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HIMSS survey: 80% of clinicians use iPads, smartphone apps to improve patient care

HIMSS survey: 80% of clinicians use iPads, smartphone apps to improve patient care | EHR and Health IT Consulting |

In corporate offices, on the street, in coffeehouses, and in the home, smartphones and tablets are becoming ubiquitous, changing the way people interact with each other and interface with the world. Doctor’s offices are no exception to this trend, as mobile devices like iPads, laptops, and smartphones revolutionize the way physicians capture information and connect with patients.


Laptops and workstations on wheels remain the most popular devices for physician use, since they provide direct access to the full EHR interface, but tablets are catching up quickly. With the popularity and relative cost-effectiveness of tablets like the iPad, Kindle Fire, and other Android devices, even devices not specifically designed for healthcare are finding a place in the consultation room. According to the survey, approximately 30% of physicians and non-physician clinicians use mobile devices to facilitate between one quarter to three quarters of patient services, while 9% indicate that 75% to all of their services rely on mobile technology to some degree.

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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Navigating Through the Muddy Interoperability Waters

Navigating Through the Muddy Interoperability Waters | EHR and Health IT Consulting |

Early last week, the Orem, Utah-based KLAS Research released a much-anticipated report on provider organizations’ journeys towards greater interoperability. Certainly this has been a hot topic of late in the health IT space, as many in the industry have been growing increasingly frustrated with the lack of progress in that area.

In fact, you don’t have to look far to sense the industry’s dissatisfaction. Most recently, the eHealth Initiative’s 11th annual data exchange survey found that health information exchange (HIE) organizations are still struggling with interoperability issues. Another survey from Software Advice found that more than half of users surveyed (56 percent) responded that integrating their EHR with other systems presented a "major" or "moderate challenge." And in the Office of the National Coordinator’s (ONC) annual report that it filed to Congress this week, it touted an enhanced focus on interoperability, but admitted that “electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.”

It doesn’t stop there. A recent New York Times piece essentially singled out Epic Systems for the industry’s lack of EHR interoperability. Our Senior Editor Gabe Perna captured this “blame game” point excellently in his blog, stating that due to the current culture of accountability in today’s society, there must be a scapegoat for everything that goes wrong or doesn’t work.

Now, back to the aforementioned KLAS report, which found that 82 percent of the 220 interviewed providers reported feeling at least moderately successful achieving interoperability, with just 6 percent of those providers reported having achieved an advanced state. However, less than half of providers said their vendor cooperates well with other vendors, instead attributing interoperability success to their own doing rather than their EHR vendors.

What’s more, in the NYT piece, the author—despite focusing mostly on the barriers to the sharing of digital medical records—actually mentioned the KLAS report. “In interviews with nearly 200 providers for a study that will be released in early October, executives at the research firm Klas said Epic’s scores were “as good or better than most of the other vendors” in its ability to share information with other systems. Moreover, at the request of Epic executives, several customers, including the Cedars-Sinai Health System in Los Angeles, the Yale New Haven Health System, and New York’s Mount Sinai Hospital, sent emails to The New York Times saying they were able to share records through Epic.”

If you’re confused, I don’t blame you. I was too. I asked myself, how could providers be so frustrated with interoperability, yet report success? Why would the NYT point a finger at Epic, but then bring up the fact that its customers are mostly satisfied with its ability to integrate with other systems?  After talking to Colin Buckley, lead author of the KLAS study, the muddy interoperability waters started to become a little clearer for me.

Specifically, Buckley had one quote that really stuck out: “Often we think about what interoperability should be, theoretically, but the more important question is, what are the needs of providers? That’s s a key in all this.” That tells me that “success” is relative—it depends on the size and type of the organization, its goals and expectations, and most importantly, its individual needs.

Listen, I’m not going to tell you today that interoperability isn’t a significant challenge for many patient care organizations—it is. Nor will I say that the frustration we have seen from so many doesn’t have validity—it does. But it’s important to keep a rational viewpoint, and realize that if the vendor’s customers are satisfied, that probably means more than what the rumor mill might be telling us or what we read in the mainstream media.

Buckley adds, “Epic gets a lot of criticism for having a walled garden, but when you actually talk to their customers, they feel pretty successful. And some of the things they’re doing are not as complex as a Cerner, but the customers’ needs are being met.”

Needs being met. Those are the three words I hope everyone who reads this blog takes from it. Providers have a myriad of internal goals and tasks that they work towards every day, and if they are progressing towards those goals, that is what really matters to them. It’s easy to panic and have the “Oh my gosh, everything is falling apart” attitude when it comes to interoperability, because that’s what we’re told so often. Keeping calm, remaining patient, and focusing on the task at hand can be far more difficult.

Maybe this KLAS report can help us keep things in perspective, though. All we have seen and heard over recent months is that interoperability is nowhere where it needs to be and that we should all throw our arms up and have a fit. But to me, the truth lies somewhere in between this KLAS report and the many others that I’ve mentioned. Years ago, in a college philosophy class, I learned that German philosopher, Friedrich Nietzsche, had said “There are no facts, only interpretations.” While this might be a bit of a stretch, the premise is valid—perspective really is a beautiful thing.

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Feds Looking to Standardize Decision Support for Ebola Screening in the EHR

Feds Looking to Standardize Decision Support for Ebola Screening in the EHR | EHR and Health IT Consulting |

Representatives from both the Centers for Disease Control (CDC) and the Office of the National Coordinator for Health IT (ONC) co-hosted a special webinar this week on the use of clinical decision support (CDS) tools in the electronic medical record (EMR) to screen potential Ebola patients.

The webinar comes as the Ebola virus has become an international topic of discussion, amid a full-on breakout in Libera, Sierra Leone, and Guinea and a smattering of cases elsewhere. In Texas, where the first case of Ebola in the U.S. was treated, representatives from the treating hospital, Texas Health Presbyterian Hospital, a Texas Health Resources facility, initially blamed workflow issues in its EMR as to why the patient, Thomas Eric Duncan, was prematurely released from the hospital. However, the hospital later recanted that statement and said the travel history workflow was available in both doctor and nurse workflows.

The idea, according to CDC’s deputy lead of the Ebola Medical Care Task Force, Dana Meaney Delman, M.D., was to explore ways in which the EMR could prompt healthcare professionals to identify those at risk for Ebola in a timely manner.

For their part, the ONC—represented by Jon White, M.D. the acting CMO and director of office and quality and safety—said they have worked and will continue to work with the electronic health record association (EHRA) to work on standardizing the CDC guidelines into a CDS tool for EMRs. “We’re looking to see how we can best support health IT developers as you work with your clients and take the guidelines we’ve been discussing and turn those into resources you can use and implement,” Dr. White said.

Later, White specifically said they’ll take the treatment algorithm and work with developers to parse that information into a standardized document that can be shared across systems. “The simplest way to do this is a human readable document. You can get a lot more specific using tools developed for Health eDecisions [ONC’s CDS standards framework] and other standards for decision support. Not everyone can use that level of specification. We’re going to have that conversation with developers to figure out what’s most useful to them,” he added.

Dr. Delman and Phil Peters, M.D., also on the CDC’s Ebola Medical Care Task Force, shared the agency’s algorithm for evaluating and identifying someone with Ebola. The key elements in that algorithm the CDC wants to see as a decisional tool in the EMR are to identify those with a fever of 100.4 degrees Fahrenheit or compatible symptoms to Ebola and those who have traveled to a country with an Ebola outbreak in the last 21 days. With cases of Ebola being confirmed in America, Delman said they would want to include in this query patients who have had any exposure to an Ebola patient.

“Those are the important elements that we’re hoping could be translated into an electronic question that’s prompted in emergency rooms or care facilities around the country,” Delman said. “That’s the first and most important step to identifying patients with Ebola.”

