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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Consistent Compliance: A Smart Plan for 2016 

Consistent Compliance: A Smart Plan for 2016  | EHR and Health IT Consulting | Scoop.it

The dawn of a new year represents a logical time to look at current business operations and commit to making improvements. One key area that physician practices should focus on is compliance.

 

There are a myriad of rules and regulations of which practices must be aware. For example, with the ICD-10 code set in place, there are new and expanded coding guidelines. Similarly, organizations have to have strong procedures for safeguarding proper medical waste disposal, worker safety, and patient information.

 

Compliance in these areas can fall short, especially in smaller practices that have limited resources, and consequences can be severe, ranging from financial penalties to blemishes on a physician practice’s reputation. Organizations cannot afford this negativity given the competitive and costly nature of healthcare today.

 

Although keeping up with the multitude of regulations may seem daunting, it does not have to be. Even though different government requirements touch on diverse topics, organizations can take a similar approach to meeting all the rules. Not only is this cost effective, it also ensures that nothing slips through the cracks.

 

The following are some key resolutions that practices can make to commit to and execute upon a strategic compliance plan:

 

Appreciate the scope. First and foremost, physician practices must familiarize themselves with the applicable regulatory requirements. Getting a firm grasp on what an agency mandates is vital to understanding the extent of necessary compliance efforts. For example, two critical Occupational Safety and Health Administration (OSHA) regulations are the bloodborne pathogens standard and the hazards communications standard. These rules dictate that organizations must have detailed written policies that outline the risks present in the organization and describe how the practice plans to address those risks, including needlesticks, exposure to dangerous chemicals, and so on. On top of these two main standards, OSHA has other requirements that relate to personal protective equipment, hazardous chemicals, workplace violence, ergonomics, and so on. Like many other compliance areas, OSHA offers information about what’s required on its website, however, this can be overwhelming and a little unwieldy to navigate. Practices should look for resources, including consulting firms and online tools, to bring the regulations down to size.

 

Perform a gap analysis. After getting a handle on what’s required, the practice should compare its current performance against the applicable regulations to identify any holes. This may involve performing an in-depth review of existing policies and/or observing operations. In the case of HIPAA, an organization may also want to have conversations with staff about how they maintain patient health information security. Although a physician practice can do some of this on its own, an outside resource, such as a software program or other side-by-side comparison tool, can ensure the assessment process can be more thorough.

 

Provide training. Once a physician practice identifies compliance gaps, it should work to implement strategies to address them. Training is often necessary at this stage because it builds awareness with staff and can alter behavior so that the organization becomes more consistently compliant. For example, targeted staff training can help with coding compliance in that it demonstrates which codes a practice should use when and why. Training can take many forms, but should include real-world examples and opportunities to practice. To make sure staff retain information long term, facilities can employ knowledge retention strategies, such as periodically quizzing staff on certain compliance situations or having them engage in sample exercises.

 

Updating policies. Another applicable resolution for closing compliance gaps is to verify that the practice has all the appropriate policies in place and these documents contain the right level of detail. OSHA, in particular, is keen on whether an organization has comprehensive policies and whether the facility regularly reviews them. Even if a physician practice experiences a compliance breach, the regulatory agency may be more sympathetic if the practice can demonstrate that it has the correct policies and is aiming to consistently follow them.

 

Gain staff feedback. Staff can be a valuable resource in compliance efforts, and organizations should empower individuals to speak up about any perceived hazards or ways to improve compliance efforts. For example, if a staff member feels that waste disposal procedures are sub-par, he should feel comfortable bringing his concerns to practice leadership, and there should be an established method for securely and safely expressing opinions. Periodically surveying staff to get their thoughts and impressions is also a good idea. One thing to keep in mind is that employee concerns should be — at the very least —acknowledged, if not directly addressed. If a staff person shares feedback, but feels that nothing ever comes of it, he or she may be less likely to report concerns in the future.

 

Now, more than ever, is a good time to commit to renewed compliance efforts. By taking a strategic approach, organizations can meet the bevy of requirements while keeping costs in check—something that will ensure a better and safer environment as well as long-term practice viability.

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Analyzing the Alleged Death of Meaningful Use

Analyzing the Alleged Death of Meaningful Use | EHR and Health IT Consulting | Scoop.it

Earlier this week, Andy Slavitt, Acting Administrator for CMS, told a group of attendees at the J.P. Morgan Annual Health Care Conference that meaningful use is on its way out.


“Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending meaningful use and moving to a new regime culminating with the [Medicare Access and CHIP Reauthorization Act of 2015] (MACRA) implementation,” Slavitt told attendees. “The meaningful use program as it has existed, will now be effectively over and replaced with something better.”


The idea that meaningful use, a program which began in 2011 and aimed to incentivize or penalize physicians for adopting an EHR system, would be over, naturally caused many physicians to celebrate. Melissa Young, an endocrinologist in Freehold, N.J., and a member of the Physicians Practice Editorial Board, e-mailed a three word reaction to the news: “Hooray! ‘Nuff said.”


The AMA had a more formal way of celebrating this news. Of Slavitt, AMA President and CEO, Steven Stack, an emergency physician, told Beckers Hospitals Review in a statement: "He listened to working physicians who said the meaningful use program made them choose between following Byzantine technological requirements and spending more time with their patients. This is a win for patients, physicians and common sense."


In his speech, Slavitt talked about winning the “hearts and minds” of physicians back. Getting rid of meaningful use would undoubtedly help the federal agency achieve that goal, as evidenced by the rising number of docs who opted out of the program due to its stringent requirements.  “The concept of meaningful use was always doomed to failure and it has been proven that there is no improvement in the quality of our healthcare delivery system and it has not reduced the costs of the provision of medical care,” Jeffrey Blank, a podiatric physician in Loxahatchee, Fla., and a member of the Physicians Practice Editorial Board, said via email.


Hold that Thought


Despite the excitement, Robert Tennant, health information technology policy director for the Medical Group Management Association (MGMA), says physicians should keep the champagne on ice. For one thing, they will still be judged on EHR and technical capability.


At the conference, Slavitt talked about MACRA, which authorized the creation of the Merit-Based Incentive Payment System (MIPS). MIPS will measure and compensate physicians on quality, practice improvement, cost, and use of technology. Within MIPS will be elements of meaningful use. Rather than rewarding physicians for using technology, MIPS will aim to pay them on using it towards improving their outcomes.


While Tennant says a reworked meaningful use is “potentially very positive,” the guidelines for MIPS are supposed to be released and finalized this year, which he notes could be a problem for physicians. “Payment under MIPS is supposed to take effect in 2019. If the traditional approach of using a two-year look back [to make those adjustments] is in place, it would mean reporting would begin in 2017,” he says. “If you look at the timing from a regulatory process, we’re concerned with how this would be accomplished.”


In essence, vendors would have to redevelop software around the guidelines, train customers, and practices would have to go live within the space of a year. Moreover, Tennant says if MIPS regulations are finalized in December of this year, they’d likely overlap with a new presidential administration.


“Any new administration, the first thing they do is typically put all pending regulations on hold and review them before they approve,” he says.  Tennant also notes practices still have to be concerned over meaningful use regulations for 2016, including a full-year reporting period and the fact that Stage 3 of meaningful use is technically supposed to be mandatory in 2018.


“We don’t know what we are moving ahead to,” Tennant says. For practices, he advises to select software that fits their clinical needs and to not worry about “arbitrary and potentially changing” regulations. “Don’t focus on 2017 or beyond. We don’t know. The vendor doesn’t know.”


Even still, he is “cautiously optimistic” about Slavitt’s remarks. “We’re hoping CMS takes this opportunity to leverage MACRA to develop a program that is achievable and clinically relevant,” he says.


Blank is interested to see what lies ahead with government regulations, but is not as optimistic as Tennant. “I'm sure that many interest groups and the insurance industry will profit and doctors like me will continue to struggle,” he says.

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What's Best Way to Boost Health Information Exchange?

What's Best Way to Boost Health Information Exchange? | EHR and Health IT Consulting | Scoop.it

A new report to Congress recommends steps to ease the secure sharing of patient information, paving the way for better coordination of care and improved patient outcomes. For example, the report recommends the creation of incentives to help overcome the "blocking" of data exchange or reluctance to participate.


Although the federal government has spent $31 billion so far on HITECH Act incentives for hospitals and physicians to "meaningfully use" electronic health records systems, Congress has been scrutinizing whether the investment has paid off in enabling the sharing of health information.


Some security and privacy experts say that while the report spotlights some of the key barriers to secure health information exchange, some of the concerns may be overstated.


For instance, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, says intentional information blocking among healthcare providers is generally not a widespread problem.


"There are bad apples in every group of humans, and healthcare providers are no exception," he says. "In my experience, malicious information blocking for competitive purposes is very, very rare, and is certainly not a big factor or even a major factor impeding health information exchange. The biggest impediment to information exchange up until now has been lack of demand. That has changed, and now that we have strong demand, we're seeing the market respond and I expect interoperability to grow dramatically over the next couple of years."

Report Findings

The Health IT Policy Committee, which advises the Office of the National Coordinator of Health IT, recently submitted its Report to Congress: Challenges and Barriers to Interoperabilityas mandated by Congress.


The report delves into the various technical, operational and financial challenges that the healthcare sector faces in achieving health information exchange. Among the issues related to privacy and security listed in the report are:


  • Misunderstanding about HIPAA and other privacy laws has led some to refrain from sharing information.
  • Applying privacy laws that were originally designed to address paper-based processes to today's electronic transactions has been problematic.
  • Designing electronic systems and rules to accommodate varying state privacy and security laws has been challenging.


The advisory panel makes four key recommendations to accelerate health information exchange:


  • Develop and enhance incentives that drive interoperability and data exchange, such as by focusing on delivery of coordinated care. For example, payers could decline to reimburse for medically unnecessary duplicate testing that could have been avoided if information was shared.
  • Develop and implement health information exchange vendor performance measures for certification and public reporting;
  • Set payment incentives to encourage health information exchange. Include specific performance measurement criteria and create a timeline for implementation.
  • Convene a summit of major stakeholders co-led by the federal government and the private sector to act on ONC's recently unveiled 10-year interoperability roadmap.


Information Blocking

Drilling down on the report's recommendations pertaining to payment incentives to help accelerate interoperability, the HIT Policy Committee specifically addresses the problem of information blocking, which involves healthcare providers refusing to share of clinical information.


