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What is HIE? | Health Information Exchange

What is HIE? | Health Information Exchange | EHR and Health IT Consulting | Scoop.it

Health information exchange (HIE) allows doctors, nurses, pharmacists and other health care providers to securely share a patient’s vital medical information electronically.

 

Reducing the need for the patient to transport or relay their medical history, lab results, images or prescriptions between health professionals. Instead, this information is shared between health care providers before the patient arrives for an appointment or goes to the pharmacy to pick up a medication.

 

What is happening in YOUR state?

 

Every state has received funds to modernize how patient health information is shared. More information about the State Health Information Exchange program—including what’s happening in each state—is available at www.healthIT.gov

 

Timely sharing of vital patient information can better inform decision making at the point of care and allow providers to:

 

Avoid readmissions, Avoid medication errors, Improve diagnoses, Decrease duplicate testing.

 

There are currently three key forms of health information exchange:

 

1. Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care: http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie#directed_exchange

 

2. Query-based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care: http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie#query-based_exchange  

 

3. Consumer Mediated Exchange – ability for patients to aggregate and control the use of their health information among providers: http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie#consumer-mediated_exchange

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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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Everyone wants a piece of pop health | Healthcare IT News

Everyone wants a piece of pop health | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

Healthcare organizations are struggling to get a handle on population health, according to a new report from Chilmark Research.

Chilmark's 2014 Analytics for Population Health Management Market Trends Report reveals a market that, while seeing strong growth of interest, is still very much in its infancy.

Healthcare organizations of all sizes continue to struggle with rapidly evolving models of reimbursement while vendors have yet to effectively build-out their solution capabilities to fully meet market needs, Chilmark researchers conclude.

Migration to value-based reimbursement models that increasingly link reimbursement to clinical outcomes is a key market driver for uptake of population health technology across the healthcare sector

To effectively compete in this environment, healthcare organizations have to leverage data (clinical, claims, demographic, and others) far more effectively to improve care delivery and manage risk, according to Chilmark.

[See also: Population Health IT promises boom]

Chilmark found more than 100 vendors claiming to address analytics for population health management, but few delivering on the promise. Researchers also found that a growing number of EHR vendors are offering data analytics for population health management, offering to work with clients to create applications.

EHR vendors, however, lag significantly behind best of breed vendors, according to Chilmark.

“Vendors can be roughly divided into two categories: best-of-breed and platform-play vendors, depending on their particular products and marketing strategies," said Chilmark analyst Cora Sharma, who authored the report, in a news release. "It is currently a best-of-breed market, with providers adapting vendor solutions to meet a particular need created by a specific payment contract."



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Walgreens and Greenway Health Complete System Wide EHR Deployment

Walgreens and Greenway Health Complete System Wide EHR Deployment | EHR and Health IT Consulting | Scoop.it

Greenway Health has completed what they’re calling one of the largest centralized pharmacy cloud-based electronic health record systems ever deployed, Walgreens Cloud EHR. Walgreens has deployed the system chain-wide, giving pharmacy staff at over 8,200 locations a single, complete view of patients’ prescription, immunization and health testing records.

The EHR platform enables Walgreens pharmacists to share patient information with other providers, helping to ensure continuity and care coordination.

“Having a chain-wide EHR platform enhances our pharmacists’ ability to provide individualized immunization and health testing recommendations, which is key to closing gaps in patient care that exist today,” said Tim Theriault, senior vice president, chief information, innovation and improvement officer, Walgreens. “This solution helps further our mission to help patients in the communities that we serve get, stay and live well.”

Walgreens Cloud EHR operates in real-time mode and communicates with various systems within Walgreens’ operational IT infrastructure. The interoperable functionality and scale of the system supports an emerging trend in healthcare to leverage real-time electronic communication to deliver high-quality care.

“Consumers are demanding access to healthcare information, and Walgreens Cloud EHR delivers,” said Greenway® CEO Tee Green. “We’re proud to work with Walgreens to deliver a single system that extends to more than 27,000 pharmacists and can process 20,000 patient encounters per hour. This implementation points the way to electronic care coordination of the future.”


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Patient safety in the balance | Healthcare IT News

Patient safety in the balance | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

With Stage 2 of a planned three stages just barely underway, it probably is too soon to assess the overall effect of the $27 billion federal EHR incentive program known as meaningful use. But critics of the current state of health IT are becoming more vocal, particularly as evidence, both scientific and anecdotal, mounts, questioning whether EHRs truly are improving patient safety.

A lengthy story in the July 20 issue of the Boston Globe hit on many of the problems.

• The newspaper attributed a 2010 death at South Shore Hospital in Weymouth, Mass., to an overdose of insulin, caused by nurses administering multiple orders from an electronic and a paper-based system, each signed by different physicians.

• As the Globe pointed out and as Healthcare IT News reported earlier this year – the ECRI Institute listed health IT data integrity failure as its top patient-safety concern for 2014. "Health IT systems are very complex," James P. Keller, the organization's vice president of technology evaluation and safety, wrote in the report. "They are managing a lot of information, and it's easy to get something wrong."

No. 2 on the list was poor care coordination, followed at No. 3 by errors in reporting of test results, two conditions that health IT is supposed to remedy.

• Politics often trumps patient interests, and the Globe suggested that the Obama administration is beholden to health IT vendors. Epic Systems CEO Judith Faulkner and then-Allscripts CEO Glen Tullman supported Barack Obama's 2008 presidential campaign, and Tullman's support goes back to Obama's 2004 run for Senate. Once in office, Obama brought in former Cerner board member Nancy-Ann DeParle to run the White House Office of Health Reform, and later made her his deputy chief of staff for policy.

• The Obama administration also ignored the recommendations of the Institute of Medicine, which, in 2011, called for mandatory reporting of health IT-related "deaths, serious industries and unsafe conditions" to a federally designated watchdog. Those reports, stripped of patient and provider identifiers, should be released to the public, the IOM said. 

However, the Food and Drug Administration, the Office of the National Coordinator for Health Information Technology and the Federal Communications Commission said in a joint report this year that there would be no such mandate over EHRs, e-prescribing and computerized physician order entry systems. Instead, the report, called for in the 2012 Food and Drug Administration Safety Innovation Act, known as FDASIA, that HHS set up a Health IT Safety Center for confidential, voluntary error reporting.

The Globe also questioned the value and pace of meaningful use and the incentive money. "[The scramble by doctors and hospitals to cash in on the incentives has thrust complex, balky, unwieldy, and error-prone computer systems into highly sensitive clinical settings at a record pace," the paper said.

The Globe did mislead readers in stating, "estimates of cost savings have thus far turned out to be dramatically overblown." In fact, supporters of the 2009 Health Information Technology for Economic and Clinical Health Act, which authorized the incentive program, did not expect to realize the promise of EHRs until Stage 3. The third stage will not start until at least 2017.

Still, members of Congress are getting restless, seeking value for all the Medicare and Medicaid incentive money Uncle Sam has shelled out since 2011, a total of $24.7 billion through the end of June. (The $27 billion estimate for the whole program represents a net amount, after factoring in expected cost savings.)

Much of the angst seems related to the slow pace of interoperability of electronic health data, and it's coming from both political parties. In July, Rep. Phil Gingrey, MD, R-Ga., said during a hearing, "It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer." A week later, the Senate Appropriations Committee, chaired by Sen. Barbara Mikulski (D-Md.) asked the ONC to "decertify [EHR] products that proactively block the sharing of information." 

Other critics outside the marble halls of the Capitol have pounced, too, hitting vendors and providers alike for interoperability and usability issues.

Vince Kuraitis, a Boise, Idaho-based consultant on digital health transformation and strategy, has argued recently that providers, have a "duty to share" patient information in the name of safer care. By extension, vendors should remove barriers to their customers sharing such data with those who use competing EHRs, Kuraitis says.

Kuraitis, a nonpracticing lawyer, tweeted in July that he was "Waiting for class action lawsuit testing liability for 'knowingly' NOT sharing pt #EHR data." He called it beyond negligent, bordering on reckless behavior, for healthcare providers to withhold records.

"There is the letter of the law and the spirit of the law," Kuraitis says. "In the case of health IT, there is a huge gap." 

Following only the letter of the meaningful use regulations, not the spirit, "hinders appropriate data sharing and interoperability," Kuraitis says.

Even if they wanted to engage in health information exchange, many hospitals and medical practices are hamstrung by their EHRs, which, in turn, might be hamstrung by health IT certification that is part of meaningful use. 

"They certainly have constrained innovation," Sarah T. Corley, MD, CMO of EHR vendor NextGen Healthcare, and vice chair of the HIMSS Electronic Health Records Association, says of the certification requirements.

Corley maintains that there has been "a lot of progress on interoperability," adding, "I think it's a little early in Stage 2 to say interoperability isn't going to work."

A number of vendors, including Cerner, Allscripts, athenahealth, Greenway Health, McKesson, Sunquest Information Systems and CPSI, came together in 2013 to create the CommonWell Health Alliance, ostensibly to promote interoperability. Many, however, have taken a more cynical view. 

"It's a coalition to compete against Epic," says Kuraitis. "It's Sun Tzu and 'The Art of War.'"

On the provider side, both Corley and Kuraitis say there must be a business case to share data with those who might appear to be competitors. Those instances are starting to appear.

"Obviously, in a referral, there is a business case," Corley says. The same is true in the context of an accountable care organization.

Population health management and liability fears also could drive HIE, according to Kuraitis, who believes that looking at data from external sources should be a standard of care. "I haven't seen any studies showing that data hoarding works as a business strategy," says Kuraitis, who expects HIE to be the norm in the next 5-10 years. "But this is one of the cases where the market can tip very rapidly," he adds.

