EHR and Health IT...
Follow
Find
18.9K views | +65 today
 
Scoop.it!

7 Ways to Attract New Patients to Your Medical Practice

7 Ways to Attract New Patients to Your Medical Practice | EHR and Health IT Consulting | Scoop.it

Promoting your practice doesn't have to be costly and time-consuming. Physicians and experts share some creative ways to lure more patients into your practice:

 

1. Get social. Have a professional website, a well-written blog, and an active Facebook page and Twitter feed.

 

2. YouTube. Ask patients for permission to tape and post online an interview you have with them. Then use your blog to promote the online video.

 

3. Become an expert. Write an article on avoidance and treatment tips for common medical issues.

 

4. Give out. Offer patients brochures, pens and fridge magnets with your office information printed on them.

 

5. Give back. Target your volunteer efforts to attract the most relevant patients.

 

6. Ask for help. Your current patients are a great opportunity for free publicity.

 

7. Say thanks. Send a handwritten thank-you card to new patients.

 

There are online tools that can make these tasks easier, and some EHR vendors offering such services as part of their solutions.

more...
No comment yet.
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
Your new post is loading...
Your new post is loading...
Scoop.it!

ICD-10: CMS won't deny claims for first year

ICD-10: CMS won't deny claims for first year | EHR and Health IT Consulting | Scoop.it

In a surprise concession, the Centers for Medicare & Medicaid Services announced Monday that it would work with the American Medical Association on four steps designed to ease the transition to ICD-10.


Despite longtime disagreements on the topic, CMS will now adopt suggestions made by none other than the AMA with regard to the code set conversion. Those changes concern:


1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family," CMS officials wrote in a guidance document.


2. Quality reporting and other penalties. "For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."


3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.


4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, "to help receive and triage physician and provider issues." The center will also "identify and initiate"resolution of issues caused by the new code sets, officials added. 


"These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change," wrote Stack.


While AMA played a pivotal role in bringing about these CMS concessions, it was not the only party calling for a smoother conversion to the new code set.


Some members of the U.S. Congress have publicly suggested a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that "a valid ICD-10 code will be required on all claims starting Oct. 1, 2015."


So as things stand today, providers have to use ICD-10 come October – but CMS will be more flexible about denials and payments than it has previously suggested it would be.

more...
No comment yet.
Scoop.it!

AMA's long war of words against ICD-10

AMA's long war of words against ICD-10 | EHR and Health IT Consulting | Scoop.it

One of the more notable things about the Centers for Medicare &Medicaid Services' revisions to its ICD-10 policy on Monday is the fact that the suggestions come straight from the AMA. After all, there's been no love lost between the two organizations when it comes to that subject these past few years.


Back in November 2011, for instance, AMA put the case as plainly as possible: "Stop the Implementation of ICD-10."


Putting its money where its mouth was, AMA's House of Delegates voted to "work vigorously" to make that happen.


Why? Because the ICD-10 switchover "will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said then AMA president Peter W. Carmel, MD. "At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions.


"The timing could not be worse as many physicians are working to implement electronic health records into their practices," he added.

A couple years later, in June 2013, HIMSS Media's longtime ICD-10 Watcher Carl Natale covered another delegates meeting. And once again, their attitude toward those 68,000 new codes could be boiled down to two letters: N-O.


"Our AMA will immediately reiterate to the Centers for Medicare & Medicaid Services that the burdens imposed by ICD-10 will force many physicians in small practices out of business," the House of Delegates averred. "This communication will be sent to all in Congress and displayed prominently on our AMA website."


Natale called it as he saw it: "It looks like they're recommending physicians cover their ears and scream, 'Nah nah nah nah nah nah nah nah nah nah.'"


In February 2014, as the original ICD-10 deadline was eight months away (this, of course just a couple months before Congress' surprise compliance date delay), AMA once again made its case: "ICD-10 is Financially Disastrous for Physicians":


"Many practicing physicians regard ICD-10 as a costly, unfunded mandate that will not improve patient care. Indeed, the cost to meet ICD-10 is much larger than originally estimated. ... The AMA strongly urges CMS to reconsider the ICD-10 mandate."


A few months later, in November of that year, AMA President Robert Wah, MD, unleashed what to this date (or to these ears, at least) is the ne plus ultra of creatively-phrased anti-ICD invective.


"Here’s an interesting fact: Each of the six Star Wars films has this line: 'I have a bad feeling about this," said Wah in a speech to AMA board members and delegates. "That’s a common reaction to ICD-10. If it was a droid, ICD-10 would serve Darth Vader."


And he added a sequel to the Star Wars-themed jibes: "For more than a decade, the AMA kept ICD-10 at bay – and we want to freeze it in carbonite!"


This spring, as the 2015 looked more and more certain to be a certainty, AMA President Steven Stack spoke withHealthcare Finance Associate Editor Susan Morse. "ICD-10 is problematic, it requires a level of specificity and precision clinicians say we don’t think we’re going to be able to provide," he told her.


He also suggested that AMA was planning to keep up its efforts to get Capitol Hill to see things its way – even at this late date: "There’s an eternity between now and October in legislative parlance," said Stack.

Whether Monday's news will be satisfactory, at last to AMA, remains to be seen. As recently as late June, the group was reiterating that its members "remain steadfast in our belief that the ICD-10 coding system offers no real advantages to physicians and our patients – and certainly no advantages to justify the time and expense the entire health care system has invested in this transition.


"Even if ICD-10 were 'the best thing since sliced bread,'" officials argued, "its forced implementation would not be worth the extensive disruptions in patient care that surely will come without the grace period."

more...
No comment yet.
Scoop.it!

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 | EHR and Health IT Consulting | Scoop.it

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.


Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.


“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”


“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD.  “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to   physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.  The actions CMS is initiating today can help to mitigate potential problems.  We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”


The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms.

The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.


CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.


The AMA also has a broad range of materials available to help physicians prepare for theOctober 1 deadline.  To learn more and stay apprised on developments, visit AMA Wire.


CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:


  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30th.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27th.


In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.


Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.

more...
No comment yet.
Scoop.it!

Meaningful Use Program: Why it failed and how to save it

Meaningful Use Program: Why it failed and how to save it | EHR and Health IT Consulting | Scoop.it

Given the "epidemic of waste [that] blights the U.S. health care delivery system," investment in health care information technology systems is a no-brainer. After all, doesn't the magic wand of IT improve the efficiency of every industry it touches? Congress thought so, and, as a result, in 2009, it allocated $20.6 billion as part of the American Recovery and Reinvestment Act to encourage doctors and hospitals to adopt and use IT systems and migrate from their old paper records to the new electronic health record systems. 

Meaningful Use program

To decide who qualifies for these generous incentives, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services, designed a set of criteria called meaningful use, a three-stage compliance program that requires providers show they're using electronic health records in measurable ways. To receive the financial incentives, doctors and hospitals must attest to reaching different stages of meaningful use.


The first stage of the program was designed to drive medical providers to adopt the records. As long as the government was willing to pick up the tab, doctors were willing to buy fancy electronic health record software and not worry about using it. Electronic health record vendors enjoyed an artificial market created by the billions of dollars of incentives included in the Recovery Act's Health Information Technology for Economic and Clinical Health Act. The majority of providers successfully attested to this first stage and as a result, record adoption rates skyrocketed.

Why the second stage failed

Now that everyone had electronic records, the next stage of the program had to logically focus on using this technology. Unsurprisingly, the second stage was not welcomed in the medical community. As of February 2015, roughly a quarter of physicians had complied with the requirements of this stage. Despite the lackluster results of the second stage of the program, HHS has already proposed the rules for the third stage, which is primarily focused on health information exchange among providers. While my own research documents huge benefits of exchanging health information, I believe that before implementing more complicated rules and regulations, we should have a clear understanding of the reasons for which the second stage of the program has failed. Without learning from the past, the future will not be brighter.


Although policymakers' hunch about the benefits of IT was correct, it failed to understand a nuanced condition under which this magic wand works: organic and voluntary adoption. Imposing these records on the medical community and forcing them to adopt and use this technology was destined to fail. Meaningful use is focused on adoption and use of electronic records as the final goal, which misses the whole point: that IT in health care, just like in any other industry, is a means to achieve the actual goal of efficiency. More importantly, meaningful use considers electronic health records as the only type of IT solution and ignores the fact that there are many other IT services that can help medical providers much more. The "one-size-fits-all approach," as American Medical Association President Steven Stack put it, of meaningful use ignores the differences between physicians and incorrectly assumes that medical care is mass-produced in the same way by all physicians and thus only one IT solution best addresses the unique needs of many different types of medical providers.