Once those at risk for Ebola are identified, the CDC is seeking a mechanism in the EMR to alert healthcare providers that the patient should be isolated immediately. They were also interested in the EMR helping alert the hospital’s infection control program and the local state health department, while also evaluating risk for exposures. However, she said it was important for any CDS to not be too complex. “If we try to be too complicated, it might not be successful,” Delman noted.

Other elements of the CDC algorithm—such as whether the patient had a high-risk or low-risk exposure to the disease—would be difficult to capture in a structured CDS tool, she said.

However, later in the webinar representatives from Texas Health Resources and Allscripts both attested to CDS products that could screen for Ebola patients in that kind of detailed manner. The representative from Texas Health Resources said they’ve built a screening tool within its Epic EMR that can determine if a patient has had low or high-risk exposure. Their tool screened travel history first and then went into symptoms.

Later, Toby Samo, M.D., the CMO at Allscripts, said the Chicago-based EMR vendor had taken the algorithm from the CDC and created a section that can be put into any note in the EMR. This CDS tool, he said, can explore whether the patient has had high, low, or no exposure to Ebola. He said they posted it on their client connect site and gave end-users the tools necessary to add that function into their EMR systems. Moreover, he said they created two version of the CDS tool: one that goes through the regular algorithm and one that is more complex for patients with high-risk exposure.

Due to the evolving nature of the Ebola outbreak, a discussion was also held on the flexibility of a potential CDS tool for identifying patients. Could there be a way to add into EMR CDS tools updated guidelines for care as well as additional travel history red-flags? Dr. White from the ONC said the first was likely doable and others on the call attested that the latter could also be done.

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Electronic Medical Records: Be Afraid, Gun Owners, Be Very Afraid - The Truth About Guns

Electronic Medical Records: Be Afraid, Gun Owners, Be Very Afraid - The Truth About Guns | EHR and Health IT Consulting |

The medical world’s pursuit of the right to self-defense, the most fundamental of all human rights, is heading underground. When responsible gun owners and their advocacy groups ground down the nomination of Vivek Murthy to become Surgeon General, they won a significant political victory. Setting aside that the position itself is an anachronism worthy of elimination, the victory inflamed bureaucrats, politicians, academics, and other master manipulators who, 223 years after ratification of the Second Amendment, still want to pretend it never happened . . .

The struggle by anti-self-defense advocates to learn who owns what kind of gun and what they are doing with it will, I predict, soon head to a very different and much murkier place: the federally mandated, three-layered, electronic medical records swamp. Most Americans are unaware that a critical plank in the Titanic that is Obamacare is the transition from a paper-based medical records system (flawed in its own right) to an electronic one that is, already, deeply troubled. The federally contrived system is a mess that is angering physicians and could actually lead to user-alert fatigue that causes more problems than it solves, especially in places like emergency departments where speed and accuracy are crucial.

But that’s not what should give gun owners pause. It’s this: we have little idea what’s in those electronic records, who sees the data, where it goes, and what they do with it. While the debate over whether physicians should routinely question patients about firearm ownership is quiet for now, that does not mean that healthcare professionals cannot or would not be encouraged, with a wink and a nod, to record gun ownership information in an electronic health record as it emerges in the course of routine conversation with a patient.

Gun owners need to know that there are three kinds of electronic records in play. The first is the electronic medical record (EMR), which replaces the paper chart in a specific clinical setting. Then comes the electronic health record (EHR), which is the granddaddy record; it is supposed to be transportable and contain all the clinical information about you from any medical professional who has interacted with you. Finally, there is the personal health record (PHR), which is the record that the individual patient is supposed to see and manage. Of course, by federal decree, all this information is secure, private, and confidential.

The electronic records systems emerging in the marketplace are all built and sold by private vendors. They are frequently modified by purchasers to meet specific needs and interests. The major incentive for providers to use these tools is federal money: the feds will reward providers who can show that their use of these electronic records improves patient care, a doctrine called Meaningful Use.

Among other things to watch, there are Clinical Quality Measures within Meaningful Use, and two of them, population and public health and patient safety, are potentially areas that providers could be told are appropriate landing grounds for recording even unintentionally disclosed (and medically irrelevant) gun ownership information. Then there is the issue of Syndromic Surveillance, which is a brand new mechanism for reporting clinical data to state and federal agencies. I am all for reporting infectious diseases, which is the historical basis for this process, because viruses and bacteria don’t respect boundaries or laws and frequently behave irresponsibly. But, this process is as yet so ill-defined that there are no boundaries. What will state or federal agencies deem collectable? Will their decisions be open and accessible for comment? How will they communicate their surveillance interests to providers in their jurisdiction?

The lack of transparency about the evolution of EMRs and EHRs has been appalling. Why is that patients are encouraged to access primarily their PHR? Why can’t they easily see their EMR and EHR, despite the government’s chest thumping over their Blue Button initiative? Even more to the point, why don’t I, as a citizen, have the right to see who has looked at my EHR data or the entities to which it has been sold or transmitted (in a de-identified manner, we are assured)? I can log on to my credit report any time and see who has requested it. Why can’t I do the same for my EHR and EMR? Why don’t I have the right to correct the records by removing information that is not medically relevant or opt-out of having my data shipped to federal agencies or academic institutions?

The obsession with big data as the solution to all that ails us is shattering privacy and responsibility walls. As physicians increasingly become employees of large health systems including gigantic health insurer-hospital alliances, their loss of professional independence will imperil their ability to resist calls that emanate from central planners and filter through their employers about what kind of “data” is needed to keep people “safe.” As Florida legislators demonstrated, and a federal appeals court agreed, it is possible to segregate medically legitimate firearms ownership inquiries from intrusive and unwarranted fishing expeditions.

Sadly, people who disavow the very concept of responsible gun ownership are missing the point of why this matters so much. In our very modern era, all fundamental rights are under assault. The medical care bureaucracy has no more legitimate need for routinely gathering information about gun ownership than it does about where you worship, whether you vote, or if you peacefully participated in a political rally.

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EHR still in play with US Ebola case | Healthcare IT News

EHR still in play with US Ebola case | Healthcare IT News | EHR and Health IT Consulting |

In a congressional hearing Thursday, a Texas Health Resources executive joined other clinical stakeholders in the U.S. Ebola crisis to shed light on myriad oversights that materialized when the Ebola virus arrived on American soil.    Daniel Varga, chief clinical officer at Texas Health Resources Daniel Varga, MD, chief clinical officer at Texas Health Resources, who video conferenced for the hearing from Texas, appeared somber. He detailed the sequence of events and missteps that transpired at TH Presbyterian Hospital when Thomas Eric Duncan, the nation's first Ebola case, showed up at the hospital emergency room on the evening of Sept. 25. After poor communication, lacking hospital processes, EHR inadequacies and a host of other issues at play, less than two weeks later, Duncan was dead.    [See also: Missed Ebola diagnosis leads to debate.]   What was first described by THR officials as a "flaw" in the hospital's electronic health record, which resulted in the failure of Duncan's travel history appearing in the physician's workflow, was later recanted by the health system.   "Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola," said Varga in his testimony before the congressional committee. "We are deeply sorry."   In his statement, Varga detailed two big failures at play. One being that Duncan's travel history to Liberia was not captured at the initial point of contact in the emergency department's admission process. This, Varga said, has since been addressed, and the hospital screening process has been amended to capture this information immediately. "This process change makes the travel history available to all caregivers from the beginning of the patient's visit in the ED," he wrote.    Another big issue? The hospital's Epic electronic health record did not have adequate pop-up visibility and travel documentation capabilities related to travel history Ebola exposure, Varga added. "We have modified our electronic health record in multiple ways to increase the visibility and documentation of information," he said. The modifications made included improving the placement and title of the screening tool; adding a pop-up that flags the patient as high-risk for Ebola with subsequent instructions if the patient answers 'yes' to certain screening questions; and exposure to known or suspected Ebola cases. Officials also added a screening question on high-risk activities for those who have been to Ebola areas.    Judy Hanover, research director of provider IT strategies at market research firm IDC Health Insights, said these pop-ups and flags are typically a "manual process," where one hospital may incorporate in alerts from CDC guidance and another hospital may not. Many of these flags and alerts, she continued, "just don't get incorporated as often as they should."   It's more of an inherent design issue with a lot of EHRs, most of EHRs on the market and not necessarily a flaw," added Hanover.   [See also: Questions raised about EHR workflow in Ebola case.]   Varga joined five others who testified before Congress on the Ebola epidemic, chief among them was Thomas R. Frieden, MD, director for the Centers for Disease Control and Prevention, who was in the hot seat for the majority of the hearing's question portion. Varga was also questioned, however.     Diana DeGette, D-Colo., for instance asked Varga straight out: Seeing as the CDC issued THR guidelines on how to handle Ebola cases July 28, were emergency department personnel properly trained on these guidelines? "No," said Varga.   