It can't happen fast enough for Ross Koppel, a University of Pennsylvania sociologist who has long been critical of what he sees as complacency among major health IT vendors. "If we wanted systems to be useful," he says, "they would have started with that."

Koppel, who first reported in 2005 on how computerized physician order entry can actually raise the risk of medication error, says clinicians miss warnings because screens are cluttered. "The systems are definitely getting better, but they've still got state-of-the-art usability of the late 20th century," he says.

"There's no focus on unified data standards and data-format standards," Koppel continues. For example, he says, there is no uniformity about how to record blood pressure. Some systems have a single column for blood pressure, while others separate systolic and diastolic readings. This can be confusing for physicians who practice in multiple settings and a nightmare for IT departments when records do get shared between facilities.

Corley says certification and meaningful use also have a bearing on usability. "The growing concern about usability, part of it we can attribute to meaningful use," she says. The requirements force providers to perform "some things you wouldn't normally have to do."

EHRs have to prompt clinicians to ask patients about tobacco use, but doctors and nurses typically use words like "smoking" and "cigarettes" rather than "tobacco products," creating a bit of a semantic headache for vendors. "We're having to map them to Snomed," Corley says.

Additionally, patient education only counts toward meaningful use if it's suggested by the software, according to Corley. And prior to MU, patient reminders had typically been sent by practice management systems, not EHRs. "But that's not what's being certified," Corley says.

She expressed hope that CMS will take such concerns into consideration in Stage 3.


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OIG: Certified EHRs aren't so secure | Healthcare IT News

OIG: Certified EHRs aren't so secure | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

It turns out, ONC's electronic health record certification process has some serious shortcomings – chief among them security practices that are wholly insufficient to adequately protect patient health information, according to a new report from the Office of Inspector General.

The report sheds light on the EHR certification procedure in its current form, which involves oversight from the Office of the National Coordinator for Health IT, and includes the National Institute of Standards and Technology, or NIST, the group responsible for developing these standards for testing and certification bodies to use.

When providers purchase certified EHRs (as of June more than 408,000 healthcare providers have received meaningful use incentive payments after purchasing a certified EHR, with CMS paying out a whopping $24.1 billion in incentives), they presumably expect these multi-million-dollar systems to meet federal security standards. 

One can't be too sure, however. Upon a closer examination of ONC's oversight process, OIG officials found the agency failed to ensure that testing and certification bodies developed procedures that "periodically evaluated whether certified EHRs continued to meet federal standards," according to Daniel R. Levinson, U.S. inspector general.

Because ONC did not enforce this, three out of the six certification bodies fell short in this arena, which caused problems down the line.   

"For example, after its initial certification, an EHR could be modified to conduct fraudulent activities, such as classifying a medical procedure as more expensive than it actually was," wrote Levinson, referring to a process known as upcoding. 

The NIST test procedures, he continued, also failed to address serious issues with password complexity. For instance, the current NIST test procedures allowed authorization bodies to certify an EHR even if it had single-character password sign on.  

What's more, after OIG reviewed security requirements and staff training at five out of six certification bodies, they found these entities were not required to have any training program in place that ensured staff were knowledgeable enough to both testy and certify these EHR and to secure patient data. Only a single entity actually trained their EHR testers in NIST IT security.

Resultantly, when holding meetings in rented office spaces, one entity used WEP to encrypt its wireless network. And, according to NIST standards, WEP is not an adequately secure encryption method. For more than a decade, industries have known this. Back in 2005, Federal Bureau of Investigation agents at the annual Information Systems Security Association meeting, for instance, using public tools were able to break a 128 bit WEP in three minutes. WEP was also at the core of one of the biggest security breaches to date -- the 2008 TJX breach when hackers stole the financial data of some 94 million people.  

For their part, ONC officials pointed out to OIG that authorized testing and certification bodies are no longer involved in the ONC Certification Program. Rather, separate ONC entities are responsible. Moreover, they put forth that in the new 2014 Edition EHR Certification Criteria, they "strengthened test procedures for common security and privacy features for inclusion in EHRs." 

OIG officials strongly disagreed, however.

"ONC's baseline does not address certain specific security concerns and industry best practices," Levinson wrote.


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How the integrated Epic EHR/PM system handles reporting | EHRintelligence.com

Reporting in Epic isn’t an easy thing to do. The system generates millions upon millions of records of data in its role as an enterprise practice management (EPM) system, yet data isn’t information. Information is created by the way the data is put together or presented in a report.
To help convert this data into information, Epic gives the user many different tools for reporting. Four of the most common tools are: Reporting Workbench, Clarity, Radar, and Reporting Workbench Extract Templates.
Each has a particular use, and it is through these that reporting is created in Epic.
Reporting Workbench
Reporting Workbench is used within hyperspace and is often referred to as “operational reports.” This is because reports created in Reporting Workbench are created using templates that pull data directly from Chronicles. You could almost say that they are “real-time” reports, yet it is because of this access that they are restricted on how much data they will return or how large the report can be.
You would not run a Reporting Workbench report for YTD data. This restriction is in place to keep Reporting Workbench from putting a strain on the servers, which would slow down day-to-day operations of the EPM.
Reports created from Reporting Workbench templates are found in a Menu item entitled My Reports. My Reports consist of three elements: My Reports, Recent Results, and Library. It is in the Library that users can either find a template to create a report or a report already created.
Let’s say a provider needs to know how many of his diabetic patients have had an A1C done in the last month. A Reporting Workbench report could give him this list, plus because it is running in hyperspace, the provider is able to double click on a name and the patient’s chart would be shown. Reporting Workbench reports are the only reports in Epic that have this capability.
Clarity
Because of the data return restriction put upon Reporting Workbench and the need for longer reports, Epic uses a Clarity database. This database is a relational database and can either be an Oracle or Microsoft SQL database. It is housed on its own server and has no impact on day-to-day operations of the EPM.
It’s using Clarity that you would run YTD or several years of data reports. Reports created using Clarity are referred to as “analytical reports,” and there is no restriction on the amount of data that can be returned. However, unlike Reporting Workbench, the data is all ways one day behind Chronicles.
This is due to a process called ETL — extract, transform, and load. This is a process that is run every night in which Chronicles data is extracted, transformed to fit the relational database, and then loaded into the database tables. Once the data is loaded, it can be used as the data source for a report. This is accomplished using a tool called SQL. SQL is a special-purpose programming language designed for managing data held in a relational database management system (RDBMS). These are your “select” and “from” statements and are called SQL script.
Once the SQL script has been created, it is used as the data source in a report-authoring tool such as Crystal Reports. Crystal gives the report its polished look.
Radar
I have included Radar in Epic reporting even though it isn’t used to create reports. Radar is used to present information and usually falls under the duties of the Epic Reporting Coordinator.
Think of Radar as a dashboard or splash screen. What is seen in Radar can be tailored to meet the needs of all most any role in the organization, from provider to billing clerk. Radar does this by the use of specialized components. There are seven of these, and each has a specific use. For example, there is a Graph component that will visually summarize data using Reporting Workbench reports or code templates as their data source.
Another component type is the Report Listing component that can display links to all of a user’s essential reports or to their My Reports and can even display PDF files created from a Crystal report. Viewing a Crystal report PDF in Radar is done through a process called Epic Crystal Integration. Usually Crystal reports are delivered to a user by email or they are given a file to go to in which they can download the report.
Reporting Workbench Extract Framework
Reporting Workbench Extract Framework is a tool that allows you to transmit Chronicles data into another system by the use of flat files. This tool works with vast sums of Chronicles data; therefore, to accommodate this data extracts are run automatically by Batch Scheduler jobs. The basis of a template is a Reporting Workbench report as well as detailed knowledge of the Chronicles structure and master files needed.
You now have a basic background of Epic reporting, but these four aren’t the only tools used for reporting. With the installation of integrated systems like Epic in healthcare facilities there has been an explosion of the amount of clinical, patient, and financial data collected.
In an effort to help a facility maximize the use of this data for clinical and financial use, Epic has developed other tools such as a data warehouse software called Cogito, BusinessObject Universes (which makes it easier to select data for reporting in Clarity), and finally BusinessObject Web Intelligence (a business intelligence software that allows for the creation of analysis and ad-hoc reports).



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Do We Really Like the JASON Recommendations for Interoperable Health Data?

Do We Really Like the JASON Recommendations for Interoperable Health Data? | EHR and Health IT Consulting | Scoop.it
While the value of health services deals showed positive increases and the volume maintained a consistent pace from the first half of 2013 to the first half of 2014, several health sectors saw reductions while other saw upticks in deal volumes during the same period and could indicate the early effects of the Affordable Care Act (ACA).
Those findings come from a recent a PricewaterhouseCoopers (PwC) US Health Services Deals Insights Quarterly. Compared to 289 total deals during the first half of 2013, the first and second quarters of 2014 included 143 and 138 announced deals, respectively. While the volume is down, the value is up — rising from $17.2 billion in 2013 to $24.6 billion in 2014 over the first two quarters.
While the numbers are relatively close, their composition is the result of several changes across health services sectors. On the downturn are decreases in the volume of deals for hospitals (-50%), behavioral health (-50%), home health (-25%), and physician practices (-7%). On the upturn are managed care and long-term care, which saw increase of 160 percent and 20 percent, respectively.
According to the authors of the report, the large upswing in managed care deal volumes is tied to attempts at adapting to the early effects of the ACA on revenues. “In the managed care sector, strategic buyers continue to seek membership volume and infrastructure related opportunities related opportunities through acquisitions to offset potentially lower margins under the ACA and to better manage the shift toward population health strategies,” they claim.
In a spotlight article featured in the report, PwC highlights the potential effects that mergers/acquisitions and innovation are having on the movement toward consumer-driven healthcare, particularly one that focuses on value and patient-centeredness.
“Traditional healthcare players were slow to respond to this shift, largely due to the highly fragmented nature of the industry and its focus on patient care,” the authors maintain. “Rather than focusing on the consumer, the industry focused its innovation on cost containment to offset the onslaught of reimbursement rate pressures.”
This focus on preserving their patient base and volume through consolidation by hospitals has apparently cleared the way for non-traditional players to vie for consumer dollars.
“These new entrants are emboldened by the fact that more and more patients are open to alternative means of care delivery,” the authors explain. “This time, the new competition does not come from familiar foes. Rather competition comes from businesses that are traditionally considered telecommunications, technology, retail, or consumer products companies.”
To stay competitive, traditional healthcare organizations are working to reconsidering their business models for delivering care and looking to leverage patient data as a means of redesigning their approach to care delivery and connecting with patients in the pursuit of high-quality care.
“We expect this evolution in care delivery to continue,” the authors conclude. “While many players will try to address this new market with homegrown options, we expect that companies will use M&A to consolidate the necessary technology and intellectual property needed to capture the consumer.”