Policy recommendations

Meaningful use should have been integrated with the capitated payment models, in which the medical providers are paid a fixed amount per patient and are rather encouraged to provide the best care at the lowest cost. The need to cut costs and increase quality would have driven medical providers to adopt a wide variety of IT solutions that specifically address their unique needs. HHS should have set efficiency as a goal and let medical practices to find out the best way to achieve it through health care IT of their choosing. Instead of mandating physicians to record the smoking statuses and vital signs of all patients, send them reminders about their follow-up visits, and communicate with them through secure electronic messages, meaningful use incentives could have been allocated to fund a wide variety of different IT solutions suggested by medical providers.


Using a small part of the incentives now used for meaningful use compliance, we can run a pilot project and test this idea. HHS should call for proposals for IT projects that each provider, based on its own unique characteristics, deems the best way to cut costs and increase quality. Just like research grants, these proposals can then be evaluated by a panel of experts and funded only if approved. This approach will open up the market for meaningful and innovative IT solutions that actually help medical providers improve their efficiency.

Rather than being stuck with electronic health records as the only IT solution, we can have a national lab in which the performance of many different IT solutions will be tested. Medical providers will find their best way to be more efficient and will adopt the IT solutions that best fits their needs organically and voluntarily. Only then IT will work its magic in the health care sector.

more...
No comment yet.
Scoop.it!

Is Dual Coding an Effective ICD-10 Training Strategy?

Is Dual Coding an Effective ICD-10 Training Strategy? | EHR and Health IT Consulting | Scoop.it

With the October 1 deadline only a mere three months away, following an effective ICD-10 training strategy is of the utmost importance in order to receive standard reimbursement from the Centers for Medicare & Medicaid Services (CMS) as well as other insurers.

One ICD-10 training strategy that a particular medical care organization followed is to dual code diagnostic records and claims in both ICD-9 and ICD-10 coding sets. The Journal of AHIMA reported that the health information management department at Baystate Health has been coding records in ICD-9 and ICD-10 since the beginning of 2014.


This type of dual-coding ICD-10 training strategy has been effective at showing healthcare professionals how the new coding set compares with the older ICD-9 codes. Recently, the organization has taken it one step further. Baystate Health’s new ICD-10 training strategy is to spend one day per week coding in only ICD-10.


This extra time spent on only coding via the new diagnostic and procedural codes will help the healthcare staff at this facility understand what their workflows will be like by the ICD-10 transition deadline on October 1, 2015.


It may benefit more healthcare organizations to use this ICD-10 training strategy and spend some time coding in only ICD-10 before the deadline takes place. The way Baystate Health has developed the new strategy is by having one individual complete the necessary codes in ICD-10 one day per week while another professional codes the same record in ICD-9 immediately afterward.


There are a variety of benefits when it comes to coding in only ICD-10 and preparing for the October 1 deadline. Instead of having to switch back and forth between two coding sets, healthcare professionals will be able to focus more on the new codes during a longer time period.

Healthcare providers should be prepared for the October 1 deadline as it is unlikely any more ICD-10 delays will take place. While there are a variety of organizations that have attempted to postpone the deadline or put an end to the coding transition altogether, the Centers for Medicare & Medicaid Services (CMS), the Coalition for ICD-10, and other federal agencies seem focused on sticking to the deadline regardless.


“Calls for a safe harbor or grace period based on code specificity appear to be a reaction to physicians’ fears that there will be a huge uptick in claims denials if non-specific codes are reported,” the Coalition for ICD-10 reported. “However, these fears are refuted by the results of CMS’ recent end-to-end testing, which showed only a 2% denial rate associated with ICD-10-related errors, thus demonstrating that the transition to ICD-10 will have a minimal impact on the rate of claims denials.”


“A safe harbor for the use of non-specific codes is unnecessary and detracts industry attention from getting ready for the ICD-10 compliance date. There is no evidence supporting the need for a safe harbor,” the Coalition for ICD-10 continued.

more...
No comment yet.
Scoop.it!

Have you hugged your EMR lately?

Have you hugged your EMR lately? | EHR and Health IT Consulting | Scoop.it

Seeking to provide balanced discourse and to recognize marginalized voices at the gooey center of health care, I kindly ask that you find a seat in the Captain’s Room of the Hilltop Motor Lodge for the inaugural meeting of Physicians for the Liberty of the Electronic Health Record, where founder and president Dr. IM Klickhffor starts the proceedings with this plenary talk.

Thank you, thank you. Many of you are using this weekend to catch up on your charting. To raise your hands from the keyboard and clap so generously fills my heart with a JOY template. This weekend wouldn’t be possible without the generosity of the IT companies crowding the exhibit hall, the motel gym, and the less humid corners of the indoor pool. But any conflicts of interest on my part are entangled more with the contradictions that make us human.


Why are we here? I’d argue it’s because medicine is in desperate need of a new orderset, and it’s called EMRpathy. Physicians must value electronic medical records, EMRs, and the larger enterprise of electronic health records, because they possess intrinsic worth. This complex, vulnerable and sensitive software shouldn’t be tolerated for their financial incentives and then insulted for destroying the doctor-patient relationship.


We must stop treating the unexpected screen, dialogue box or pop-up menu as an uninvited guest and instead embrace the opportunity to be questioned by these beneficent and diligent systems. In this way, our colleagues might discover what we’ve known all along — the meaning at the heart of “meaningful use.”


But such radical ideas tug at the roots of precepts that anchor the medical profession, namely the Hippocratic writings. We’ve all been to medical school. We’re familiar with aphorisms such as, “it is more important to know the patient who has the disease than the disease the patient has.” I dare not contradict Hippocrates, but medicine has advanced over the past 2,500 years. An ICD-10 diagnostic code exists for the craziest stuff, like “Spacecraft crash injuring occupant, initial encounter,” but you won’t find a code for restoring the imbalance of the four humors.

No disrespect to Hippocrates, after all, he’s famously the father of western medicine. But when it comes to the challenges in our modern age, he risks appearing as a deadbeat dad.


The most important element in the care of our patients in 2015 is documentation. If we don’t represent the patient in the EMR, the patient doesn’t exist. If not documented appropriately, a skilled and expert physical exam never happened, and intimate conversations with a patient or family become figments of our imaginations. We don’t get paid if the coders can’t play the coding game, and where do they play that game — on the field of the EMR.


The EMR holds the heart, lungs and soul of medicine. In a better world, we wouldn’t need lobbyists to fight for EMRpathy, but my own story speaks to the challenges before us.


My personal journey almost ended at the login page. Ten hours of formal training outside of my hectic clinical schedule, followed by thirty hours on my own time practicing and cursing the system. Like you, I screamed in my sleep, woke up dripping in sweat. I went to a dark place, seriously chewed on the idea of a professional reboot out of clinical medicine, the profession I loved.


But during one ER shift, I asked the EMR representative why most EMRs seemed designed by medical students who graduated last in their class. Why couldn’t the EMR be more user-friendly, intuitive and ready to go out of the box? She listened with unflappable calm, blew a thread of chestnut hair that had drifted over her eye. “Let’s explore,” she said, beaming, and clicked through each busy screen like an astronomer canvassing a night sky. “Take a seat,” she said. “But before logging in, I want you to contemplate the important relationships in your life, your family, and close friends. Were they always smooth sailing? Of course not. If marriage requires work, why wouldn’t your relationship with the EMR, who you’ll be spending more time with than your wife, be any different?”


“But isn’t empathy with the user a fundamental principle of design thinking?” I said. “Because I don’t feel the love.”

“Didn’t Hippocrates say the patient comes first?” she said.

“But this system doesn’t put the patient first, either.”

“It puts their chart first,” she said. “If Hippocrates had to document on his patients, he wouldn’t have had time to write what he did.”

That revelation struck me in the head like a dropdown menu. Resentment won’t make the EMR better, only patience and EMRpathy.  Imagine Hippocrates working as an ER physician in 2015. He would be stomping around the trauma room in clogs, grumbling and scratching under the collar of his scrub top. Why? His Press Ganey surveys were riddled with patient comments about his sandals and tunic.


Physicians complain about the utility of such patient satisfaction scores, especially when it’s tied to their reimbursement, and I must confess that I agree with them on this point. Does it make sense to evaluate and compensate physicians on our interactions with patients when medical practice is now about the Doctor-EMR relationship? Studies show that ER physicians spend twice as much time with the EMR than with their patients, and that’s high touch intimacy, with over 4,000 mouse clicks in a busy 10-hour shift. Who touches patients 4,000 times in a shift?