Some 4,493 people have lost their lives from what the World Health Organization is calling the deadliest outbreak of Ebola in history. Nearly 9,000 people have confirmed and suspected cases reported. As pointed out in the congressional hearing, between 100 to 150 people come to the U.S. from the "hot" areas affected by Ebola. Some 94 percent of those individuals are being screened. 

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FDA computer network vulnerable to data breaches

FDA computer network vulnerable to data breaches | EHR and Health IT Consulting |

A penetration test of the U.S. Food and Drug Administration's computer network conducted by the U.S. Department of Health and Human Services Office of Inspector General uncovered several vulnerabilities, according to a reportpublished Oct. 21.

The report identified five problems with the network, including:

  1. Inadequate Web page input validation: "We identified FDA Web pages that did not perform adequate input validation on data entered by the user," the report's authors wrote. They added that exploitation could open the door for hackers to send "malicious input" to the agency's Web pages to hijack a user's Web browser or to redirect users to malicious pages.
  2. External systems that don't enforce account lockout: Despite repeated failed log-in attempts to the site, the report's authors found external systems that did not enforce account lockouts after a number of consecutive tries.
  3. A lack of assessments performed on external servers: OIG was not permitted by FDA to perform penetration testing on seven external systems it deemed mission critical.  "Hence, we could not verify whether security vulnerabilities existed within these systems and whether the vulnerabilities could be exploited to gain unauthorized access to FDA systems and data," the report said.
  4. Error messages that reveal sensitive information: Many times, the report's authors said, error messages generated via system applications revealed application code to attackers. However, according to the report, the National Institute for Science and Technology requires all federal information systems to generate error messages that reveal only enough information to take corrective measures.
  5. Demonstration programs that reveal system information: "Oftentimes, software may leave demonstration programs or sample scripts available as part of a default installation," said the report's authors, who identified demonstration programs that could be run on FDA systems. To that end, such programs "revealed sensitive internal system environment settings."

Last October, a hack of the FDA's online submission systems enabled unauthorized users to gain access to confidential business information, medical data belonging to patients enrolled in clinical trials and names, phone numbers, email addresses and passwords for 14,000 user accounts.

No unauthorized access was granted to FDA's network during the penetration test, according to OIG.

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How to Avoid EHR Gaps Seen in the Ebola Crisis

How to Avoid EHR Gaps Seen in the Ebola Crisis | EHR and Health IT Consulting |

When the Liberian citizen carrying the Ebola virus first presented himself at Texas Health Presbyterian Hospital last month, he was initially sent home with antibiotics and pain relievers, according to reports. This outcome gave him three more days without treatment and put others he came in close contact with at risk in contracting the deadly disease.

The big question of course is, “How could this have happened?” Here’s how.

It turns out that while the admitting nurse asked all of the right questions and even took the time to input the information into the hospital EHR, proper dissemination to physicians in charge never happened because the nurse's EHR work flow was separate and not integrated with the physician EHR work flow.

While this caused a public outcry of why keywords such as fever, vomiting, and a patient visiting from West Africa weren’t enough to create real-time people-to-people communication across the emergency room floor, it is important to consider the “chaotic” status of the hospital at that time in terms of staffing, noise-level, and other urgent crisis care needs rolling in the door.  The hospital and its staff counted on the technology to do the work for them, but previously unknown gaps suddenly became very apparent. 

Since then, the hospital has remedied its EHR work flow system, but where does that leave the rest of us? How do other healthcare facilities and physician practices overcome the fact that too many more health systems have similar separate functions and modules which do not share information to users on a timely basis? 

Here are three of my thoughts:

1. EHR systems must be communication-comprehensive.  Systems need to be automated to immediately share vital information about incoming patients with all users (nurses, technicians, and physicians), and to address enhanced public health and syndromic surveillance. To achieve this, the work flow component must have an alert system attached and the ability for users to find and gather data with a minimum number of clicks.

2.  Interoperability must be the basis of the system functionality.  Total integration is an indispensable requirement for any healthcare system. All of the EHRs and practice management systems used at every level within a healthcare system (from the individual practices to the larger hospital), must be able to “talk” to each other. This will improve operations and provide appropriate, responsive patient care and communication. When different systems are being used for the emergency department and inpatient and ambulatory care, the lack of interoperability creates the biggest handicap for fast and efficient response.

3. Communication must be sent throughout the medical team. The nurse in the Texas hospital ER used an Ebola check list, which included a question about travel history. The patient told the nurse that he had recently visited Liberia, which has been ravaged by the Ebola outbreak. But the information was not widely enough shared with the medical team treating Duncan.

EHR systems must not only have the ability to alert when data and keywords are entered, but to aggregate and utilize the data and analytics for fast response. This can only happen if EHR systems are integrated and programmed to properly analyze the big data to result in actionable responses on dynamically emerging disease patterns. EHRs should have a common "flag" to indicate a serious threat, such as Ebola. When such issues are flagged, an automatic alert should be sent to staff to inform them to contact local public health authorities as well as the CDC.

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22% of EPs, 5% of Hospitals Fail Meaningful Use Audits |

22% of EPs, 5% of Hospitals Fail Meaningful Use Audits | | EHR and Health IT Consulting |
Drew Memorial Hospital in Monticello, Arkansas is celebrating a successful appeal of its failed meaningful use audit today, but not all healthcare organizations that have undergone the process are about to break out the cake and party hats.  Jim Tate, a meaningful use consultant from EMR Advocate who helped Drew Memorial through its trials, told EHRintelligence that the failure rate for Stage 1 meaningful use audits is around 5% for eligible hospitals and 22% for eligible professionals.
In mid-September, Drew Memorial CEO Scott Barrilleaux revealed that insufficient documentation about their security risk assessment prompted CMS to ask the organization to return more than $900,000 in EHR incentive payments from two years of participation in the program.  Barrilleaux stated at the time that Drew Memorial was already filing their appeal paperwork, and enlisted Tate to help them.  They learned on October 20 that their appeal was successful, Tate said, and that the hospital will keep its incentive payments.  “It took probably less than two weeks before they heard, so now they don’t have to have anything recouped,” Tate said.
The security risk assessment has been a major pain point for healthcare organizations the beginning of the audit program.  Early in 2013, Rob Anthony, Deputy Director of eHealth Standards and Services at CMS, even flagged the risk assessment as an area where providers would be getting themselves in trouble, and it looks like an accurate assessment.
“A big part of the audit failures come from the security risk assessment,” Tate said. “Hospitals are generally more likely to do something about it.  But if you have a small practice, you might not understand what that really is.  When you attest, it just asks if you did it, and you check either yes or no.  But then if you get audited, they’ll ask, ‘Where is it?’  You can’t just say, ‘Well, I thought – I don’t know – I didn’t understand that.’”
CMS is understandably tight-lipped about its auditing processes, but Steve Spearman of Health Security Solutions went so far as to file a Freedom of Information Act request to get access to data on how many audits were being conducted and how many organizations were failing them.  Figliozzi & Co., the firm tapped by CMS to conduct the audits, has completed 613 post-payment audits of hospitals and more than 8,000 audits of eligible professionals.  CMS had originally projected a target of auditing about 10% of healthcare organizations.
While data on the number of successful appeals is not currently available, Tate himself has represented several organizations that had their failure decisions overturned.  The appeals process is simple, he says, but nearly entirely opaque.
“The one thing that’s different with the appeals process is that you get one shot at it,” Tate said.  “With the audits, you know who you’re dealing with.  If they tell you they need more information, you can provide that for them before they make their determination.  With the appeal, you get one shot.  You put your best documents together and try to make them as simple as possible, then you put them into an email address and hear back one way or the other.  There’s no leeway at the appeal level.”
“They’ll never tell you why they reversed the appeal, but we did add additional documentation and presented it in such a way that we convinced them that we met the requirement,” he added.  “We just tried to make it as simple as possible so it would be clear.  If someone has no security risk assessment, and they appeal that…well, there’s no way they are going to be successful.  But you just have to make your best argument and find any possible documentation that might be relevant and appropriate.”

