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Make IT vendors your partner for a smooth EMR transition

Make IT vendors your partner for a smooth EMR transition | EHR and Health IT Consulting |

Vendors talk about partnering with medical practices all the time – especially in the information technology (IT) world of electronic health records (EHRs) and practice management systems.


But, ask any physician about their IT solution and most will express dissatisfaction, unhappiness, or harsh complaints.


The reason? For the most part, medical groups are not trained effectively for integrating IT into their work flow.


Vendors complain that physicians just won’t make the time to be trained. Training is critical before going live on an EHR, and ongoing training is essential for optimizing the EHR implementation after go-live.


First-time buyers don’t know what they don’t know and have been lulled into complacency by the simplification of so many consumer technologies.


EHR complexity requires training in earnest and all too often the unknowing buyer eliminates many hours of training during initial negotiations with the vendor. The vendor is willing to go along with it because they want to make the sale of their software.


Effective use of technology can control and reduce operating costs in a medical practice. Technology can drive revenue, monitor reimbursement, and position and support a practice’s participation in payers’ new reimbursement models. But only if the practice is well trained in the utilization of that technology.

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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Study: Most patients don’t understand electronic lab results |

More and more patients may be accessing their personal health information online through patient portals thanks to Stage 2 of meaningful use, but only slightly more than half of patients, on average, were able to decipher electronic lab test results on their own, says a study from the University of Michigan.  Patients who scored on the lower end of numerical and health literacy tests were twice as likely to express confusion when shown a hypothetical blood glucose test result, said study author Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health.
The researchers recruited more than 1800 adults to take an online test, and asked them to respond as if they had Type 2 diabetes.  The participants were also given quizzes to measure their mathematical literacy and familiarity with viewing health information.  When presented with a display that showed blood test results common to a diabetic patient, 77% of patients who scored highly on the literacy tests were also able to identify hemoglobin A1C levels that were out of range.  Just 38% of patients who scored on the lower end of the literacy tests could do the same, illustrating a significant difference in how patients are able to digest their own information.
“We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them,” Zikmund-Fisher said. “The problem is many people can’t imagine that giving someone an accurate number isn’t enough, even if it is in complex format.”
While other studies have shown that patient portal access can improve medication adherence, increase the rate of vaccinations, and even turn patients into loyal customers, confusion and frustration surrounding the online engagement feature persist.  A third of patients aren’t even aware that they may have access to a patient portal, another recent survey found, while those who do access their information online are confronted with interfaces that are difficult to use.  More than ten percent of patients reported that their top frustration with portals was the medical jargon providers used in their notes.
“If we can design ways of presenting test results that make them intuitively meaningful, even for people with low numeracy and/or literacy skills, such data can help patients take active roles in managing their health care,” said Zikmund-Fisher.  “In fact, improving how we show people their health data may be a simple but powerful way to improve health outcomes.”

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CAQH: Electronic transactions could save healthcare billions |

CAQH: Electronic transactions could save healthcare billions | | EHR and Health IT Consulting |
The healthcare industry has the potential to save billions of dollars in administrative transactional costs by simply adopting electronic systems and automating processes, according to findings of a Council for Affordable Quality Healthcare (CAQH) 2013 report.
“We conclude that the healthcare industry could save billions by continuing the shift from manual to electronic transactions for the six processes studied,” the authors maintain. “We estimate that most of the potential savings from continued automation of routine processes would accrue to healthcare providers and facilities.
The non-profit alliance’s analysis of healthcare efficiency in 2013 indicates the health plans and healthcare providers could generate savings of $1.43 billion and $6.7 billion by digitizing six kinds of transactions with the revenue cycle:
• claim submission
• eligibility verification
• prior authorization
• claim status
• claim payment
• remittance advice
The second category of transactions — eligibility verification — holds the most promise to reduce healthcare costs on the whole by reducing the current manual cost of $6.83 per transaction down to $0.22 through electronic processing ($4 billion annually).
Comparatively, claims submissions are nearly entirely digital among those health plans and healthcare organizations covered in the report, with 91 percent of claims occurring electronically. Lagging behind electronically are electronic claim payments and remittance whose levels of adoption are used by the half of these respondents: 56 percent and 53 percent, respectively.

Credit: CAQH

The authors of the report contend that the implementation of the Affordable Care Act (ACA) should only increase the potential for savings around these transactions:
To start, the number of insured individuals is expected to grow substantially over the coming decade under the ACA, simultaneously increasing the number of administrative transactions that are conducted daily and the amount that can be saved by conducting them electronically. In addition, the third set of ACA-mandated operating rules that go into effect January 1, 2016, and address healthcare claims, health plan enrollment/disenrollment, health plan premium payments, referral/certification/prior authorization, and claim attachments, provide new avenues for moving away from manual administrative processes.
To improve efficiency, CAHQ has three recommendations for the healthcare industry: adopting electronic administrative transactions and reducing manual and phone-based processes, benchmarking progress, and becoming a participating organization in its index.
The council is looking to several areas for improving the study of healthcare efficiency many of which involve compiling more specific data to improve the precision of its projections and have a richer picture of the resources required for each of the transactions covered.
“On balance, we have probably underestimated potential industry savings in some areas and overestimated it in others. We believe the 2013 total national savings estimates should be taken as a benchmark for 2012 industry results, and ongoing refinements in data specification and collection will improve the precision of our future estimates,” the CAQH concludes.

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Has CMS shortchanged eligible hospitals of EHR incentives? |

Here’s a warning that eligible hospitals in the EHR Incentive Programs should take notice of immediately.
Some eligible hospitals in the EHR Incentive Programs have received insufficient meaningful use incentive payments as a result of the use of an incorrect transition factor by the Centers for Medicare & Medicaid Services (CMS), law firm King & Spalding indicated in a notice earlier this week.
“We have learned that CMS has paid Medicare EHR Incentive Program Payments to some eligible hospitals using an incorrect transition factor, understating total payment,” reports Christopher Kenny (via JD Supra Business Advisor). “CMS personnel have informed us that they are aware of this problem and that the agency intends to implement a system edit that will pay the remaining balance using the correct transition factor no later than the end of October 2014.”
For those needing a refresher, the transition factor is one of three determinants of the size of an EHR incentive payment to hospitals have successfully attested to a stage of meaningful use — the others being the base sum during the specific payment year and the Medicare Share.
(Editor’s note: For a math lesson in calculating the Medicare Share and incentive payments, see Jen Bresnick’s article here.)
Beginning at 1.00, the transition factor decreases based on the first year an eligible hospital begins participating in meaningful use. After three years, it drops by .25 annually. This is what reduces the total payments to hospitals over the course of the Medicare EHR Incentive Program.
The law firm is advising eligible providers to take a closer look at the amount of incentive received through the EHR Incentive Programs.
“Eligible providers that have successfully attested to Meaningful Use should verify that their payments have been made using the correct transition factor,” Kenny continues. “Those providers paid using an incorrect transition factor should monitor their pay-to account and verify that CMS has paid the remaining balance by the end of October.”
According to FAQ2899, CMS disburses payments to hospitals one to two months after a successful meaningful use attestation:
Medicare EHR incentive payments to eligible hospitals and critical access hospitals (CAHs) will also be made approximately four to eight weeks after the eligible hospital or CAH successfully attests to having demonstrated meaningful use of certified EHR technology. Eligible hospitals and CAHs will receive an initial payment and a final payment. Final payment will be determined at the time of settling the hospital cost report. CAHs will be paid after they submit their reasonable cost data to their Medicare Administrative Contractor (MAC).
CMS has made no notification of the error publicly available at the time of this publication.

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Electronic Attachments: The Missing Element of the Claims Submission Process

Electronic Attachments: The Missing Element of the Claims Submission Process | EHR and Health IT Consulting |

Healthcare continues on its way to digitizing business processes. According to a recent study from CompTIA, half of healthcare providers are currently using electronic health records and one-third expect to increase IT spending by 5 percent or more throughout the next year. Additionally, as more and more providers make the switch to electronic records, they’re able to also complete transactions with the payers electronically, reducing costs and further eliminating unnecessary administrative tasks for practices and their payer partners.