Physicians lament how EMRs keep them away from the bedside of their patients. But the bedside is vanishing, too. Through telemedicine, patients  exist on the screen, not sitting on a stretcher before us. No bedside to sit at. Nobody to examine. And with no body to examine, we point to the physical exam, and it looks very different. Despite the evolving state of the clinical encounter — bedside or screen — our patients’ digital symptoms are seamlessly melded with orders and decision-making and preserved as one in the EMR.


Hippocrates still breathes, only it’s Hippocrates 2.0. We’re creating a digital life. Physicians must turn their gaze to the EMR with eyes wide open and appreciate the EMR as another respected colleague.

Corporations are considered people, so why not EMRs? The EMRpathy orderset asks physicians to be sensitive to the EMR’s feelings and point of view. Medical schools must recognize EMR disparities and develop curricula in EMR cultural competency. Reading literature that ventures beyond the people-centric canon would mark a solid first step in changing the culture. It will take time. But if we teach and champion effectively, the next generation of physicians won’t flinch at each honk and hard stop, or respond rudely to the dialogue boxes insisting on conversation. They’ll accept documentation as a quest. They’ll understand that our response to obstacles defines our character as individuals and physicians.


What can you do right now? Acknowledge our keyboard intimacy, that our fingertips know the personality of each key better than it ever recognized an enlarged spleen or an S3 heart sound. Tenderly welcome each click and greet each drop down menu as an invitation for friendship. Slow down and click. And click again. And click some more. Be present in the moment, these endless moments of great meaning.


I’m happy to take questions. But if you want to take the next ten minutes to catch up on the charts, honor them with my blessing.

more...
No comment yet.
Scoop.it!

Diabetes Registries under Meaningful Use Objectives Boost Care

Diabetes Registries under Meaningful Use Objectives Boost Care | EHR and Health IT Consulting | Scoop.it

Meaningful use objectives have brought about a significant push toward improving the quality of patient care as well as population health outcomes. The Medicare and Medicaid EHR Incentive Programs cover a wide variety of medical care processes including physician EHR use, electronic prescribing of medication, and public health reporting.


A team of researchers analyzed whether using diabetes registries to meet meaningful use objectives among primary care providers actually led to a variance in healthcare quality and rates of hospital utilization, according to the Journal of the American Medical Informatics Association (JAMIA).


The researchers conducted a practice assessment poll to find out how primary care practices were utilizing diabetes registries. The study looked at insurance claims data from five years ago and compared health outcomes in patients who were treated at facilities using diabetes registries to meet meaningful use objectives against the patient outcomes from other medical care settings.


The research team used logistic hierarchical linear modeling to study the data. The analysis covered more than 12,000 diabetic patients among 50 primary care practices. Type 2 diabetes patients who were treated in facilities with diabetes registries were given scheduled reminders had a higher rate of recommended laboratory testing and dilated retinal exams.


Type 2 diabetes patients who received regular reminders through diabetes registries had less likelihood of avoidable hospitalizations as well as emergency department visits. While Type 2 Diabetes patients saw improvements due to the meaningful use objectives requiring a registry, Type 1 diabetes patients did not see any significant implications due to the use of a registry.


The study concludes that healthcare providers who meet meaningful use objectives by using diabetes registries does, in fact, lead to lower hospitalization rates and higher likelihood of completing recommended lab tests among Type 2 diabetes patients.


Along with utilizing diabetes registries, digital health solutions for tracking health and wellness could also impact chronic disease management. Tactio and Influence Health have come together to offer effective health technologies that utilizes EHR data from multiple systems to help patients and caregivers monitor and track disease progression like diabetes along with utilizing a patient portal to better communicate with providers regarding an appropriate treatment plan.

“With Influence Health and Tactio, patients can track their health on their iPhone, iPad and Android devices. They can receive the coaching and education to live healthier lifestyles and better control chronic diseases such as obesity, hypertension, diabetes, atherosclerosis and COPD,” Michel Nadeau, P.Eng., President, CEO and Founder of the Tactio Health Group, said in a company press release. “Additionally, with consistent branding across an organization’s website, patient portal and mobile health apps, patients are able to access the healthcare organization they trust – anytime, from anywhere.”


These tools will help patients track their weight, blood pressure, and physical fitness metrics. Such technologies may lead to better chronic disease management and improved population health outcomes across the country.


“Partnering with Tactio provides an additional layer of information expanding capabilities and helping healthcare organizations strengthen patient participation in their health,” stated Bradley Case, GM/SVP, Clinical Solutions of Influence Health.

more...
No comment yet.
Scoop.it!

How An EHR Makes A World Of Difference - EHR News & Industry Resources

How An EHR Makes A World Of Difference - EHR News & Industry Resources | EHR and Health IT Consulting | Scoop.it
Imagine, sometime in the future, how great it will be when every doctor and patient will be using the power and convenience of the mobile EHR (and for you doc’s out there, imagine a mobile EHR that is simple, effective, and easy to use – but I digress).  I bring this up, because while on vacation in Hawaii a few years ago, I fell and was dragged on a reef that did some not so great things to my back as you might imagine.  Well, I was lucky enough to be near a fairly large clinic to get stitched up, but that is where the convenience factor ended. After filling out form after form in their waiting room, I was finally taken care of.  I know I’m offering just the patient’s point of view here, but the customer experience really is what is defining success for businesses – everyone knows it, right? So, let me paint the picture of going through a traumatic experience without the benefit of an EHR system.
 
I can’t think of anything more ridiculous than expecting someone who can barely move to fill out a full medical history, let alone being able to actually remember what medications they’re allergic to.  I can’t even remember my medication allergies on a good day to be honest with you.   During this process, it was all I could do to push through the burning pain I felt on my back and I worried if my wounds were infected, and how many stitches I would need. There had to be a better way to be taken care of – the whole waiting and filling out forms thing felt like torture and certainly not the way I’d imagined spending my vacation.
After filling out various, repetitive forms about family medical history (Most of which didn’t seem applicable to my current situation – Come on, why would my father’s history of diabetes affect my back being stitched up?) I was finally admitted and stitched up.  The actual stitching up process took less than 30 minutes.  In total, I spent over three hours trapped inside of the clinic.  I don’t know about you, but I went to Hawaii to enjoy the beaches, not the emergency clinics.
Maybe its just because I am exposed to products like drchrono, but looking back on this helpless, frustrating situation, I couldn’t help but imagine how greatly improved my experience as a patient would have been if this clinic would have utilized ANY sort of an EHR.  drchrono’s EHR offers simplistic, customizable, and intuitive design and holistic functionality for physicians to offer the ultimate patient experience.  By utilizing drchrono’s EHR, this clinic would have been able to onboard me with a few taps on an iPad instead of having me manually write out answers on forms (much more preferable of an action for someone in so much pain – and quicker too!). Additionally, if referral information was required that would have been easily accessible as well.
If you’re interested in providing the ultimate patient experience, consider the right tools to enable your practice to deliver that. drchrono’s EHR solution specializes in giving you access to the services and information you need to provide the highest quality care – don’t let processes and mechanics get in the way of your success – make every interaction you have with your patients an opportunity to educate, inspire, and build a connection towards better health.
For those of you vacationing near the beach this summer – watch out for the reefs!
more...
No comment yet.
Scoop.it!

Increasing Productivity with Your EHR: 5 Strategies

Increasing Productivity with Your EHR: 5 Strategies | EHR and Health IT Consulting | Scoop.it

With the passage of the HITECH Act in 2009, the federal government began requiring physicians to adopt EHR technology. The act mandates "meaningful use" of EHRs by providing incentivized Medicare and Medicaid payments to physicians who use the technology and imposing Medicare penalties on non-adopters. Since then, physicians have voiced concern about decreased productivity and revenue with EHR implementation.


Study results have been mixed, with some studies showing decreased productivity and others showing stable or increased productivity after implementation. Given these inconsistent results, it's reasonable to conclude that success varies among practices with respect to EHR adoption.


So how do you implement an EHR and maintain or improve your productivity? Here are five strategies to consider.


1. Provide Quality Training


Some people in your practice may be technical whizzes. Most are probably not and will require in-depth training to begin feeling comfortable and efficient using an EHR. Successful training requires an initial assessment of physician and staff computer skills, several days of individualized in-house training, as well as ongoing feedback sessions and tutorials. One training technique that has been shown to be effective is to create peer "super users" within the practice who can help others get up to speed with the new system.