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EHR Usability Cause of Key Pain Points for Healthcare CIOs |

EHR Usability Cause of Key Pain Points for Healthcare CIOs | | EHR and Health IT Consulting |
Whereas EHR adoption continues to increase among healthcare organizations and providers, EHR usability remains a problem for end-users trying to enter and access data efficiently, according to a new Frost & Sullivan survey of healthcare CIOs.
EHR users have often complained about the time commitment associated with EHR data entry and its impact on physician-patient interaction, but they appear to be encountering difficulties finding information in the EHR as well.
Running from March to May 2014, Frost & Sullivan surveyed health IT professionals in conjunction with the College of Health Information Management Executives (CHIME), focusing primarily on healthcare CIOs working in mid- to large-sized community hospitals.
According to preview of the report, problems related to searching EHRs are commonplace. The slowness of the EHR systems and a lack of precise query results are preventing EHR users from conveniently accessing unstructured data or performing targeted searches.
The report identifies main causes of these EHR search-related problems as rudimentary search functionalities and poor EHR usability rather than a lack of end-user training or clinical resistance to EHR adoption. Helping improve search features in core EHR technology is a mixture of national language processing and visualization tools, the authors of the report claim.
The authors indicate that immaturity of current EHR technology should generate competition among EHR and health IT developers to create more useable EHR software. However, a lack of progress now could have could have far-reaching effects moving forward on patient safety let alone the delivery of quality care, says the head of the association connected with the survey.
Interoperability and usability of the data are important as we continue to push for clear standards including patient matching and data definition,” President and CEO Russell P. Branzell, FCHIME, CHCIO, tells “Without improved EHR usability, the effectiveness of EHRs will be limited.”
EHR usability is front and center of the framework published last month by the American Medical Association (AMA), which recognizes the need for more useable EHR technology as a national imperative.
“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” AMA President-elect Steven J. Stack, MD, said last month. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”
The framework listed eight EHR usability priorities that require “significant” work by healthcare vendors, clinicians, organizations, patients, researchers, and policymakers:
  • Enhance physicians’ ability to provide high-quality patient care
  • Support team-based care
  • Promote care coordination
  • Offer product modularity and configurability
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient engagement
  • Expedite user input into product design and post-implementation feedback
That the EHR Incentive Programs are advancing toward their third phase and EHR usability is continuing to lag behind raises questions about the role meaningful use requirements are playing (or not playing) in leading EHR vendors toward developing more user-driven designs for their EHR technology.
Unless the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) are able to address the lack of EHR interoperability and usability, their efforts might just prove to be a hindrance rather than a help

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Black Book: 90% of Nurses Felt Ignored during EHR Selection |

Black Book: 90% of Nurses Felt Ignored during EHR Selection | | EHR and Health IT Consulting |
EHR satisfaction among nursing staff is even lower than among physicians, if possible, according to a new Black Book poll, with an average of 90% of nursing administrators saying that their organizations did not consider their needs and duties during selection of an electronic health record system.  The survey of nearly 14,000 nurses from across the country found abysmally low approval rates from some of the heaviest technology users in the healthcare system, even though a majority of nurses choose where they will work based in part on the EHR they will have to use.
“Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially,” said Doug Brown, Managing Partner of the survey firm Black Book Market Research. “Technology can help nurses do their jobs more effectively or it can be a highly intrusive burden on the hospital nurse delivering patient care,” said Brown. “Many compounding nurse productivity problems of can be sourced to the failure of those selecting and implementing an EHR to involve direct care nurses in the process.”
Eighty-four percent of nurses say that EHRs have negatively influenced their job satisfaction, and 85% struggle on a daily basis with flawed technology.  Despite the promises of a seamless, integrated healthcare delivery system by health IT vendors and federal agencies, 90% of nurses feel that EHRs have made communication with patients more difficult, and just a quarter think that EHRs improve the quality of patient information.
For-profit healthcare systems can boast the dubious distinction of having the unhappiest nurses, the survey found, with 98% stating that the time they spend with patients is inadequate compared to the time they spend with their EHRs.  Ninety-three percent in for-profit facilities do not have computers in every room or mobile devices to ease documentation requirements, while 91% can’t even find a computer station to use when they need to.
With more than three-quarters of nurses stating that the hospital’s EHR is one of the top three reasons for selecting a place of employment, hospitals that don’t pay attention to the needs and experience of nursing staff when choosing a vendor could be setting themselves up for significant staffing shortages down the line.  “Nurses will drive a new wave of inpatient EHR replacements and advances to outdated hybrid systems as it becomes harder to retain and recruit staff,” said Brown. “Hospitals, particularly in competitive markets, will experience an exodus of nurses who will change employers for those with flexible, highly usable EHRs, where nurses feel they can get more real time to care of patients.”
Not only will hospitals need to implement user-friendly EHRs, but they will also need to improve the knowledge and helpfulness of their IT departments if they want to keep nurses happy.  Just 15% of nurses in for-profit organizations are satisfied with the way the IT department handles questions and suggestions, and only 30% think IT staff respond quickly to documentation vulnerabilities they identify.
More than two-thirds use the word “incompetent” to describe the EHR expertise of the IT department when an organization is staffing the help line in-house.  Among hospitals that outsource their EHR support, 88% of nurses are frustrated with the call center and 98% state that complaints and questions typically go unresolved.
Nurses typically blame the cringe-worthy results on hospital administrators, including financial officers and chief information officers.  Eighty-eight percent believe that hospital leaders have selected substandard EHR products while trying to trim a few dollars off the budget, sacrificing care quality and usability for a lower price tag.
“The meaningful use financial incentives for hospitals have many IT departments scurrying to implement these EHR’s without consulting direct care nurses, according to the majority of those polled by Black Book,” Brown said.  “Add to that the unique software interfaces from medical equipment and the multiple EMRs each individual physician’s office, it’s no surprise that hospital nurses are getting discouraged and seeking employment in less complex organizations.”