That said, one administrative area that’s experiencing substantial growth in practices and where technology solutions is currently having a significant impact on the billing process is electronic claims submission and the process for doing so. According to a 2006 Milliman study, the cost to process a manual claim is $6.63 compared to $2.90 for one that is processed electronically. Because of this cost savings, a number of health insurers are moving in the direction of requiring that claims be submitted electronically by providers. Therefore, it’s not surprising that America’s Health Insurance Plans (AHIP) found that 75 percent of all health insurance claims are now submitted electronically, up from 24 percent in 1995. However, there are other obvious additional benefits to electronic claims submission, such as:

  • Reduced administrative tasks for health systems and practices
  • Increased accuracy of claims and data exchanged
  • Faster payments from payers

The Cost of Attachments

Even with electronic claim submissions becoming standard practice, claims that require additional documentation are still primarily being submitted manually. Although only between 4 percent and 10 percent of claims require attachments, they tend be high-dollar claims that significantly impact provider cash flow. A 2002 Health Insurance Association of America survey found that lack of required documentation was the primary reason for pending claims; this is still the case.

Attachments average four pages in length and are traditionally submitted manually via mail or fax. If a medical billing manager does not utilize electronic attachments, he typically submits the entire claim and attachment manually, thus, taking time away from value-added business processes. Paper claims and attachment submissions take anywhere from between 28 and 120 days to be processed by the insurer; however, electronic submissions are often processed in seven to 14 days, greatly reducing reimbursement cycle time.

A typical medical billing organization submits an average of more than 750,000 claims annually. If just four percent of those claims require attachments, that’s 30,000 claims, and at an average of $6.63 per claim, the cost equals almost $200,000. In comparison, it only costs $87,000 to process those claims electronically at $2.90 per claim, resulting in a savings of more than 50 percent.

Furthermore, with the Center for Medicare and Medicaid’s (CMS) nationwide Recovery Audit Contractor (RAC) program, the requests for claim attachments and additional documentation will increase. CMS and their contractors have discovered billions of dollars in overpayments to providers because of miscoding on claims or outright fraud. As a result of its findings, CMS has placed stiffer regulations on the medical necessity behind patient procedures that requires providers and medical billing organizations to submit a greater number of attachments in support of their claims [HU1]. CMS issued a policy that allows it to request additional documentation on 1 percent of all claims submitted for every 45 days of the previous calendar year. So, for example, if a provider submitted 426,000 claims the previous year, CMS could send up to 532 additional documentation requests every 45 days.

If the responsibility of the medical billing department is to maximize the revenue per claim and minimize the cost per claim, it only makes sense to employ an electronic attachments clearinghouse to completely automate the claims submission process. Most electronic attachment service providers like MEA|NEA provide secure, HIPAA-compliant solutions and do not require expensive software purchases or upgrades.

Eliminate Paperwork and Phone Tracking

With lack of documentation often causing claims to be pended or denied, more time must be dedicated to follow-up, rework and the re-submission of claims. When filing a claim that requires an attachment, the biller must fill out the claim form on the computer, but then also print out that form along with the required documents and images for the attachment. The attachments must then be either faxed or mailed, and receipt and approval of the claim and attachments is often verified with the insurance company via phone. The average paper claim takes 20 to 30 minutes to track via phone with average labor costs of $3.70 per inquiry, whereas an electronic claim and attachment can be verified and tracked on a web portal without the billing manager ever having to pick up the phone.

Imagine the time and cost savings if paper and phone tracking were completely eliminated from the billing manager’s to do list. By employing electronic attachments, all   attachments can be submitted, tracked and stored through the electronic attachment clearinghouse’s secure web portal.

Increase Accuracy

Providing accurate information to the insurance companies can be the difference between a paid claim and a pending claim. Adding electronic attachments to the claims process not only further reduces the likelihood of human error, but also allows medical billing organizations to submit the supporting attachments with the initial electronic claim, thus, greatly increasing the first-pass rate on many claims.

When submitting attachments electronically, the biller scans or uploads the required documentation, eliminating the possibility of lost attachments. Some electronic attachment clearinghouses offer features that enable medical biller’s to determine additional documentation requirements by payers for adjudication purposes per the clinical codes listed on the claim. This functionality eliminates the need to wait for a request for additional documentation from the payer.

Overall Improved Payment Performance

Attachments are a small piece of the claims process, but can have a dramatic impact on the speed of the payment process. The average billing cycle for a clean electronic claim is seven to 14 days compared to the average 28-day cycle for a clean manual claim.

With electronic attachment submissions reducing administration tasks and time, as well as improving claim first-pass rates, overall payment performance will improve. For example, EmblemHealth’s dental division processed almost 20,000 electronic attachments last year, and when calculating the average cost per claim, it have saved close to $74,000.

Overall, electronic attachments can offer the most significant impact by improving the efficiency and accuracy of the claims submission process. By partnering with an electronic attachments clearinghouse, providers and medical billing organizations can submit 100 percent of their claims electronically, capitalizing on the benefits that technology brings to streamlining business processes and improving overall payment performance.


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Will health information exchange repair care coordination? |

At Baylor College of Medicine, the progress of health information exchange (HIE) over the past year proceeded quickly. It first began along with other area hospitals using an Epic EHR and is about to widen its reach by signing on with the Greater Houston Healthconnect HIE.
While the progress is certainly positive, Baylor College of Medicine’s CMIO reveals that it is a long time coming. According to Jeffrey Steinbauer, MD, several factors have caused care coordination among providers to break down, but fortunately the exchange of health information via HIEs and the use of standardized electronic formats have the potential to remedy the situation.
In this one-on-one interview, the CMIO and family physician explains how HIE use is changing the way providers deliver care and the long-term benefits of increased HIE adoption to healthcare as a whole.
What motivated the decision to sign on with Greater Houston Healthconnect?
Given the incentive programs such as meaningful use have a trajectory from encouraging basic installation and operation of electronic records to sharing of information and quality improvement, we have seen an enormous growth in the use of electronic records and the ability to share electronic data throughout the country. Our practice is largely specialist and the majority of our patients in the Baylor clinic come to us as patients referred by other providers or patients who have challenging, unusual, or esoteric types of problems.
The ability to gather information that has already been performed on the patient and/or to share that information back with the community where they will go for their continuity of care is very important for us. We see a terrific opportunity to both increase the quality of care through better coordination and communication among providers and potentially reduce the cost of care if we are able to access all the tests and evaluation done on the patients prior to the time they come to see us.
How has coordination of care changed over the years? What has contributed to the difficulties of communicating between physicians?
I’m a primary care physician, a family doctor, and I have been in practice for about 35 years. I have seen this come a long way and one of the things I have noticed over those years of practice is that the coordination of care between specialists and generalists or between specialists and specialists has eroded.
There are a number of reasons why this has occurred: the explosion in the number of specialists who are available; the patient’s ability to pick and choose which providers to see and those providers may be in very different geographic locations (certainly not within the same clinic); and lastly but not unimportantly the effects of insurance panels and the patient being driven to one provider or another based on who their insurance has approved for them.
Why is HIE important to you as a primary care physician?
For me as a primary care clinician, if I am seeing 25 to 30 patients per day, the amount of effort it would take to get on the phone and call all the different providers involved in the patient’s care becomes unmanageable. The opportunity for us to share electronically, for me to have a direct address to share information securely or to pull information from a patient’s previous physician, would be invaluable.
A not uncommon vignette in our very large market would be for a patient to come and see me for a “post-hospital visit” and it may be a patient whom I know very well who was admitted to a hospital somewhere in the city and the first time I knew the patient was in the hospital was in that visit. Not only do I not know the reasons for being admitted but I also don’t know what was done. The patient’s ability to give the history accurately in understandably not as good as we would like and the reason for that is that there are so many tests done and they may not be told what all the results are. If we are able to share information through the transitions of care document which can now be shared electronically, we have that information immediately available.
Where does Baylor currently stand with HIE adoption?
Our institution has just signed a contract with Greater Houston Healthconnect and that organization has a contract with Medicity as a HISP. Shortly, we will be receiving transitions of care documents on our patients regardless of where they have been admitted and regardless of which electronic health record that institution is using.
At the present time, if you’re a patient in another hospital that uses Epic, our ability to pull information from that hospital on your hospital stay is pretty good from Epic to Epic but it is not good from Epic to Cerner, Epic to McKesson, or Epic to any other EMR. Through the national program of Direct Trust, the health information service providers have been standardized in a way now that if you sign on with one that is Direct Trust-approved, you have access to all the others which opens huge pathways for information exchange.
What will HIE use at Baylor look like in the months ahead?
Right now we’re seeing that exchange of information occur in a way that it did not occur 12 months ago — it didn’t happen at all. Now the Epic-to-Epic transfer of information is happening with some frequency and in 12 more months we expect the Epic-to-non-Epic transfer to be happening with great regularity and to see a logarithmic in that kind of data exchange. The impact of this on patient care, continuity, quality, cost reduction, and so on is anticipated. I hope we see it happen and quite convinced that it will.