2. Delegate Tasks to Your Staff


The work flow of your practice will change as you adapt to using an EHR. One way to improve the new work flow and increase efficiency is to delegate certain data entry tasks to support staff. You can enable medical assistants and nurses to enter vital signs, social and family histories, problem lists, and medical reconciliation into the electronic chart. You can even grant certain staff the ability to enter orders that are later electronically co-signed by you. Each task you delegate is less time that you spend at the computer and more time available for your patients.


3. Customize Your EHR


Do you like your notes and charts formatted a certain way? Do you order certain tests frequently? Almost all EHRs allow for customizable templates as well as ways to create lists of "favorite" or frequently used orders and order sets. Customizing your EHR can significantly decrease the number of "clicks" you need to make for each patient encounter.


4. Decrease Your Typing


For years, physicians used paper charts and transcription services, so it's not surprising many of them feel that typing slows them down. Consider working with a medical scribe who not only is a speedy typist but who is also trained in medical terminology as well as effective and thorough charting. If hiring a scribe seems like it would be too much of an expense, consider purchasing voice recognition software to decrease your burden of typing and boost your productivity.


5. Implement a Patient Portal


Patient portals are convenient for your patients because they allow people access to their health information online. But patient portals can also be convenient for your practice and can even improve your office's efficiency. Ask your patients to fill out new health information, issues, and concerns from home a day to two before coming in to see you, thus allowing you to have access to patient questions in advance and to save time during appointments. Encourage patients to use the portal to request and "pick up" prescription refills, referrals, and lab test orders, as well as to schedule office visits — all of which will free up your support staff to attend to other duties.


Since the passage of the HITECH Act, medical practices have been mandated to adopt EHRs. While the transition to new EHR technology can be challenging, various strategies can be used to enable a practice to quickly increase productivity and revenue.

more...
No comment yet.
Scoop.it!

At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability

At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability | EHR and Health IT Consulting | Scoop.it

On June 24, Doug Fridsma, M.D., Ph.D., in a presentation to the AMDIS Physician-Computer Connection Symposium being held at the Ojai Valley Inn and Spa in Ojai, Calif., shared with CMIO attendees some of the latest activity going on with regard to the American Medical Informatics Association (AMIA), the association of which Fridsma became president and CEO last fall, after having served as chief science officer in the Office of the National Coordinator for Health IT.


Fridsma shared with his CMIO colleagues some of the highlights of the recently released “Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs,” referred to in shorthand as “EHR 2020.”


As part of the opening of that report, published online on May 29 in the Journal of AMIA (JAMIA), notes, “Over the last five years, stimulated by the changing healthcare environment and the HITECH Meaningful Use (MU) EHR Incentive program, EHR adoption has grown remarkably, and there is early evidence of benefits in safety and quality as a result. However, with this broad adoption many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, transferred new and burdensome data entry tasks to front-line clinicians, and lengthened workdays.” Further, the report’s introduction stated that “Interoperability between different EHR systems has languished despite large efforts. These frustrations are contributing to a decreased satisfaction with professional work life. In professional journals, press reports, on wards and in clinics, we have heard of the difficulties that the transition to EHRs has created.”


With regard to the way forward, the authors of the report said in their introduction, “Ultimately, our goal is to create a robust, integrated, inter-operable health system that includes patients, physician practices, public health and population management, and support for clinical and basic sciences research. EHRs are an important part of this ecosystem, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the ecosystem working together. This ecosystem has been referred to as the ‘learning health system.’”


What’s more, the report’s authors noted, “Potentially every patient encounter could present an opportunity for patients and clinicians alike to contribute to our understanding of health care and participate in research and clinical trials. As part of the learning health system, EHRs have long been touted as beneficial to the safety and quality of health care, and studies have shown potential benefits related to information accessibility, decision support, medication safety, test result management, and many other areas. However, implementation of any new technology leads to new risks and unintended consequences; these too have been well documented.”


Speaking of the release of “EHR 2020,” Fridsma told the AMDIS audience on Wednesday that Senator Lamar Alexander, chair of the Senate HELP Committee, “was running around at Vanderbilt, saying, ‘This is something that addresses a lot of the concerns we have.’”

Fridsma noted in his comments that the effort that led to the “EHR 2020” report predated his tenure at AMIA, but reflects the broad focus of the association at this point in time. “We brought together experts to say, what will the EHR look like in the next few years, and what kinds of things could we discuss? And then the Senat HELP Committee testimony that occurred ten days after this was done” created results. “Lamar Alexander took the five principles and said, ‘I’m going to have five hearings on those principles.’” And that, Fridsma said, is what is expected to happen.


Fridsma summarized the learnings shared in the report by noting four main areas of focus. “The first thing we had in the report,” he said, “was that we need to simplify documentation. We went through a series of discussions on why documentation is so complex. We are accelerating to the next stage, but we’re not necessarily getting to the end goal. So we create a whole series of activities” around physician documentation, as a health system, he said, “one set around what is required by regulation, and the other necessary for patient care. Some of this is tied to how our reimbursement works. But the most important development at ONC was the CMS [Centers for Medicare & Medicaid Services] targets for alternative payment models, because that gives physicians and other providers financial incentives to move forward in this area. That will be more of an incentive than Stage 3 of meaningful use, which was really front-loaded.”


The other areas of focus of the report were the need to make regulation more focused; the need to increase transparency around EHR functions; and the need to encourage innovation. As for encouraging innovation, Fridsma told his audience, “That really speaks to a lot of the work going on at ONC right now around FHIR, etc. We’re moving from document-centered ways of viewing information to data-centered ways of viewing information. The EHRs we are using today are not the EHRs that the people we are training today are going to be using. And the way we’ll get there is to encourage APIs and other solutions.”


And he added that, with regard to the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.” He added that “Our plan is to pick themes like these over the next year, and to focus on those themes” at AMIA, in a strategic way intended to help guide healthcare industry thinking on EHR development and evolution.

more...
No comment yet.
Scoop.it!

From data to EHRs, clinician offers 'modest technology agenda'

From data to EHRs, clinician offers 'modest technology agenda' | EHR and Health IT Consulting | Scoop.it

While big data, electronic health records and patient engagement tools are seen as the big solutions to improving healthcare, there are more modest goals clinicians eye to provide better care, says Gurpreet Dhaliwal, a staff physician at the San Francisco VA Medical Center.

Gurpreet, in a post for the Wall Street Journal, offers a "modest technology agenda" that he, as a front-line clinician, hopes to use to do his job better. The agenda includes:


  • Using good data, instead of just big data. Massive data sets don't often help to change a practice, he writes. What clinicians need is constant access to study findings; synopses that have already been confirmed and scrutinized. In May, Jason McNamara, the Centers for Medicare & Medicaid Services senior technical director of Medicaid health IT, said the industry needs to "keep challenging the data, keep asking questions."
  • When it comes to electronic health records, the tools need to be used not just for documentation and billing, but also to help clinicians learn, Gurpreet says. EHRs should make it easy for doctors to answer quick questions about how their patients are doing, as well as to schedule reminder emails about notes and labs for specific patients.
  • Getting updates from patients should be as easy as sending an email or setting up a videoconference, Gurpreet adds. There is "the outdated emphasis on face-to-face visits," he says, and electronic communication makes it easy to see patients more often.


"It is more important to be connected to your healthcare provider than it is to be connected to your Fitbit," he writes.

One healthcare provider, Cleveland Clinic, is taking the promise of telemedicine in stride. The health system is working on the deployment of a telemedicine service tapping mobile devices to provide patients a virtual consultation within minutes.


In addition, from clinicians like Gurpreet to nurses and other providers, roles in the healthcare industry are changing because of technology and these changes require that all players become tech-savvy.

more...
No comment yet.
Scoop.it!

A better road to information interoperability?

A better road to information interoperability? | EHR and Health IT Consulting | Scoop.it

In the national discourse about interoperability, much of the focus is on enabling a doctor using one electronic health record to access patient information residing in a different hospital’s EHR, even when another vendor built it.


But is that really the best way to give doctors the data they need?

"Having the government mandate interoperability is completely wrong," JaeLynn Williams, president of 3M Health Information Systems, told me. "I think we should let the market drive it – and the market says physicians want a single workflow."


That workflow does not have to be directly in an electronic health record, either, and in all likelihood it won't be as the industry moves beyond its initial digitization and into what many are hailing as the post-EHR era, wherein new platforms come to market that enable clinicians to more effectively follow their patients.


If you picture the EHR as one piece of a software stack, rather than the entire application, these technologies are a layer of abstraction above the EHR and essentially reach down to get that data.


"That's what clinicians want. They don't care about interoperability," said Stuart Hochron, MD, chief medical officer at mobile collaboration platform maker Practice Unite. "They want the information."