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Adding HIE Info to EHR Data Raises Medication Accuracy to 91% |

Adding HIE Info to EHR Data Raises Medication Accuracy to 91% | | EHR and Health IT Consulting |
EHRs fare significantly better with the help of community health information exchange (HIE) resources when it comes to medication list accuracy, finds a new study in the American Journal of Managed Care (AMJC).  While the EHRs at two sample hospitals captured an average of 80% of medications accurately, the addition of commercial database information and data from a community-based HIE was able to improve that number by 11 percent.  The additional accuracy can be a crucial advantage during transitions of care, which are highly vulnerable to negative patient safety events.
Preventable adverse drug events (ADEs) are not only a patient safety issue, but can also be a source of significant financial penalties for hospitals.  Large organizations are nearly three times more likely to be fined for patient safety violations, one study found.  Patient safety failures claim up to a thousand lives a day through hospital-acquired injuries, preventable surgical complications, infections, and improper medication administration.  Only a quarter of hospitals in a recent Leapfrog survey earned high marks for patient safety, indicating the enormous effort needed across the healthcare continuum to ensure that patients don’t suffer from negligence, bad data, and a lack of communication.
Patients admitted to the hospital are at risk for 1.4 potential ADEs during their stay, the AJMC study adds, 75% of which may be preventable.  Most ADEs can be traced back to inadequate information from pre-admission sources, which led the researchers to examine the impact of adding external data sources to the EHR information of 858 patients at two upstate New York hospitals within the same healthcare system.  The patients were taking a total of 7731 medications.
The organizations have been using their EHR system since 1989, which suggests a great deal of maturity and familiarity that lead to the 80% medication accuracy rate in the EHR data.  Clinicians also had access to a commercial medication database that contains information from a national e-prescribing network, including claims data and information on prescriptions that have been filled.  A local HIE run by a Regional Health Information Organization (RHIO) provided the third source of data, and covered 1.6 million patient lives at the time of the study in 2010 and 2011.
The researchers compared aggregated data from the trio of sources with a patient-generated, validated list of medications.  The hospital’s own EHR was nearly twice as accurate as the commercial medication database, which captured 45% of prescriptions, and significantly more accurate than the community HIE, which was only accurate for 37% of medications.  Twenty-three percent of the medications were accurately captured across all three data sources, but 9% weren’t found in any of the databanks.  When all three sources were combined, overall accuracy increased to 91 percent.
“Giving providers access to information that is accurate and complete during the prescribing process may improve patient safety by improving patients’ recall of their own medication history and allergy information, as well as by reducing medication discrepancies,” the researchers wrote.  “Combining at least 2 sources of medication history information resulted in largely complete and accurate information for classes of medications identified by others as associated with high risk for preventable ADEs, including hypoglycemic and blood flow medications.”
“Likewise, combining medication history information resulted in nearly complete allergy information, and allergic reactions are a common cause of ADEs,” the study continues. “Reducing preventable ADEs by decreasing unintentional medication discrepancies and increasing knowledge of patients’ allergies may increase patient safety and decrease hospital costs.”

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Mobile docs get most from their EHRs | Healthcare IT News

Mobile docs get most from their EHRs | Healthcare IT News | EHR and Health IT Consulting |

One of the takeaways of a recent survey conducted by Software Advice indicates that mHealth users are better at using electronic health records – and getting more out of them – than doctors who use PCs.

It may say as much about the type of person who uses mobile devices as it does about the state of EHR adoption in the U.S.

The survey of 600 users from a diverse range of medical specialties and practice sizes, collected this year by Software Advice in collaboration with Research Now, found that 76 percent still access EHRs via a desktop or laptop, while only 26 percent use a tablet or smartphone, so mobile access isn't a top priority just yet. However, 58 percent of those accessing EHRs from a mobile device reported they were "very satisfied" with the EHR – but only 28 percent of non-mobile users were that happy.

[See also: Clinical mobility market grows by leaps.]

One reason for this discrepancy could be that mHealth users tend to be more technologically savvy, so they're more familiar with EHR technology and perhaps more apt to understand it. In fact, only 39 percent of those surveyed who use mHealth, the survey found, said they were challenged by EHR software, while 58 percent of non-mobile users encountered difficulties. Another reason? Mobile users might be accessing EHRs at home, after work, when they're more relaxed and more apt to work their way through any difficulties.

This trend carries over into workloads as well. According to the study, 73 percent of mHealth users reported that an EHR did not decrease productivity; only 42 percent of non-mobile users made that claim. That's an important point to make for mHealth: Clinicians who can access EHRs at the bedside, in the corridors or in the lab are likely getting more work done than the doctor or nurse who has to find the time in a busy day to sit down at a computer workstation or power up the laptop. In addition, with a 2013 Black Book survey noting that 89 percent of primary care and internal medicine physicians already using smartphones to communicate with other staff, using those same devices to access EHRs isn't that far-fetched.

[See also: Upward mobility.]

The survey goes on to ask some non-mobile-related questions, though those answers still have some bearing on the mHealth landscape. For example, 28 percent of those surveyed expect to increase their investment in EHR technology through the end of the year, while 54 percent said they'd keep their level of investment the same (in contrast, 13 percent said they weren't sure and only 9 percent said EHR investments would decrease through the rest of the year). This indicates that EHRs (whether new or replacing legacy systems) are still at the top of many to-do lists, pushing telehealth and mHealth investments to the back-burner.

More promising for the mHealth advocate is what clinicians say they're investing in with regard to EHRs. A full 36 percent said they're increasing their investment in patient portals, with the goal of not only meeting stage 2 requirements of meaningful use but giving consumers easier access to their medical records at any time and place (and from any device). This may be a subtle indication that doctors are taking to heart the shift to consumer-facing healthcare.

Also high on the list of increased investment is e-prescribing, with 29 percent saying they plan on boosting their investments. While a requirement for stage 1 of meaningful use, it's also one of the more popular tools of the mobile clinician.

Finally, according to the survey, 56 percent said integrating their current EHR with other systems represents a "major" or "moderate" challenge going forward, and 49 percent cited issues with EHRs slowing productivity.

Harkening back to the first survey questions, in which physicians who are comfortable using mHealth were more apt to be comfortable with their EHRs and to get more value from them, this would indicate that mHealth may represent an important step in the right direction for EHR adoption – at least for clinicians who try it out.

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Nurses not happy with hospital EHRs | Healthcare IT News

Nurses not happy with hospital EHRs | Healthcare IT News | EHR and Health IT Consulting |

Frustration with electronic health records has never been higher among RNs, with vast majorities complaining of poor workflows, bad communication and scant input on implementation decisions, a new survey shows.

[See also: RNs key to EHR improvement, says CIO]

Although they're on the front lines of care delivery, and the most frequent users of EHRs, an overwhelming 98 percent of the 13,650 licensed RNs polled by Black Book for its latest EHR Loyalty Poll say they've never been included in their hospitals' IT decisions or design.

Their dissatisfaction has reached "an all time high," according to Black Book, with 85 percent of nurses saying they grapple daily with flawed EHR systems.

[See also: CNIO position on the rise]

These nurses are pointing fingers: 88 percent of poll respondents say they blame financial administrators and CIOs for selecting low-performing EHR systems based on price, and of cutting corners at the expense of quality of care.

Indeed, 84 percent of nursing administrators in not-for-profit hospitals (and 97 percent of those at for-profit facilities) say EHRs' impact on nurses' workloads were not considered highly enough in their administration's final EHR selection decision.

"Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially," said Doug Brown, managing partner of Black Book Market Research, in a press statement announcing the findings.

Meaningful use has "many IT departments scurrying to implement these EHR's without consulting direct care nurses," he added.

Among other complaints from the Black Book report:

  • 94 percent of nurses don't believe their current EHR has improved the communication between the nurse and the care team
  • 90 percent say their EHR has adversely affected communications between nurses and their patients.
  • 67 percent of nurses say they've been taught workarounds in flawed EHRs to allow other health team members to view pertinent patient information
  • 69 percent of nurses in for-profit hospitals say their IT department is "incompetent"
  • Just 30 percent say their IT departments respond quickly to fix aspects of the EHR that nurses point out as vulnerabilities in documentation.

Just 26 percent say they agree with the statement: "As a nurse, I believe the current EHR at my organization improves the quality of patient information."

Nurses were most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems, according to Black Book. Meditech, Allscripts, eClinicalWorks and HCare got the lowest satisfaction scores.

The efficacy of a hospital's EHR is starting to have big effects on recruitment and retention of RNs: 79 percent of job-seeking nurses polled say the reputation of the hospital's EHR system is a "top three" consideration in their choice of where they will work.

"Many compounding nurse productivity problems can be sourced to the failure of those selecting and implementing an EHR to involve direct care nurses in the process," said Brown.