Sometimes information blocking is related to misinterpretations and misunderstandings about HIPAA and other privacy laws, the report notes.


"There are many examples where misinterpretations of complex privacy laws inhibit providers from exchanging information that is permitted under HIPAA," the report notes. "Also, many providers do not fully appreciate that the HITECH Act gives patients the right of electronic access to their EHR-stored information. As the Centers for Medicare and Medicaid Services defines new payment incentives ... it should incorporate mechanisms that identify and discourage information blocking activities that interfere with providers who rely on information exchange to deliver high-quality, coordinated care."

Other Recommendations

The document also outlines some previous recommendations made by the HIT Policy Committee to ONC, including:

  • Explore regulatory options and other mechanisms to encourage appropriate sharing of certain sensitive information, including substance abuse and mental health data;
  • Provide guidance about best practices on the privacy considerations associated with sharing of individuals' data among HIPAA covered entities and other community organizations;
  • Guide efforts to establish "dependable rules of the road" and to ensure their enforceability in order to build trust in the use of healthcare big data.
Overcoming Privacy Hurdles

David Whitlinger, executive director of the Statewide Health Information Network of New York - the state's health information exchange - says privacy and security issues clearly represent some of the biggest hurdles to overcome before achieving nationwide data exchange.


"Privacy and security regulations vary across different states, and those difficulties are exacerbated even more in sharing sensitive health data, such as mental health, substance abuse, HIV, reproductive health, and information about minors," he says. EHR platforms don't easily support compliance with varying laws when data is exchanged, he notes.


But he points out that industry players are discussing the use of various technologies that "tag" sensitive information so that patients have more control over what part of their health records can be shared among healthcare providers. Also under discussion are policy issues such as "giving patients complete control over their data, so that they ultimately make the decisions about what subsets of data they'll share," he notes.


Tripathi says the biggest barrier to health information exchange, from a privacy and security perspective, "is the heterogeneity of privacy rules that any particular provider faces, which has a paralyzing effect on electronic information exchange."


For instance, in Massachusetts, HIV and genetic test results require consent from patients for each disclosure, he notes. "So even though a Direct [secure email] transaction doesn't require any special consent, certain types of payloads may trigger other consent requirements. So ... as a healthcare provider ... I will hesitate to send out anything until I understand which laws pertain and whether that data my EHR sends triggers any of those other laws."

What's Next?

Members of Congress now must decide whether to act on the HIT Policy Committee's various recommendations.


An aide to Sen. Lamar Alexander, R-Tenn., chair of the Senate Committee on Health, Education, Labor and Pensions, says in a statement provided to Information Security Media Group: "Sen. Alexander is focused on making electronic health records something that physicians and hospitals look forward to instead of something they endure, and he looks forward to hearing what recommendations [the HIT Policy Committee] outlined in [the] report."


While the report notes that steps could be taken to begin implementing various recommendations within the next six months, some healthcare IT experts say it could take years for comprehensive health information to be securely and readily exchanged among healthcare providers by using health information exchange organizations and EHR systems.

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All I Want For Christmas: Seven Things I Wish My EMR Could Do

All I Want For Christmas: Seven Things I Wish My EMR Could Do | EHR and Health IT Consulting | Scoop.it

Dear Santa,


I’ve been a very good doctor all year. I have checked all my boxes and aced all my Meaningful Use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:


1) I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniature window. That would save time and help me not miss abnormal results.


2) I wish the patient’s next appointment date was displayed next to any incoming report I have to review. That would help me decide if I need to contact the patient about the results or if I’m seeing them soon enough that I can talk about the report then.


3) I wish I could split my computer screen so I could see an X-ray or consultation report or a hospital discharge summary at the same time as I type or dictate the narrative of my office note. That would help me quote them correctly.


4) I wish, when I open a patient’s actual visit note for today, the place where I do my documentation, that I could automatically see at least the beginning of the latest of every category of information we have received – latest labs, X-rays, outside reports and phone calls. It takes too much time to go searching in the places for each category separately just in case there might be something recent to catch up on in the visit.


5) I wish my EMR would know that prn medications, such as nitroglycerin, are not meant to be used for only a limited time, like 30 or 90 days, and would agree to e-prescribe them without a “duration”. If I could do that, they would not disappear from the medication list all the time.


6) I wish my EMR would automatically display the patient’s kidney function and allergies next to where I pick what medications to prescribe. That would make prescribing quicker and safer.


7) I wish my EMR wouldn’t alert me to drug warnings and interactions that are too obvious to need reminders for. I mean, any doctor would know that adding a second diabetes pill can cause low blood sugar (that’s why we do it) and that combining two drugs that can cause fatigue may cause even more fatigue! More intelligent warnings would be taken more seriously; now my trackball finger is automatically poised to close the “warning” pop-up, because I’m expecting it to be irrelevant.


I’m sure if I tried, I could think of an even ten wishes, or maybe even twelve – one for each day of Christmas. But these seven things illustrate the underlying, fundamental wish I have: that my EMR will evolve to be more user friendly. I wish, now that the basic functionalities of EMRs are in place, that somebody comes back to people like me and asks how to take this thing to the next level.

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Adapting to Flexibility in the Age of the EHR

Adapting to Flexibility in the Age of the EHR | EHR and Health IT Consulting | Scoop.it

I love traveling for a variety of reasons. One of the biggest is the ability to meet a diverse group of people who start as strangers and become friends. On a recent trip to San Francisco, I had breakfast with an IT professional working in the banking industry. Our conversation turned to the proliferation of data in both of our worlds, and how it can complicate the analysis and productive use of that data.


I have worked as a PA for more than 34 years, and have witnessed a dramatic transition of how we collect and view patient health records, from paper records and manual charting to the modern EHR and computerized physician order entry (CPOE) systems.


In my travel buddy’s banking world, similar to the medical world, data management is an expensive proposition. The size and complexity of the data expands exponentially every year. Software is the interface between professionals in our fields, allowing us to interpret and record information into this burgeoning database.


It has dawned on me on more than one occasion that the weak link in this whole system is the end user, and this is true for every industry. I have observed over the years the age diversity of physicians, PAs and others providers directing patient care within the healthcare system in the U.S. Prior to computers and digital data, we all charted the same way. The only tool that we all had was pen and paper. This has changed dramatically over the past ten years.


A number of policy changes on the federal level, as well as the Affordable Care Act, have driven a rapid transition to the EHR at every level of the healthcare system. A combined carrot and stick economic stimulus has been the force behind this transition. It has, at times, been challenging from a provider standpoint. I imagine that it has been the same from the corporate level.


I can only address the view from the trenches. What used to be a uniform documentation system has moved into one in transition. We don't allow anything but CPOE in our hospital. However, we still allow handwritten progress notes. Administration has moved gently in this area in order to cater to some providers’ lack of computer skills. While everyone is different, having practiced healthcare for many years, technology adoption can fall into several transitive groups.


Today’s recent medical professionals are highly computer literate, and have never touched a paper record, and never will. They can research a patient problem, FaceTime with their friends, text, and handle e-mail all at the same time, from a variety of devices.


Then, there is a middle group who have grown up in the computer era and have decent computer skills. They remember the paper era, but see the promise of the digital age and are able to keep their heads above water in the burgeoning digital age.


The last cohort is my age group, those nearing retirement who have spent the majority of their careers in medicine in the paper age. Many in this age group find managing technology to be a frustrating endeavor. However, with challenges and transitions come opportunities and I have seen many baby boomers and hospitals adapt to leverage more holistic systems. It simply takes patience and a little bit of flexibility.


That said, we have to be gentle in our expectations of the transition towards a digital world. Big organizations, like the one running the hospital in which I work, have deployed many resources towards easing the transition towards the EHR that are available 24/7.


Unfortunately, some providers in private practice might not be so lucky, and find themselves having to go it alone. Assisting all those at every level of EHR skill and ability is imperative toward full implementation of the EHR.


Patience is an important virtue in this transition. Nothing this difficult and complex can be done easily or quickly. However, by being reasonable and rational about the problem that we are trying to solve — being flexible and ensuring we are building tools that will ultimately allow us to better serve our patients — will help with the solutions towards dealing with the mountain of data that is burying every industry in the nation, service or otherwise.

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Are EHR Vendor Contracts Hindering Patient Safety Research?

Are EHR Vendor Contracts Hindering Patient Safety Research? | EHR and Health IT Consulting | Scoop.it

Adhering to patient safety standards is of vital importance when using an EHR, which is why proper review and research among different systems are critical for innovation. However, are supposed gag clauses in EHR vendor contracts inhibiting this kind of review and research?


A recent Politico article written by Darius Tahir presents considerable research into the matter. According to Tahir, EHR users are being completely prohibited from sharing adverse events and negative feedback regarding their EHRs. This stems from different gag clauses included in EHR vendor contracts, and seriously affects innovation that can help improve patient safety.


But HealthAffairs article by Kathy Kenyon, JD, MA, tries to clarify many of the legal implications of EHR vendor contracts, and discusses the realities of the “gag clauses.”

According to Kenyon, gag clauses in EHR vendor contracts do not necessarily prohibit users and researchers from offering negative feedback regarding their EHR systems. However, as soon as users or researchers include a screenshot of an EHR screen in their critique, they are breaching the “gag clauses” that actually deal with protecting intellectual property.


Kenyon states that many EHR vendor contracts include clauses that prohibit users from publically sharing screenshots of the EHR while reviewing the product without vendor permission. These clauses exist to protect the intellectual property of EHR vendors.  However, they are actually quite vague and unclear, giving vendors the power to prohibit potentially vital research that could improve the EHR for patient safety.

The true ‘gag clause’ problems with EHR vendor contracts appear to be related to the confidentiality and intellectual property terms, which are overbroad and unclear, and limits on ‘authorized uses’ of the EHR, as those terms apply to research and reporting that requires access to the EHR and use of screenshots,” she writes.

Furthermore, when researchers are able to access screenshots to share information for system improvement, vendors are given a high level of control regarding what system information is released. This potentially prevents unbiased information from being published, hindering the improvement process.


“As long as researchers must ask vendors for permission to do research or to publish screenshots, and as long as vendors can deny permission for any reason, including not liking the results, there is a serious danger that research will be designed and findings presented in ways that garner vendor permission,” she writes.


Kenyon points out that these clauses exist to protect the intellectual property of EHR vendors. The vendors are concerned that should information regarding the look and functionality of their software be released to the public, other vendors may steal these features. This would cause vendors to lose “competitive advantage,” Kenyon says, and would hurt the business of the EHR industry.