Eclectic collective

I'm going to group a bunch of tools together, for simplicity's sake, and christen them as part of a new breed of software delivering that patient data. 


Practice Unite and 3M, with its workflow tools, are in there. Others include par8o, with its boldly-marketed "operating system for the entire healthcare industry," ExamMed's newly-minted "universal healthcare technology platform" and the TapCloud smartphone app, which the company calls "a powerful overlay to an EHR."


Overlay. That's the operative word and, indeed, while ExamMed and par8o are more about reaching and tracking patients they also, for lack of a better term, overlay EHRs and other software systems.

It's important to explain that, rather than being direct competitors, these vendors are a representation of emerging technologies that more closely tie clinicians with patients in a way where all parties have access to relevant data. Hospitals could implement and use two or more of them. And they are just a few of the countless innovators coming to market.


Make no mistake: None of these are going to take over the world and solve today's existing interoperability issues alone. Instead, what they have the potential to do is create pockets of interoperability that might not get us to the Holy Grail of any doctor being able to see all the records of any patient – but might land us somewhere close enough. 


Take par8o, for instance. Lancaster Regional Medical Center is using the platform on top of multiple vendors' EHRs from triage to tracking patients' next steps in care outside its own facilities, according to Lancaster Regional CEO Russell Baxley, to essentially tie together various providers in the area with specialists, patients and payers. Other par8o customers such as MGM Resorts and Mt. Sinai in New York also have the potential to enable wide regions of information interoperability.

An industry misguided?

The Office of the National Coordinator for Health IT is at the epicenter of all this. Its 10-year roadmap to interoperability ambitiously aims for the end point of a learning health system – which is, in my opinion, a noble goal and one worthy of the federal government's efforts.

  

But not everyone will agree with me on that, of course. When I asked Williams if she thinks that the government should back off its efforts to drive standards that fuel interoperability, she cut to the chase: "I would say 'yes.' We're relying too much on standards."

Baxley didn't pull punches either.


"I think we played it out all wrong to get to where we need to be. There's nothing pushing anybody toward true interoperability," he said. "The incentives and the penalties are placed on the wrong people. The only way we'll have true interoperability is when the penalties are placed on the EHR providers and bonuses offered for those vendors to make their systems interoperable."

Inching closer

This new crop of platforms won't supplant ONC's work, of course, but they could soar right on by.


"The ability to capture data selectively and share it opportunistically in ways that empower the clinician will surpass any plans to create huge data warehouses and EHR-to-EHR interoperability," predicted par8o co-founder Adam Sharp, MD. 


Indeed, as more and more pockets of interoperability expand outward, we inch ever closer to that broad-accessibility of data that so-called interoperability promises. But will that be close enough to nationwide interoperability to affect the care delivery improvements we all want?

"I think regions are good enough," 3M's Williams said. "We have pieces of interoperability that exist right now. I believe that we are a lot closer than we think."

more...
No comment yet.
Scoop.it!

Lack of Certified EHR Technology in ASCs Fixed by Congress

Lack of Certified EHR Technology in ASCs Fixed by Congress | EHR and Health IT Consulting | Scoop.it

Previously, meaningful use requirements made it difficult for healthcare providers to receive financial incentives from the Medicare and Medicaid HER Incentive Programs if they send their patients to ambulatory surgery centers (ASCs). Since ASCs do not have certified EHR technology, it was not possible for providers to obtain these incentives.


However, the Electronic Health Fairness Act has changed these issues, as it has averted the need for services performed in ASCs to be counted toward the 50 percent patient encounters threshold under meaningful use requirements until the Office of the National Coordinator for Health IT (ONC) develops certified EHR technology for this particular segment of healthcare settings, according to the HIMSS website.


“The Electronic Health Fairness Act of 2015 (H.R. 887/S. 1347), introduced by US Representatives Diane Black (R-TN) and David Scott (D-GA), would exempt patient encounters performed in an ASC from being counted toward meaningful use of EHRs until such time as a CEHRT exists for the ASC setting,” theAmbulatory Surgery Center Association stated. “The legislation would also authorize the US Department of Health and Human Services (HHS) to certify an EHR system for ASCs.”


Republican Senator Johnny Isakson (R-GA) and Senator Michael Bennett (D-CO) both brought the S. 1347 bill forward. Additionally, Congresswoman Diane Black (R-TN-06) and Congressman Earl Blumenauer (D-OR-03) authored the H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act. This particular bill includes language referencing the Electronic Health Fairness Act. The bill was passed by the House of Representatives.


“One third of Medicare beneficiaries in Tennessee are enrolled in a Medicare Advantage (MA) plan. Seniors in my district consistently tell me that they enjoy the flexibility and choice of MA. I’m proud that the House acted today to strengthen this important program both for current beneficiaries and future retirees – and we did it in a bipartisan way that puts patients and their doctors first,” said Congresswoman Diane Black in a public statement. “Our seniors deserve access to health coverage specifically tailored to their needs and dedicated to their unique health and well-being. With the passage of these bills, we have taken an important step forward in achieving that goal.”


As previously reported by EHRIntelligence.com, Dr. Scott Ketover, the President and Chairman of the Board of Digestive Health Physicians Association (DHPA) and the President and CEO ofMinnesota Gastroenterology, finds that healthcare providers were more likely to transfer their patients to more expensive hospital settings in order to keep their meaningful use financial incentives instead of lower cost, more effective ambulatory surgery centers. The Electronic Health Fairness Act, however, prevents this issue from occurring.


Additionally, this new bill will allow “technology to catch up with the legislative requirements,” according to Dr. Ketover. As time marches forward and healthcare tools evolve, ASCs will likely adopt new certified EHR technology under ONC’s certification objectives.

more...
No comment yet.
Scoop.it!

Take Control of Your Data Ownership

Take Control of Your Data Ownership | EHR and Health IT Consulting | Scoop.it

A recently published report by the Annenberg School for Communication at the University of Pennsylvania describes the "Tradeoff Fallacy." Companies interpret your willingness to give them, or allow them to use, your information as a sign that you feel you are getting fair value in exchange. When you become a customer or client of a company that offers a one-of-a-kind product or service, they interpret your action as a sign that you are pleased with their policies and with the value you are getting. Only companies that have a monopoly can get away with this. A company doesn't have to be big and predatory to have a monopoly.  


Amazon, Netflix, iTunes, Facebook, LinkedIn, Twitter, your e-mail provider (if your address is me@ myprovider.com), your EHR, the bank where your direct deposits are sent, etc., each have a monopoly as far as an individual user/customer is concerned.


Does a business' estimate of the value you're getting jibe with yours? According to the study it doesn't. The "Tradeoff Fallacy" concentrates on personal information but the concept actually extends to any business that has you locked in, such as when your EHR vendor asks (forces) you to pay for an upgrade. It happens when any product that you use changes their terms and conditions and takes your continued use as evidence that you agree with them.


The reason the authors say it's a fallacy is that what the business believes about the value of their stuff is generally different from how people see things. People don't like being asked to reveal themselves, but they do it. They feel powerless to do anything else. There is generally no way to negotiate other terms and conditions, something that might be possible in a face-to-face interaction, so most people have simply resigned themselves to being ordered around that they no longer even look at the fine print.


There are a couple of things you can do to avoid being sucked in these vortices. One is to "just say no" to services that play fast and loose with your information, such as selling it without your knowledge. These services can be addictive so if you can't escape your dependence completely, perhaps you can cut the number way down and avoid the urge to sign up for more.


Another strategy to avoid getting locked in by monopolistic products and services is to use commodities, freeware, and products that are "open source" and eschew DRM (which prevents downloading your Kindle eBook so you could continue to use it if Amazon goes bust. Here's more about DRM). Commodities are interchangeable. Fundamentally a lettuce is a lettuce and a car is a car. It's hard to get locked into a commodity item.


Freeware can be obtained and used anonymously. If you like it, and use it a lot, you can pay for it anonymously, which is a good idea if you would like it to be around in the future. Some freeware alternatives to proprietary products that I find useful are:


• LibreOffice, a pretty good — and getting better — replacement for Microsoft Office.


• Calibre, an absolutely wonderful program for managing and reading eBooks, especially the ones that are free, open source, and DRMless. It will even convert free eBooks to Kindle format and transfer them to the device.


• VLC, a media player with most of the function found in iTunes and the Microsoft media player.


• GIMP, is a freely distributed app for such tasks as photo retouching, image composition, and image authoring. It's no Photoshop, but it's free.