"Add to that the unique software interfaces from medical equipment and the multiple EMRs of each individual physician's office, it's no surprise that hospital nurses are getting discouraged and seeking employment in less complex organizations.

"EHRs have become an advantage for some hospitals in attracting top nursing talent, but in many cases a poorly implemented EHR with chaotic processes and bungling IT support is becoming a detriment to hospital nurse retention and recruitment," he said.

It doesn't have to be this way. Earlier this year Healthcare IT News spoke with Dave Holland, vice president and CIO at Southern Illinois Healthcare, a three-hospital system based in Carbondale, Ill.

He makes nurses a focal point of his IT decision-making, recognizing them as critical players in helping develop better EHR usability and effectiveness.

"When you're in the hospital, I know physicians make a lot of decisions about your care, but it's really nurses who deliver your care," Holland said.

"The EHR can be a very efficient tool, but you have to buy into it, you have to know about it. The people that are using the systems – unless you get them excited about it, and get them enough training so they see the value of it – it just becomes a hammer."

He and his team took a close look at the workload of SIH's nurses, and realized they were having to do too much "from the seat of their pants," said Holland.

"We realized that nursing has so many interruptions, so many different things they have to do and so many processes, that anything we could do to make it easier on them – to help them not only do a good job, but feel confident and know that they did a good job – was very beneficial."

Too many nurses are "burned out and frazzled at the end of the day," he said. "We need to give them tools to help them deliver quality care and help them to know they're doing a good job."

Dr Martin Wale's curator insight, October 24, 1:07 AM

This pulls no punches, although the construction of the study isn't clear.  Cerner came out as one of the more usable EHRs.!

Cloud Adoption On The Rise Though Security Concerns Remain

Cloud Adoption On The Rise Though Security Concerns Remain | EHR and Health IT Consulting |

A survey reveals sluggish cloud adoption is the result of lingering data security concerns.

Despite the many benefits of cloud computing, it seems healthcare organizations are slow to make the transition.

A recent white paper by the Institute for Health Technology Transformation (iHT2) examines the reluctance of most healthcare organizations to migrate clinical data to the cloud and describes how cloud vendors are addressing providers’ concerns. The study also discusses key benefits of partnering with a cloud services provider and explores different types of cloud structures that might suit different providers for their data storage and software maintenance needs.

In the study, Answers to Healthcare Leaders’ Cloud Questions, researchers examine why healthcare has been such a slow cloud adaptor. According to a KLAS Research survey in 2011, only 55 percent of healthcare providers had any data in the cloud and that nearly a quarter of this group – largely physician practices and small community hospitals – had remotely hosted EHRs. Overall, respondents were reluctant to migrate their main information systems to the cloud.

And HMISS found that, while cloud adoption was instituted for reasons of cost (56 percent), speed of deployment (53 percent), insufficient internal staff/expertise (52 percent), disaster recovery (50 percent), demand for scalable, 24/7 solution (45 percent), regulatory compliance (42 percent), security (27 percent), and workforce mobility (27 percent), it also demonstrated the primary reasons for resisting cloud migration remained security (62 percent), a focus on in-house IT operations (42 percent), and availability and uptime concerns (39 percent).

Other surveys and iHT2 interviews have revealed similar concerns with cloud migration, but it is clear that these are diminishing concerns as providers identify the greater benefits of going to the cloud, including reduced infrastructure costs, enhanced security, scalability, speed of deployment, expertise of cloud services, universal accessibility and sharing capabilities, and efficient use of health IT staff.

Although 27 percent of healthcare organizations surveyed by HIMSS stated that they adopted cloud computing for security reasons, iHT2 interviews revealed there is still lingering distrust of cloud security among HIT professionals.

Among the action points of the white paper are:

  • Healthcare providers are feeling more comfortable regarding cloud security, in part due to BAAs, and cloud service providers say their data centers are more secure than on premise operations due to their expertise.
  • HIPAA rules mean that cloud vendors must pay more attention than before to regulatory issues, and have increased obligations to protect security and report breaches.
  • Cloud services have less downtime than typical healthcare systems and can provide superior disaster recovery and backup resources.
  • Cloud services can also provide much more bandwidth availability at much lower costs, making it a cost-effective solution to data storage.
  • Costs are starting to even out, and one cloud vendor says that providers can save 20 percent over a five year period by adopting a private cloud, or 40 percent in the public cloud.
  • In terms of complexity, both vendors and providers agree that management in the cloud actually should be less complicated than using an on premise system.

Transitioning to the cloud can free up in-house IT staff to focus on other, more vital projects for their healthcare organization.

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Nurses Dissatisfied with EHRs, Report Finds

Nurses Dissatisfied with EHRs, Report Finds | EHR and Health IT Consulting |

Much has been made of doctors’ dissatisfaction with electronic health records (EHRs) but a new report details that nurses are as equally disenchanted with the software systems.

Authors of the report, from the New York-based Black Book Research, polled nearly 14,000 licensed registered nurses from forty states, all utilizing implemented hospital EHRs over the last six months. A whopping 92 percent of them are dissatisfied with their inpatient EHR system. Eighty-four percent of those polled said that EHR’s causing disruptions in productivity and workflow have negatively influenced their job satisfaction.

Most telling, 88 percent blame nonclinical administrators and CIOs for selecting inferior systems based on EHR pricing and government EHR incentives only. Most say that the EHR selection did not account nursing workflow into account. An astoundingly high 69 percent of nurses in for-profit inpatient settings say their IT department is incompetent.

Nine out of 10 nurses say the EHR has negatively impacted communication between nurses and patients and 94 percent say it hasn’t improved communication between providers.

“Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially,” Doug Brown, managing partner of the survey firm Black Book Market Research, said in a statement. “The meaningful use financial incentives for hospitals have many IT departments scurrying to implement these EHR’s without consulting direct care nurses, according to the majority of those polled by Black Book.”

In terms of vendors, Cerner, McKesson and Epic Systems were the highest rated vendors by nurses, while Meditech, eClinicalWorks and HCare were the lowest. Cerner, in particular, was ranked as the most nurse user-friendly inpatient EHR vendor, particularly in interoperability with ancillary and physician EHRs.

Most polls on this topic have centered on doctors’ dislike of EHR systems. In 2013, the Santa Monica, Calif.-based nonprofit policy think tank, RAND Corporation published a widely-distributed report the detailed how the systems were affecting their job satisfaction.

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Federal HIT Committees OK Public API Recommendations to ONC

Federal HIT Committees OK Public API Recommendations to ONC | EHR and Health IT Consulting |

An Oct. 15 joint Health IT Policy/Standards Committee meeting approved a set of task force recommendations that the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services focus effort on a public API (application programming interface) specification. But committee members asked to remove language suggesting that CMS and ONC should consider delaying or staggering meaningful use Stage 3 to accommodate an accelerated development process for an initial public API.

Meaningful use Stage 2 experience shows that overly broad and complex requirements slow progress on all fronts,” Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and co-chair of the JASON Task Force, told the joint committee meeting. A focus on interoperability will send a strong signal to the market and allow providers and vendors to focus their resources, he said. “On the task force, there was consensus that this narrow focus is the way to go.”

But some members of the two federal advisory committees balked. While supportive of the work on public APIs, Christine Bechtel, of the Bechtel Health Advisory Group, said she couldn't support recommendations to delay Stage 3 requirements. “I am not sure you have looked at what we would lose,” she said. “There are some really important advancements around provider notifications, clinical decision support and patient-generated health data.”

Committee member and entrepreneur Paul Egerman questioned whether loading public APIs into Stage 3 makes sense. “The experience with Direct might guide us,” he said. “People liked the idea, but it hasn’t been a huge success. We run the same risk here,” he said.