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Can a Client Server EHR Provide All the Same Benefits of Cloud EHR? | EMR and HIPAA

Can a Client Server EHR Provide All the Same Benefits of Cloud EHR? | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

One of the most popular battles discussions we’ve had on this site since the beginning is around client server EHR software versus cloud EHR software. It’s a really interesting discussion and much like our US political system, most people fall into one camp or the other and like to see the world from whatever ideology their company approaches.

The reality I’ve found is that there are pros and cons to each side. Certainly cloud has won out in most industries, but there are some compelling reasons why cloud hasn’t taken hold in many parts of healthcare.

With that in mind, a client server EHR vendor asked me to list out the reasons why someone should go with a Cloud EHR over client server. Here’s my off the cuff responses:

No IT Support Needed beyond desktop support – This is a big benefit that many like. Plus, they add in the cost of the server, the cost of the local IT person and so they see it as a huge benefit to go with cloud software

Automatic Updated Software – Not always true with the cloud, but they like that the software just updates and they don’t have to go around updating software. Of course, this also has its downsides (ie. when an update happens automatically and breaks something)

Small Upfront Cost – Most Cloud solutions are billed on a monthly charge with little to no upfront cost. We could argue the accounting pieces of this and whether it’s really any better, but it feels better even if many cloud providers require the 1-2 year commitment. In some large organizations this type of payment plan is better for their accounting as well (ie. depreciation of equipment, etc)

More Secure – Obviously this could be argued either way, but those that believe cloud is more secure believe that a cloud provider has more resources and expertise to make their cloud secure vs an in house server where no one might have expertise

More Reliable (backup/disaster recovery) – Similar to the secure argument as far as expertise and ability to provide this reliability

Single Database – There are cool things you can do with data when every doctor is on one database and one standard data structure.

Available Everywhere – At home, office, hospital, etc. (Yes, this can be done by many client server as well, but not usually with the same experience).

I’m sure that a cloud EHR provider could add to my list and I hope they will in the comments. As I was making the list, I wondered to myself if a client server EHR vendor could provide all of the benefits listed above. Let me go through each.

No IT Support Needed beyond desktop support – Some EHR vendors will do all the IT support for the user. Plus, it’s a little bit of a misnomer that you need no IT support with a cloud hosted EHR. You still need someone to service your network and computers. More importantly though, most client server EHR vendors are offering a hosted EHR option which basically provides this same benefit to a practice.

Automatic Updated Software – More and more client server vendors are moving to this approach for updates as well. This is particularly true when they offer a hosted EHR environment where they can easily update the EHR. It’s a different mentality for client server EHR vendors, but it can be done in the client server environment.

Small Upfront Cost – We’ve seen this same offer from almost all of the client server EHR companies. It’s a hard switch for EHR companies to make the change from large up front payments to reoccurring revenue, but I’m seeing it happening all over the industry. The only exception might be the big hospital EHR purchase. In the ambulatory EHR market, I think everyone offers the monthly payment option.

More Secure – This is one that could be argued either way. Either one could be more secure. Client Server vs Cloud EHR doesn’t determine the security. A client server EHR can be just as secure or even more secure than a cloud EHR. I agree that generally speaking, cloud EHR is probably more secure than client server, but that’s speaking very broadly. If you care about security, you can secure a client server EHR as much or more than a cloud EHR.

More Reliable (backup/disaster recovery) – Similar to secure, you can invest in a client server infrastructure that is just as reliable as a cloud EHR. It’s true that a cloud EHR vendor can invest more money in redundant systems usually. However, a client server EHR vendor that hosts the EHR could invest just as much.

Single Database – This is the one major challenge where I think client server has a much harder time than a single database cloud EHR provider. Sure, you can export the data from all of the client server EHR software into a single database in order to do queries across client server EHR installs. A few vendors are doing just that. So, I guess it’s possible, but it’s still not happening very many places and not across all the data yet.

Available Everywhere – This can be done by client server as well, but the experience is often a subset of the in office experience. Although, this is rapidly changing. Bandwidth and technology have gotten so good, that even a client server install can be done pretty much anywhere on any device.

Conclusion
Looking through this list, it makes a great case for why client server EHR software is going to be around for a long time to come. There’s nothing on the list that’s so compelling about cloud hosted EHR software that makes it a clear cut winner.

As I thought about this topic, I tried to understand why cloud’s been the clear cut winner in so many other areas of technology. The answer for me is that in our lives portability has mattered a lot more to us. In healthcare it hasn’t mattered as much. Plus, new client server technologies have been portable enough.

Long story short, I’m a fan of cloud technologies in general, but if I were a provider and a client server technology provided me more features, functions, better workflow, etc, than a cloud EHR, I wouldn’t be afraid to select a client server EHR either.

Also worth clarifying is that this post outlines how a client server EHR can provide all of the same benefits of a cloud EHR. However, just because a client server EHR can provide those benefits, doesn’t mean that they do. Many have chosen not to offer the above solutions. Although, the same goes for cloud EHR as well.

What do you think? Are there other reasons why cloud EHR technology is so much better than client server? Is there something I’ve missed? I look forward to reading your comments.

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KLAS foresees EHR replacement among ambulatory providers | EHRintelligence.com

More than a quarter of ambulatory care providers are eyeing an EHR replacement as a means of achieving greater integration with neighboring systems and improving technical functionality while increasing return on investment, according to a new KLAS report.
Although more than 25 percent of large and small ambulatory practices are considering a replacement to their current EHR system, roughly half that number (12 percent) say they lack the financial or organizational support to make the switch a reality.
“There are different reasons for this shift,” Jared Dowland, the author of Ambulatory EMR Perception 2014: New Leaders Emerging as Market Shiftssaid in a public statement. “Larger practices are seeking to consolidate from multiple EMRs and tighten their relationships with nearby hospitals, while smaller practices are seeking to resolve functionality, support, and cost concerns.”
The findings come on the heels of another KLAS report noting the increasing competitiveness of the EMR market earlier this week between Epic Systems and Cerner Corporation following the latter’s acquisition of Siemens Health Services.
“For the past several years, Cerner has taken second place to Epic in the annual race to sign up new hospitals,” researcher Colin Buckley writes in a KLAS blog. “Each year, however, Cerner has progressively been closing the gap with Epic. Or have they? Certainly this is true when it comes to raw hospital counts, but some say not all hospitals are created equal.”
According to Buckley, the decline of Siemens over the years was the result of not being able to meet the needs of customers quickly enough.
“Over the years, providers have indicated that Siemens is too slow to achieve reliable go lives at customer sites, too slow delivering code fixes and upgrades, and too slow evolving their portfolio—most notably in producing an integrated Soarian ambulatory EMR,” he adds.
The end result was a boon for Epic which added a dozen former Siemens customers and along the way edged out Meditech for the top spot in terms of market share.
In the ambulatory space, the competition is open to many more players with the likes of athenahealth, Allscripts, and Practice Fusion being just a few of the frontrunners in the space.
In June, athenahealth announced that 59 percent of the 485 eligible providers successfully attesting to Stage 2 were customers even though just 3 percent of providers nationally using its services. Back in April, Practice Fusion maintained its spot atop the Black Book Rankings for primary care providers for the fifth year running. Meanwhile, Allscripts has apparently restored itself to its former glory under the leadership of its current CEO Paul Black.



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Patient access, VDT, CDS focus of latest meaningful use FAQs | EHRintelligence.com

The Centers for Medicare & Medicaid Services (CMS) is advising eligible professionals and hospitals to review a few recently added frequently asked questions (FAQs) covering three components of the EHR Incentive Programs.
Two of the three deal with patient access. The first (FAQ10454) addresses technical restrictions that might limit the ability of patients to participate in secure messaging, a requirement of Stage 2 Meaningful Use. In particular, the question focuses on a lack of broadband access and how eligible professionals are supposed to work under these limitations:
I am an eligible professional. What should I do if my patients don’t have broadband access?
Some meaningful use objectives require broadband access. The infrastructure required for the Secure Electronic Messaging objective is similar to the infrastructure required for the Patient Electronic Access objective’s successful usage of an online patient portal, as required in the second measure.
Therefore, CMS finalized an exclusion for those two requirements:
An eligible professional that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability, according to the latest information available from the FCC, on the first day of the EHR reporting period may exclude the second measure of the Patient Electronic Access objective and the Secure Electronic Messaging objective.
The FCC’s National Broadband Map allows eligible professionals to search, analyze, and map broadband availability in their area: http://www.broadbandmap.gov/.
The second question (FAQ10456) tackles the form patient data must take relative to the view, download, and transmit (VDT) objective in Stage 2 Meaningful Use:
In the inpatient setting, when providing patient data to satisfy the Summary of Care and View Online, Download, and Transmit objectives, does a hospital have to provide two different documents for patients and providers?
Eligible hospitals may create one consolidated document for the download requirement of the View Online, Download, and Transmit objective and the Summary of Care objective, as long as it:
• Has the required fields in it for both objectives
• Meets the standards for structured data for both objectives
The third and final FAQ in the CMS update (FAQ10228) provides details about clinical decision support (CDS) and how providers are to be notified about interventions:
For the certification criteria that providers must have in place to meet the Clinical Decision Support (CDS) objective, what type of interventions must the EHR technology trigger to meet the criteria? For this and for the Eligible Provider and Eligible Hospital Core Measures related to the Objective “use clinical decision support to improve performance on high-priority health conditions,” are “pop-up” alerts the only type of intervention that a provider can use to meet the CDS objective?
The intention of the CDS intervention certification requirement is to ensure certified EHR technology helps providers make timely and informed decisions. The certification requirement that CDS interventions be ‘triggered’ means that a CDS intervention — which may come in many forms other than “pop-ups” — be based on relevant, timely patient and care process information and that it may appear in ‘real time’ when it is most relevant to improve care provision.
CDS is not simply an alert, notification, or explicit care suggestion. Providers can meet the objective by using other kinds of CDS, including, but not limited to clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support; and contextually relevant reference information. In addition, CDS interventions are not only for doctors or nurses, but also for support staff, patients, and other caregivers, and may be delivered outside of the examination room or treatment setting.