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Will the tech savvy of newer docs improve care coordination? |

The generational gap within the provider community is visible in the familiarity and ease with which younger physicians take to technology, both health IT and social media.
Although in his current position as the CMIO for Baylor College of Medicine he is “not in the mainstream of medical education,” Jeffrey Steinbauer, MD, sees a tremendous opportunity for improvements to care coordination built on the experience of tomorrow’s physicians who have grown up in a digital culture and used to connecting with others online.
In this companion to yesterday’s story on the growth of health information exchange (HIE) at the Texas healthcare organization, Steinbauer touches on the potential for EHR and health IT to promote greater care coordination among providers while still emphasizing the need for informal as well as formal information exchange.
Is physician education sufficiently focusing on the role of care coordination in patient-centered care?
In general, our students are taught to practice the way our attendings practice and attendings are struggling to learn some of this coordination. I hope that there will be curricula developed around this for both residents and students to make it part of the normative process of how they think about providing care — to be asking, “Where did you get your care previously?” and “What was done?” — to try to coordinate those things. But at the present time, I don’t see that as being a big thrust.
On the other hand, our students are all now taking classes to learn how to use these electronic records. In many cases, the students are better and more adept at it and certainly bond with it more quickly than some of our older faculty. It’s just part of their culture. My hope in a meta-trend sort of way is that the younger physician’s experience with social media may make the exchange of information and communication using IT with other providers more natural to them than it has been for those of us who came up when it was still paper, a pen, and a telephone.
What role could EHR technology have in making connections between providers?
In some ways, maybe the electronic record and how we share that information will take on more of a social media-type look and feel so that physicians can communicate with each other informally as well as formally.
I remember when I first started training that one of the ways I communicated with my consultants was in a doctor’s lounge, literally in the hospital where we practiced. You go in and get a cup of coffee and people would come in and chat about a case, follow up on a case, talk about the management of it, and coordinate the care. It was that kind of informal face-to-face that really helped with care coordination. That’s gone now.
Why is informal exchange as important as formal exchange of health information?
We’re getting better at formal exchange, sometimes it’s the informal exchange — it’s what is between the lines of that data —that means as much as the data itself. Our ability to find ways to share information with people we have never met or people we don’t know other than online may enhance that care in the future. My hope would be that not only would the software grow to allow us to do that but also that the students’ own cultural experience will demand it and make it readily achievable.

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AMA seeks further delays for Open Payments system |

Citing lingering flaws in the Open Payments system brought back online last week by the Centers for Medicare & Medicaid Services (CMS), the American Medical Association is calling on the federal agency to give providers more time for registering and using the system in order to review and identify the need for corrections to claims.
The Open Payments system is a byproduct of the Sunshine Act and aims to provide greater transparency about the financial relationships between healthcare organizations (e.g., device manufacturers, pharmaceutical companies) and providers.
Unveiled earlier this month, the system experienced significant enough flaws to warrant CMS taking it offline temporarily. But just last week, the federal agency announced that the system was back online and that physicians and teaching would have until September 8 to review their records before the Open Payments system became available to the general public on September 30.
AMA is strongly opposed to this proposed timeframe:
CMS reports that it has reopened the Open Payments database as of today, but indicates it will only allow physicians until September 8th to complete registration and seek correction of data. Yet, the agency has not fixed the major problems that continue to mark the roll-out of this database including confusing and inaccurate information, lack of reliable functionality, and excessive time required to register and review reports. This inadequate response will lead to inaccurate publication of data.
How CMS handled taking the Open Payments system offline was another pain point identified by the provider association:
CMS created widespread confusion by taking the Open Payments database offline without notice to physicians or physician organizations and without any indication of when the database would be available again. According to media reports, the Open Payments system was taken offline the evening of August 3rd due to significant technological problems. CMS inadequately communicated about website failures, not releasing a public statement about the system being offline until August 7th and not providing any indication of when the database would be available again, causing confusion among physicians.
Based on these concerns, AMA has proposed a deadline of March 31, 2015, to ensure both participation by physicians and the integrity of data contained in the Open Payments system.
“The lack of faith physicians have in the system at this point in time, is making them wonder if taking time away from patients to go through the process is even worthwhile,” the association’s President Robert M. Wah, MD, said publicly.
Perhaps the experience of the Department of Health & Human Services and CMS with have money concerned about the federal government’s ability to roll out a healthcare-related system that is reliable and effective.

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Little To Show For 26 Billion Health IT Investment

Little To Show For 26 Billion Health IT Investment | EHR and Health IT Consulting |

The electronic sharing of information (health information exchange) plays a critical role in improving the cost, quality, and patient experience of healthcare. However, there is very little electronic information sharing among clinicians, hospitals, and other providers despite more than $24 billion in incentive payments to hospitals and eligible professionals who "meaningfully use" electronic health records, and another $2 billion spent on interoperability standards and EHR certification over the past five years.

This according to a health policy brief written by Janet Marchibroda, director of the Health Innovation Initiative at the Bipartisan Policy Center published by Health Affairs and supported by the Robert Wood Johnson Foundation.

Marchibroda explains, “While considerable investments in health IT have been made, advancement of interoperability and electronic information sharing across systems has been slow,” and “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”

Because most payment in the U.S. healthcare system today is volume based versus outcomes or value based, “there is little financial incentive to share information across settings to reduce costs or improve the quality of care.” Although new care models are expected to expand the business case for interoperability and information sharing, Marchibroda reports “so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”

The major obstacles to electronic sharing of information include the lack of a business case, the financial cost associated with exchange, a lack of standards adoption and interoperability of systems, continued concerns about privacy and security, and concerns about liability.

A study published by Health Affairs found that, of physicians surveyed in 2013, only 14 percent electronically sharing data with providers outside of their organizations. Meanwhile, a 2012 study published by Health Affairs indicates 51 percent of hospitals surveyed were sharing information with ambulatory care providers outside of their organizations, while 36 percent were sharing information with other hospitals outside of their organizations. And, another study cited by the brief revealed only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.

“In order to achieve electronic information sharing, EHRs and other clinical software must be ‘interoperable’ or have the capability to exchange information using agreed-upon standards, and those providing care and services must be willing to share information,” Marchibroda argues. Yet, to date, the requirements for both interoperability and electronic information sharing under the HITECH Act to date have been “fairly limited,” and Marchibroda specifically references Stage 1 of the meaningful use program.

“Stage 1 made it optional for providers transferring a patient to the care of another provider to furnish that provider with a summary of care record 50 percent of the time, and noted that such information need not be transmitted electronically,” she states.

Marchibroda does describe Stage 2 MU requirements as “more robust” and sees Stage 3 as a “significant opportunity to advance the interoperability of EHR technology and electronic information sharing among providers.”

Ultimately, the study concludes, “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”

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How did a rural NH hospital achieve Stage 2 Meaningful Use? |