Kenyon says that many EHR users state that this fear of vendors is not entirely well-founded considering the ease with which competitors are able to gather information regarding a certain EHR.


“...it is not that hard to discover what different EHRs look like. For vendors hoping to improve their EHRs by ‘stealing’ from others, waiting for research with screenshots to be published would be an exceptionally inefficient way to do so,” she writes.


Furthermore, many physicians maintain that no price can be put on the safety of patients, Kenyon reports.


Kenyon maintains that under existing contracts, the provisions made to protect intellectual property are not functional for researchers. To increase patient safety while using EHRs, different standards are going to have to be implemented, Kenyon suggests.


“Stakeholder groups for patient and EHR safety, including parties to EHR contracts, should share interests in making health IT safety-related research and reporting as easy as possible,” Kenyon explains. “EHR vendor contracts should reflect as much consensus on these issues as is possible.”


She continues to provide suggestions for the construction of future EHR vendor contracts, stating that there should be no gag clauses, but rather clauses that encourage research and encourage reporting of adverse outcomes. By identifying these areas for improvement in EHR vendor contracts, research and adverse event reporting may potentially help increase patient safety.

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ICD-10 Compliance a Struggle for Some Physician Practices

ICD-10 Compliance a Struggle for Some Physician Practices | EHR and Health IT Consulting | Scoop.it

October 1 has come and gone, and nearly two weeks in to ICD-10 compliance most of the healthcare industry is relatively mum on the transition to the newer clinical diagnostic and procedural code set. More than likely, healthcare organizations and professionals are busy enough adapting to ICD-10 and its more specific set of codes.

That’s not to say some are not speaking out or in support of ICD-10 compliance.


Two recent weekend reports in the Florida’s Crestview News Bulletin and Maine’s Bangor Daily News paint two very different pictures of ICD-10 compliance at the two-week mark.


Apparently, some physician practices in the Florida panhandle are going through the motions in adapting to the federal mandate for ICD-10 compliance which began back on October 1. Brian Hughes reports that medical offices are encountering difficulties with the code set.


“Large practices and medical companies, such as Peoples’ Home Health, usually have coders on staff. Their only job is to enter the numbers into billing records and insurance reimbursement forms,” he writes. “For smaller offices like Dr. Herf’s and Mir’s, the increased coding tasks take away staffers’ time with patients.”


Betty Jordan, the manager of physician practice of Abdul Mir, MD, views ICD-10 as more of a hindrance than a help.


“It requires so much extra work. If my doctor treated someone for rheumatoid arthritis, there’s hundreds of codes. It’s got to be specific,” she told the Crestview News Bulletin.


“It is horrible for a primary care doctor,” she further revealed. “For a specialist, they deal with the same things over and over. For us in family practice, we see all kinds of things. It’s overwhelming.”

For an administrator at the practice of David Herf, MD, the challenge of ICD-10 compliance is the result of increased specificity being married to an increase amount detail.


“It’s really, really detailed,” Andrew Linares told the news outlet. “Instead of just saying, ‘cyst of the arm or trunk,’ you have to get really specific.”


For one of the physician practices, adapting to ICD-10 is akin to learning a whole new language.


The climate in Maine appears much sunnier regarding ICD-10 compliance. Jen Lynds reports high levels of preparation among Maine healthcare organizations and professionals leading to a smooth transition.


“Health care providers across the state began working Oct. 1 with a new system of medical codes that has them describing illnesses and injuries in more detail than ever before, and officials from hospitals and medical associations said earlier this week that they are prepared for the challenge,” she writes.


According to Gordon H. Smith, the Executive Vice President of the Maine Medical Association, complaints are scarce as are ICD-10 implementation delays. Director of Communications for the Maine Hospital Association reports the same situation.


That being said, leadership at Eastern Maine Medical Center are preparing for transition-related productivity decreases for coders and billers used to the previous code set. However, things are still proceeding as planned.


“Our transition to ICD-10 has gone very smoothly here at Eastern Maine Medical Center,” Director of Coding and Clinical Documentation Improvement Mandy Reid told the Bangor Daily News. “We are using nine contract coders through outside vendors to support the ICD-10 go-live, and we secured them several months ago to be prepared. We also have added three positions in the outpatient area to help support growing volume, as well as ICD-10 coding.”


The lesson learned so far is that a clinical practice’s ability to invest in ICD-10 preparation (e.g., training) correlates to its present-day confidence in ICD-10 compliance.

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AAFP: Health IT Industry Should be Closer to EHR Interoperability

AAFP: Health IT Industry Should be Closer to EHR Interoperability | EHR and Health IT Consulting | Scoop.it

Although the Office of the National Coordinator for Health IT (ONC) recently released itsInteroperability Roadmap, the American Academy of Family Physicians (AAFP) does not believe that is enough to achieve nationwide EHR interoperability in a timely manner.

In a recent letter addressed to National Coordinator Karen DeSalvo, MD, MPH, MSc, AAFP’s Board Chair Robert Wergin, MD, FAAFP expressed his and the organization’s dismay at the slow progress of nationwide interoperability.


“Our members and the AAFP are very concerned with the very slow progress toward achieving truly interoperable systems. Furthermore, we strongly believe there is need for increased accountability on industry and decreased accountability on those who are using their inadequate products,” wrote Wergin.


According to Wergin, care coordination, patient engagement, and population health management all need greater support through increased interoperability. However, at the rate the healthcare industry is moving with regard to interoperability, those goals are not expected to be achieved soon. To change this course, Wergin says the industry needs more action rather than more planning. Additionally, providers and organizations that are playing their parts in increasing interoperability need more support.


“We need more than a roadmap; we need action. First, it is our belief that without significant changes in the way health care delivery is valued (e.g. paid) then it will not matter how many standards are created, how many implementation guides are written, how many controlled vocabularies are fortified, or how many reports are created; we will still struggle to achieve interoperability. Any roadmap for interoperability needs to ensure payment reform toward value based payment, in addition to the technical work. This aligns the health care business drivers to the achievement of true interoperability.”


Wergin argued that certified EHR systems are a contributing factor for this slow growth toward nationwide interoperability. In 2007, he said, the AAFP was responsible for creating a set of standards for healthcare summary exchange. However, despite the adequacy of those standards, Wergin reported that practitioners still experienced difficulty in exchanging information due to incompetencies of EHR systems. Because the EHR systems cannot interpret the data that is being exchanged between systems, physicians are finding themselves manually inputting data from one system to another.

“Instead, physicians must view the documents on the screen, just as they would a fax, to find the important information. Then they must re-key that information into their EHR if they want to incorporate some of the summary information into the patient’s record,” Wergin explained.

Wergin described an urgent need to transform interoperability. If practices are expected to achievemeaningful use and other incentive-based models, interoperability needs to be a high priority for the health IT industry.

“Everyone including technology vendors, hospitals, health systems, pharmacies, local health and social service centers and physicians, must come together as a nation to achieve the interoperability levels laid out in this roadmap at a more rapid pace,” Wergin wrote.


Comparing the push for interoperability to President Kennedy’s push to get to the moon, Wergin states that the health IT industry should be able to achieve its goals in the same 10-year timeframe that Kennedy did. By 2019, Wergin stated, the entire healthcare industry should be using completely interoperable systems.


“We should be much closer to our goal and it should be accomplished within ten years (2019),” Wergin wrote. “The AAFP is dedicated to continue our work to achieve interoperability which is fundamental to continuity of care, care coordination, and the achievement of effective health IT solutions.”

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Epic Systems Tabbed to Expand Hold of Ambulatory EHR Market

Epic Systems Tabbed to Expand Hold of Ambulatory EHR Market | EHR and Health IT Consulting | Scoop.it

Epic Systems is in the driver's seat compared to other ambulatory EHR vendors and poised to take control of an even larger portion of the outpatient EHR market, according to a recent survey of more than 170 ambulatory care facilities.


Conducted by peer60, the report shows Epic to control close to 20 percent of the ambulatory EHR market several points ahead of its main competitor Cerner Corporation, which owns less than 15 percent.


The authors of the report base their predictions for Epic's growth on the perceived market dominance of the Wisconsin-based EHR vendor — that is, "mindshare." Epic and Cerner are neck and neck among ambulatory care facilities in this area, hovering around 32 percent.

"As has been the case in past years, Epic’s and Cerner’s aggressive positions will continue to gobble up pieces of the ambulatory pie currently occupied by vendors that have struggled to stay relevant in this space," the report states.


Also likely to make gains are athenahealth and eClinicalWorks whose mindshare ranges between 14 and 20 percent:

The other half of the market share and mindshare story and equally impressive is athenahealth’s and eClinicalWorks’ significant mindshare figures at approximately eight and five times their current market share in the overall ambulatory EHR market, respectively. This indicates these vendors are finding significant ways to positively connect with providers.

According to the authors, the disparity between market share and mindshare indicates a need for EHR vendors to improve their standing among ambulatory care providers, a caveat being that EHR vendors focusing on independent facilities have less to lose because many ambulatory centers base their EHR selection on hospital EHR selection.


For these independents, Epic and Cerner trail NextGen based on market share, the latter holding close to 20 percent of the marketplace. As for mindshare, NextGen's prospects are not good "considering they occupy no space in the future plans of independent ambulatory providers," the authors contend. Meanwhile, eClinicalWorks is set to make major gains among these ambulatory care settings well ahead of both Epic and Cerner.


Factoring in to future ambulatory EHR selections will be EHR vendor recommendation scores from providers. On average, ambulatory providers are more likely than not to recommend their current ambulatory EHR technology to others — 6.2 out of 10. The scores for individual EHR vendors is not made public, but five vendors scored above the 6.2 mark with one scoring as high as 9.3.


What will likely influence ambulatory EHR selections are solutions to the top challenges for provider EHR users. The top EHR challenges are missing EHR functionality (55%), lack of EHR usability (42%), and support of a practice's strategic objectives (30%).


Despite these responses, the ability of EHR vendors to make inroads in the ambulatory care setting will be difficult. A vast majority of respondents (85%) are not actively looking for EHR replacement technology. This is the case for both hospital-owned and independent ambulatory facilities.

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AMA Urges CMS to Give Hardship Exemptions for Meaningful Use

AMA Urges CMS to Give Hardship Exemptions for Meaningful Use | EHR and Health IT Consulting | Scoop.it

As the waiting game for the Stage 3 Meaningful Use final rule and Stage 2 modification rule continues, the American Medical Association (AMA) is calling on the Centers for Medicare & Medicaid Services (CMS) to start taking actions to account for their delay. According to a recent press release, AMA is asking CMS to make an automatic hardship exemption due to the delay in the final rule’s release.