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Ten-year Vision from ONC for Health IT Brings in Data Gradually

Ten-year Vision from ONC for Health IT Brings in Data Gradually | EHR and Health IT Consulting | Scoop.it

This is the summer of reformulation for national U.S. health efforts. In June, the Office of the National Coordinator (ONC) released its 10-year vision for achieving interoperability. The S&I Framework, a cooperative body set up by ONC, recently announced work on the vision’s goals and set up a comment forum. A phone call by the Health IT Standards Committeem (HITSC) on August 20, 2014 also took up the vision statement.

It’s no news to readers of this blog that interoperability is central to delivering better health care, both for individual patients who move from one facility to another and for institutions trying to accumulate the data that can reduce costs and improve treatment. But the state of data exchange among providers, as reported at these meetings, is pretty abysmal. Despite notable advances such as Blue Button and the Direct Project, only a minority of transitions are accompanied by electronic documents.

One can’t entirely blame the technology, because many providers report having data exchange available but using it on only a fraction of their patients. But an intensive study of representative documents generated by EHRs show that they make an uphill climb into a struggle for Everest. A Congressional request for ideas to improve health care has turned up similar complaints about inadequate databases and data exchange.

This is also a critical turning point for government efforts at health reform. The money appropriated by Congress for Meaningful Use is time-limited, and it’s hard to tell how the ONC and CMS can keep up their reform efforts without that considerable bribe to providers. (On the HITSC call, Beth Israel CIO John Halamka advised the callers to think about moving beyond Meaningful Use.) The ONC also has a new National Coordinator, who has announced a major reorganization and “streamlining” of its offices.


So what does the 10-year vision offer? It’s well worth reading, consisting of just 13 pages in fairly everyday language. I summarize the three stages as:

  • 3-year goal (2017): get health records to exchange data

  • 6-year goal (2020): bring patient-generated data into the health care system

  • 10-year goal (2024): use analytics

A few other themes run through the document, such as the ever-critical protection of patient privacy, but the three goals I just listed strike me as the three peaks we are striving to capture.

The 3-year goal reinforces the emphasis that the ONC has placed on interoperability for at least five years, since David Blumenthal served as National Coordinator and Stage 1 of Meaningful Use was designed. Because results of the efforts at interoperability and data exchange are so frustrating, it’s entirely reasonable for the ONC to concentrate on these basics for the first three years. But leaving aside patient-generated data and analytics temporarily also leads to risks and unrealized potential.

For years, manufacturers of popular fitness devices and other sites have created multiple, incompatible storage formats for data that is either collected from fitness and mobile devices or generated manually by patients. FDA-approved medical devices are also a Tower of Babyl. Unsurprisingly, computer companies such as Apple have finally moved in to innovate with platforms that the health care industry has failed to provide. But of course, Apple HealthKit, Google Fit, and Microsoft HealthVault are also incompatible, although HealthVault recognizes some industry standards and I expect the others to make similar steps toward standardization under pressure.

Interoperability should be a goal here at least as much as in current EHRs. All health reformers stress that personal behavior change is the key to controlling the chronic illnesses that take up most health care professionals’ time. In a few years, the real action will be in the patients’ daily lives, not in the sanitized clinics where EHRs are ensconced.

The ONC may not be ready yet to lead, but it could be playing a parental role in the current rush to satisfy Quantified Selfers and bring more patients into the quest to collect personal data. We should advise the platform developers to learn from the disturbing history of EHRs and work together before fragmentation becomes yet again the only real standard. Furthermore, leaders in health care have a perspective that goes beyond the focus of the computer vendors on consumerization: it is up to the health care, for instance, to ensure that standards encompass the medical devices used for treatment and monitoring, not just fitness devices.

How about analytics? These are among the thorniest technical issues in health care. Data quality varies so widely that it’s hard to trust the results of data crunching. Public health data sets are pretty clean and have been used succesfully in planning for quite some time–for instance, in this app for predicting health trends–but clinicians are wildly inconsistent in the types of data they record and where they record it (or whether it’s in a structured format at all). The quality CMS data seems to lie somewhere in between, depending on the data set. Statistical algorithms can handle a certain amount of outliers and untrustworthy samples, but they aren’t magic.

Unfortunately, we can’t wait 6 to 10 years for analytics to start being developed. Accountable care requires predictable, measurable results. Some ACOs are making headway, probably by picking off low-hanging fruit. (It doesn’t require much technology to phone patients a few days after a hospital discharge to ask whether they’re following their treatment plan, and the call can do wonders for their recovery.) But they aren’t using data effectively yet, which they eventually must do in order to make effective use of their resources.

The ONC paper has great goals. Their vision of a system that “allows patients to be active partners in their health and care” (p. 2) and spreads data throughout the system are right on target. But health care practice–whether patient self-monitoring or attempts to institute performance-based reimbursements–are running far ahead of the technical capabilities needed to support them. I don’t want to be making this same complaint 10 years from now.



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CMS quality improvement program raises concerns for AHA, FAH | EHRintelligence.com

The transition to two new national Quality Improvement Organizations (QIOs) has raised concerns for the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) following a litany of setbacks included in a letter to the Centers for Medicare & Medicaid Services (CMS) late last week.
“We understand that any new system will have its challenges, and know that your staff is working to resolve the issues as quickly as possible,” states the letter to Patrick Conway, MD, Deputy Administrator for Innovation & Quality and CMO for CMS. “However, the transition to the two new national QIO contractors for Beneficiary and Family Centered Care (BFCC) is not working as it should for patients and hospitals, and it will require on-going leadership attention until it is working well.”
Since the beginning of this month, hospitals in the QIO program have reported myriad challenges to their organizations and patients as a result of working with BFCC. The letter includes nine examples:
• Patients and hospitals are waiting, in some cases 10 or more days, for a decision from the QIO on whether a discharge should occur. The 24 to 48 hour goal for a decision on a patient discharge appeal is rarely met.
• It takes too long for hospitals and patients to reach the QIO by phone. Some hospital staff were on hold for as much as six hours before reaching a BFCC staff member to file an appeal request. We have heard similar stories from patients or family members who have been on hold for up to two hours.
• Hospitals have spent hours faxing documentation to the QIO rather than sending files electronically because the secure electronic data transmission systems are not in place for at least one QIO.
• Paperwork that has been sent has been lost by the QIO in several instances.
• BFCC reviewing physicians are overwhelmed with the volume of requests and charts.
• Documentation of a decision from the BFCC back to the hospitals is either faxed or transmitted orally. As stated above, this is occurring because there is no secure electronic transmission mechanism.
• BFCC decisions have been sent to patients instead of hospitals, and in some instances decisions have been sent to the wrong hospital contact, causing further delays.
• Conflicting information has been given to patients and hospitals about what the BFCC’s decision was on an appeal.
• Patients are being told that their extended stay was not approved, and they are now responsible for multiple days of full Medicare charges.
Both hospital associations contend that as a consequence of these setbacks related to the transition their patients will receive “significant bills” not reimbursable by Medicare, they may lose patients, or become the focus of Recovery Audit or Medicare Administrative Contractors.
“Hospitals are managing all of these issues at the same time and are concerned that there could be significant patient and payment consequences. We are seeking your guidance on the best way to protect patients and hospitals from unintended consequences resulting from all of these changes,” the associations observe.



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NexGenic Launches ImageInbox App for Seamless, HIPAA-Compliant Delivery of Medical Imaging Between Patients and Healthcare Providers

NexGenic Launches ImageInbox App for Seamless, HIPAA-Compliant Delivery of Medical Imaging Between Patients and Healthcare Providers | EHR and Health IT Consulting | Scoop.it

NexGenic  has announced the launch of a proprietary technology called ImageInbox®, an app which makes it possible for patients to control and store essential medical images and diagnostic reports, and securely deliver them on demand to healthcare providers as easily as sending an email.

ImageInbox allows patients to electronically send and receive the full-resolution medical images necessary for healthcare providers’ key treatment decisions. Patients have their choice of using the free iPhone/iPad app (app is 99 cents after introductory three-month period) downloaded from the Apple App store that is configurable with their personal Google Drive file storage accounts. If they prefer, patients can download a free desktop version of the app from NexGenic.com for local file storage. The secure technology encrypts and transfers medical images between provider and patient in seconds, eliminating the time, cost and hassle of physically retrieving and delivering the vital information on CD – and eliminating unnecessary radiation that results from additional diagnostic testing if images are otherwise unavailable.