• Firefox Web Browser has many useful features that are not found in the browsers that come from the monopolizers. Occasionally webpages don't render or function correctly but it's still my go-to browser.


• Thunderbird E-mail Client is less vulnerable to attack than Microsoft Outlook. I've tried Outlook and Apple Mail and neither of them have the flexibility and usability of this one.


All of these run on Windows, Mac, and Linux minimizing lock-in.


A big question remains: Are the companies that use lock-in as the means of getting your information right or are the authors of "Tradeoff Fallacy" right? Do you value information about yourself highly or not very much? If the answer is "not very much" then maybe you are getting fair value in exchange for handing it over. If the answer is "a lot" then, unfortunately, you're being taken advantage of and it's going to take some work to develop a strategy for keeping as much of it private as possible.

more...
No comment yet.
Scoop.it!

AMA, CMS Help Providers Meet ICD-10 Transition Deadline

AMA, CMS Help Providers Meet ICD-10 Transition Deadline | EHR and Health IT Consulting | Scoop.it

With regard to the ICD-10 transition taking place later this year, the Centers for Medicare & Medicaid Services (CMS) has partnered up with the American Medical Association (AMA) to assist healthcare providers in preparing for the coming ICD-10 deadline.


According to a press release from the AMA, CMS will continue to provide additional guidance for providers around the nation. In particular, information on claims auditing and quality reporting will be offered.


“As we work to modernize our nation’s healthcare infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services, said in a public statement. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”


Both AMA and CMS are working together to ensure providers are ready for the ICD-10 transition well ahead of the October 1 deadline. Both organizations will be holding webinars, on-site training, and provider calls to ensure the ICD-10 transition goes smoothly.


“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs. The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

more...
No comment yet.
Scoop.it!

OIG Found Inaccurate EHR Incentive Payments in Arkansas

OIG Found Inaccurate EHR Incentive Payments in Arkansas | EHR and Health IT Consulting | Scoop.it

The Medicare and Medicaid EHR Incentive Programs were established to improve the quality of care, boost population health management initiatives, and reduce overall healthcare costs, which is known as the Triple Aim of Healthcare. With these goals in mind, it is important to track the progress of meaningful use requirements and EHR incentive payments throughout the healthcare industry.


The Office of the Inspector General (OIG) found a major flaw in the EHR incentive payments completed by the Arkansas Department of Human Services. A total of 14 hospitals received incorrect EHR incentive payments, which resulted in an overpayment of $1.2 million.


An OIG report states that the organization looked at EHR incentive payments among 20 of the highest paid hospitals from November 1, 2011 to June 30, 2013. It was found that the Arkansas Department of Human Services paid 20 hospitals more than $19 million, which covered 65 percent of the total amount paid between the time period of the audit.


“The State agency did not always pay EHR incentive program payments in accordance with Federal and State requirements,” the report stated. “The State agency made incorrect EHR incentive payments to 14 hospitals. Specifically, for 13 hospitals, the State agency made incorrect payments totaling $1,225,734.”


The Arkansas Department of Human Services caused these errors because the agency had foregone following federal requirements with regard to cost report data elements concerning EHR incentive payments. Additionally, the organization failed to review supporting documentation for figures available in the reports.


The OIG recommends several measures that the Arkansas Department of Human Services will need to follow. First, it is important to refund $79,428 to the federal government. Also, the agency will need to modify the EHR incentive payments across the hospitals that received incorrectly calculated disbursement.


Additionally, it is suggested that the Arkansas Department of Human Services review all payment calculations given to hospitals that were not part of the 20 hospitals within the audit. The organization will need to determine whether payment adjustments are needed.


“The State agency did not concur with the recommendation to refund the net overpayment of $79,428 but stated that the incentive payments for 8 of the 13 hospitals had already been adjusted in accordance with our finding,” the report states. “The State agency also stated that it expected the incentive payments for the other five hospitals to be adjusted in accordance with our findings. The State agency also did not concur with our recommendation to work with the one hospital for which the total incentive amount was set aside to recalculate the incentive payment using the June 2009 cost report data.”


The Office of the Inspector General plays a major role in ensuring that various medical organizations are sticking to federal and state mandates. Hospitals and other providers attesting to meaningful use requirements under the EHR Incentive Programs will also need to ensure all information submitted to federal and state agencies are accurate in order to receive EHR incentive payments.

more...
No comment yet.
Scoop.it!

The 'fatal cost' of poor IT rollouts

The 'fatal cost' of poor IT rollouts | EHR and Health IT Consulting | Scoop.it

Too often, health organizations "make rookie mistakes" in their technology implementations, writes Leapfrog President and CEO Leah Binder. And too often, these rollouts leave hospitals vulnerable to serious patient safety risks.


"They assume everything is plug-and-play, then panic when things go wrong. They set unrealistic timelines that demoralize staff. They rely too much on vendors. And they expect technology to somehow electronically solve complex human and managerial issues."


Beyond causing "widespread dissatisfaction – sometimes outright revolt" – from clinicians and nurses, Binder shows how poorly-considered implementations have the potential to be fatal.


Leapfrog offers hospitals a test to assess the efficacy of their order entry systems, for instance, she notes.


One-third of the orders tested each year at more than 1,000 hospitals "don’t properly alert to errors," Binder writes. "Worse, one in six of the orders we test that would have killed the patients don’t get stopped by the systems."

more...
No comment yet.
Scoop.it!

At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability

At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability | EHR and Health IT Consulting | Scoop.it

On June 24, Doug Fridsma, M.D., Ph.D., in a presentation to the AMDIS Physician-Computer Connection Symposium being held at the Ojai Valley Inn and Spa in Ojai, Calif., shared with CMIO attendees some of the latest activity going on with regard to the American Medical Informatics Association (AMIA), the association of which Fridsma became president and CEO last fall, after having served as chief science officer in the Office of the National Coordinator for Health IT.


As part of the opening of that report, published online on May 29 in the Journal of AMIA (JAMIA), notes, “Over the last five years, stimulated by the changing healthcare environment and the HITECH Meaningful Use (MU) EHR Incentive program, EHR adoption has grown remarkably, and there is early evidence of benefits in safety and quality as a result. However, with this broad adoption many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, transferred new and burdensome data entry tasks to front-line clinicians, and lengthened workdays.” Further, the report’s introduction stated that “Interoperability between different EHR systems has languished despite large efforts. These frustrations are contributing to a decreased satisfaction with professional work life. In professional journals, press reports, on wards and in clinics, we have heard of the difficulties that the transition to EHRs has created.”


With regard to the way forward, the authors of the report said in their introduction, “Ultimately, our goal is to create a robust, integrated, inter-operable health system that includes patients, physician practices, public health and population management, and support for clinical and basic sciences research. EHRs are an important part of this ecosystem, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the ecosystem working together. This ecosystem has been referred to as the ‘learning health system.’”


What’s more, the report’s authors noted, “Potentially every patient encounter could present an opportunity for patients and clinicians alike to contribute to our understanding of health care and participate in research and clinical trials. As part of the learning health system, EHRs have long been touted as beneficial to the safety and quality of health care, and studies have shown potential benefits related to information accessibility, decision support, medication safety, test result management, and many other areas. However, implementation of any new technology leads to new risks and unintended consequences; these too have been well documented.”


Speaking of the release of “EHR 2020,” Fridsma told the AMDIS audience on Wednesday that Senator Lamar Alexander, chair of the Senate HELP Committee, “was running around at Vanderbilt, saying, ‘This is something that addresses a lot of the concerns we have.’”

Fridsma noted in his comments that the effort that led to the “EHR 2020” report predated his tenure at AMIA, but reflects the broad focus of the association at this point in time. “We brought together experts to say, what will the EHR look like in the next few years, and what kinds of things could we discuss? And then the Senat HELP Committee testimony that occurred ten days after this was done” created results. “Lamar Alexander took the five principles and said, ‘I’m going to have five hearings on those principles.’” And that, Fridsma said, is what is expected to happen.


Fridsma summarized the learnings shared in the report by noting four main areas of focus. “The first thing we had in the report,” he said, “was that we need to simplify documentation. We went through a series of discussions on why documentation is so complex. We are accelerating to the next stage, but we’re not necessarily getting to the end goal. So we create a whole series of activities” around physician documentation, as a health system, he said, “one set around what is required by regulation, and the other necessary for patient care. Some of this is tied to how our reimbursement works. But the most important development at ONC was the CMS [Centers for Medicare & Medicaid Services] targets for alternative payment models, because that gives physicians and other providers financial incentives to move forward in this area. That will be more of an incentive than Stage 3 of meaningful use, which was really front-loaded.”