Critical access hospitals (CAHs) tend to lack the resources of other hospitals which can put them at a disadvantage when pursuing health IT initiatives such as meaningful use. However, the collaboration of executive, clinical, and administrative staff at Cottage Hospital in rural New Hampshire was resource enough for the CAH to attest successfully for Stage 2 Meaningful Use, one of very few eligible hospitals of any size to do so.
Especially critical to Cottage Hospital’s success was the handoff between IT and clinical staff as the technical implementation of the CAH’s certified EHR technology moved to the actual use of the technology by providers. Led by Director of IT Rick Frederick and Clinical Informatics Specialist Tamra Deming, the successful implementation and adoption of Stage 2 EHR technology was the end result of proper preparation and clear communication between both departments.
In this one-on-two interview with Frederick and Deming, the two explain how Cottage Hospital was able to attest for Stage 2 Meaningful Use and prepare for what’s next.
How important is having support from the top down to the hospital’s success in meaningful use?
Rick Frederick: We had full support from the top for meaningful use, so that is one battle I didn’t have to fight. I didn’t have to go asking for money. All I had to do was say what it would cost us in hardware to achieve this milestone. So we bought the hardware and came up with a plan for how to quickly implement the stuff. Fortunately, at that point we had brand-new servers so we used the old ones to test the MEDHOST software in a non-production environment. Once we figured that out, we installed the software, tested it, and handed it off to the informaticists.
Tamra Deming: Hearing other people’s stories and some of the things they’re going through, not everyone has that on their side. We are very fortunate. From there we took each measure and sat down as a group to decide what was most appropriate to be assigned to which department.
How did each of your departments handle the transition to Stage 2?
RF: Because we have strong informaticist talent here at Cottage, we broke off the IT beds and clinical beds. The part I took charge of were the IT beds which started with figuring out what was necessary to get the software and hardware set up to support what we needed to get going. From then on, we handed it over to the informaticists using the meaningful use specifications to figure out where all the gaps were between the software and where we need to be.
TD: Each week we would meet and go over where we were with each measure. There were particular stakeholders who had to speak to that measure and why they thought it was meeting or not meeting and watching for any trends. All through attestation, we met on a weekly basis to go over that and identify any risks or opportunities that we might have missed on the initial go-around. We continue to meet even today every two weeks just to make sure that our data are still meeting expectations for meaningful use. It was really an all-hands-on-deck effort.
How did the technical infrastructure change to support the requirements of Stage 2?
RF: A little more than a year before we planned to test, we started gathering information about what was going to be needed from a hardware perspective, and it turned out that we needed a fair amount of hardware because Stage 2 Meaningful Use was so much more data-intensive. The servers that we had running the EHR were not up to the task. We took the spec that MEDHOST provided back then and added another 25 percent of processing power on top of it — that’s how we came up with how much we thought we might need or possibly even going forward with Stage 3.
How do you ensure success moving forward with the full year of Stage 2?

TD: During our attestation, of course there was all this pressure to meet every day. Now that we have passed our 90-day attestation period and moving on to the full year where you still have to maintain the same standards and same data, I find that that pressure is not on there as much as it was before. So we have to make sure that everyone stays just as involved as they were during the attestation period because moving forward it is just going to get harder and harder. It is something we’re constantly going to be chasing our tails with

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ONC highlights EHR adoption by community health centers |

The Office of the National Coordinator for Health Information Technology (ONC) is looking to the progress made by community health centers whose adoption of EHR technology is nearing 90 percent as any indicator of significant improvements to delivering high-quality care to patients.
In a post on Health IT Buzz, Kerry Souza, ScD, MPH, and Michael Wittie, MPH, highlight data released by the Health Resources and Services Administration (HRSA). According to the recently publishing 2013 data, more than 1,200 national program grantees are providing care to 21.7 million patients.
A total of 87.8 percent of these federally funded health centers are using EHR systems and an even 54 percent are operating patient-centered medical homes (PCMHs). Although the percentage of PCMHs remains unchanged since 2012, the corresponding number for EHR adoption has increased by nearly ten percentage points in one year, up from 79.3 percent in 2012.
“Health centers are not just using health IT, they are using it as part of clinical transformation,” write Souza and Wittie. “Community health centers across the country are also using EHRs to capture and use patient work information to learn more about their patients’ work and health.”
Of the 1,202 grantees, only 50 reported not having an EHR installed. The aforementioned 87.8 percent (1,055) have an EHR system available to all providers at all sites and the remaining 8.1 percent (97) have EHR system availability limited to some sites or some providers.
Here’s a rundown of the EHR functionalities in use among the 1,152 federally funded health centers with EHR technology available to providers:
• Patient history and demographic information (99.9%; 1,151)
• Clinical notes (99.9%; 1,151)
• Computerized provider order entry (CPOE) for lab tests (98.6%; 1,136)
• CPOE for radiology tests (80.3%; 925)
• Electronic entry of prescriptions (99.5%; 1,146)
• Reminders for guideline-based interventions or screening tests (97.2%; 1,120)
• Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (85.9%; 990)
• Notifiable diseases: notification sent electronically (48.3%; 556)
• Reporting to immunization registries done electronically (74.9%; 863)
• Ability to provide patients with a copy of their health information on request (95.9%; 1,105)
• Capacity to provide clinical summaries for patients for each office visit (99.5%; 1,146)
• Protection of electronic health information (99.9%; 1,151)
Apparently, federal funding through HRSA can serve as an indicator of EHR implementation and utilization. Now, if only those remaining 50 sites would get on board, the program would be a perfect success from a health IT perspective.

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Managing the administrative technicalities of meaningful use |

Having the right kind of technology is essential to achieving the various stages of meaningful use. Certified EHR technology (CEHRT) must be in place and used by clinicians to capture required data. But simply having and using the EHR system are not enough.
Eligible providers must also take the next step to report their data correctly to the Centers for Medicare & Medicaid Services (CMS) in order to receive incentive payments. This is where the technical side meets the administrative one. It is also where a breakdown in coordination and management could lead to failure.
Critical access hospitals (CAHs) and other resource-strapped facilities are especially taxed by the administrative requirements of the EHR Incentive Programs, claims health IT consultant explains Marcia Cheadle, Senior Director of Meaningful Use and Advanced Clinicals for Engage.
“We also partner with our hospitals on the administrative side of meaningful use,” she explains. “All of those requirements that are not necessarily technical in terms of the software EMR but are as critical in the registration side of the program so that sites can have a seamless attestation program.”
A major administrative technicality for CAHs involves account reporting to the federal government, something unique from the prospective payment system in place for other healthcare organizations.
“The CAHs in particular are challenged there because of the way the government views their cost accounting, which is different than the PPS,” says Cheadle. “They also have to go the fiscal intermediary related to the depreciation of assets required for each of the stages. So we partner very closely to make sure that the information they have is available for receiving incentive funding in addition to protecting them should an audit occur.”
The division of Inland Northwest Health Services supporting these and similar hospitals work to ensure that the latter have access to accurate data about their progress in meaningful use from a high and low level.
“We provide our partner sites a web-based portal view of their day-to-day operations as it relates to meeting the threshold requirements for meaningful use,” Cheadle reveals. “The hospitals have different stakeholders who can go in and see how from an adoption perspective their clinicians are able to utilize the program and demonstrate meaningful users.”
On top of this, the consultancy handles changes in requirements that emerge as a result of CMS updates to meaningful use via frequently asked questions (FAQs) or other notices, freeing their organizations they support to focus on the clinical side of meaningful use more fully. Likewise, the group coordinates with vendors and state government to ensure their readiness for receiving meaningful use data or prepare for changes in data specifications.
Most recently, Stage 2 Meaningful Use has ramped up the need for these administrative activities. Getting an eligible providers on to an EHR certified for Stage 2 takes planning and communication. “Most vendors recertified and so we needed to enable each of our systems for that certification program,” Cheadle maintains. “That required coordination of the vendor programs as well as testing and providing education to each site on what the clinicians would experience with the new upgrade.”
Requirements in the second phase of the EHR Incentive Programs also required similar planning and communication because of the need for health information exchange (HIE).
“The second big technology change was related to both the transitions of care and patient portal,” Cheadle continues. “Not only in general were those new modules, but they also required a degree of interoperability from a technology standpoint that was not truly there in the Stage 1 platforms, so the coordination of that from a technology standpoint was necessary.”
Technology is front and center in meaningful use, but proper administration is what ensures that attestation are successful and incentive dollars are received.

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Apple's HealthKit app will be linked to Epic's MyChart - iMedicalApps

Apple's HealthKit app will be linked to Epic's MyChart - iMedicalApps | EHR and Health IT Consulting |

When Apple announced HealthKit a few months ago, I wrote how the relationship they were forging with Epic — the electronic medical record that covers a majority of the US patient population — had the potential to be a game changer.

Epic’s MyChart app enables patients to communicate with their physicians, schedule appointments, and view their lab results.  Although it doesn’t have a sophisticated input scheme built in, it does provide the all important bridge from patient portal to the chart your physician views.

I mentioned how it would be transformative if Apple was able to link HealthKit directly to Epic’s MyChart, so a patient’s bluetooth blood pressure cuff  would automatically send the data to their Epic Chart.

Reuters is reporting this is exactly what appears to be happening. Apple is currently trying to navigate the legal minefield of personal health tracking to bring the collection of health metrics to a large population based level.

Further, Allscripts, another EMR, is reported to be in play for a similar type of integration.