“Images are at the center of major treatment decisions,” explained NexGenic’s Co-Founder and Chief Executive Officer, Stephan Erberich, Ph.D. “The ability to provide those images safely and confidently to medical personnel should be in the hands of patients who may need to do so at a moment’s notice.

NexGenic offers ImageInbox® to healthcare providers in a freemium pricing structure determined by the needs of their monthly exchange volumes. Providers using less than 100 transfers (image exams and diagnostic reports) per month can use the service for free. Those with 100-999 transfers are charged a flat rate of $199/month, and those with more than 1000+ transfers are charged a flat rate of $499/month. NexGenic also offers multiple versions of their ImageInbox® Annex Servers, fitted to the image exchange demands of the individual healthcare provider.

“The cost for healthcare providers to utilize ImageInbox® is drastically lower than the costs generally budgeted by medical professionals and facilities for imaging records sharing,” elaborated Erberich, “while the faster delivery and reliability of the images allows for improved overall care for patients. At a time when the healthcare industry is facing tremendous pressure to engage with patients who expect modern, mobile communication tools, it also faces declining reimbursements and shrinking budgets for technology investments. The technical breakthrough ImageInbox® offers benefits both providers and patients by addressing these demands, mobile health and cost savings.”

For those patients who want to share snapshots of medical images with friends and family, such as an ultrasound image to announce a pregnancy, NexGenic is including an optional social sharing feature in its iPhone/iPad app. 



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Where is Voice Recognition in EHR Headed? | EMR and HIPAA

Where is Voice Recognition in EHR Headed? | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

I’ve long been interested in voice recognition together with EHR software. In many ways it just makes sense to use voice recognition in healthcare. There was so much dictation in healthcare, that you’d think that the move to voice recognition would be the obvious move. The reality however has been quite different. There are those who love voice recognition and those who’ve hated it.

One of the major problems with voice recognition is how you integrate the popular EHR template documentation methods with voice. Sure, almost every EHR vendor can do free text boxes as well, but in order to get all the granular data it’s meant that doctors have done a mix of clicking a lot of boxes together with some voice recognition.

A few years ago, I started to see how EHR voice recognition could be different when I saw the Dragon Medical Enabled Chart Talk EHR. It was literally a night and day difference between dragon on other EHR software and the dragon embedded into Chart Talk. You could see so much more potential for voice documentation when it was deeply embedded into the EHR software.

Needless to say, I was intrigued when I was approached by the people at NoteSwift. They’d taken a number of EHR software: Allscripts Pro, Allscripts TouchWorks, Amazing Charts, and Aprima and deeply integrated voice into the EHR documentation experience. From my perspective, it was providing Chart Talk EHR like voice capabilities in a wide variety of EHR vendors.

To see what I mean, check out this demo video of NoteSwift integrated with Allscripts Pro:

You can see a similar voice recognition demo with Amazing Charts if you prefer. No doubt, one of the biggest complaints with EHR software is the number of clicks that are required. I’ve argued a number of times that number of clicks is not the issue people make it out to be. Or at least that the number of clicks can be offset with proper training and an EHR that provides quick and consistent responses to clicks (see my piano analogy and Not All EHR Clicks Are Evil posts). However, I’m still interested in ways to improve the efficiency of a doctor and voice recognition is one possibility.

I talked with a number of NoteSwift customers about their experience with the product. First, I was intrigued that the EHR vendors themselves are telling their customers about NoteSwift. That’s a pretty rare thing. When looking at adoption of NoteSwift by these practices, it seemed that doctor’s perceptions of voice recognition are carrying over to NoteSwift. I’ll be interested to see how this changes over time. Will the voice recognition doctors using NoteSwift start going home early with their charts done while the other doctors are still clicking away? Once that happens enough times, you can be sure the other doctors will take note.

One of the NoteSwift customers I talked to did note the following, “It does require them to take the time up front to set it up correctly and my guess is that this is the number one reason that some do not use NoteSwift.” I asked this same question of NoteSwift and they pointed to the Dragon training that’s long been required for voice recognition to be effective (although, Dragon has come a long way in this regard as well). While I think NoteSwift still has some learning curve, I think it’s likely easier to learn than Dragon because of how deeply integrated it is into the EHR software’s terminology.

I didn’t dig into the details of this, but NoteSwift suggested that it was less likely to break during an EHR upgrade as well. Master Dragon users will find this intriguing since they’ve likely had a macro break after their EHR gets upgraded.

I’ll be interested to watch this space evolve. I won’t be surprised if Nuance buys up NoteSwift once they’ve integrated with enough EHR vendors. Then, the tight NoteSwift voice integrations would come native with Dragon Medical. Seems like a good win win all around.

Looking into the future, I’ll be watching to see how new doctors approach documentation. Most of them can touch type and are use to clicking a lot. Will those new “digital native” doctors be interested in learning voice? Then again, many of them are using Siri and other voice recognition on their phone as well. So, you could make the case that they’re ready for voice enabled technologies.

My gut tells me that the majority of EHR users will still not opt for a voice enabled solution. Some just don’t feel comfortable with the technology at all. However, with advances like what NoteSwift is doing, it may open voice to a new set of users along with those who miss the days of dictation.

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CMS announces three weeks of ICD-10 acknowledgement testing | EHRintelligence.com

CMS will provide three dedicated week-long opportunities for ICD-10 acknowledgement testing in 2014 and 2015, according to the most recent MLN Matters bulletin.  While acknowledgement testing does not confirm that a test claim would be paid or produce any remittance advice, it does ensure that providers can successfully submit claims coded in ICD-10 to Medicare.
“While submitters may test ICD-10 claims at any time through implementation, the ICD-10 testing weeks have been created to generate awareness and interest, and to instill confidence in the provider community that CMS and the Medicare Administrative Contractors (MACs) are ready and prepared for the ICD-10 implementation,” the announcement says. “These testing weeks will allow trading partner’s access to MACs and CEDI for testing with real-time help desk support. The event will be conducted virtually and will be posted on the CMS website, the CEDI website and each MAC’s website.”
The testing opportunities will take place:
November 17 – 21, 2014
March 2 – 6, 2015
June 1 – 5 2015
In March of 2014, the first acknowledgement testing week produced an 89% success rate among approximately 2600 participating providers, said Niall Brennan, Acting Director of the CMS Offices of Enterprise Management.  “Testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted,” he wrote in an email at the time.
While the basic testing is important for providers who need to ensure their basic infrastructure is appropriately configured, a large number of industry advocacy groups have been clamoring for more opportunities to conduct sophisticated, end-to-end testing with Medicare before the new implantation date of October 1, 2015.  CMS has assured providers that end-to-end testing will form a significant part of their implementation strategy, but no official opportunities have yet been announced.
“While engaging in end-to-end testing with every Medicare provider may not be practical, we do believe there must be sufficient and robust testing with a range of trading partners – hospitals, physicians (large and small practices from different medical specialties), clinics, clearinghouses and Medicare secondary payers,” wrote Jim Daley, Chairman of the Workgroup for Electronic Data Interchange (WEDI) to HHS Secretary Kathleen Sebelius before her resignation. “This will give the industry a higher level of confidence that the Medicare claims processing system will operate as intended when ICD-10 goes live.”



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Debunking several arguments against the necessity of ICD-10 | EHRintelligence.com

In latest issue of the American Health Information Management Association’s eponymous journal, the association’s Senior Director of Coding Policy and Compliance Sue Bowman, MJ, RHIA, CCS, FAHIMA, has gone about explaining why various arguments against the transition to ICD-10 are unfounded.
First, Bowman takes to task the claim that the replacement of ICD-9-CM (clinical modification) is not necessary.
“Both costs and dangers are associated with continued use of the outdated ICD-9-CM coding system,” she writes. “Its limited structural design lacks the flexibility to keep pace with changes in medical practice and technology. The longer ICD-9-CM is in use, the more the quality of healthcare data will decline, leading to faulty decisions based on inaccurate or imprecise data.”
According to Bowman, replacing ICD-9-CM is essential to EHR adoption and interoperability moving forward. “Without ICD-10-CM/PCS, the US investment in EHRs will be greatly diminished, as the value of more comprehensive and detailed information will be lost if it is aggregated into outdated, broad, and ambiguous codes such as those in ICD-9-CM,” she adds.
Second is the notion that the increase in the number of codes in ICD-10 will lead to increased difficulties for coders and the coding process as a whole:
The major reason for much of the code expansion is identification of the affected side of the body. This specification of laterality accounts for 46 percent of the total increase in the number of codes. And for those ICD-10-CM codes with greater clinical detail than is found in ICD-9-CM, much of that detail was requested by organizations representing clinicians because this level of detail was thought to be clinically significant. With the growing emphasis on linking quality and payment, and the movement toward value-based purchasing, it is clear this additional clinical detail will be important.
The specificity of ICD-10, argues Bowman, makes the new code set capable of eliminating ambiguity and capably of improving accuracy — both sufficient enough reason to warrant its implementation.
Lastly, there is the belief that SNOMED CT or ICD-11 is a viable alternative to ICD-10. Bowman sees several reasons why this isn’t the case.
One is the nature of SNOMED CT as terminology set for documenting clinical care not for classification purposes to be used in billing, data sharing, and data comparisons — the difference between input and output.
“SNOMED CT and ICD are designed for different purposes and each should be used for the purpose for which it is designed,” Bowman emphasizes. “While ICD’s focus is statistical, SNOMED CT is clinically-based and focused on capturing the information needed for clinical care.”
Another reason is the fact that ICD-11 does not yet include a procedure classification system:
The process of evaluating ICD-11 for use in the US, developing a national modification to meet US information needs, and developing a procedure coding system would take at least a decade, followed by the rulemaking process to adopt ICD-11 as a HIPAA code set standard. In the case of ICD-10, it took eight years to develop a US modification of ICD-10 and a procedure coding system, and 19 years for a final rule to be published. Five years after publication of this final rule, and 24 years after the World Health Assembly endorsed ICD-10, the US has still not implemented ICD-10-CM/PCS.
With the effective date for ICD-10 compliance now set for Oct. 1, 2015, healthcare organizations and providers are quickly approaching the one-year mark for getting their facilities and systems prepared knowing full well that another delay is highly unlikely.