The other areas of focus of the report were the need to make regulation more focused; the need to increase transparency around EHR functions; and the need to encourage innovation. As for encouraging innovation, Fridsma told his audience, “That really speaks to a lot of the work going on at ONC right now around FHIR, etc. We’re moving from document-centered ways of viewing information to data-centered ways of viewing information. The EHRs we are using today are not the EHRs that the people we are training today are going to be using. And the way we’ll get there is to encourage APIs and other solutions.”


And he added that, with regard to the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.” He added that “Our plan is to pick themes like these over the next year, and to focus on those themes” at AMIA, in a strategic way intended to help guide healthcare industry thinking on EHR development and evolution.

more...
No comment yet.
Scoop.it!

CHIME Highlights Need to Improve Certified EHR Technology

CHIME Highlights Need to Improve Certified EHR Technology | EHR and Health IT Consulting | Scoop.it

The College of Healthcare Information Management Executives (CHIME) has shared a handful of recommendations with the Senate Committee on Health, Education, Labor and Pensions with the purpose of realizing the potential of certified EHR technology to improve patient care.


The organization's letter to the Senate HELP Health IT Working Group outlines challenges and solutions for five use cases, the first centering on improving care quality and patient safety.


According to CHIME, the "most significant challenge" is the lack of a unique patient identifier:


"As our healthcare system begins to realize the innately transformational capabilities of health IT, moving toward nationwide health information exchange, this essential core functionality – consistency in patient identity matching – must be addressed," the letter states. "As data exchange increases among providers, patient data matching errors and mismatches will become exponentially more problematic and dangerous."


The organization is asking Congress to remove a prohibition preventing federal funds from going toward the development of a unique patient identifier. "Robust information exchange and nationwide interoperability can flourish only once we can confidently identify a patient across providers, locations and vendors," claim CHIME President & CEO Russell P. Branzell and Board Chair Charles E. Christian.


CHIME is also calling on Congress to help simplify quality reporting for healthcare organizations and providers, especially holding off on a requirement to the electronic submission of clinical quality measures (CQMs) until the Centers for Medicare & Medicaid Services (CMS) have conducted sufficient testing of the accuracy and completeness of submitted data.


As for the use case of health data exchange and interoperability, the organization emphasizes the need for Congress to drive standards identification and adoption in nine areas:

1. Patient identifiers

2. Standards for resource locators (e.g. provider directories)

3. Standard terminologies

4. Detailed clinical models

5. Standard clinical data query language based on the models and terminology

6. Standards for security (standard roles and standards for naming types of protected data)

7. Standard Application Program Interfaces (APIs)

8. Standard transport protocols

9. Standards for expressing clinical decision support algorithms

Additionally, CHIME calls into question the ability of the health IT certification program administered by Office of the National Coordinator for Health Information Technology (ONC) to ensure interoperability between certified EHR technology (CEHRT).

The organization maintains that Congress should require the ONC to change its approach to testing, enhance ONC's ability to enforce adherence to the certification program, and enable greater transparency into the interoperability of CEHRT.


The CHIME letter also include recommendations related to patient engagement and IT resources to improve patient safety. For the former, the organization makes the case for CMS to consider alternatives to the patient portal for providers to more effectively engage their patients. "Congress should consider the discrepancy between HHS’ priorities for patient engagement, and patients’ self-indicated priorities," argue Branzell and Christian.


For the latter, CHIME reiterates the dangers presented by limited EHR interoperability and again calls for a patient identification strategy to avoid errors.


Patient privacy is the last of the five use cases covered by CHIME. " CHIME calls on Congress to lead an open dialogue to help states align privacy and consent policies that enable cross border exchange of health information in a secure manner. This should include reexamining certain provisions of the Health Insurance Portability and Accountability Act (HIPAA)," the letter states.


The letter concludes with one additional caveat — changes to meaningful use requirements. These recommendations for the EHR Incentive Programs include a delay for Stage 3 Meaningful Use and a revised approach to measuring quality among others.

more...
No comment yet.
Scoop.it!

Infographic: An Illustrated History of EHR

Infographic: An Illustrated History of EHR | EHR and Health IT Consulting | Scoop.it

Love them or hate them, Electronic Health Records (EHRs) are here to stay! We built a handy dandy infographic to illustrate the history of EHRs.  We hope you find the information useful and interesting.

more...
No comment yet.
Scoop.it!

Three EHR 'Add-Ons' to Boost Your Practice's Efficiency

Three EHR 'Add-Ons' to Boost Your Practice's Efficiency | EHR and Health IT Consulting | Scoop.it

Your practice invested in its EHR for a variety of reasons. Sure, achieving meaningful use was a part of the equation. But you also saw the promise of making your practice more efficient. If driving efficiency's still in your game plan, here are three EHR "add-ons" you may want to consider.


1. A scanning solution


One option is adding a scanning system to your EHR, said Joncé Smith, vice president of revenue management at Bethel Park, Penn.-based Stoltenberg Consulting. With a scanning solution connected to your EHR, you can create a digital archive of patients' insurance information, their contact details, and their signed HIPAA consent forms. "A scanning system is helpful to the front-office staff who are trying to schedule a follow-up appointment and to the billing office if they run into a problem with insurance. If the billing staff can't resolve a problem with a patient's insurance, they can contact the patient directly," she said.


2. A practice management system


If you want to streamline billing and scheduling, a practice management system that includes both capabilities may be a good fit. Selecting a practice management system provided by your EHR vendor is key, advised Morris Stemp, CEO of Long Island City, NY-based Stemp Systems, a healthcare IT consulting firm.


"If you're using systems from two different vendors, you're going to be duplicating data. Anytime you have to manually enter information from one system to another, you leave yourself open to human error," he said. While integrations between systems from different vendors can be helpful, those integrations break, noted Stemp. "When an integration breaks and your practice stops functioning, who's responsible for fixing what's broken if there are two vendors involved?"


While Stemp acknowledged that switching in order to have practice management and EHR platforms from the same vendor can be a costly proposition, over time the benefits outweigh the costs. If you have platforms from two different vendors and either vendor updates its software, you'll probably need to update those integrations. Neither the practice management nor the EHR vendor wants to invest in supporting integrations to a variable number of other systems, he said.


3. A data analytics solution


Data analytics tools should also be on the short list, according to Shane Pilcher, vice president at Stoltenberg Consulting. "There's a [data analytics] tool and process for every size organization. [Data analytics] can take your revenue cycle data and pair it with data from the clinical side of your practice, and you can see how your practice is really taking care of your patients. With this information in hand, you can really make decisions and changes to the way you deliver care. You can improve patient outcomes and decrease the cost of care, which impacts your bottom line," he said.


With access to this data — in the form of dashboards and visual roadmaps — practice leadership can have access to information pulled from disparate systems, advised Smith. For example, with a data analytics solution, practices could have greater insight into which patients are using their patient portal successfully and then align resources around making the patient portal more user friendly.

Technology's not going to fix all of your problems, though. Any smart practice should make sure to fix any broken processes before throwing technology at a problem and hoping for a "fix," advised Pilcher.

"Putting new technology around an inefficient process only exacerbates that inefficiency," he said. Pilcher's advice? "Look at the processes that you're using, identify changes and make them more efficient, and then wrap technology around that. That's going to allow you to see a bigger return on investment and better success of the overall project."

more...
No comment yet.
Scoop.it!

How Small- and Medium-Sized Practices Can Use Big Data

How Small- and Medium-Sized Practices Can Use Big Data | EHR and Health IT Consulting | Scoop.it

Is big data the right fit for your practice? It could be if you're part of an accountable care organization (ACO) or a Patient-Centered Medical Home (PCMH) and your practice is now directly accountable for keeping your patients healthy.


Dan O'Connor, vice president of client relations at Bethel Park, Penn.-based Stoltenberg Consulting, likes to talk about the TV show "House" when describing how big data works in healthcare. On "House," which ran on Fox for eight seasons and finished up in 2012, patients presented with two or three symptoms of a particularly exotic disease and Dr. House spent the entire episode wracking his brain — and the brains of his clinical team — to diagnose and then treat these patients.


When it comes to big data in healthcare, you take that idea about focusing on one patient and you apply it to searching vast amounts of data based on key words to bring back relevant information to your practice. O'Connor said that practices that are trying to embrace the PCMH and ACO models need to be able to utilize all the data they have access to within their EHR and claims data from payers.


When Amarillo Medical Specialists joined an ACO — along with nine other physician practices — in January 2013, it became immediately apparent that the entire ACO needed to figure out whether the services it was providing were actually serving their patients' needs. Each of the practices in the ACO needed to find out how their costs fit into the overall cost of care, according to William Biggs, an endocrinologist and internal medical physician at the Amarillo, Texas-based practice and medical director of the ACO.