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What do most accountable care organizations have in common? |

In the context of healthcare reform, accountable care organizations (ACOs) are clear examples of an effort to shift from volume to value and for providers to assume greater risk. Given their relatively recent creation, gauging the effectiveness of these care models to help achieve the triple aim remains difficult, but new findings from the eHealth Initiative do provide details about the characteristics that many ACOs share with each other.
In a presentation earlier this week, the non-profit organization unveiled details from its 2014 survey of ACOs, which focused on the health IT infrastructure and workforce in place to support these patient-centered forms of care delivery.
The first takeaway is the newness of most of the responding ACOs. Little more than one-third of respondents (35%) indicated being in operation for more than two years with a larger percentage (40%) hovering around one to two years. A similarly large percentage (33%) are funded and administered by health systems. Medical groups are the next leading category at half that percentage (16%).
Although a majority receive funding and governance from health systems and medical groups, the shared savings model still predominates in terms of contracting with 84 percent reporting the use of this model. Next in line are fee for service (FFS, 45%) and sharing savings and losses model (28%).
The number of physicians working as part of these ACOs is reportedly high. Eighty percent of responding ACOs indicated having more than 500 physicians (41%) and 101 to 500 physicians (39%) on staff. These physicians tend to practice in primary care (90%) or specialties (84%) although physicians at acute care hospitals (57%), health systems (53%), and other hospitals (51%) are popular. Less likely physicians specialize in long-term care (22%).
Concerning the number and kinds of patients served, the largest percentage of ACOs care for 10,001 to 50,000 lives (38%) followed by those caring for a patient population between 50,001 to 100,000 individuals. Medicare beneficiaries (85%) are the most likely to receive care through ACOs, which makes sense considered that many ACOs are part of the Medicare Shared Savings Program (MSSP).
In terms of health IT, ACOs use myriad technologies to track quality, manage their patient populations, and handle physician payments and contracts:
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Digital Health: How to Make Every Clinician the Smartest in the Room

Digital Health: How to Make Every Clinician the Smartest in the Room | EHR and Health IT Consulting |

Remember the “World Wide Web” before search engines? Less than two decades ago, you had to know exactly what you were looking for and where it was located in order to access information. There was no Google—no search engine that would find the needle in the haystack for you. Curated directories of URLs were a start, but very quickly failed to keep up with the explosion in growth of the Web. Now our expectation is that we will be led down the path of discovery by simply entering what’s on our mind into a search box. Ill-formed, half-baked questions quickly crystalize into a line of intelligent inquiry. Technology assists us by bringing the experience of others right to our screens.

Like the Internet, EHRs are a much-needed Web of information whose time has come. For a long time, experts preached the need to migrate from a paper-based documentation systems – aka old school charts—to electronic records. Hats off to the innovators and the federal government who’ve made this migration a reality. We’ve officially arrived: the age of electronic records is here. A recent report in Health Affairs showed that 58.9% of hospital have now adopted either a basic or comprehensive EHR—this is a four-fold increase since 2010 and the number of adoptions is still growing. So, EHRs are here to stay. Now, we’re now left to answer the question of what’s next? How can we make this data usable in a timely, efficient way?

My career as a radiologist spanned a similar, prior infrastructure change and has provided perspective on what many practitioners need—what I need—to make the move to an all-electronic patient record most useful: the ability to quickly get my hands on the patient’s current status and relevant past history at the point-of-care and apply this intelligence to make the best decision possible. In addition to their transactional functions (e.g., order creation), EHRs are terrific repositories of information and they’ve created the means but not the end. But today’s EHRs are just that—repositories. They’re designed for storage, not discovery.

20 years ago, we radiologists went through a similar transition of infrastructure in the move to the PACS systems that now form the core of all modern medical imaging. Initially, these highly engineered systems attempted to replicate the storage, display, and annotation functions that radiologists had until then performed on film. Initially, they were clunky and in many ways, inefficient to use. And it wasn’t until several years after that initial digital transition that technological improvements yielded the value-adding capabilities that have since dramatically improved capability, efficiency, and value of imaging services.

Something similar is happening to clinicians practicing in the age of EHRs. Publications from NEJM through InformationWeek have covered the issues of lack of usability, and increased administrative burden. The next frontier in Digital Health is for systems to find and deliver what you didn’t even know you were looking for. Systems that allow doctors to merge clinical experience with the technology, which is tireless and leaves no stone unturned. Further, technology that lets the less-experienced clinician benefit from the know-how of the more experienced.

To me, Digital Health means making every clinician the smartest in the room. It’s filtering the right information—organized fluidly according to the clinical concepts and complex guidelines that organize best practice—to empower clinicians to best serve our patients. Further, when Digital Health matures, the technology won’t make us think less—it allows us to think more, by thinking alongside us. For the foreseeable future, human experience, intuition and judgment will remain pillars of excellent clinical practice. Digital tools that permit us to exercise those uniquely human capabilities more effectively and efficiently are key to delivering a financially sustainable, high quality care at scale.

At MGH, our team of clinical and software experts took it upon ourselves some 7 years ago to make our EHR more useful in the clinical trench. The first application we launched reduced utilization of radiology studies by making clinicians aware of prior exams. Saving time and money for the system and avoiding unnecessary exposure for patients. Our solution also permitted a novel, powerful search across the entirety of a patient’s electronic health record and this capability “went viral”—starting in MGH, the application moved across departments and divisions of the hospital. Basic EHR search is a commodity, and our system has evolved well beyond its early capabilities to become an intelligent concept service platform, empowering workflow improvements all across a health care enterprise.

Now, when my colleagues move to other hospitals, they speak to how impossible it is to practice medicine without EHR intelligence—like suddenly being forced to navigate the Internet without Google again. Today at QPID Health, we are pushing the envelope to make it easy to find the Little Data about the patient that is essential to good care. Helping clinicians work smarter, not harder.

The reason I chose to become a physician was to help solve problems and deliver quality care—it’s immensely gratifying to contribute to a solution that allows physicians to do just that.

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Study: Better EHR alerts could reduce 70% of inpatient UTIs |

A simplified EHR alert that encourages infection control measures could reduce the number of urinary tract infections (UTIs) in hospitalized patients by up to 70 percent, resulting in 380,000 fewer infections and saving 9000 lives per year, says a study from the University of Pennsylvania.  By redesigning the standard patient safety alert to reduce the number of necessary clicks from seven to two, clinicians removed seven times as many unnecessary catheters and decreased the rate of catheter-associated infections by .20 per 1000 patient-days.
“Our study has two crucial, applicable findings,” said the Penn study’s lead author Charles A. Baillie, MD, an internal medicine specialist and fellow in the Center for Clinical Epidemiology and Biostatistics at Penn Medicine. “First, electronic alerts do result in fewer catheter-associated urinary tract infections. Second, the design of the alerts is very important. By making the alert quicker and easier to use, we saw a dramatic increase in the number of catheters removed in patients who no longer needed them. Fewer catheters means fewer infections, fewer days in the hospital, and even, fewer deaths. Not to mention the dollars saved by the health system in general.”
The study involved more than 222,000 patients admitted to UPenn’s three hospitals between 2009 and 2012.  Clinicians were prompted to enter the reason for catheterization into the EHR at the time of the procedure.  The software then triggered an alert at the end of the recommended time period for catheter use based on the condition reminded the physician to reevaluate the need for the device or remove it entirely.
The EHR’s out-of-the-box patient safety features, which required a series of interactions with the software, were still able to reduce the UTI rate from .84 per 1000 patient-days to .70 per 1000 patient-days.  The simplified alerts further cut the infection rate from .70 to .50 per 1000 patient days, the study found.  With up to a quarter of admitted patients receiving urinary catheters during their stay, the improvements in timely removal or reevaluation add up to significant changes in the way patients experience care.
“As more hospitals adopt electronic health records, studies such as ours can help point the way toward improved patient care,” said senior author Craig Umscheid, MD, MSCE, assistant professor of Medicine and Epidemiology and director of Penn’s Center for Evidence-based Practice. “Thoughtful development and deployment of technology solutions really can make a difference. In this study, we learned that no two alerts are alike, and that changes to an alert’s usability can dramatically increase its impact.”

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Does EMR Paves the Way for Big Data?

Does EMR Paves the Way for Big Data? | EHR and Health IT Consulting |

According to Kalorama Information, electronic medical records are the crucial component needed to make Big Data in healthcare a reality, and this a factor that will drive system sales.  As part of the American Recovery and Reinvestment Act, the U.S. government dedicated $20.6 billion to electronic medical record (EMR) projects and penalties will start applying soon for use of paper records.

Kalorama Information, in its complete study of the EMR industry, EMR 2014: The Market for Electronic Medical Records, says that despite these incentives many challenges face the industry in the coming years – as the healthcare market as we have known it changes, driven toward a “Big Data” revolution. The report can be found at:

Big Data is a blanket term for the enormous datasets produced by manufacturers, healthcare providers, regulatory bodies, scientists and others. Many stakeholders believe that Big Data has the potential to improve operations and produce faster, more informed decisions.