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With help, eRx has come a long way | Healthcare IT News

With help, eRx has come a long way | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

The feds have been taking a bit of a drubbing lately, what with the paltry early returns for Stage 2 meaningful use attestations. But if providers are having a hard time proving their worth for that next round of electronic health record incentive checks, there's one place the government can claim some undeniable stimulus success: e-prescribing.

The prevalence of prescribing via EHRs has skyrocketed over the past decade. Almost unheard of in 2006, nowadays more than 70 percent of physicians e-prescribe, according to recent data from the Office of the National Coordinator for Health IT.

Thanks in large part to two federal initiatives – first the Medicare Improvements for Patients and Providers Act of 2008, also known as or MIPPA or the "eRx incentive" program, and later meaningful use – e-prescribing has made huge gains through the first quarter of 2014, the report from ONC's Meghan Hufstader Gabriel and Matthew Swain shows.

Using data from Surescripts, the nation's largest e-prescription network, the study shows a steep and steady climb for eRx – from 7 percent in 2008, when MIPPA was passed, to 24 percent in 2011, when meaningful kicked off, to 70 percent today.

The growth has occurred nationwide, Gabriel and Swain point out. At the end of 2008, only one state, Massachusetts, had physicians prescribing via EHR on the Surescripts network at a rate that exceeded 20 percent.

Just over two years later, in January 2011, 35 states could boast e-prescribing rates above 20 percent, with five states above 40 percent.

By this past spring, those numbers were even higher, with every state above 40 percent and 28 states exceeding 70 percent of their physicians using EHRs to prescribe. Minnesota, which stood at 100 percent; Iowa, at 95 percent; and Massachusetts, at 94 percent, had the highest rate of physicians e-prescribing as of April 2014.

Beyond the doctor's office, e-prescribing has made even bigger gains in pharmacies – in the same period, the percentage of community pharmacies nationwide wired to accept prescriptions via EHR has reached 96 percent. Maine and Delaware are the top two states, with 99 percent each.

Meanwhile the number of new and renewal prescriptions sent electronically has increased a whopping 14-fold, according to the ONC report. In 2008, just 4 percent of new and renewal prescriptions were sent electronically. By 2013, that number was 57 percent.

Interestingly, the four states with highest volume of prescriptions – California, Texas, New York and Florida – are all below the national average.

This "presents an opportunity to increase the proportion of new and renewals sent electronically among these states," wrote Gabriel and Swain.

Still, it's hard to deny that huge gains have been made in the past decade, due in no small part to federal largesse. The ONC data is just further proof that incentives have worked. In 2013, for instance, a Health Affairs study was published showing that, for the 26-month period before MIPPA, there were 1,437 new electronic prescribers per month, on average, among physician prescribers; after the federal incentives, that number leapt to 6,346 from 2008 to 2010 – a rather-less-than-modest increase of 450 percent. 

"There has been an ongoing debate regarding the efficacy of financial incentives in convincing physicians to move into the digital age, trading in their paper-based systems for electronic health records," wrote Max Sow, vice president of business intelligence at Surescripts, upon the study's release. "Thanks to new research, we can now point toward firm evidence that shows financial 'carrots' make a tremendous difference in bringing 21st century modernization to the doctor's office."

For all this progress, however, there are still limitations when it comes to e-prescribing. Writing in a July 21 guest post on John Halamka's "Geek Doctor" blog, Marvin Harper, MD, chief medical information officer at Boston Children's Hospital, spotlighted what he said was a bothersome gap in current eRx standards.

"Being able to write and route prescriptions electronically provides many advantages over the handwritten paper prescription process that inherently uses families as couriers," he wrote. "Nonetheless the current standards for e-prescribing have created a void that permits limitations in certified vendor software on both the prescribing and pharmacy receiving side."

For instance, he pointed out that "the current limitation for the entire prescription sig line within a prescription to be transmitted electronically is 140 characters. Basically a tweet.  Not close to enough for many prescriptions. As a result we must continue to provide some prescriptions on paper to the patient."

This, coupled with many other easily fixable gaps in rules and processes mean, "our patients are not yet benefiting from the full potential of e-prescribing," he wrote.



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One Physician’s Experience Seeing an Ophthamalogist Pre and Post EHR

One Physician’s Experience Seeing an Ophthamalogist Pre and Post EHR | EHR and Health IT Consulting | Scoop.it

I always love to hear doctor’s perspectives on EHR and how they’re impacting their day. You can be certain that they’ll lead with a long list of complaints. Many of the initial complaints are minor things that can be easily resolved with workflow or by a small enhancement by the EHR vendor. Once you get past the initial complaints, then you get to the heart of what they really think about the EHR software. I’ve had this experience hundreds of times and it’s always insightful.

However, this time a doctor shared something even more interesting. This was a doctor visiting another doctor as a patient. Rather than put words in his mouth, I’ll just share with you what he shared with me (EHR vendor name excluded since this could apply to many different EHR vendors):

I was in my ophthalmologist today. He is a really nice, busy doctor. He is in group practice and used to run his wing with one long time nurse with no hassles. He could previously see a patient in 10 min finish refraction, move from room to room and breeze through cases jotting what he needed to write down on one clean ophthalmology SOAP note. Since 2011 they have had EHR Vendor A. (because a consultant sold them on it and promised rewards from CMS)

Today, It took them a total of 1.5 hours to get my refraction, eye exam done. The workflow seemed to be in a complete disarray (remember this is an installed cloud based software since 2011, supposed to the be cream of the crap for Ophthalmology). What shocked me the most was that he now has 4 ladies doing inane things with EMR, trying to help him. I can also see why errors can creep in because he was reading out numbers for the assistant/ Nurse to enter into EHR Vendor A. Distraction fatigue, EMR ennui can cause errors of entry. So the cost of running crappy software far exceeds the physical costs / monthly service costs of the product. It amplifies personnel costs. It took the lady 20 minutes to take totally pointless history and do ROS!

I did not tell her I was a physician and she was clicking away to glory. I counted more than 50 clicks before anything of substance was even gathered. Based on the EMR prompts she made me do finger counting and asking me if I can see her face etc..>! I had clearly indicated to her that I just wanted a retinal exam and prescription for glasses because I wanted to buy new lenses and that I had not required change of prescription for glasses in 10 years!

Then I walk out with mydriatic in my eyes…and saw a hazy illusion of one of my ex-patients, a severe schizophrenic waiting for his turn to be checked in. He was talking about meeting Jesus and asked if I have had a “meeting Jesus moment” in my life.. I assured him I just did…

In those 1 hr and 45 min, the good doctor had seen just 4 patients and 6 more were still waiting impatiently on one arse looking irate, checking their iphones and smart watches …spreading anxiety.

I’m always torn on sharing these type of stories. I know that this doesn’t have to be the case since I know many EHR users who don’t have these issues. However, far too many of them do that it’s worth keeping this perspective in mind. Plus, regardless of how efficiently someone has incorporated the MU requirements, it’s had a huge impact on everyone that’s participating.



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Walgreens pharmacies complete implementation of Greenway EHR | EHRintelligence.com

In an effort to arm pharmacists with the same tools available to other members of the healthcare community, Walgreens has completed the implementation of a cloud-based EHR platform from Greenway that allows pharmacists to gain full access to a patient’s medication lists, immunization history, and lab test records.  The project represents a general widening of healthcare options for consumers as well as an opportunity for EHR vendors to move into markets beyond the physician’s office or hospital setting.
“Having a chain-wide EHR platform enhances our pharmacists’ ability to provide individualized immunization and health testing recommendations, which is key to closing gaps in patient care that exist today,” said Tim Theriault, senior vice president, chief information, innovation and improvement officer, Walgreens. “This solution helps further our mission to help patients in the communities that we serve get, stay and live well.”
“Consumers are demanding access to healthcare information, and Walgreens Cloud EHR delivers,” added Greenway CEO Tee Green. “We’re proud to work with Walgreens to deliver a single system that extends to more than 27,000 pharmacists and can process 20,000 patient encounters per hour. This implementation points the way to electronic care coordination of the future.”
In recent years, retail pharmacy chains have made a concerted effort to become more than a place to pick up some aspirin or cold medicine.  Retail clinics, staffed by nurse practitioners and physician assistants, have become an increasingly popular place for patients to seek low-level care for sore throats and ear infections.  While some providers may worry that the addition of non-physician care sites would fragment a patient’s record, the retail chains have been investing in EHR technology to ensure that doesn’t happen.
CVS also recently announced a significant foray into EHR technology.  The company has selected Epic Systems to implement an EHR in its rapidly expanding chain of MinuteClinic sites, and is hoping that the healthcare system will take its drop-in clinics seriously.  “We’ve reached a point in the evolution of our clinical practice where a more advanced EMR that facilitates more immediate information sharing with other health care providers is needed,” said Andrew Sussman, MD, President of MinuteClinic and Senior VP and Associate CMO of CVS Caremark Corporation.
The Walgreens pharmacy EHR isn’t the company’s first attempt to integrate its patient care activities with the larger healthcare community.  A group of national chains, including Walgreens, CVS, and Rite Aid, have been delivering immunization data directly to providers through the Surescripts network since 2012, while an accountable care agreement with CHE Trinity Health, an 80-hospital health system in Illinois, will allow the company to exchange medication lists and other patient data to ensure continuity and quality of care.



