pretty basic info, things that are fairly easily knowable about you without any hacking, normally sourced through Open Source Intelligence (OSINT) gathering. However, grabbing a big fat collection of such data might still earn a bad guy some black market bucks, say if a spammer needed fresh targets.

The illegal earnings potential goes up a notch if you can grab Level 2 data. Scammers can use that to carry out several kinds of identity theft, creating fake IDs, opening credit card accounts, committing tax fraud (filing fake returns to get a refund) or even use it to answer challenge questions to online accounts, thereby pivoting the attack to new digital beachheads. Even Level 2 data is enough to commit some types of medical ID theft, though the bad guys have no clue how healthy or sick you really are (here’s a pretty scary case of what can be done with just a stolen driver’s license).

Level 3 data just makes all of the above that much easier; plus, it enables new forms of badness. Some crooks prefer taking over an established account to opening a (fake) new one. the number of electronic records or EHRs that actually contain financial or payment data is not clear, but obviously a lot of healthcare entities do handle it at some point, making them a target for digital thieves who turn around and sell it on carder forums.

When you get to Level 4 data, the badness takes on a new dimension. If an attacker has a patient’s full (or partial) history, it’s easy to imagine matching up a willing bidder who has a need for a similar medical procedure with a donor record to (roughly) match, in an attempt to get pinpointed specific services they would otherwise have difficulty receiving.

But the options for selling medical history-style Level 4 records may be much narrower in scope than, say, bulk repackaging and resale on the underworld markets of lower levels, appealing to any buyer who wants to assume an identity, spread a wider net and attack other properties, or engage in fraudulent activity which is then blamed on you (if it’s your record that was compromised).

Of course, the threatscape may well change as the EHR becomes more universal. With the proliferation and sprawl of third party providers who are somehow tapped into a cohesive health ecosystem, there will always be various specialized smaller providers whose business is targeted to a specific subset. That’s not bad, it’s just how the health segment does business; in many cases it leverages strengths of one organization to help another. But it does imply a larger potential attack surface, which has implications for security if the data sprawl is not carefully managed. For example, if an attacker can gain a beachhead in one of the providers in the ecosystem, will they then have an elevated trust relationship with other systems within this ecosystem?

And here’s the rub: having instant digital access to all of a patient’s medical data (or other sensitive information) wherever a doctor happens to physically be is a wonderful tool, but now we have many more endpoints in question with security environments to understand and corral. This implies an ongoing need, not just for really smart endpoint protection, but also strong encryption, and authentication, as well as sane network segmentation, vigilant network monitoring and reliable disaster recovery.


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EXTREME essentials for interoperability

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

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

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

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


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

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

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

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Are Policies, Standards Enough to Boost EHR Interoperability?

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

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


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


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


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

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


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


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


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


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


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


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

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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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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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UCLA Health to integrate genomic data into EHR in pilot

UCLA Health to integrate genomic data into EHR in pilot | EHR and Health IT Consulting | Scoop.it

UCLA Health will soon begin a pilot project with Seattle-based startup ActX that will integrate genomic patient data into its Epic EHR system, with the eventual intent of applying precision medicineto a large-scale patient base.

ActX, founded in 2012 and just out of stealth mode six months ago, collects a patient’s genetic information by way of a saliva sample, and then analyzes the information in real time. The data is integrated into an EHR – already, ActX is working with Allscripts and Greenway Health – and physicians will receive an alert about a medication and possible side effects, or warn of potentially serious risks for cancer.

Think of it as a 23andMe that is integrated into an EHR and available to the patient.

Molly Coye, chief innovation officer at UCLA Health, which operates four hospitals, said that’s precisely what intrigued the academic health system.

“Our goal is to try to bring precision medicine to a much larger proportion of patients,” she told MedCity News. “Right now it tends to be focused particularly on people with cancer, and even then on a low number of patients.”

She added that genomic data combined with an EHR could have “real clinical meaning for a larger number of patients than we could have known about five or 10 years ago.”

The pilot will begin in the coming weeks on 50 patients that the health system thinks will be a good fit, Coye said. Depending on initial success, it will be expanded to a greater number.

“If successful, and our physicians are enthusiastic about it, we’ll rapidly make it available more widely,” she said, adding that most UCLA Health pilots range from three-to-six months.

ActX co-founder and CEO Andrew Ury, a physician who has worked extensively in the EHR space, said up until now, few if any genomic data collectors have been integrated into an EHR. Dr. Ury previously worked for Practice Partner, which was acquired by McKesson in 2007.

As he sees it, EHR integration is the only way to harness genomic data on a large scale while at the same time providing the results for patient.

“We believe the way to do that is to build it into the everyday tool, the EHR,” he said. “The consumer factor is because we have to get the patient’s genomic data in order to make it work, so we offer access to affordable DNA sequencing. In order to that, we involve the patient.”

Given that UCLA Health uses an Epic system, which dominates the hospital market, Coye said the potential to reach a mass of patients is significant, and that such an EHR add-on could someday be a standard feature if it proves successful.

“They’re actually working with Epic, so decision support means a lot more if it pops up in the EHR,” Coye said. “This is going to be a game changer, I think. That’s the real promise that everyone recognizes about genetic testing,  that this will become a standard. It’s just a question of how you do it early on.”

Importantly, Coye cited the autonomous nature of ActX in how it’s available to both patient and physician.

Dr. Ury elaborated on the potential of precision medicine and EHR integration from a clinical standpoint.

“What this means is that if a patient’s genetic data is on file, because we’ve analyzed it, each time the physician writes a prescription in the EHR, it’s going to see if a drug is going to work, or if there’s an adverse reaction,” he said. “If there is an issue, the physician will get an alert.”

The data, and its use within an EHR, can also help physicians better determine if a patient is at higher risk of a genetic disease or a certain type of cancer. With that knowledge, more effective medications and treatments can be determined far earlier than before.

Coye said UCLA Health hopes the pilot can bring precision medicine to primary care and a further breadth of specialists “across a wide variety of clinical conditions.”

ActX is so far privately funded and has about 25 employees and independent contractors, including scientists, pharmacists, genetic counselors, physicians and software developers, according to Dr. Ury.

Dr. Ury noted that it’s “the dawn of precision medicine,” referring to the $235 million initiative championed by President Obama and overseen largely by the NIH.

“While genetics can’t predict everything, genetics can predict more and more and whether a patient has a side effect,” he said. “We think this is the future.”


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