As more of health data is gathered by EMRs it is becoming more of an issue of where to store all the data. Growth is also coming from additional patient enrollments as well as technology advancements, particularly in imaging, where storage requirements are very high. According to industry participants, data storage requirements for the healthcare sector is doubling every 18 months and capacity to accommodate it is lagging behind. Fortunately, the availability of the cloud is another option that is getting serious attention.

Kalorama says that investing in technology that is designed to address Big Data will help provide more personalized care. Toward that end, EMR vendors such as Allscripts, athenahealth, Cerner, CPSI, Greenway and McKesson have joined forces to form the CommonWell Health Alliance.

The CommonWell Health Alliance is an independent, not-for-profit trade organization open to all health information technology suppliers devoted to the simple vision that health data should be available to individuals and providers regardless of where care occurs.  The belief is that it is absolutely critical for interoperability to be built into our health IT systems, while protecting health data and other personally identifiable data associated or shared with healthcare providers.

Kalorama has continuously examined the fast-changing market for electronic medical records (EMR) for nearly a decade. The global market for EMR was $23.2 billion in 2013.  But despite continued investment in this realm, 100 percent EMR adoption could still be more than a decade away.

The Kalorama Information report EMR 2014: The Market for Electronic Medical Records is a complete global analysis of the EMR market.  The report includes the important trends that will affect companies offering software, hardware and services related to EMR.  Kalorama is now conducting research into Big Data efforts in Healthcare and will publish a report in August.

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Case study: How clinical analytics helps with meaningful use |

Whether a healthcare organization is attesting to Stage 1 or Stage 2 of meaningful use this year, the process may not be entirely intuitive for physicians and other clinicians responsible for documenting patient care.  At Massachusetts General Hospital (MGH), physicians have a little bit of help from the hospital’s Queriable Patient Information Dossier (QPID), a clinical analytics engine developed at the hospital that provides actionable insights drawn from patient information stored in EHRs and data repositories, making meaningful use attestation just a little bit easier for harried clinicians.
“You can imagine that with all the components of meaningful use that our physicians are responsible for, they are begging the hospital leadership to help them get the data that they need to put into the chart and do it in a way that doesn’t require them to take their energies away from seeing the patient,” says Dr. David Ting, Associate Medical Director for Information Systems at the MGH Physicians Organization.
“One example of this was smoking status, which you have to document in a coded field,” he explained to EHRintelligence.  “What we found is that most of the time our doctors do document it, but in a text record.  They’ll say, ‘Here’s a 28-year-old woman with a history of smoking for the past two years.’  So, clearly that is a woman who smokes, but it’s not entered in a coded field, so it doesn’t count for meaningful us even though it’s in the record.”
Dr. Ting realized that instead of browbeating physicians into changing the way they operate, QPID could be used to identify data in the free-form text fields and automatically populate the correctly coded field.  “We said, ‘Let’s create a service where QPID scans all of the notes for all of the patients seen at Mass General within a certain timeframe, and do an analysis based on what you find in the chart about who was not a smoker.’  And the reason I said not a smoker was that I needed to make sure with high specificity that we can tell that a patient definitely does not smoke,” Ting said.
“After doing the study, we found that QPID was 99% specific.  If QPID says you’re not a smoker, then you are not a smoker.  In fact, we did a head-to-head study using human nurses doing chart reviews, and QPID came out better than the human nurses because the humans were missing things.  We took that data from the text fields and we automatically put it in the EHR in a coded field, so we managed to fulfill that measure without bothering the doctors.  They could document it where they were used to and still meet the requirement for meaningful use.”
Massachusetts General is in the process of attesting to Stage 2 of the EHR Incentive Programs, and is also in the middle of switching out its homegrown EHR in favor of Epic Systems, Ting said, while exploring ways to hold on to the rich functionalities that QPID provides. “Certainly there are search tools within Epic, but they don’t have the whole galaxy of functionalities that we’re used to,” Ting points out.  “When you go to a vendor product, you lose a lot of the flexibility of having control over your own system design.”
The organization will, however, gain the ability to standardize its technology across multiple care sites, as well as reduce the amount of time and effort being spent to develop and maintain health IT applications in-house.  “We realized that we can’t sustain being a software company,” Ting says.  “We are really an integrated health delivery system, and so our main initiative is to take care of patients.  That’s where the Epic decision came in.  Our challenge right now is figuring out how to bolt QPID onto our future EHR as much as possible.  We need to be aware of where that integration can happen.”

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Providers say HIE improves care quality but increases liability |

Providers say HIE improves care quality but increases liability | | EHR and Health IT Consulting |
Health information exchange (HIE) is a mixed bag for most providers who have the ability to transmit patient data between organizations according to new data from the ONC, but healthcare professionals are generally optimistic that data exchange may improve care quality and address the significant gaps in patient information that lead to medical errors or repeated procedures and tests.  As Stage 2 of meaningful use ramps up the requirements for data exchange, the ONC admits that there is “room for improvement” when it comes to HIE capabilities for hospitals and physician providers.
In 2013, before Stage 2 began, nearly four in ten physician providers were able to electronically transmit any sort of data with other providers.  HIE within organizations was more than twice as prevalent as data exchange with external partners, and providers were 8.5 times more likely to exchange data internally than with unaffiliated hospitals.  For physicians, the relatively low rates of HIE adoption may be due to a general feeling that the investment in time and resources is not always worth the rewards.
While 89% of providers said that HIE improves quality of care and 80% believe they are more efficient when exchanging data, a quarter of providers believe that HIE lacks the privacy and security safeguards necessary to prevent an increase in liability.  Thirty-eight percent thought the influx of data made it more difficult to pull out sensitive health information from other data being shuttled back and forth, and 42% were wary of the increases in cost associated with adopting HIE technology.  Two-thirds of providers disliked the fact that HIE was not integrated into their primary EHR or practice management systems and required multiple portals to access information.
Hospitals experienced somewhat higher rates of data exchange in 2013, the survey shows.  More than half of hospitals exchanged lab results and radiology reports, and just over a third transmitted medication histories.  While 70% of hospitals said they had the capability to transmit clinical care summaries in a structured format, just 42% of organizations actually did so.  Less than fifty percent send emergency department notifications to primary care providers, and when they do, it is usually to a physician within the healthcare system.
This is problematic for the one in three patients who have experienced at least one notable gap in their health information.  Eighteen percent of patients have had to repeat their medical history because their provider hadn’t received the data from a colleague.  Seven percent had to tell their story again because their chart simply couldn’t be found.  Nearly one in five had to hand-carry test results to their providers, and 11% said they waited longer than reasonable for their results.  Six percent had to repeat a test or procedure because their results were no longer available.
While the HIE landscape remains patchy, the ONC notes that the healthcare industry has made significant progress in building the infrastructure necessary to support data exchange since 2012.  The number of states with at least one operational HIE service provider increased from 59 percent to 90 percent between Q2 of 2012 and the end of 2013, while the presence of mater patient indexes rose from 39 percent to 73 percent over the same time period.
While HIE is a good barometer of how the industry is progressing on care coordination, future measurements should also take into account the interoperability of EHR systems. “Interoperability measurement will be a key focus going forward,” the report concludes.  “Data show growth in exchange capability and activity, but also show there is substantial room for improvement.”

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Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking | EMR and HIPAA

Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting |

Investing in an electronic health record (EHR) is largely based on the decision to improve patient safety, align with clinical guidelines, enhance revenue cycle times, and capture government-based incentives. But without a proper EHR adoption plan in place, healthcare providers risk never optimizing their investment and achieving their intended goals.

Once an EHR is implemented, healthcare organizations must continue striving toward their goals to optimize their systems. Improving workflows, establishing best practices and increasing overall proficiency of end-users in this application are all components of optimization. Healthcare organizations that are able to maintain this level of focus will see improved clinical and financial outcomes.

This process isn’t easy and requires a commitment to the initial performance metrics that drove the healthcare organization to purchase the new system. Today, nearly half of all healthcare organizations use an EHR, but many struggle to ensure it provides clinical value across the organization. They carefully select and implement systems but fail to make the tool work as originally envisioned. Just because they bought a new EHR doesn’t mean it is serving their patients, providers, or bottom line.