According to AMA President Steven J. Stack, MD, many physicians with the AMA are concerned that they will not be able to meet meaningful use standards because the details of the Stage 2 modification rule have not yet been released.


“The AMA has regularly stressed that CMS must finalize Meaningful Use modifications well ahead of Oct. 1 to provide the time that physicians need to plan for and accommodate these changes, yet CMS has continued to delay finalizing this rule,” says Stack. “As a result, many physicians who were counting on this flexibility will be subject to financial penalties under the rules currently in place.”


An automatic hardship exemption would exempt providers of financial penalties if they are not able to meet certain meaningful use standards. CMS developed hardship exemptions for providers who can demonstrate that adhering to meaningful use rules would cause a considerable hardship. AMA maintains that the considerable delay in the final rule is viable cause for an automatic hardship exemption.

The AMA is not the only organization expressing distress over the meaningful use final rule. Many entities, such as the Medical Group Management Association (MGMA) are calling on CMS to extend the meaningful use reporting period due to the delayed final rule.

The organization is concerned that medical groups will not have time to report for the final 2015 reporting period if not given adequate notice of the new EHR Incentive Program modifications.


MGMA stated that even if the modifications rule had been announced in early September, providers still would not have had adequate time to adjust workflows for the final reporting period beginning on October 3. Instead, MGMA suggested CMS extend the reporting period to either the first 90 days of 2016, or the final 90 days of 2015.


Other entities, such as the College of Healthcare Information Management Executives (CHIME), have simply urged CMS to release the modification final rule sooner. CHIME, in addition to several other co-signing industry stakeholders, states that CMS withholding the final rule is preventing providers from having adequate time to prepare to the program modifications.

CHIME reiterated that many industry stakeholders commend CMS’ efforts to refocus meaningful use standards, but feels as though inadequate time is being given to providers to make their own adjustments in time for the October 3 final reporting period.


As the final reporting period is mere days away, CMS will need to release the final rule for the meaningful use modifications soon, or many providers will be left unable to meet the final reporting deadline.

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Senator Gives 5 Reasons to Delay Stage 3 Meaningful Use

Senator Gives 5 Reasons to Delay Stage 3 Meaningful Use | EHR and Health IT Consulting | Scoop.it

Joining the group of critics of Stage 3 Meaningful Use, Senate Chairman of the Committee on Health, Education, Labor, and Pensions (HELP) Lamar Alexander (R-TN) urged the administration not to move forward with the rule in a statement before administration officials, according to a press release.

Alexander advocated against implementing Stage 3 Meaningful Use rules, stating that doing so would be a detriment to the administration’s goals of providing better and more coordinated care for patients. Using that logic, Alexander stated that there was no downside to taking their time in developing an effective and manageable rule, while giving providers adequate time to achieve Stage 1 and Stage 2 Meaningful Use.


Alexander continued by underscoring the importance of the meaningful use programs in achieving broader goals within the healthcare industry, such as goals for precision medicine and transitioning Medicare payments to value-based payments. Because of the high-stakes surrounding meaningful use, Alexander argues that it needs to be developed carefully in order for it to be effective and successful.

In his testimony, Alexander listed five reasons why the administration should delay the Stage 3 rule:


Stage 2 Has Not Yet Been Successful


First, Alexander explained how Stage 2 Meaningful Use has not yet been successful, citing the statistics that a mere 12 percent of physicians and 40 percent of hospitals have managed to achieve Stage 2 success. It would make more sense, Alexander argues, to pause Stage 3 implementation and allow providers more time to comply to Stage 2.


Medicare Payment Issues Meaningful Use Penalties


In Medicare’s transition from fee-for-service payments to value-based payments, the program has put a priority on providers meeting meaningful use standards. Because of this, providers will face harsh penalties if standards are not met. To that end, Alexander explains, it is important that providers be given ample time to properly meet these standards.


Industry Leaders Also Recommend a Stage 3 Delay


Alexander states that the general consensus that he has gathered amongst prominent providers is an overall fear of Stage 3 rules.

“Physicians and hospitals have said to me that they are literally ‘terrified’ of stage 3, because of the complexity and because of the fines that will be levied,” he explains.


Stage 3 Requirements May Actually Hinder Interoperability

A leading goal for the administration includes the interoperability between EHR systems. However, a recent GAO report which Alexander commissioned stated that many industry stakeholders find thatmeaningful use rules hamper interoperability. This is because they concentrate on achieving program requirements rather than on effectively achieving interoperability.

The Final Rule Should Match the Legislation’s Primary Goals

When developing the meaningful use programs, the administration identified seven goals for the program. Alexander argues that meaningful use rules should match and enhance these goals. The seven goals include:


  1. Decreasing unnecessary physician documentation;

  2. Enabling patients to have easier access to their own health records;

  3. Making electronic health records more accessible to the entire health care team, such as nurses;

  4. Stopping information blocking

    1. This could be described as intentionally interfering with access to my personal health information;

  5. Ensuring the government’s certification of a records system means what it says it does;

  6. Improving standards; and

  7. Ensuring the security and privacy of patient records.


Alexander suggests a timeline that would begin with phasing in Stage 2 Meaningful Use modifications, aiding providers in achieving that step of the overall program. From there, Alexander suggests the administration phase in subsequent stages “at a rate that reflects how successfully the program is being implemented.”


Alexander has advocated for delaying Stage 3 Meaningful Use before. Recently, he and Senator John Thune cosigned a letter to HHS Secretary Sylvia Matthews Burwell. In the letter, the two request that the final rule for meaningful use not be implemented until January 1, 2017 at the earliest. This letter, along with Alexander’s testimony before the administration, are just two examples of congressional resistance to the final rule.

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EHR Integration Target of DoD EHR Modernization Subcontract

EHR Integration Target of DoD EHR Modernization Subcontract | EHR and Health IT Consulting | Scoop.it

The Leidos-led team that won the Department of Defense Healthcare Management System Modernization (DHMSM) award — that is, the DoD EHR modernization project — has made another addition to its squad for the purposes of health IT integration and health information exchange.


The Leidos Partnership for Defense Health now includes Orion Health as a subcontractor, the health IT company announced Monday.


"Orion Health is proud to be part of the Leidos Partnership for Defense Health, the team that has been selected as the best value solution for the DHMSM contract," President Paul Viskovich said in a public statement.


"Together, our qualified and experienced team is working with the Department of Defense to deliver a world class interoperable electronic health records solution for our nation’s armed forces, their families and beneficiaries," he continued. "We look forward to the work ahead and are committed to improving access to comprehensive healthcare data in order to facilitate improved clinical outcomes for our deserving men and women in uniform."


According to the statement, the partnership is looking to take advantage of the company's health IT integration engine to facilitate the exchange of health data between the DoD Cerner EHR and the health IT systems of non-military healthcare organizations and providers.


Last month, the Leidos Partnership for Defense Health added Clinovations Government + Health to spearhead the team's training of "clinicians, nurses, clinical advisors and clinically-trained technical personnel to help the delivery team ensure the resulting solution is finely tuned for the military’s medical environment."


The focus now appears to be shifting to the technical nuts and bolts of ensuring that health data flows inside and outside the Military Health System, a decisive factor in the Leidos bid winning the DHMSM contract.


"Cerner’s demonstration of wide-ranging provider interoperability on multiple, different platforms were the huge differentiator over Epic’s garden-walled methodology to system user data sharing," Black Book Managing Partner Doug Brown told EHRIntelligence.com when the contract was awarded.


As part of the Leidos-led bid, Cerner beat out rivals Epic Systems and Allscripts for the project that could approach $10 billion when all is said and one.


According to research published by IDC Health Insights, financials also proved to be a key differentiator between the Cerner- and Epic-backed bids.


"The DoD's requirements are unique, which makes comparisons difficult, but pricing was surely a critical factor in the DoD decision," the research organization stated. "IDC Health Insights views the pricing of the winning bid as having come in quite low when compared with commercial EHR contracts in recent years. This gives the DoD the potential to realize higher ROI from its EHR investment than is likely possible at many private health systems."


The company will be hosting its annual user conference next week and new details about the DoD EHR modernization project are likely to emerge.

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Why Our Independent Practice May Be at Its End

Why Our Independent Practice May Be at Its End | EHR and Health IT Consulting | Scoop.it

We are many things: husband and wife, doctor and administrator, and parents. When you first meet us we appear pretty vanilla, but in fact, in our lives, when we come upon two metaphorical roads diverged in a wood, we often choose the one less traveled by. This month, on September 9, we celebrated 15 years of marriage and took time to reflect on our path so far and where we think we're going next.


Here are a few unusual choices we've made along our path so far. We met on Match.com in 1999 when very few people did that. We got engaged only six months after meeting and married nine months after that. Uncle Sam paid for Terence's medical school education which meant we spent the first six years of his career — and our marriage — as an active-duty military couple. The Air Force took us away from our home state of Massachusetts; we lived three years in Dayton, Ohio, and the next three in Albuquerque, New Mexico. In 2006, we opened our solo pediatric micro-practice even though everyone, including our accountant at the time, told us it couldn't be done. And in 2008, we met a beautiful four-and-half-year-old little boy whom we adopted a year later.


From 2006 to 2014, our micro-practice model worked well for us. We enjoyed an average income for primary-care pediatricians in our area all while maintaining work-life balance and giving patients long appointments that run on time. We also continually received high marks on patient satisfaction surveys and performed very well on the quality measures set by our independent physician association (IPA). And, because we were small and flexible, it was easy for us to adapt to changes, like integrating behavior health, into our model. It's not that small practice ownership has even been simple, but until recently we could make it work.


Our model in 2015, though, has stopped working as well. Understanding why our revenue is down, over 20 percent, is pretty easy and almost all due to the consolidation of insurance companies. To be clear, our problems are not at all uncommon; we see many primary-care peers, in all sorts of different practice models, suffering for the same reason. We are losing confidence that any independent practice model has the power to survive against the oligopoly of powerful insurance payers.


The pressure to abandon independence, and along with it the many benefits to ourselves and our patients, is increasing exponentially. The day is drawing near when we must choose between the road everyone else is taking —namely to abandon independence — or find a more creative road less traveled. For now, we appear to be on a single-lane, one-way highway to selling out without an off ramp to stay independent in sight.