Yet others expressed optimism about the change in direction that a shift in focus away from document-centric exchange would mean. “What you are proposing represents a profound change for provider experience,” said Jeremy Delinsky, senior vice president and chief technology officer at athenahealth Inc. A major benefit would be fundamental changes in what data looks like to a provider, he said. So much of the data being exchanged now is pushed rather than pulled, because the documents don’t make any sense to providers. Consuming a document is laborious. An API would offer a far more real-time, automated way to incorporate outside data. With document-based exchange, we will never get there, he said.

The task force has noted that FHIR (Fast Healthcare Interoperability Resources) and FHIR profiles are currently the best candidate API approach to data-level access to healthcare data. (FHIR is a standard under development by HL7.)

Tripathi and co-chair David McCallie, senior vice president of medical informatics at Cerner, introduced other task force recommendations:

• ONC should immediately engage the federal advisory committees to further flesh out Jason Task Force recommendations on Public API-based architecture.

• ONC should immediately contract with a standards development organization or other recognized operationally active industry consortium to accelerate focused development of initial Public API and Core Data Services and Profiles for inclusion in MU Stage 3 and associated certification.

The task force also recommended that ONC develop a public-private vision and roadmap for a nationwide coordinated architecture for health IT. The coordination should target enabling and encouraging HIT market forces towards developing Data Sharing Networks that can leverage a new Public API that exposes Core Data Services and Core Data Profiles.

They recommended that the coordinated architecture should be based on the use of a public API that can enable data- and document-level access to EHR-based information in accordance with modern interoperability design principles and patterns. They recommend that the first uses of the public API should support data-sharing networks that promote EHR-to-EHR interchange, and consumer access to the core data services via patient portals.

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Will patient-generated data from HealthKit reshape the EMR? | mobihealthnews

Will patient-generated data from HealthKit reshape the EMR? | mobihealthnews | EHR and Health IT Consulting |

Some industry stakeholders from providers to investors to consumer device makers think something like Apple’s HealthKit could be the catalyst that finally brings the patient — and patient-generated data — into the healthcare ecosystem in a way that electronic medical records have persistently failed to do. While the conversation at Jannssen Labs and Johnson & Johnson Innovations’ Digital Diagnosis event in Cambridge, Massachusetts this week ranged over an impressive number of topics, HealthKit and EMRs were two of the big themes.

“I really believe this Apple HealthKit thing is a transformational opportunity,” Andy Palmer, a serial entrepreneur and healthcare seed investor, said during a panel discussion. “Credit to Microsoft and Google for trying with HealthVault and Google Health, but the time has come now, and all that patient-generated data has a safe place to live in HealthKit. The Google guys have to come back with something on Android and that competitive dynamic is really going to deal with that opportunity. Because all that data that’s being generated can’t live in an EMR. They don’t want to manage it in any way, shape, or form.”

Palmer was joined by Boston Children’s Hospital CIO Naomi Fried, Microsoft Healthcare Strategist Clifford Goldsmith, and John Wilbanks, Chief Commons Officer at Sage Bionetworks, a nonprofit focusing on changing the way healthcare data is collected for research. The panel was moderated by Chris De Luca, digital innovation lead at Johnson & Johnson.

Palmer and Goldsmith led the charge against big EMR vendors like Epic, with the latter suggesting that the US government’s early prioritization of EMRs has led to a point where one of the groups with the most power over what innovations take hold is also a group with the greatest interest in the status quo. 

“The challenge you’re going to face is that the EMRs that dominate the hospital already control [what software can be used], and many IT directors still wait on those EMRs,” he said. Later in the discussion, he added, “I think what happens is they’re very, very slow to change. The people who owned the vacuum tube, the RCAs of the world, didn’t want to give up on that. They continued to make big radios out of wood, while the Japanese made smaller transistor radios that were affordable. That’s a disruptive technology. And that’s what I think we have to look for in that industry. What could change everything?”

To make matters worse, Palmer pointed out, EMRs have had very bad luck creating patient portals that actually promote patient engagement. And, as Wilbanks mentioned, they also suffer from accuracy problems.

“We would not accept the errors in our banking records or our credit records that we accept in our medical records,” he said. “That’s just sort of a shockingly depressing statement. If you do research on EMRs you find out pretty quickly that 20 to 25 percent of the record is wrong — entered wrong, translated wrong. It’s ridiculous that in our consumer lives we have this incredibly well-mediated experience and in our healthcare lives we don’t. And we sort of accept it.”

Wilbanks gave an example of a legacy technology that could be made both cheaper and more effective with already existing mobile technology, and with a model by which a person owns their own data and chooses to share it with a clinician.

“A lot of things that patients get reimbursed for are really gauzy handwavy things,” he said. “My favorite is the gait test in Parkinson’s, which is a reimbursable test. It’s a scale of 1 to 5 that I assess based on how well I think you’re walking today. 1 – 5. That’s as granular as it gets for a test performed by a skilled neuroscientist, who then gets reimbursed. And what we can do is send a notification to a phone that says ‘holding the phone in your right hand, take 20 steps forward and 20 steps back’, scrape the gyroscopes and the accelerometer, and get a much more quantifiable version of your data. [We can do that] every week for a year and measure progression, when you’re not paying attention, as opposed to when you’re in the office trying to impress the neuroscientist who’s getting paid. We get that longitudinal data at zero cost because no one has to be reimbursed to run the test. And it’s mine and I get to carry a copy everywhere.”

Fried, the sole provider on the panel, didn’t really address EHRs, but pushed back on the notion that health data should be entirely out of the provider’s hands. She spoke about how Boston Children’s Hospital promotes physician entrepreneurship and focuses on technology — like MyPassport — that empowers and engages the patient, but still originates from the hospital.

“Don’t you want your doctor to know all about you and know all about all your conditions and to have the information from the other sources?” she said. “I don’t think most of us are going to go hopping from primary care doctor to primary care doctors. We usually have one primary relationship where we look to someone to really be our healthcare concierge and take care of us. That’s a hard job right now and it’s a hard job to do when it’s paper based or phone-based. And that’s what we need to do with solutions, and that’s where I see a huge opportunity. You can’t forget the role of the clinician, and in that sense healthcare and digital health is different from a lot of aspects of consumer health that you see.”

Overall, panelists agreed that the only way to break the hold of big EMR players over the industry is to disrupt it so much that they have to get on board. Having a viable personal health record — which Apple’s Health app could become — is a good first step in that process, but it’s been tried many times before. The real disruptive innovation would be the bridge that connects a patient’s personal cache of health data to their care provider effectively. And that’s where panelists advised entrepreneurs to focus their efforts.

“I think we’re just at the tip of the iceberg,” said Fried. “I think we’re very excited. There’s a lot of froth in the market right now. We have most of the work ahead of us. What’s exciting is that technology is not the limiting factor anymore. It’s now a driver, and the challenge is applying technology in a way that makes a difference to outcomes and safety and health.”

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Mature CDI Program Helped Prepare Us Early for ICD-10 Switch |