A parallel comparison can be made with buying a high-end, a mobile exercise device to track aerobic and anaerobic steps. Individuals seeking a healthier lifestyle invest in these devices, hoping it will help them achieve their personal health goals. After making the initial investment and adapting daily habits to wear the device, one can begin to adopt the technology to achieve improved health goals. But realizing these goals takes work and commitment. If performance is not monitored, results can plateau and, in some cases, regress. This could result in a growing waist line for the person trying to lose weight, an ironic and unfortunate twist. For healthcare organizations, their growing waistline is unhealthy organizational performance, visible through increases in adverse drug events, recurrent admissions, revenue cycle times and government penalties, all symptoms of goal misalignment. The more healthcare organizations look away from their initial performance goals and utilize EHRs for data storage only, the more noticeable the symptoms become. Both individuals and healthcare organizations can benefit from the process of system optimization to make the tool work for the betterment of the individual or organization.

Extensive research has been conducted by The Breakaway Group (TBG), A Xerox Company, to identify elements that lead to optimization. TBG reports the key adoption elements exhibited by healthcare organizations that optimize their EHRs:

Engaged and Clinically Focused Leadership
Healthcare organizations must demonstrate engaged and clinically focused leadership. Clinical leaders must align their EHR by refining workflows, templates, utilization, and reporting to meet their organizations’ clinical and financial goals. The Chief Medical Information Officer (CMIO) is well suited for this venture.

Targeted Education and Communication
Healthcare organizations must provide targeted education and communication.  When system upgrades are released, organizations must effectively and efficiently educate end users to alleviate reductions in proficiency and productivity.

Comprehensive Metrics
Healthcare organizations must be able to use EHR data.  Organizations must move past the superficial use of an EHR and begin to analyze what is entered. The EHR is of little value, if the data is neither clinically valuable nor used.

Sustained Planning and Focus
Healthcare organizations must sustain planning and focus. Change occurs frequently in healthcare, so system optimization requires preparation, adjustment and real-time communication.

With these adoption elements, healthcare organizations can make their technology work as originally intended—to improve patient and financial outcomes. To overcome the EHR implementation plateau, they must focus on their original performance goals to truly optimize health information technology systems. This process isn’t easy. It requires endurance, but the payoff is worth it. It’s time to “Breakaway” from the status quo and work IT– by optimizing use of HIT systems!

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AHA opposes proposed home health audit, payment procedures |

The American Hospital Association (AHA) strongly opposes one provision in a proposed rule that would establish new audit procedures as part of the update to the payment system for home health providers, according to a letter submitted to the Centers for Medicare & Medicaid Services (CMS) on Monday.
Although the association supports many of the provisions comprising the Home Health Prospective Payment System (HH PPS) for 2015, it is contesting the proposed establishment of new auditing procedures concerning medical necessity. One of these procedures includes basing a provider’s audit on a medical record belonging to another provider.
“While we understand the intent of the audit provisions in this proposed rule,” writes AHA Executive Vice President Rick Pollack, “CMS’s mix-and-match audit approach is inappropriate and would place HH providers at risk of a denial based on the documentation of individuals outside of their oversight and control. Therefore, we strongly urge CMS to withdraw the following three audit-related proposals to avoid violating providers’ accountability boundaries.”
The letter provides further explanation of what the proposed audit procedures could mean to payments to a home health agency: “Under this proposal, if the certifying physician’s record lacks sufficient documentation of eligibility for Medicare HH services, payment would not be rendered to the HH agency.”
Additionally, the association is urging CMS to withdraw a related proposal to “base payment for physician claims for certifications (and re-certification) of HH eligibility on the status of a separate provider’s claim — the HH claim.”
A proposed new physician condition of payment has also drawn the ire of the AHA. Based on the association interpretation of the proposed, a physician claim tied to a denied home health claim would suffer the same fate and CMS remains unclear as to how the latter’s denial is triggered.
“The AHA urges CMS to withdraw this proposed condition of payment, due to both the noted policy and process concerns,” Pollack maintains. “If the agency elects to proceed with a regulatory proposal, it should do so through the physician fee schedule to ensure that all stakeholders, especially physicians, are aware of this proposed change and have the opportunity to submit public comments.”
The solution to the problems, the AHA letter claims, is education for providers and auditors irrespective of the proposed provisions going into effect
“Given CMS’s intent to use this section of the proposed rule to encourage timelier and better documented assessments of patients transitioning to HH services,” Pollack continues, “education is imperative for both providers and auditors — even if these proposals are withdrawn. Specifically, education is needed on Medicare coverage and documentation requirements for face-to-face encounters and HH certifications.”
The comment period for the proposed rule ends September 2. Nearly 70 comments have been received at the time of publishing.

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Interoperability, EHR data quality of top concern to industry |

Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) may not have been expecting such an avalanche of input from the health IT industry when they requested comments on the struggle to turn disparate EHR systems into an interoperable network of high quality health data, but the responses just keep pouring in.  More than a dozen provider groups and leadership organizations have written to the lawmakers to express their support of the urgent need for interoperability, health information exchange, centralized registries to encourage clinical analytics, and industry-wide standards to underpin the data-driven healthcare ecosystem.
Here are highlights from some of the responses to the Senate Finance Committee provided by industry experts.
Why healthcare data must be accessible and interoperable
Healthcare reform efforts that include the shift to accountable care and the introduction of population health management techniques rely on clean and complete data sources that support the delivery of coordinated, cost-effective care, says the Bipartisan Policy Center. “Streamlined, meaningful quality metrics are critical to organized systems of care, and can facilitate public reporting of information that consumers can use to make decisions about their care and that providers can use to understand how their performance relates to their peers.”
The American Hospital Association adds, “Healthcare-related data is a growing but largely untapped resource for accelerating improvement in health care quality and value.  The ability to make that data available and useful in a meaningful way will impact health care delivery and consumers for years to come.”
“Patients and families need easy access to information that helps them evaluate the options open to them for their specific medical conditions, the relative risk and benefit of available options, and the quality and cost of such options (often hyper-variable and regionally-specific),” says the Gary and Mary West Health Institute. “Given that most personal bankruptcies in the country are related to healthcare debts, it is essential that whenever possible, the total cost of care to be borne by the patient be available prior to commitment to a specific treatment plan.”
Addressing data quality and fragmentation
Despite the growing need for robust data sources, healthcare information remains fragmented in disparate systems that cannot interact in a seamless way.  The American Medical Group Association (AMGA) calls this state of affairs “completely inadequate,” and urges more investment in clinical analytics that can harmonize data sources and generate meaningful insights for providers and patients.
The Pacific Business Group on Health (PBGH) encourages the development of multi- and all-payer claims databases that can inform employers’ decisions about provider networks and empower consumers with information about the cost of treatments and services among various hospitals and doctors. While these databases are statewide initiatives, federal support for harmonization of data collection standards among states would encourage their proliferation by minimizing the reporting burden for multi-state payers.”
Patient privacy must still be paramount
While making data accessible to more stakeholders is important, the patient must remain at the center of all decision making.  Ensuring patient privacy is vital if healthcare organizations want to maintain trust and make healthcare information truly useful to the consumer.
The National Committee for Quality Assurance (NCQA) notes that “privacy rules are not intended to impede good patient care. Current privacy rules under HIPAA explicitly authorize sharing of data for most medical treatment, payment and operations purposes, but are often misinterpreted as precluding this very type of essential data sharing.”
“Secure HIE that protects patients’ privacy rights and honors their wishes and directives is at the core of implementing broad data sharing among providers, payers, patients, and other stakeholders,” adds the HIMSS Electronic Health Record Association (EHRA). “It is widely recognized that the inconsistencies in various state and federal privacy laws as they pertain to sensitive health information, such as that protected under 42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records), continue to be obstacles to widespread HIE. . . Harmonization of state privacy laws is essential, therefore, in order to deliver a mechanism that provides a nationwide, privacy-focused legal framework for access and disclosure of sensitive PHI based on patient-directed consent.”
“While many consumers are concerned about misuse of personal health information, most do want their data shared as long as they know with whom and why, and to meet care needs,” NCQA concludes. “They also understand that problems result when information is not shared as needed for care coordination purposes. Further study on the logistics, limitations, and implications for recording and adhering to patient-stated preferences for data sharing is warranted.”

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Hospital M&A Cost Boosted Significantly By Health IT Integration

Hospital M&A Cost Boosted Significantly By Health IT Integration | EHR and Health IT Consulting |

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.