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ONC Posts Health IT Policies for Improved Accountable Care

ONC Posts Health IT Policies for Improved Accountable Care | EHR and Health IT Consulting | Scoop.it

The Office of the National Coordinator for Health IT (ONC) has released a full document containing health IT policy levers on its website, giving various healthcare professionals access to different ways states leverage health IT to increase accountable care.


The document, entitled the State Health IT Policy Levers Compendium, reportedly lists nearly 300 different health IT policy levers and explains how states are able to use them to advance the use of health IT, interoperability, and system delivery reform.



For example, the document starts off by discussing how accountable care organizations (ACOs) can work to leverage different health IT policies. ACO payers such as Medicare or Medicaid within different states can require participants to use an interoperable EHR or participate in a health information exchange (HIE).

State entities contracting with providers for participation in an accountable care arrangement can align provider requirements with activities supporting interoperability. For instance, providers may be required to demonstrate they have adopted interoperable health IT or are participating in a health information exchange service in order to participate in the arrangement. Providers who can demonstrate adoption of interoperable health IT could also be provided with opportunities to earn greater rewards/access to shared savings under the terms of the arrangement.

These policy levers work by incentivizing different health IT capabilities. When the states implement certain health IT requirements, or create rewards for using different capabilities, they support the impactful adoption of health IT. All in all, this can help advance the triple aim of healthcare for better care, better spending, and better patient health.


“A health IT policy lever can be defined as any form of incentive, penalty, or mandate used to effectuate change in support of health IT adoption, use, or interoperability,” ONC writes in aCompendium overview. “This tool will help advance the country toward a delivery system with better care, smarter spending, and healthier people.”

The Compendium lists several different healthcare programs that can leverage health IT, and shows that many of them can help advance interoperability. For example, state appropriated funds can be focused on statewide HIE programs, or state lab requirements can include provisions regarding interoperability.


Some of the initiatives can also be leveraged to improve quality care and patient safety. State insurance commissioner policies can be focused on care quality through meaningful adoption ofinteroperable health systems. Additionally, state privacy and security policies can include provisions that “allow for more computable privacy while ensuring appropriate data is protected and shared.”


In addition to describing different potential policy levers, ONC lists the different states that have already embraced such levers. For example, when describing the state privacy and security policies, ONC reports that 16 states have already adopted that lever, including Alaska, Arizona, Arkansas, Colorado, Illinois, Iowa, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, Texas, Utah, and Wisconsin.


The compendium also has several limits. In lacking a full examination of how these different policy levers have worked for the states, the compendium is limited in giving a truly meaningful list of policy suggestions. Additionally, ONC acknowledges that its data sources are limited, and that state policymakers should consult other data sources in order to get a full view of how different policy levers would work to better their health IT use.


In all, the ONC hopes to continue to build on this document as the varied uses of health IT continues to grow. This will help ensure that states adjust their policies with each change that the industry sees.

“ONC expects to maintain the Compendium via periodic updates,” ONC writes in its document overview. “This initial launch will serve as a foundation upon which ONC will work with states to update and refine the information in the tool. It will also allow ONC to make improvements to the structure and possibly the format of the Compendium.”

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Recapping Recommended Changes to Meaningful Use Requirements

Recapping Recommended Changes to Meaningful Use Requirements | EHR and Health IT Consulting | Scoop.it
The American Health Association (AHA) is the latest industry group to share its recommendations for changes to meaningful use requirements following the publishing of modifications to Stage 2 Meaningful Use and requirements for upcoming Stage 3 in October by the Centers for Medicare & Medicaid Services (CMS).

As a result, it's worthwhile in light of the AHA's most recent comments to recap the similar recommendations made by these industry groups representing large constituents of healthcare organizations and professionals.


Adopting 90-day reporting period

AHA joins the College of Healthcare Information Management Executives (CHIME) and Healthcare Information Management Systems Society (HIMSS) in calling for a 90-day reporting period for Stage 3. Echoing CHIME, the former contends that the first year of any stage requires considerable buildup and preparation.


"Experience to date indicates that the transition to new editions of certified EHRs is challenging due to lack of vendor readiness, the necessity to update other systems to support the new data requirements, the mandate to use immature standards, an insufficient information exchange infrastructure and a timeline that is too compressed to support successful change management," AHA Executive Vice President Thomas P. Nickels states.


Postponing the start of Stage 3

Neither AHA nor CHIME wants the next stage of the EHR Incentive Programs to begin prior to 2019. For its part, the former is seeking alignment between meaningful use requirements and those likely to come out of the Medicare Access and CHIP Reauthorization Act (MACRA).


Both organizations have pointed to provider struggles with previous stages of meaningful use as proof that the program's timeframe does not reflect experience-to-date of eligible hospitals and professionals whose success in Stage 1 did not carry over into Stage 2.

"All providers require sufficient time to implement and upgrade technology and optimize performance before moving to more complex requirements for use," adds Nickels.


Eliminating all-or-nothing approach

The American Medical Association (AMA) was likely the first industry group to advance this notion, but it now has company.

AHA, CHIME, and the aforementioned organization all seek the removal of the all-or-nothing thresholds required by the EHR Incentive Programs. AHA goes so far as to set the bar at 70 percent for EPs and EHs in successfully demonstrating meaningful use.


Reducing reporting burden on providers

Here AMA and CHIME are in agreement. The former was much more explicit in calling on CMS to allow providers to get the most out of the data they already have that can be used for the EHR Incentive Programs, Alternative Payment Models (APMs), and the Merit-based Incentive Payment System (MIPS).


Advancing interoperability

AHA, CHIME, and AMA all agree that Stage 3 needs to play a significant role in advancing interoperability and therefore must change significantly in order to do so.


For AHA, it's about use cases. "Prioritization of use cases that accelerate the exchange of the current meaningful use data set that is being captured to support care will build confidence and support for tackling the capture and exchange of additional data elements," writes Nickels.


Echoing AMA, the organization emphasized the need for more time for the healthcare and health IT community to address the issue. "The AHA urges CMS to allow the current market pressures for information exchange from consumers and from new care delivery models to accelerate demand for information exchange," added Nickels.


Many more recommendations comprise the letters from these industry groups to CMS, but a consensus is growing more steadily for some changes.


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HITPC Claims Interoperability Progress Not Fast Enough

HITPC Claims Interoperability Progress Not Fast Enough | EHR and Health IT Consulting | Scoop.it
Four general policies and developments could help speed up the interoperability initiative.


As a part of a federal mandate to improve EHR use, interoperability, and connected care, the Health IT Policy Committee (HITPC) has submitted its December report to Congress explaining barriers and policy suggestions with regard to interoperability.


Develop Health Information Exchange (HIE) Measures

The first policy suggestion the HITPC explained to Congress was the establishment of HIE-sensitive measures which would not only measure the amount of information providers were exchanging amongst one another, but the meaningfulness and impactfulness of that information. In order for providers to receive high scores on these measures, the information exchanged would need to be used meaningfully, as to reflect an important use of the information.


“In order to enhance the strength of incentives that drive interoperability, a set of specific measures should be developed that focus on the delivery of coordinated care, facilitated by shared information across the entire health team (including the individuals and families) and throughout the continuum of care settings,” the HITPC explained. “An example of an HIE-sensitive measure would look at medically unnecessary duplicate testing.”


This new policy could be effective in strengthening incentives by first allowing payers to incorporate these measures into their payment methods, and second by integrating these measures into public reporting that would in turn reveal which providers give the highest level of coordinated care.


Develop Vendor HIE Measures for Certification

Just as providers should be tested against certain HIE-sensitive measures, as should vendors. Such measures could potentially serve as a direct catalyst to improve vendor developments and performances.


Specifically, HITPC is looking for these measures to occur in practical use -- not in a lab -- and to take into account needs that go beyond certification measures for the EHR Incentive Programs.

“Today, purchasers of EHR systems lack such measures to inform purchasing decisions or to use as a lever to put pressure on vendors to improve,” HITPC confirmed. “Although vendors have strong incentives to pass the interoperability requirements for EHR certification, this process is “one-time” and occurs in a lab. It has not been shown to translate into interoperability that is affordable or easy to implement in the field.”


HITPC also listed a few specific measures that could record vendor HIE performance:

  • Number of data exchanges from external sources, which could include other providers, community social-service organizations, consumers, payers, etc. (denominator that measures ability to exchange data with another electronic system such as an EHR, HIE or consumer application (app));

  • Percentage of external data elements viewed (numerator that measures perceived value of the external data);

  • Percentage of external data elements incorporated/reconciled with internal records (represents meaningful data); and

  • Percentage of time viewing of external data changed current activity (e.g., appeared in clinical decision support, led to change in order being written), which demonstrates impact of external data.

Accelerate Incentive Payments for Interoperability

HITPC maintained that in order for providers and vendors to make interoperability progress, they must have adequate incentive payments. Not providing incentive payments encourages providers to deal with internal needs rather than prioritize interoperability.

Today, the lack of palpable financial incentives for interoperability favors the status quo. Pressing internal priorities compete for attention and resources are needed to achieve interoperability, especially when specific actions to enact interoperability are complex and time-consuming. This results in slow progress. Moving interoperability up the priority list will likely take financial incentives that are more targeted than a broad shift from fee-for-service to pay-for- 17 value. To have the desired effect, the incentives must be strong and specific, with clearly defined measures and a deliberate implementation timeline and effective dates.

Initiate Sustained Multi-Stakeholder Action

In order for the above-mentioned goals to be met, HITPC explained that multiple stakeholder groups will need to take action in the overall interoperability efforts. Several of the policy suggestions, such as creating HIE-sensitive provider measures, require multiple voices for development, and multiple interpretations of the ONC Interoperability Roadmap.

Thus, HITPC suggested creating an interoperability Summit of various industry stakeholders in order to collaborate on interoperability efforts.

The output of the Summit would be an action plan with milestones and assigned accountabilities for achieving the milestones in the context of this larger interoperability initiative. We expect the compelling call-to-action would engage the stakeholders to continue their activities after the Summit as a way of meeting the payer-driven incentives that reward HIE-sensitive measures of coordinated care.

Earlier this year, Congress requested a report from the Office of the National Coordinator for Health IT (ONC) which detailed the issues surrounding information blocking. In the report, the ONC both defined information blocking as a practice, and provided examples.

Specifically, ONC defined information blocking as using criteria of interference, knowledge, and lack of justification for refusing to share information.