For example, before the practices had access to information about the medications and home health and skilled nursing services prescribed by doctors, they didn't know how much any of these services cost — nor did they know the  quality of the care they were providing to patients.


"When we became accountable as an ACO and saw how much we were spending in those categories and how much was being wasted and not used in a constructive way, that was a big eye opener for the doctors," said Biggs. By analyzing data gleaned from the practices' EHRs, its health information exchange, and claims data from insurance companies and Medicare, the practice was able to determine, for example, the appropriateness of patients' emergency room visits and how medically necessary they were.


This meant that the practices involved in the ACO have had to grapple with how accessible they are to patients, according to Biggs. "Are patients able to [be seen] in a timely fashion when they are ill? Or is the front desk just telling them to go to the emergency room? Or are they put on hold and the message tells them to go to the emergency room if this is an emergency — without talking to anybody?"


Fixing a practice's accessibility problem is left up to the individual practice. Biggs said that typically starts with reviewing urgent calls from patients. One solution can be to provide a usable script to the front desk staff that walks them through helping a patient decide if an emergency room visit is required. Having a nurse available to triage patients is also helpful, as is leaving enough slack in the schedule to work in urgent patients rather than sending them to the emergency room.


In its first year, the ACO was able to save Medicare about $4.85 million. About half of that amount was shared among the practices, and a large portion of that amount was shared with the doctors in bonuses. The ACO also saw a 23 percent reduction in hospitalizations in the first 18 months.

more...
No comment yet.
Scoop.it!

Do Stage 3 Meaningful Use Requirements Need More Flexibility?

Do Stage 3 Meaningful Use Requirements Need More Flexibility? | EHR and Health IT Consulting | Scoop.it

As the Centers for Medicare & Medicaid Services (CMS) continues to tweak the EHR Incentive Programs and its subsequent meaningful use requirements, a variety of healthcare organizations and associations have sent forward their comments to proposed changes. For instance, the American Academy of Family Physicians (AAFP) believes that CMS should delay the implementation deadline of the proposed Stage 3 Meaningful Use requirements.


AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., sent a letter addressed to CMS Acting Administrator Andrew Slavitt in which he explained that the timing of Stage 3 Meaningful Use requirements collides with the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS).


Blackwelder asks CMS to delay the deadline for Stage 3 and wait until there is more efficient integration of certain MIPS requirements and the objectives under the Medicare and Medicaid EHR Incentive Programs. Additionally, Blackwelder feels more time is needed to develop interoperable and effective health IT systems before Stage 3 Meaningful Use requirements should be out in full force.


“Current health IT does not yet have the interoperability required to support value-based payment nor the functionality to be efficient and effective in this new paradigm. We strongly urge CMS to delay Meaningful Use Stage 3,” Blackwelder stated in the letter.


“The AAFP opposes the agency’s proposal to remove the 90-day EHR reporting period currently available to eligible professionals, eligible hospitals, and critical access hospitals attempting to demonstrate meaningful use for the first time and instead require them to report a full calendar year reporting period after 2015. This proposal places an enormous burden on all new adopters of EHRs but also those struggling to modernize their practices and meaningfully use an EHR.”

The AAFP feels that CMS should consider using the currently-in-place 90-day reporting period instead while expecting that healthcare providers will continue using certified EHR technology year-round.

Also, the AAFP representative explained that CMS should institute a policy in which healthcare providers can gradually progress through the meaningful use stages as they see fit instead of mandating that providers move toward Stage 3 Meaningful Use requirements “in 2017 and beyond.”


Additionally, the all-or-nothing approach that CMS has put forward when it comes to meeting meaningful use requirements poses significant difficulties to providers who are attempting to attest to the objectives but may have some barriers to overcome. Allowing for certain leniencies and exceptions that lead to partial financial incentives under the EHR Incentive Programs or at least prevents the payment penalty from occurring could be an important part of meaningful use requirements going forward.


As CMS continues to parse through comments and develop more consistent Stage 3 Meaningful Use requirements over the coming days, the future of the healthcare industry will depend on whether more flexibility will be offered through the final Stage 3 ruling and whether the deadlines for meaningful use regulations will be postponed.

more...
No comment yet.
Scoop.it!

How health systems can help physician practices prepare for ICD-10

How health systems can help physician practices prepare for ICD-10 | EHR and Health IT Consulting | Scoop.it

Many physician practices are ill-prepared for ICD-10, and health systems must ensure the right tools are in the hands of those who need them most, according to Bill Reid, senior vice president of product management and partners at SCI Solutions.


"Hospitals risk unsuccessful transitions if physician offices in their communities aren't ready," Reid writes for ICD10Monitor.com. Recent studies show that many still are not, despite the Oct. 1 implementation deadline looming.


For instance, a survey unveiled by the eHealth Initiative earlier this month showed that of 271 providers, half said they have conducted test transactions using ICD-10 codes with payers and clearinghouses. Only 34 percent said they have completed internal testing, while 17 percent have completed external testing.


Eighty-eight percent of test claims were accepted during the Centers for Medicare & Medicaid's second round of ICD-10 testing in April.

There are tools that health systems can use to ensure their "healthcare brethren" are moving forward with ICD-10, according to Reid. A cloud-based business management tool can help create a "crosswalk" to convert the ICD-9 code used most often to ICD-10 equivalents. The business management tools help ensure incidents are coded correctly, he says.


"These electronic bridges help ... make it as easy as possible for community physicians to send in accurate orders and referrals, with the correct codes being used from the start of that workflow," Reid says.


One scenario where this works includes if a patient needs to be scheduled for a CT scan. While the patient is at the practice, staff can use the management tool to schedule the order and while doing so select the prognosis which the program will then autopopulate the correct ICD-9 and ICD-10 codes.

The Workgroup for Electronic Data Interchange has warned that unless all industry segments move forward with implementation of ICD-10, "there will be significant disruption on Oct. 1, 2015."

more...
No comment yet.
Scoop.it!

Specialty Specific EHR

Specialty Specific EHR | EHR and Health IT Consulting | Scoop.it

What scares me is that if we’re not careful, the specialty specific EHR vendor might be a dying breed. This isn’t because the specialty specific EHR vendors aren’t loved by their users more than the alternatives. Instead it’s the shift towards hospital owned medical practices that puts the specialty specific EHR in danger.


While hospital systems would love to support a best of breed approach to EHR software and allow each specialty to choose their own, I’ve never seen it actually happen. When push comes to shove, the hospital system starts rolling out an EHR vendor that “supports” every one of their specialties. It’s hard to blame an executive for making this choice. The logistics of supporting 20+ EHR vendors is onerous to put it lightly. The efficiency of one EHR vendor for a large multi specialty organization is just impossible to ignore. Long term however, I wonder if the downsides will cause major issues.


I should also declare that I don’t think a specialty specific EHR is always the best option. Some specialty specific EHR software aren’t very good either. In fact, I was recently thinking through the list of medical specialties and there were a lot of specialties where I didn’t know of a specialty specific EHR for them.


The one that struck me the most was that I didn’t know of an OB/GYN specific EHR. Is that really the case? I’ve seen hundreds of EHR and I couldn’t think of ever seeing an OB/GYN specific EHR. Maybe I’ve missed it, and if I have then I’d love to learn about one. I imagine the reason there isn’t one is because many of the larger All in One EHR vendors have put a decent focus on OB/GYN functionality. So, maybe no one wanted to compete with what was out there already? That’s speculation. What’s odd to me though is that OB/GYN seems like the perfect case where a specialty specific EHR could really benefit that specialty. They have some really unique needs and workflows. I’d think there would be massive competition around their specific challenges.

What I’ve also found is even the EHR vendors that are happy to sell to any specialty and probably have a few templates for that specialty (Yes, that’s how many EHR vendors “support” every specialty), even the All In One EHR vendors work better for certain specialties. This is often based on which specialties the EHR vendor had success with first. If 80 of your first 100 EHR sales are to cardiologists, then you can bet that your EHR is going to work better for cardiologists than it will for podiatrists.


With this in mind, let’s work as a community to aggregate a list of specialty specific EHR vendors. I’ll be generous and say that if an EHR vendor works with more than 10 EHR specialties, then it’s not a specialty specific EHR (5 is probably a better number). If you’re an EHR vendor and want to admit which specialties you work better for, then I’d love to hear that too.


Can we find a specialty specific EHR for every medical specialty?

more...
No comment yet.