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How healthcare M&A push consumer-centric, value-based care | EHRintelligence.com

While the value of health services deals showed positive increases and the volume maintained a consistent pace from the first half of 2013 to the first half of 2014, several health sectors saw reductions while other saw upticks in deal volumes during the same period and could indicate the early effects of the Affordable Care Act (ACA).
Those findings come from a recent a PricewaterhouseCoopers (PwC) US Health Services Deals Insights Quarterly. Compared to 289 total deals during the first half of 2013, the first and second quarters of 2014 included 143 and 138 announced deals, respectively. While the volume is down, the value is up — rising from $17.2 billion in 2013 to $24.6 billion in 2014 over the first two quarters.
While the numbers are relatively close, their composition is the result of several changes across health services sectors. On the downturn are decreases in the volume of deals for hospitals (-50%), behavioral health (-50%), home health (-25%), and physician practices (-7%). On the upturn are managed care and long-term care, which saw increase of 160 percent and 20 percent, respectively.
According to the authors of the report, the large upswing in managed care deal volumes is tied to attempts at adapting to the early effects of the ACA on revenues. “In the managed care sector, strategic buyers continue to seek membership volume and infrastructure related opportunities related opportunities through acquisitions to offset potentially lower margins under the ACA and to better manage the shift toward population health strategies,” they claim.
In a spotlight article featured in the report, PwC highlights the potential effects that mergers/acquisitions and innovation are having on the movement toward consumer-driven healthcare, particularly one that focuses on value and patient-centeredness.
“Traditional healthcare players were slow to respond to this shift, largely due to the highly fragmented nature of the industry and its focus on patient care,” the authors maintain. “Rather than focusing on the consumer, the industry focused its innovation on cost containment to offset the onslaught of reimbursement rate pressures.”
This focus on preserving their patient base and volume through consolidation by hospitals has apparently cleared the way for non-traditional players to vie for consumer dollars.
“These new entrants are emboldened by the fact that more and more patients are open to alternative means of care delivery,” the authors explain. “This time, the new competition does not come from familiar foes. Rather competition comes from businesses that are traditionally considered telecommunications, technology, retail, or consumer products companies.”
To stay competitive, traditional healthcare organizations are working to reconsidering their business models for delivering care and looking to leverage patient data as a means of redesigning their approach to care delivery and connecting with patients in the pursuit of high-quality care.
“We expect this evolution in care delivery to continue,” the authors conclude. “While many players will try to address this new market with homegrown options, we expect that companies will use M&A to consolidate the necessary technology and intellectual property needed to capture the consumer.”



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Will telemedicine help healthcare achieve the triple aim? | EHRintelligence.com

The triple aim is the goal of current healthcare reform through the implementation and adoption of health information technology, but are healthcare organizations and providers overlooking the role of telemedicine in achieving this end?
“The country is trying to figure out how you improve the quality of care for everyone and do so at a lower cost,” says Yulun Wang, PhD, President of the American Telemedicine Association Board of Directors and Chairman & CEO of InTouch Health. “There aren’t many ways to do that, to be frank.”
The healthcare industry is already facing a difficult challenging in transition from volume to value in terms of reimbursements. Add to that what is down the road and the challenge is exacerbated.
“You’ve got an aging population,” Wang explains. “You’ve got the ongoing advancement of medical care so the potential of quality care is always getting better because medical science is getting better. You’ve got a shrinking number of healthcare providers. Given those trends lines, how do you achieve higher quality of care for everyone at a lower cost?”
So what is the solution? According Wang, telemedicine has an important part to play in answering that question.
“Telemedicine — which is really all about getting the right expertise to the right place at the right time to do the right thing — is one of the cornerstone solutions to the problem,” he argues. “It can be used across a very large number of applications. In some shape or form, telemedicine can be used in any aspect of healthcare delivery at a lower case while driving up quality simultaneously.”
Next month, the ATA Fall Forum will provide the setting for discussing how telemedicine can have a positive effect on reducing healthcare costs while improving patient outcomes and access to quality care in the context of chronic disease management. A telehealth approach to chronic disease, claims Wang, could help address the source of many preventable costs to the healthcare industry.
“Chronic disease patients have a lot of stuff being done to them and thus costing a lot of money,” he observes. “As we transition to being paid for value and keeping a chronic patient well and therefore not consuming as many healthcare resources, that is a fundamentally different payment model.”
In many ways, chronic disease management is a microcosm of a much larger challenge for healthcare organizations and providers that are grappling with transitioning their business models to accommodate these changes in reimbursement. “Change is hard and the healthcare system today is going through a transformation,” adds Wang.
The emphasis on outcomes and wellness in value-based care highlights the need for preventive measures and identifying problems before they escalate into more costly treatments. Preventive care and telemedicine seemingly go hand in hand.
“That is the general idea,” continues Wang. “You link to the person in the home who has a chronic disease with some methodology for gaining accurate data more frequently such that you can more proactively head off negative trend lines that might take longer to happen otherwise.”
Perhaps the real question to ask is this: Why aren’t health systems, hospitals, and physician practices working more aggressively to allow telemedicine support their move to outcomes-based care?



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Confusing Workflow Technology With Workflow Is Like Confusing Your Database With Your Data

Confusing Workflow Technology With Workflow Is Like Confusing Your Database With Your Data | EHR and Health IT Consulting | Scoop.it

You wouldn’t confuse your baseball card collection with the Microsoft Access database management system you use to manage it. Or confuse your patients with your EHR. But people, especially in healthcare, confuse workflows with workflow management systems all the time. I’ve discussed this important distinction before (EMR Workflow Systems vs. EHR Workflow Management Systems). But I think it is worth revisiting. Confusing workflow with workflow technology is what gives rise to the notion that introducing process-aware information systems into healthcare and health IT is mere “tweaking” of workflow.

Last week I moderated one of the weekly #HITsm tweet chats (Fridays, 12-1 EST Thank You To All Who Tweeted About Healthcare Workflow, Wearables, BPM, and Flowcharting!). It was well attended, 40 percent above average. In the introductory post I wrote for the HL7Standards blog I emphasized the distinction. Here is the shorter version of that.

Workflow is what actually happens when work is done. It is a series of steps, or tasks, that consume resources (money, time, effort, attention), and achieve one or more goals. Virtually all purposeful activity involves workflow.

Workflow technology, on the other hand, has some sort of model of workflow. This is model is executed or consulted, in conjunction with human users, when they do their jobs. These executable process models are at the heart of what distinguishes healthcare workflow technology from generic healthcare information technology. All information systems “affect” workflow (that is, influences workflow, for good or ill). But healthcare workflow technology “effects” workflows (that is, drives, makes it so, in the Captain Picard, Star Trek sense).

Why do I harp upon workflow technology all the time? Because it is the next generation of application architecture heading down the pike toward health IT, which is about a half a generation or more behind other industries. Sometimes folks say, “So what! Fix the incentives and the tech will fix itself.” I agree we need to fix healthcare incentives (whatever that means, I hear lots of strenuous debate about that particular topic). But even if we fix the incentives, billions of dollars have cemented frozen healthcare workflows into place. Similar to, by analogy, early human proclivities (such as eating until overfull in the presence of food) plaguing us this modern day, a decade of frozen health IT workflow will resist pressures to change for the better, if the better even presents itself.

Furthermore, regardless of which incentive regime we finally impose, it won’t work unless we have true workflow technology to make it work. It doesn’t matter, free market vs. socialized medicine, Meaningful Use-driven software development vs. Meaningful Use-Be-Gone-driven software development. We will have invested so much in workflow-oblivious, workflow-frozen healthcare information systems, that (A) they’ll be too expensive to change, and (B) we won’t have enough will or resources left to change them. We need to begin making our health IT systems more process-aware, now.

The sentiments of the previous paragraph are why I wrote Fixing Our Health IT Mess: Are Business Models or Technology Models to Blame?, one of my most popular (or at least most tweeted) blog posts.

Moving to executable models of work is not merely tweaking workflows. It is moving to a more flexible, effective, efficient, transparent and systematically improvable substrate in which to realize whatever systems of healthcare incentives we ultimately move to. And I can guarantee you one thing. We won’t get them right the first, second, or even third time. That’s why we need to create systems of health information management in which workflows can be more easily “tweaked.”

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EHR makers among America's fastest growing companies | Government Health IT

EHR makers among America's fastest growing companies | Government Health IT | EHR and Health IT Consulting | Scoop.it

Health IT vendors and EHR makers in particular are once again faring quite well on the list of fastest growing companies.

Inc. Thursday published its hallmark annual ranking of America's 5,000 fastest growing companies, and found 377 — or 8 percent — to be healthcare related. Despite the low percent, however, the sector accounted for the lion's share of revenue ahead of all industries at $21.8 billion.

Among the fastest growing were three recognized EHR platform companies: CareCloud; drchrono and eClinicalWorks, which ranked 127th, 249th and 4064th respectively. Both CareCloud and drchrono are new to this year's list.

The Web-based EHR and revenue cycle management company CareCloud based in Miami, Fla., saw a blistering three-year growth rate of nearly 3,000 percent, raking in $10.5 million in revenue last year.

"We are honored to be recognized," said Albert Santalo, CareCloud chairman and CEO, in a prepared statement, "for CareCloud's trajectory over the past three years." Added Santalo, "It's important to remember that this growth is a direct result of bringing a modern platform to an industry too often constrained by decades-old technology."

Drchrono, a considerably smaller physician-targeted EHR company, brought in a modest $2.9 million last year, but saw three-year growth rates up more than 1,834 percent.

Then there's the Westborough, Mass.-based eClinicalWorks, which raked in $269.7 million in revenue during 2013, growing 73 percent over the last three years.