The information provided in this most recent report from HITPC could potentially put an end to those negative information blocking practices by providing incentives for fostering HIE and interoperability. Between monetary incentives and a clear prescription of HIE measures, both providers and vendors could ideally implement more effective interoperability strategies.


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An Early Retirement for the EHR Incentive Programs in 2016?

An Early Retirement for the EHR Incentive Programs in 2016? | EHR and Health IT Consulting | Scoop.it

The coming year will be the last for the EHR Incentive Programs as a result of no longer proving valuable to eligible hospitals and professionals, according to DirectTrust.


The non-profit association with the mission to support health information exchange and interoperability made the claim as one of its six predictions for 2016.



"Having accomplished the significant goals of greatly expanded EHR adoption and baseline interoperability via Direct, but also having alienated almost the entire health care provider community by overreaching for the final, Stage 3 version of its regulations, the Meaningful Use programs will be phased out by the end of 2016," the organization maintained in a public statement. "Providers are particularly worried because the requirements of Stage 3 MU do not align well with MIPS and MACRA, the new rules under which Medicare will pay for value and performance, rather than for volume of care."

DirectTrust sees things playing one of two ways.


"It may occur as a result of massive defections by providers willing to face fee schedule penalties rather than spend more resources on health IT that doesn’t add value to their practices and hospitals, it continued. "Or, it may happen as a result of Congressional action, or because CMS and ONC see the hand-writing on the wall and scale down and bow out gracefully."


The organization's prediction echoes the sentiments of Beth Israel Deaconess Medical Center CIO John D. Halamka, MD, MS, who less than a month ago asserted that meaningful use had served its purpose and ought to give way to Medicare Access and CHIP Reauthorization Act (MACRA).


Similarly, both DirectTrust and Halamka consider the lofty aims of Stage 3 Meaningful Use are sufficient cause for moving away from the federal program.


Elsewhere in its health IT predictions for 2016, DirectTrust expects patients to take on a more significant role in ensuring the electronic exchange of their health data:

Patients will have greater access to their clinical records, and they will be able to more freely and easily move those records whenever and to whomever they choose. Health care consumers will take as their right control of their own health information in much greater numbers. The corresponding willingness of provider organizations to permit this patient engagement — and to view it as positive and productive to attaining better health outcomes — will also become more evident across the U.S.

The consequence will be a freeing of data and an increased focus on patient-facing applications although it may not go as smoothly as desired.


"This will not happen linearly; rather it will grow explosively, and then suffer hiccups and setbacks as the privacy and security risks of such systems are first exposed, and then dealt with. But it is going to happen," the group added.


This is likely to tie in with another of its predictions — the coming to the fore of health data security and privacy in 2016.


"The cost of data breaches in health care is simply too high to be tolerated," DirectTrust stated. "As use of electronic health information exchange soars, we will experience a corresponding rise in concern about and actions taken to mitigate the risks of exposure of both data at rest and data in transit. Parties involved in electronic data exchanges will insist on more and more rigorous certification, accreditation, and audit of security and identity controls as a first condition of participating in data sharing."


In its remaining predictions, the organization anticipates a movement toward greater interoperability on the part of federal and state agencies as well as a growing reliance on Direct exchange for enabling the secure and interoperable movement of health data between and among providers for the purposes of care coordination.

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ICD-10 Success for Large Practices, Problematic for Small

ICD-10 Success for Large Practices, Problematic for Small | EHR and Health IT Consulting | Scoop.it

Several weeks following the implementation of the ICD-10 code set, the progress of the transition appears to vary according to size of the practice. While many large practices are reporting success with the transition, some smaller ones are reporting difficulty.


According to a blog post by the Coalition for ICD-10, many of the group’s members -- which happen to be larger healthcare providers -- are reporting great success with the transition. Many, like Centegra Health System, credit this success to the ample time for preparation they received.


“Centegra Health System was prepared for a smooth ICD-10 transition after two years of careful planning. Our information technology systems have been updated and our educational plans were deployed to help with the initial roll-out,” said Centegra’s Executive Vice President, Chief Financial Officer, and Chief Information Officer David Tomlinson.



Additionally, some coalition members stated that their success on October 1st is due in large part to their early implementation of the code set.


“Northwest Community Healthcare’s transition to ICD-10 has been smooth. This is due, in part, to our early clinical rollout of ICD-10 with our Epic Go-Live date of May 1, 2015,” said President and Chief Executive Officer of Northwest Community Healthcare Stephen Scogna.


Other members of the coalition, such as insurer Blue Cross Blue Shield of Michigan, reported a few bumps in the road amidst a generally smooth transition.


““BCBSM’s ICD-10 implementation went very smoothly. Call center volumes and overall inquiries are very low. Professional and facility claims are processing as expected. A few issues noted, which we are resolving, but nothing major to report,” the insurer said.


BCBSM also reported that it was the first private insurer to reimburse the hospitals it serves.


“Received kudos from our hospitals stating that BCBSM was the first payer to pay ICD-10 claims and these claims are paying as expected. Hospitals are not reporting any major issues. Other Payers (Priority, Cigna, Aetna) are reporting the same experience in that they are not seeing any major issues.”


However, this success is in contrast to what some other smaller providers are reporting. The impact of ICD-10 on smaller providers is a little bit more weary as these providers have fewer resources to work with.

For example, Linda Girgis, MD, FAAFP, told EHRIntelligence.com that due to how small her practice is -- she and her husband are the only physicians in the family practice -- its workload has grown much larger. This work includes changing patient problem lists from ICD-9 codes to ICD-10.

"The doctors are doing it right now," she says. "I'm doing it as I come across different patients, but definitely it's adding time on to the workday."


Smaller practices are especially affected by ICD-10 troubles because much of their revenue comes from the Centers for Medicare & Medicaid Services (CMS), and the agency has been reportedly unreachable throughout the transition.


"My biller tries to call every day. Since October 1, they have messaged that they are down due to technical difficulties so it's impossible to get through to any person there,” Girgis said.


Not receiving CMS payment is problematic for small practices like Girgis’ because those payments may amount to almost 30 percent of hospital revenue. While a larger hospital, like those mentioned above, may be able to do without 30 percent of its revenue for a month or two, this kind of issue could be potentially detrimental for a practice like Girgis’.


"Big organizations, hospitals, and groups can go a few months without 30 percent of their reimbursement coming in. But for small practices, that can be devastating," argues Girgis.


CMS set a timeline for rolling out ICD-10 payments, stating that those claims would be reimbursed within the first 30 days of the new code set. As that 30-day timeline draws to a close, small practices will be waiting to see if their claims are reimbursed.

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EHR Interoperability Limited in Integrated Care Facilities

EHR Interoperability Limited in Integrated Care Facilities | EHR and Health IT Consulting | Scoop.it

EHR interoperability has been brought to the forefront lately as various health organizations and government agencies push for nationwide health information exchange. Furthermore, as integrated healthcare and care coordination become fixtures in the healthcare delivery industry, interoperability of systems between different kinds of practitioners shows itself to be critical.

A recent study by Maribel Cifuentes, RN, BSN, Melinda Davis, PhD, Doug Fernald, MA, Rose Gunn, MA, Perry Dickinson, MD, and Deborah J. Cohen, PhD, discussed how EHRs operated in 11 practices that were integrating the delivery of primary and behavioral healthcare. The researchers found that when behavioral health and primary care begins to integrate, the two kinds of practitioners brought separate EHR systems with them. This caused challenges and subsequent workarounds and solutions associated with EHR interoperability.


The study took 11 integrated practices in the Colorado area and gathered data regarding how EHRs worked for their needs, the challenges practices faced, what kinds of workaround strategies practices developed, and what kinds of long-term solutions the practices identified in order to promote care coordination over an EHR.

One of the challenges many of the integrated practices faced was that the EHRs were not necessarily designed to collect a certain kind of data. For example, in a primary care facility that hired several behavioral health counselors (BHCs), the facility’s EHR may not have been conducive to collective behavioral health data.


Second, EHRs generally lacked templates for primary care physicians and BHCs to develop coordinated care plans.


Third, many EHRs were not interoperable with each other, hindering primary care physicians and BHCs from working together in delivering coordinated care. The EHRs were also not compatible with tablet devices that were used to collect behavior health information in the waiting room prior to appointments. These tablets were used to present questionnaires that would provide behavioral health data. However, the lack of interoperability between these devices and EHRs made it so the data collected in the questionnaire could not easily be uploaded into the EHR.


The study reports four workarounds that were developed in the face of these challenges. First, as stated above, when the primary care and behavioral health practices first integrated, the physicians often had their own separate EHR systems. In order to make sure both systems had patient information, physicians had to manually enter the data into both EHRs. While this method may have been effective in ensuring patient information was stored in both EHRs, it was not particularly time or financially effective.


Second, medical assistants had to manually scan printed documents into EHRs. While this method may have also been effective, it presented several time and financial issues. Furthermore, the scanned documents were often harder to find in the EHR, hindering the physician from delivering care to patients in a timely manner.


Third, practitioners relied on patients and other physicians to recall patient information. This workaround was not effective because patient and physician memory was neither reliable nor accurate. One physician reported having to recall patient information that was told to him several weeks before meeting with the patient. Due to the amount of time that had passed since he had last discussed this patient, he was unable to determine what kinds of services the patient needed. This resulted in the patient taking tests that had already been administered.


Fourth, practitioners employed “freestanding tracking systems,” such as spreadsheets, that were not a part of the EHR. For example, one practice stored information regarding adolescents taking selective serotonin reuptake inhibitor medications in an Excel spreadsheet. Although this was widely used amongst the practice, it took enormous effort from practitioners to maintain, and the information on the spreadsheet was not easily integrated into the EHR.


By the end of the study, researchers observed that practices began moving past workarounds and toward more long-term solutions to their challenges in order to make their integrated practices more sustainable in the future. The researchers noted that these solutions were created by each practice’s own HIT teams and required their own funding. Three key solutions amongst the participating practices emerged.


First, many practices created their own customized EHR templates. These templates existed within their pre-existing EHR systems, and simply added more fields for data entry that would be more suitable for practitioners’ needs. However, developing these templates was an arduous task.


“Creating customized EHR templates was time consuming and required dedicated HIT staff working collaboratively with BHCs and primary care providers,” the researchers reported. “Practices that did not have access to these resources were not able to create customized templates as readily, or had to pay EHR vendors to do so.”

Second, some practices purchased EHR upgrades and reported several improvements from doing so, including increased interoperability, enhanced reporting templates, and more interfaces for integrating primary and behavioral health care.