Access Market Intelligence's curator insight, August 18, 7:18 PM

Of course this peculiar lack of interoperability has traditionally been considered a feature, rather than a bug, by most insular, indifferent hospital systems - a protective barrier, rather than an appalling hindrance to systematic delivery of health care. Let's see if the 'alignment incentive' of a sharp bite in the wallets of hospital leaderships results in anything like systemic change.....!

33% of patients don’t know if they have patient portal access |

33% of patients don’t know if they have patient portal access | | EHR and Health IT Consulting |
While it may be worrying for Stage 2 meaningful use hopefuls that just one in three patients confirmed they have access to a patient portal, an even more alarming statistic is that thirty-three percent of patients simply don’t know anything about the possibility of online engagement at all.  When asked by Software Advice about their online interactions with providers, those patients who have attempted to use portal systems generally expressed frustration, confusion, and annoyance with both the technology and the people behind it.
Patient portals have often been touted as a quick and easy way for patients to communicate with their providers between appointments while conducting routine administrative tasks that would otherwise keep staff members on the phone for most of the day.  But far from providing convenience and reassurance to patients, portals seem to be falling short of consumer expectations – and providers may be partly responsible.
Thirty-four percent of patients said their top frustration with portals was unresponsive staff who didn’t communicate effectively, leaving patients to abandon the computer and pick up the phone anyway.  Twenty-two percent also cited automated emails as a chief complaint, calling them impersonal and annoying.  Patients were also dissatisfied with the interfaces that patient portals present.  A third stated that it was difficult and confusing to find the information they wanted, while 11% found that their records were stuffed with medical jargon when they did manage to locate their data.
The widespread frustration isn’t due to the fact that patients resent being steered towards online communications.  They are generally eager to embrace the amenities the technology purports to provide.  Nearly a quarter of patients stated that online appointment making is their most-requested portal feature, while 22% wanted to view lab results and 21% wanted the ability to view and pay their bills online.  Nineteen percent would like to refill prescriptions over the internet, while just 10% cited email access with their providers as a must-have.
Elderly patients were most likely to seek online appointment making and prescription management, perhaps due to the fact that seniors are more likely to juggle multiple medications and providers while experiencing limited mobility. Younger patients were more likely to request access to lab and test data, but cared surprisingly little about the ability to schedule appointments through the portal.
The survey suggests that providers should spend more time explaining the benefits of portals to their patients, and pay special attention to educating patients about the availability of online access to their data.  When choosing a portal, providers may wish to focus on simple interfaces that can provide consumers, especially the elderly, with a user-friendly experience.  As healthcare organizations adapt to the increasing levels of patient engagement required by the EHR Incentive Programs, they may also wish to educate staff members about effective communication strategies and timely, helpful responses to patient inquiries that arrive through the portal systems.

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Mobile devices in the hospital: How much is too much? | mHealthNews

Mobile devices in the hospital: How much is too much? | mHealthNews | EHR and Health IT Consulting |

Seven years ago, Parkview Medical Center launched a bedside medication verification program with single-use wireless devices. The program proved popular with clinicians, who could quickly and easily make sure their patients were getting the right medication at the right time.

With the foundation in place for an mHealth platform, the 350-bed acute care hospital is now adding on critical tools. Parkview officials recently added HIPAA-compliant messaging to the devices, enabling care team members to receive lab orders, reference patient information and communicate with other clinicians at a moment's notice.

Steve Shirley, the Pueblo, Colo.-based hospital's CIO, said the evolution of the mobile device from a one-use platform to a multi-functional tool was a careful process. Officials didn't want to overload the platform with too many functions, making the devices more cumbersome than useful, but they did want to give doctors and nurses what they need to improve workflows.

[Related: Health systems that are designing their own apps.]

"For us, patient safety was the absolute reason that we got into the (mHealth) environment," he said. "It's just so critical. One mistake can be fatal. We had to make sure that what we were giving (clinicians) improved that process."

And an important new tool in that toolbox is instant communications.

Parkview's partner in this process is PatientSafe Solutions. The San Diego-based company supplies the hospital with PatientTouch devices, which operate on Apple iOS. What began as a medication administration project now also handles specimen collection, blood product administration, care team intervention and communication, as well as integration with the lab and pharmacy departments. The latter functions are handled by PatientSafe's new Emma system, which consolidates alerts, notifications and text, image and audio communications through voice-over-IP.

"Since time immemorial, nurses and doctors have been running around with a folded-up sheet of paper in one hand, trying to find other members of the care team … and when they get a chance they have to sit down at a nurse's station somewhere and enter that information into the EMR. That's a critical gap in healthcare," said Steve Davidson, PatientSafe's chief medical information officer. "To be able to bring all that data into a single point of capture of information … and to add a communication tool so that the members of the care team can share this information – that's what (nurses and doctors) want."

Both Shirley and Davidson pointed out that mobile devices in the hospital won't solve any problems if they complicate the workflow rather than improve it. A doctor or nurse who has to stop what he or she is doing and play around with a device is going to eventually ditch the device and go back to old habits. In Parkview's case, Shirley said, officials were able to start with one-use devices; once they were comfortable with that use, more functions were added.

Communication tools were the next phase in the process, Davidson said.

"Human-to-human communication has always been siloed on one channel, while human-to-IT communication has been siloed on another channel, forcing the clinician to pull it all together and integrate it in their head," he said. "This pulls it all together onto one (platform) that enhances the cognitive workload."

Shirley sees the communication platform as the logical next step in a mobile device. "The ability to understand who the care team is really takes us into a new workflow," he said. "It eliminates that randomness."

But they also have to be careful. "We had visions of loading all kinds of apps" on the device, he said. "We realized than that we were starting to put a lot of stuff onto one device, and had to be careful."

"The number of internal devices jumping onto wireless is just massive," Shirley added. "We have to make sure we're not doing too much."

To that end, Shirley said he talked to hundreds of clinicians about the PatientSafe platform before the hospital integrated the Emma system, and found that many were worried. They didn't want electronic medication verification taken away from them or compromised by new tools, he said.

That's why it's important to phase in new uses on a device, he said.

"Once they could see what they can do with (the PatientTouch devices) and see that it doesn't interrupt their workflow, they were ready," he said.

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North America may see 75 million telehealth visits in 2014 |

Patients and providers in North America may conduct up to 75 million telehealth visits in 2014, a Deloitte report predicts, representing an increase of 400% over 2012 levels.  With 100 million electronic visits (eVisits) taking place worldwide by the end of the year, the global healthcare system may be saving more than $5 billion as smartphones and mHealth change the way patients seek care.
Telehealth is reaching a tipping point as providers implement more sophisticated health IT infrastructures that can automate and organize many aspects of remote care, the report explains.  Reliable broadband internet access and advances in practice management tools, as well as the rise of third-party vendors offering add-on telehealth services, allow providers to integrate remote consults into their routine workflows, while the prevalence of smartphones, tablets, and other devices among patients has allowed engagement on an unprecedented scale.
“The business environment in 2014 is primed for significant growth in the volume and value of eVisits,” the report says.  “Trends such as the increasing global physician shortage and the increasing availability of health insurance for the formally uninsured are also likely to drive increased interest in eVisit technology.  eVisits enable less travel time and cost and increased convenience and faster treatment for patients, so demand should be strong.”
Electronic visits can include much more than video calls or pictures of a rash attached to an email.  Deloitte predicts that most telehealth interactions are likely to be text-based: patients may fill out forms or questionnaires that identify routine conditions such as strep throat or sinus infections, which will prompt a clinician to provide a prescription without ever meeting face-to-face.  With 110 million office visits a year related to low-level conditions like sore throats, earaches, and skin rashes, these quick and efficient remote interactions could ease the burden of overworked primary care providers with little time to spare.
As telehealth becomes more widespread, lawmakers and healthcare stakeholders are working to untangle the web of prohibitive regulations that restrict providers from fully embracing remote care.  Changing reimbursement structures are making it easier for providers to bill for telehealth activities, but many providers are still wary of being on call for remote care.
Providers will need to be educated about the value of remote consults if telehealth is to succeed, the report says.  “Media coverage tends to focus on the benefits for patients and payers.  However, for eVisits to take root, physicians will need to invest in improving their technology infrastructure and staff up for a potential flood of new online interactions.  As long as liability for virtual diagnoses is handled properly, physicians will likely enjoy many other features of eVisits, including the ability to share clinical data and information virtually with colleagues, the ability to help more patients in less time and across greater distances, and the potential for more flexible work arrangements.”

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