Other health IT-related companies also joined the list. Health IT consultancy The HCI Group, for instance, took the No. 13 spot on the overall Inc. 5000 list, reporting 2013 revenues of $34.6 million, and seeing three-year growth rates increase by a whopping 13,231 percent. The HCI Group specializes in big name EMR vendor implementations. (Think Epic, Cerner, Allscripts, MEDITECH and McKesson.)

Consulting firm Nordic, which specializes in Epic implementations, also boasted impressive numbers, coming in at No. 46, with revenues of $81.4 million and a staggering 5,593 percent growth within the three-year mark.

Data analytics newcomer Health Catalyst also made the list, coming in at 1,497, with reported revenue of $4.5 million, up from $3.7 million in 2012.



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Why early success in meaningful use matters in the long run | EHRintelligence.com

The EHR Incentive Programs comprise various stages (Stage 1, Stage 2, etc.) and each of these stages of meaningful has multiple phases (90 day, full year, etc.). So much of an eligible hospital’s success in demonstrating meaningful use is tied to its ability to build and sustain momentum and to communicate the importance of the project to stakeholders.
“I do often hear from providers, ‘We’re only doing this because MU says we need to,’” says Tamra Deming, Clinical Informatics Specialist for Cottage Hospital. “Obviously, it’s part of the case, but I try to bring it back to the benefits for the patient and how it is going to positively affect their care.”
For a critical access hospital (CAH) such as Cottage Hospital, meaningful use is both a mandate and opportunity to deliver on an important component of its mission — to provide appropriate, quality care to its community of patients. It is therefore necessary for the hospital’s leadership to stand together and emphasize why participation in the EHR Incentive Program is a good thing, whether required or optional.
“For us, it is another way of proving to ourselves that we have our thumb on the pulse of our patients’ and community’s needs,” explains Maryanne Aldridge, Director of the Office of Community Relations & Fund Development at the CAH. “When we take something that we know could benefit patient but is also a mandate and make it work, it helps build our teamwork, inter-departmental relationships, and has many other variables that help strengthen our hospital as a whole.”
Considering the limited resources that the CAH has, every dollar spent must count. In the case of meaningful use, the goals laid out by the Centers for Medicare & Medicaid Services (CMS) happen to align with those of Cottage Hospital. Investing in the program then is a worthy one.
“Our goals align with the whole idea behind meaningful use. CMS’s drive is to improve outcomes and every dime that we spend on any system within the hospital is all intended to improve the outcomes,” adds Director of IT Rick Frederick.
An object in motion stays in motion
Given the time and activities required by meaningful use, losing focus is a real threat to ongoing success. To avoid this, Cottage Hospital has kept the end goal clear: benefitting patients.
“Whenever I have tried to teach anything to a provider and get it to stick, I always have to bring it back to their patients and the benefit they’re providing for them,”Deming says of her work to sustain clinician buy-in for meaningful use.
“If I am there in front of them,” she continues, “I’ll remind them they’re doing medication reconciliation because it’s the safest step for your patient to make sure they’re on everything they should rather than say you need to do med-rec’s because meaningful use tells us to.”
Another method for staying on point is giving responsibility and access to staff members so that they understand firsthand what is at stake:
When it comes to other end-users — any of the clinical staff or stakeholders within the hospital — what I try to do is put the monitoring of the data in their hands and then ask them at our meetings to speak to the trends they might be seeing. That way they’re in tune. We use a tool to pull all this data for us, a business intelligence tool, and all the stakeholders have login access to this and they watch each of the measures they are responsible for. Having them speak to those measures on a biweekly basis keeps the focus of what we’re trying to do in the forefront.
This approach is vital to the hospital’s long-term success in meaningful use because each subsequent stage builds off the previous. Clinical quality measures are an example of a meaningful use requirement that continues to grow in importance and number stage over stage.
“With meaningful use, we want to make sure that it is meaningful,” says Deming. “We want to keep track of where we are and where we are going with CQMs. We should always be showing improvement. Tracking that is going to be at the forefront for us as well as preparing for what Stage 3 Meaningful Use will bring us.”
According to Deming, early success in meaningful use at Cottage Hospital is part of laying the groundwork for similar achievements down the road so that when Stage 3 assumes it’s final shape the hospital will be ready. Until then, the order of business is to maintain what has worked so far.



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KLAS Report: One out of four ambulatory EMRs are in danger of being replaced

KLAS Report: One out of four ambulatory EMRs are in danger of being replaced | EHR and Health IT Consulting | Scoop.it

More than 25 percent of both large and small ambulatory practices report that they are considering replacing their EMR, according to the latest KLAS report on ambulatory EMR perception. The study further finds that another 12 percent would like to replace their system but cannot do so for financial or organizational reasons. Which products are most likely to be replaced and which vendors providers are considering are also among the findings.

“There are different reasons for this shift,” said report author Jared Dowland. “Larger practices are seeking to consolidate from multiple EMRs and tighten their relationships with nearby hospitals, while smaller practices are seeking to resolve functionality, support, and cost concerns.”

As part of this study, KLAS interviewed more than 400 large and small practices across the country about their EMR solutions. The report reveals not only why ambulatory practices are replacing their EMRs, but where they are considering going. Some of the EMR vendors discussed in the report include Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, GE Healthcare, Greenway, McKesson, MEDITECH and NextGen.

For more detailed information on each vendor’s performance and on the KLAS report, “Ambulatory EMR Perception 2014: New Leaders Emerging as Market Shifts,” visit KLAS online at www.KLASresearch.com/reports. The report is available to healthcare providers and vendors. Providers receive a significant discount off the standard retail price or can receive a complimentary summary report in exchange for a survey about one of their current suppliers.



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EHRs: How Vulnerable to Theft?

EHRs: How Vulnerable to Theft? | EHR and Health IT Consulting | Scoop.it

A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be. Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change.

Are my medical records stored electronically?

At least some of the information you share with your doctor or any hospital or clinic where you've been treated is probably stored on a computer. It's pretty common for most hospitals, clinics, and doctors' offices to digitally store your basic information including your name, address and insurance company, the same way many retailers do.

It's also likely that at least some information about your specific medical conditions is linked to that data. Healthcare providers have been using computers to help them get paid for decades. That means many computer-generated bills sent to you and/or your insurance company contain medical details like the conditions you were treated for, prescriptions, and referrals to specialists.

Where things are really changing quickly is in the use of electronic records for day-to-day patient care. Until recently, most doctors used paper charts to record information generated during patient visits. But the 2009 economic stimulus package offered doctors and hospitals tens of thousands of dollars each to help buy computers and software designed to replace paper charts. Adoption was slow at first, but as of June most hospitals and close to half of all doctors in America report that they are using systems that qualify for those payments. Some are aggressively digitizing older records stored on paper, others are not.

Does the Affordable Care Act require doctors and hospitals to use electronic medical records?

No. The stimulus package, which pre-dates Obamacare, offers doctors, hospitals, and some other health providers money to help them upgrade from paper to digital records, but the Affordable Care Act does not. Nor does it require digital record use.

But the health law does offer bonus payments to healthcare providers that can prove they're more efficient and not unnecessarily duplicating tests and procedures. Electronic records make that easier. The ACA also includes penalties for those who fail to meet performance measures such as keeping people from returning to hospitals because they weren't treated properly the first time. More hospitals are starting to use electronic records to track patients, coordinate inpatient and post-hospital care, and to record how well they're performing in an effort to win bonuses and avoid penalties put in place by the ACA.

If electronic medical records are so common, why can't I email my doctor?

Some patients can. But concerns about privacy and payment mean many doctors would rather communicate with patients on the phone or face to face.

Standard email isn't secure enough to meet the standards of America's umbrella medical privacy law, known as HIPAA. That's why many doctors don't communicate with patients via email, and continue to send prescriptions and referrals via fax.

Some electronic records systems offer secure "patient portals" that allow patients and doctors to communicate electronically. More doctors and hospitals will have to start offering this service if they want to qualify for the maximum amount of stimulus act payments for going digital. But not all insurance companies will pay doctors for the time they spend communicating electronically, so many require patients to schedule an office visit instead.

How secure are my electronic medical records?

As more doctors and hospitals go digital with medical records, the size and frequency of data breaches are alarming privacy advocates and public health officials. Although healthcare providers face serious penalties if they allow patients' electronic records to be breached, thieves also have tremendous incentives to get around protections because health records contain so much valuable information.

Privacy experts argue the health industry has been slow to respond to such incidents by adopting the encryption techniques used for years by financial companies.

In the recent breach of Community Health System, a hospital chain based in Franklin, Tenn., Chinese hackers bypassed the hospitals' security systems and stole personal data, including names, Social Security numbers and addresses of 4.5 million patients. Community Health said it would offer identity theft protection to affected patients, and it carried cyber insurance to mitigate some of its losses.

This video from the federal Health and Human Services department's Office of Civil Rights explains some of the protections currently in place, as does as this fact sheet. The Federal Trade Commission offers this advice on preventing identity theft and protecting digital personal information.

Can emergency room doctors call up my electronic medical records if I'm in an accident and unable to give them basic information?

Probably not. A major criticism of electronic medical records in America is that the companies that make them have financial incentives to keep them from being easily shared. It's kind of like Windows versus Mac operating systems. Many companies are trying to win market share by creating software that doesn't "talk" to that made by other companies, so if a big hospital uses software from company X, then all the doctors that work with that hospital will have an incentive to buy that software, too.

If you're unconscious and an ambulance takes you to a hospital you've been to before, they can probably call up their records for you if you're carrying some kind of identification. But they may not be able to access pertinent information stored on other doctors' or hospitals' computers.

Some states have good clearinghouses that allow healthcare providers to pull in all of a patient's digital health files, but they're still the exception at this point.



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