However, EHR upgrades were considerable financial investments for practices. Practices were not allowed to upgrade their EHRs using the money allocated to them by participating in the study, so the upgrade needed to be a part of the individual practice’s investments. This financial burden made it so only five of the 11 participating practices were able to upgrade their EHRs.


The final emerging solution was the union of two EHRs. At the start of the study, four of the 11 participating practices were using two different EHRs -- one for behavioral health care and one for primary care. By the end of the practice, three of them were in the midst of merging those two EHRs, and one had built an interface that extracted data from multiple EHRs and stored the data in one place. While these solutions were quite complicated and costly, they were the most effective in overcoming interoperability challenges.


Despite the advances these practices made, the researchers maintained that integrated providers may still face hurdles in the future.


“EHR systems are not yet optimally designed to meet the needs of practices integrating behavioral health and primary care,” the researchers stated. “Our study found that EHRs generally lack features essential to support key integration functions such as documenting and tracking longitudinal data, working from shared care plans, and template-driven documentation for common behavioral health conditions such as depression.”


The researchers provided guidance on how to improve EHR use in integrated care situations, stating that perhaps systems need to start being designed for integrated care, as should different incentive programs.


“In the future, HIT systems should be intentionally designed, in cooperation with clinicians; to support and enable these integrated care functions, as well as the different modes of communication and care coordination tasks that occur between multi-professional members of integrated teams,” the researchers maintained.


Furthermore, the researchers stated that more financial incentives should be provided to allow practices to make these kinds of changes. Although several EHR and interoperability incentive programs exist, none of them provide incentives that would help practices change their EHR systems to make it more usable in an integrated practice.

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NIST Ties Limited EHR Usability to Patient Safety Risks

NIST Ties Limited EHR Usability to Patient Safety Risks | EHR and Health IT Consulting | Scoop.it

The National Institute of Standards and Technology (NIST) has issued new guidance for ensuring patient safety by improving EHR usability.


The results from a technical evaluation, testing, and validation of EHR usability list three "major critical risk areas: the EHR data identification, EHR data consistency, and EHR data integrity.


"Ultimately, the data from this study demonstrate that during safety-critical tasks and times, patient safety is negatively affected, in part because mistakes and critical use errors occur more frequently and because users are highly frustrated, and thus more likely to employ workarounds, such as relying upon supplemental artifacts, e.g., paper ‘shadow charts’ or whiteboards," the authors conclude.


The NIST report identifies a handful of ways EHR problem areas contribute to inadequate patient care:


  • clinically relevant information being unavailable at the point of care
  • lack of adequate EHR clinical documentation
  • inaccurate information present in the clinical record
  • inability to retrieve clinical data


Based on empirical analysis of inpatient and ambulatory EHR use, the NIST document proposes three EHR usability enhancements that EHR technology incorporate to eliminate or reduce risks to patient safety.


The first centers of how critical patient identification data is presented. According to NIST, this information should be presented in a reserved area. The authors of the report recommended reserving the upper left-hand corner of all screens or windows and remain persistent regardless of scrolling or navigation throughout the EHR. Additionally, they hold that a patient's name appear with last name first, followed by first and middle names, modifiers, data of birth, age, gender, and medical record number (MRN) number. For EHR mobile technology, the NIST guidance allows for the presentation of this information horizontally to maximize screen space.


The second enhancement calls for the use of visual cues to "reduce risks of entering information and writing orders in the wrong patient's chart." The enhancement would prevent EHR users from entering information into multiple charts simultaneously as well as visually different between read-only and editable charts. Under this guidance, EHR users would have to deliberately enable the software to move between charts and maintain unrestricted access and provide clear cues when an EHR user moves between charts.


The third and final enhance places an emphasis on supporting the effective identification of "inaccurate, outdate, or inappropriate items in lists of group information by having information presented simply in a well-organized manner." The NIST document contains several examples:

3.1 Lists of patients assigned to a particular clinician user should be presented in consistent, predictable locations within and across displays and print-outs and the content should not vary based on display location.

3.2 The status of a note and order as draft as compared to final shall be clearly indicated on appropriate displays.

3.3 Clearly indicate the method by which the system saves information, whether auto-save or requiring deliberate action to save, or combinations thereof.

3.4 Inputted information should be automatically saved when a user transitions from one chart to another.

3.5 The language used should be task-oriented and familiar to users, including being consistent with expectations based upon clinical training.

3.6 Enable a user to easily order medications that have a high likelihood of being the appropriate medication, dose, and route. The likelihood is increased when displays are tailored to specialty-specific user requirements, comply with national evidence-based recommendations, are in accordance with system, organizational, unit, or individual provider preferences specified in advance, or are similar to orders made by the same physician on similar patients, on the same patient in the past, or providers with similar characteristics.

3.7 Support assessing relationships of displayed information and allowing users with appropriate permissions to modify locations and relationships for inaccurately placed information, including laboratory results, imaging results, pathology results, consult notes, and progress notes. This includes information within a single patient’s chart as well as information placed in the wrong patient’s chart. The information about the time and person that made the change should be viewable on demand.

On top of these recommendations, the guidance provides two use cases to illustrate the components of EHR usability testing in identifying and mitigating potential patient safety risks in both inpatient and outpatient settings. 

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Ensuring Quality Throughout the Evolution of Clinical Documentation

Ensuring Quality Throughout the Evolution of Clinical Documentation | EHR and Health IT Consulting | Scoop.it

Throughout my HIM career, I have seen many different methods of capturing clinical documentation. We are always looking for solutions to get accurate and complete clinical documentation into the medical record in a timely manner with minimal disruption to the provision of care. The processes for gathering documentation have evolved with advances in technology and HIM professionals have been very involved in ensuring the quality of the documentation.


When I first began working in an HIM department, we had a Transcription department with hospital-employed transcriptionists and a management team devoted to medical transcription. Quality reviews were performed regularly and the transcriptionists had an ongoing relationship with the physicians to provide feedback and get clarifications. As part of this department, there were file clerks in charge of filing the transcribed documents onto the paper medical records throughout the day and into the night. When I think back on these practices, it seems like an entirely different lifetime from today’s practices yet it really wasn’t that long ago.


Over time, transcriptionists began to disappear from hospitals as the task became outsourced. Vendors have offered to do the job for less cost and they guaranteed a high quality rating of the transcribed reports. However, transcribed reports often still come back to the medical record with blanks and anomalies that must be corrected by the dictating clinician which can delay the documentation reaching the chart. It’s important to review documents to make sure there are no obvious errors that may have been misinterpreted by the transcriptionist or the back-end speech recognition system.


Many are still relying on outsourced transcription as a major source of capturing documentation but this is evolving as EHRs have created new opportunities for documentation. EHRs provide documentation tools such as templates to import data into the notes and allow for partial dictation for the narrative description. The negative side of this is that copy and paste is used frequently due to the ease of grabbing documentation from the rest of the EHR and pasting it into the note to save time. Clinicians using copy and paste may not realize that the information could be outdated or it could be against company policies. This now requires quality reviews to monitor the use of copy and paste and the relevance of the documentation to maintain the integrity of the medical record. This should be incorporated into chart audits or other quality review processes.


Front-end speech recognition tools are popping up frequently as an additional tool to capture documentation. A concern with this is the shift from having quality reviews performed by the transcriptionist to now relying on the clinicians to edit their documentation as they dictate. Many are creating positions in HIM departments to perform quality reviews on the documentation to not only ensure the documentation is in the record in the adequate timeframe but making sure the documentation is accurate for each patient. It will be interesting to see how clinical documentation continues to evolve as new methods of capturing documentation are developed and deployed. No matter how the information gets into the medical record, HIM professionals still have the ultimate responsibility to ensure the quality of the documentation for patient care and appropriate reimbursement.

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How Improving Physician EHR Use Can Benefit the Diagnoses

How Improving Physician EHR Use Can Benefit the Diagnoses | EHR and Health IT Consulting | Scoop.it

Although physician EHR use has many benefits, including increased care coordination and patient engagement, issues with interoperability and health information exchange sometimes hinder the diagnosis process.

Such was the case with the first Ebola patient in Dallas, Texas last year. According to a post by Dean Sittig, PhD, and Hardeep Singh, MD, MPH, there are various different EHR practices that could have been done that may have potentially changed the outcome of the patient’s Ebola diagnosis.


Sittig and Singh based their theories on an Institute of Medicine (IOM) report that made suggestions for best practice uses for EHRs that would make diagnosis easier and more precise. According to the authors, had some of these practices been in place during the time of Ebola Patient Zero’s hospital visits, his diagnosis may have been more effective.


First, Sittig and Singh discussed the care coordination benefits of EHRs and how they may not have been fully utilized at the time of Ebola Patient Zero’s first emergency room visit. Although Ebola Patient Zero’s medical and travel history were taken by the ER nurse, that information was not passed along to the ER doctor, something which may have been prevented had different EHR practices been in place.

We recognize that there are many other ways to improve teamwork but in this day and age a major component of making teams function well is having EHRs that support teamwork and communication. Unfortunately, EHRs are not inherently designed this way and substantive ‘real-world’ usability testing is needed in order for them to do so,” wrote Sittig and Singh.

The authors suggest that EHR interfaces could improve both nurse and physician workflows in such a way that care coordination and teamwork would be better facilitated. For example, note-taking screens should not necessarily distinguish between physician notes and nurse notes, Sittig and Singh suggest. Instead, all members of the care team should be privy to all of the patient’s medical history.


“The ability to review every patient’s complete medical history in a longitudinal manner is a key factor in making an accurate and timely diagnosis. EHR screen designs could be greatly improved if they were shared among all EHR users, regardless of vendor,” the authors wrote.

Furthermore, Sittig and Singh discuss certain misuses of EHR technology. For example, the authors suggest that perhaps EHR quality measures and incentive programs should not always require nurses be tasked with gathering information regarding patient flu vaccination history. The authors maintain that although it is impossible to know whether this change in workflow would have improved Ebola Patient Zero’s diagnosis, it is a commonly acknowledged fact that certain required EHR incentive measures have an effect on how clinicians communicate with patients.


Sittig and Singh state that Ebola Patient Zero is a case study for all of the work that can be done to improve EHR use in diagnostic settings. These improvements can be made through industry collaboration and the sharing of best practices. Furthermore, the pair states that EHRs need interoperability to allow for collaboration and to help paint a complete picture of the patient’s care. Through the participation of policymakers and industry stakeholders, Sittig and Singh state that EHR healthcare can become safer and more effective.

