EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Managing a Successful EHR Implementation Extension Program

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

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

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


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


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


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


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


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


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


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


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


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


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


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


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

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EHR Data Interoperability Should Meet Five Use Cases

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

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


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


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


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


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


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


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


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

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New Grant Program Advances Health Information Exchange

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

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


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


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


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


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


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


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


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


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

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

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

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

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

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

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

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

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

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

Taking a step back, several points are inescapable:

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

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

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

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

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

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

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

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


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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 EHR Use Vital in Healthcare Quality Improvement

Physician EHR Use Vital in Healthcare Quality Improvement | EHR and Health IT Consulting | Scoop.it

When considering EHR integration, the way physicians use certain EHR features should be addressed, as there may be key differences among a group of doctors. Physician EHR use could correlate with the costs and quality of care at medical facilities.

A study from the Journal of the American Medical Informatics Association (JAMIA) found that healthcare providers using the exact same EHR systems had differing patterns when it came to utilizing certain EHR features. The study followed 112 physicians and nurse practitioners who interacted with nearly 100,000 patients over the course of three and a half years.

The providers studied were all part of the Institute of Family Health network located in New York City and a few regions surrounding the city. The network includes 18 sites and took part in EHR integration 12 years ago. Approximately 50 percent of providers within this healthcare system met Stage 1 Meaningful Use in 2012.

Some of the EHR feature use analyzed under this study included the updating of patient problem lists, the interaction with clinical decision support tools and alerts, the sharing of after-visit summaries, and the incorporation of panel management options into regular use.

The study at hand was conducted in order to show how different organizations may customize, implement, and use EHR features in varying ways, which may be why the quality of care and patient safety contrasts across the country.

Some results from the study showed that, as the frequency of alerts increased, the response rates to decision-support alerts fell. To clarify, for every extra 100 alerts, physicians accepted one percent fewer than before. Additionally, responsiveness to decision-support alerts varied among physicians.

There was a significant amount of variability seen with the updating of problem lists. The yearly average rate of problem list updates ranged from 5 percent to 60 percent depending upon the provider.  Another trend that differed among doctors was the number of days needed to review laboratory test results. Between 2010 and 2012, there was also a slight increase in the number of patients participating in the patient portal.

Some of the other differences that researchers encountered include the providers’ behavior with new patients versus established ones. Additionally, response to common alerts varied from responses to new alert types.

Considering this type of variation could be an important task during EHR integration as well as when updating systems. These contrasts among physician EHR use could also impact the costs and quality of care associated with health IT. In addition, some Stage 1 Meaningful Use requirements may be too basic for providers such as illustrating that the decision support tools have been implemented; technically providers do not have to show they have accepted any alerts.

The researchers conclude that EHR systems will not reach their intended goal of improving healthcare quality if their features are not used regularly. Since providers incorporated personalized patterns of EHR use even at the same center, this variability could be valuable for further study on the quality outcomes of physician EHR use.


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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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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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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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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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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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Meaningful Use Requirements Impact Adoption of EHR Functions

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

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

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

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

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

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

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

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

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

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

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

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

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


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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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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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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.