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CMS Administrator Welcomes Providers to ICD-10 Compliance

CMS Administrator Welcomes Providers to ICD-10 Compliance | EHR and Health IT Consulting | Scoop.it

On October 1, the healthcare industry began ICD-10 compliance after countless months of preparation. In a CMS post, Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) welcomed providers to ICD-10 and provided words of guidance to industry stakeholders on the transition day.

According to Cavanaugh, it may take a little while before CMS is able to assess how the transition to ICD-10 is proceeding. The reasons for this are twofold: first, most providers do not file claims on the same day as a service has been provided, and second, it takes a few weeks for CMS to process Medicare and Medicaid claims.


“Even after submission, Medicare claims take several days to be processed, and Medicare -- by law -- must wait two weeks before issuing  payment. Medicaid claims can take up to 30 days to be submitted and processed by states,” Cavanaugh wrote.


It is most likely that CMS will be able to assess ICD-10 progress following the first complete billing cycle. This is consistent with other CMS claims. In aconference call with industry stakeholders which took place a week before the October 1 deadline, CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, confirmed the same timeline for checking ICD-10 progress.

Until then, Cavanaugh explained, CMS plans to closely monitor the transition. Furthermore, CMS will be managing problems and questions that are submitted to the ICD-10 Coordination Center, which is staffed by several Medicare, Medicaid, billing, coding, and health IT experts to assist during the transition. In addition to the ICD-10 Coordination Center, Cavanaugh points providers toward other ICD-10 assistance resources, including William Rogers, MD, the ICD-10 ombudsman, and Medicare Administrative Contractors (MACs).


Cavanaugh also discussed the potential benefits of the ICD-10 transition, including the promise of more detailed health data reporting and and better healthcare delivery. By increasing the detail with which medical care is reported, policy changes can be more specific to the needs of populations.


“The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country,” he wrote. “ICD-10 will help move the nation’s health care system to better, smarter care.”


These hopes for ICD-10 have been mirrored by many industry stakeholders, including AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. Thomas Gordon recently stated howICD-10 will be of great benefit for patients because it will allow for better healthcare innovation due to the extensive detail of health records.

“As an active leader, supporter and advocate for ICD-10, AHIMA is pleased that the greater detail inherent in the code set will reverse the trend of deteriorating health data and tell a more complete and accurate patient story,” she said.


As providers continue with their transition to ICD-10, CMS is expected to report any major issues and provide guidance in fostering the smoothest transition possible.

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Why More Physicians Will Adopt Electronic Health Records

Why More Physicians Will Adopt Electronic Health Records | EHR and Health IT Consulting | Scoop.it

When President George W. Bush issued an executive order in April 2004 to establish the Office of the National Coordinator for Health IT, he had a clear vision in mind: to create a secure, nationwide interoperable network that allows authorized users to access medical records of anyone at anytime and anywhere in the U.S. President Barack Obama knew very well that his plan for providing health insurance to all Americans would not be successful unless it was paired with a plan for controlling the quality and cost of health care services.


Ironically, Bush’s health IT network was (and remains) the instrumental element that guarantees the financial sustainability of Obamacare. It was no surprise that the economic stimulus package of 2009 allocated $25.9 billion for promoting the adoption and use of electronic health records systems among American physicians and hospitals. But a decade and $30 billion later, only half of the U.S. office-based physicians have adopted a basic electronic health records system and a mere 20 percent of them use such software, according to the latest statistics byRobert Wood Johnson Foundation.


Now that the government funds for promoting adoption and use of such records are dried up, what will happen to the rest of doctors who have not ditched their old-school paper charts yet and still keep their patients’ records in a filing cabinet? In the following, I discuss three drivers which together will lead the other half of physicians to adopt electronic health records systems in the near future.


Marketing efforts by vendors


To increase their profit margins, electronic health record vendors prefer to target customers who will either make a large purchase (large health care organizations with multiple users) or are close by and thus do not require expensive marketing efforts. That is part of the reason why many of the physicians who have adopted such systems are affiliated with larger hospitals or are located in populated urban locations. Now that the low-hanging fruits are all harvested, vendors will focus their marketing efforts on small, office-based practices and will ultimately increase adoption rates.


Mergers and acquisitions in the health care sector


With the march toward value-based payment models, new forms of health care organizations will continue to emerge. Some of the individually owned physician offices will become a part of an accountable care organization or will be acquired by a larger health care organization. When these smaller practices join larger ones, they will have to adopt the technologies that are already being used by the larger organization. While electronic health records may not create substantial value for an independent practice, they will be an unavoidable necessity when small practices join larger organizations. Without them, it will be impossible for a large health care organization to coordinate patient care, manage population risks and efficiently submit insurance claims.


Data analytics tools


With a basic electronic health record, a physician can record patient demographics, medications and problems, as well as type in his clinical notes and prescriptions. (No, he cannot electronically send the prescription to the pharmacy.) A physician can also view laboratory and imaging results (only if the record system is interoperable with that of a laboratory or imaging center). That’s it; nothing more. Almost all of the definedfunctionalities of a basic electronic health records system could be achieved by an elaborate Excel spreadsheet. That is why many doctors are still not willing to use them, even for free. Electronic health records by themselves are just cranky databases that only archive data.


However, with the advances in artificial intelligence and decision support systems, the data that was onerously collected by frustrated doctors can now be used to create something meaningful that make doctors’ lives a little easier. The health care industry is gradually getting out of the data collection era and is now entering into the data analysis era. When doctors see tangible benefits of analytics tools such as Isabel and Watson that are based on their electronic health record data, they will flock to such systems powered by analytics tools.

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Four ICD-10 Myths from a Critical Doc

Four ICD-10 Myths from a Critical Doc | EHR and Health IT Consulting | Scoop.it

Have you ever stood near the tracks and listened to a train coming? When the train is far away all you can hear is the distant echo of the whistle. It’s easy to ignore.  As the train gets closer you hear the engine and see the smoke. As the train comes to the station it becomes a thundering, screeching, hissing mass of steel.

If you are close enough, it can even startle you.


With an Oct. 1 start date imminent, the ICD-10 train is getting awfully close. Anyone harboring hopes of Congress rescuing us at the last minute is kidding himself. If your practice is not prepared, there are plenty of health IT companies out there who will gladly take your money to rescue you safely away from the tracks.


The supporters of ICD-10 —bureaucrats, health IT vendors, and medical academicians —have been assuring us this is for our own good. The era of big data in healthcare is coming, so they say, and ICD-10 is the perfect vehicle for collecting the rich, detailed data that will bring the next big age of medicine. ICD-9 is decades old and needs to be replaced by a system which can accommodate the advances in diagnostic acumen of recent years. Privately, these groups ridicule our misgivings and assume that we’ll complain for a while and just get over it.


Last February, Congress held hearings on ICD-10. This was supposed to be the last decision-making step before committing to the program. In reality, it was a choreographed farce designed to suppress the concerns of real-world physicians. The witnesses included two health IT vendors, two lobbyist groups, one academic physician, and two private practice physicians. All but one of the witnesses, the late urologist and president of the Medical Association of the State of Alabama, Jeff Terry, supported ICD-10.  Most of the remaining witnesses either stood to benefit financially from ICD-10 or were insulated from its effects by the academic environment.


But there is more to ICD-10 than the propaganda peddled by supporters.  Let’s look at some of the myths about ICD-10:


1. ICD-9 is outdated and needs to be replaced.  The former is true.  The latter is not.  The structure of ICD-9 (five numeric placeholders) theoretically allows for 100,000 codes.  ICD-9 could have been easily expanded by adding one or two placeholders and allowing letters to be used. This would expand capacity to over two billion codes. It would have allowed horizontal expansion (i.e., the addition of Ebola infection to the appropriate category —a favorite example of ICD-10 supporters) as well as vertical expansion (the breakdown of otitis media into left vs. right).  This could have been done without rendering any ICD-9 codes obsolete. 


2. ICD-10 based big data will improve patient care.  ICD-10 supporters would have us believe that ICD-10 based data will lead to medical miracles falling from the sky.  These utopian fantasies fail to consider the implications of the scientific method.  Medical advancements come only from experiments based on hypotheses.  Hypotheses dictate experimental design, including the methods and structure of data collection.  Lacking any hypotheses, ICD-10 creates a one-size-fits-all data collection method for all fields of medicine.  This makes absolutely no sense.


3. ICD-10 will improve quality of data collection.  I almost believed this until I began to prepare my practice for ICD-10 months ago.  Instead of a rational expansion of diagnoses I found —for my specialty, at least —a haphazard, nonsensical collection of codes created seemingly at random.  I’m not talking about the “burned by water skis on fire” stuff we have all heard about.  I discovered that every code related to ear pathology is obsessively divided into left ear, right ear, or both.  Even “vertigo of central (nervous system) origin,” which by definition does not involve the ears, requires a choice of left or right ear!  But other diagnoses —facial paralysis, head and neck cancers, sinusitis, and others —have no ICD-10 division by side.  The diagnosis of vocal cord paralysis, in which the side of involvement has long been recognized to be clinically significant, is not separated by side.  In fact ICD-10 has fewer codes for vocal cord paralysis than does ICD-9.  Does this mean that ear disorders are more worthy of big data research than sinusitis, head and neck cancer and vocal cord paralysis?  Who decided that?  There is no way, for otolaryngology at least, that such a poorly designed coding system will yield any useful data.  Don’t hold your breath waiting for any big data medical miracles.


4. Third-party payers are ready.  Who are they kidding?  Didn’t CMS claim that healthcare.gov was ready two years ago?  How many test payments to providers were sent?  There is no way to adequately test a system this complex before it goes live. Remember that CMS and private insurers have no risk on the table.  If their systems “mysteriously” fail to pay claims, they benefit by keeping the cash they would otherwise have paid out.  On the other hand, physicians will be unable to pay rent and make payroll if payments on claims are interrupted more than a few days.


The only rationale that explains ICD-10 is the desire of its supporters for a top-down, big government, centrally controlled healthcare system that regards doctors and patients as nothing more than cogs in the machine.  The folks at the top fancy themselves worthy of conscripting the rest of us into becoming uncompensated data collectors.  Doctors know that quality of care starts from the bottom, not the top —with a doctor, a patient, an exam room, and a conversation.  At best, ICD-10 will be an expensive distraction that draws money and time away from patient care.  At worst, it will paralyze the health care system.

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