Mature CDI Program Helped Prepare Us Early for ICD-10 Switch | | EHR and Health IT Consulting |
Clinical documentation improvement (CDI) is the cornerstone of any successful ICD-10 transition program.  While the ICD-10 delay has given healthcare organizations an extra twelve months to get their providers on board with the increased requirements for detail and specificity, those organizations that have jumped the gun on CDI may be in an even better position for a smooth switch on October 1, 2015.
At the University of Washington Medical Center, Sally Beahan, RHIA, MHA, Director of Health Information Management, has been overseeing CDI and ICD-10 transition efforts for quite some time.  Implementing a comprehensive CDI program long before the imminence of ICD-10 has had wide-ranging effects on the health system’s quality improvement efforts while paving the way for earlier testing, dual coding, and educational activities related to the new codes.
What CDI efforts do you currently have in place?
We have had a CDI program at UW Medical Center for going on five, six years now, and Harbor view Medical Center had implemented a CDI program a few years prior to that.  We also have two other hospitals in our health system at University of Washington Medicine that have implemented CDI programs, too.
We have a team of nurses that review documentation in the inpatient setting during the time that patients are in-house.  They use a tool that works as a decision tree.  They enter information from the clinical documentation and it prompts them to gather more specific documentation from the providers if necessary. It’s been very successful for us.  Our case mix has improved and our physicians are used to getting the clarifications, and we can do it all before billing, which is fabulous, so we don’t have to re-bill.
What was the impetus for focusing on documentation improvement?
It didn’t have anything to do with ICD-10.  It was more that the financial officers started looking at the bottom line and realizing that we had a lot of opportunity to get paid better for the complexity of the patients we’re treating.  Plus, we have so many quality indicators that we have to track now that we needed to make sure our documentation was complete and correct.
Our CDI program has been instrumental in allowing us to make sure that we’re getting the appropriate documentation so that we’re not getting dinged, if you will, on quality scores unnecessarily.  In the past, and prior to having a CDI program, if we had quality scores that were of concern, we went through the process of reviewing documentation.  Now that we have a CDI program, we know the documentation is being reviewed by the CDI Specialists and we can hone in on other areas that may have impacted the quality scores.
We’ve gotten a lot more proactive in our quality and our patient safety indicator (PSI) processes, because in the past we’d receive our data several months later, and so we would have to look back retrospectively at several hundred records to try to figure what was going on. There was a lot of noise in the data, which at the time caused false positives in the data unnecessarily.
Instead, we put in a proactive process where we code the record after discharge.  We run our discharge codes through the AHRQ algorithm for patient safety indicators, and then we’re able to identify which discharges trigger a PSI.  We then review the codes, work with the CDI team to see if additional documentation is warranted, and ask the provider for documentation clarification if applicable.  That’s all done prior to billing.
How else are you preparing for the ICD-10 transition?
We have a program director in charge of ICD-10 for all of our entities.  It was one of the first cross-enterprise projects at UW Medicine.  My role has been project advisor for coding and CDI across the health system.
We gave our coders biomedical training to assess their medical terminology, pathophysiology, and pharmacology which were going to be skills needed with ICD10. Even though many of our staff have been coding for years, the specificity in ICD-10 is so much greater that we wanted to make sure that they had a refresher, if needed, on biomedical training.  We also purchased ICD-10 training materials that were all online in a modular format, and we gave our coders from October until the end of February to finish their training.
We also trained our physicians in the months of February and March with the goal of April 1, 2014 being the day that we start documenting to ICD-10 specificity and that we start dual coding.  Even though the delay happened, we made a decision as an organization to continue with that timeline, and we did start dual coding on April 1.
We worked with another IT company to develop a tool to collect ICD-10 documentation feedback. One of our challenges with all of the entities we have is that some of our providers practice at multiple entities.  We wanted the ability to collate their documentation feedback and run a report for them, no matter which entity it was from.  Our coders started using that tool on April 1, and we’ve been disseminating documentation feedback to our providers.
We’re looking at potentially flipping the switch early and having our coders natively code in ICD-10 but still bill in ICD-9.  I feel like the impact to the coding team might be less if we can do it early and we can get through the rough spots prior to the billing actually happening in ICD-10.
Are your coders prepared for the magnitude of the change?
We just implemented computer-assisted coding (CAC).  For those coders who have been coding for years, it’s kind of frustrating to them because they know their ICD-9 codes.  It’s going to be a lot more beneficial in ICD-10.  The system allows the coder to code in ICD-10 and it translates to ICD-9.  They still have to validate their work, we are looking at coding natively in ICD10 in the future and possibly prior to the go-live date per my prior comment.
For the most part, the coders are anxious because ICD10 is a big change.   But they’re practicing.  We’re currently looking at DRG shifts to identify which ones are controllable. Is there additional coder training that’s needed or are they uncontrollable shifts and we’re just going to see a change in DRGs for these specific areas?  That’s one benefit of doing dual coding early: we have more time to get our heads around the impact from a payment standpoint.
We all look at it that it’s one more thing to change.  But I think a lot of us in HIM leadership, we really see the need to go to ICD-10 and we see the benefits.  Hopefully, it won’t get delayed again.  We’re going to push really hard to try to make that so it doesn’t happen, because we’ve invested a great deal in training and practicing.
What’s your advice to other providers who are looking to gear up their transition programs during the final eleven months?
Originally when we first started talking about ICD-10 and developing a program around it, it was sort of perceived as just a coding initiative.  But people really need to get their arms around it now because it’s not just coding.  It impacts the revenue cycle, the clinical team, IT systems and interfaces, and all our data, reporting, and decision support.  I’m glad that we started early because it’s complex.
One of the things that concerns us, and what I think everyone has to worry about, is that we have remediated all of our systems for ICD-10 – we have a lot of separate IT database systems and vendor systems.  If ICD-10 gets delayed again, the chance of updates or upgrades or new systems being implemented and then us having to of start over would be really expensive.  We’ve invested a lot, so we’re hoping we don’t have to do that.  It took us a couple years to inventory everything and make sure everything was going to be either sun-setted before the ICD-10 date or updated so that it was capable of handling ICD-10.  I’m hopeful it will be implemented in 2015 and that won’t be an issue, but it’s definitely something to keep in mind.

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AMA's Steven Stack on ICD-10: The sky's not falling, but at times it feels like it

AMA's Steven Stack on ICD-10: The sky's not falling, but at times it feels like it | EHR and Health IT Consulting |

For health IT, it is both the best of times and the worst of times, according to American Medical Association President-Elect Steven Stack.

While it is a great time to be a doctor and a patient because of the opportunities technology offers, the incredible morass of policies and regulations is interfering with what healthcare providers want to do, Stack said during the Workgroup for Electronic Data Interchange's annual fall conference in Reston, Virginia, on Wednesday.

A lot of the government efforts--from e-prescribing and Meaningful Use to the Physician Quality Reporting System and ICD-10--offer "very poor data and seriously flawed methodology," Stack said. Because of that, he continued, "it makes it improbable, if not impossible, for a lot of physicians to ever succeed in the program, no matter what they do."

Stack, in particular, spoke out against ICD-10, which has seen numerous delays. The AMA policy isn't to delay the new coding system, "it wants to kill it," he said.

"This is not the sky is falling, but, boy, it sure does at times feel like it," Stack said.

He mentioned issues with the new system that include an overabundance of codes, the need for additional data that providers may simply not have and costs for providers

AMA thinks there should be grace period during which payers can't deny payment or do "take backs" just because of imprecision in coding, Stack said.

For electronic health records, Stack said that design and use of the tools "impede rather than enhance how physicians are able to do their jobs.

"I wouldn't trade a nurse for an EHR any day," he added.

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Weekly EHR Use New and Updates for Oct. 13-Oct. 17 |

Weekly EHR Use New and Updates for Oct. 13-Oct. 17 | | EHR and Health IT Consulting |
Stay up-to-date on the latest developments in EHR implementation and adoption, meaningful use requirements, and health IT innovation with this quick recap of the top stories from the past week. Unsurprisingly, recent developments at the federal level impacting the EHR Incentive Programs and interoperability dominated the week.
Here’s some light reading for the weekend in preparation for the week ahead:
EHR Implementation Gaffes Leave Calif. Hospital Cash-Strapped
The Bay Area’s Alameda Health System finds itself in a financial crisis as a result of myriad factors, one of which is its plan to implement the Siemens Soarian EHR system — an investment originally expected to cost $77 million to move the healthcare organization from paper to electronic records.
Is Today’s EHR Technology Able to Support Tomorrow’s Care?
David DeAngelis, Healthcare General Manager of EMC, claims the small percentage of healthcare providers currently ready for next phase of EHR-enabled healthcare delivery should not come as a surprise to those keeping a close eye on the progress of the EHR Incentive Programs and meaningful use.
The Obvious Use Case for HealthKit Integration with Epic EHR
Not too long after Apple release HealthKit to the public did Ochsner Health System in New Orleans reveal that it had fully integrated the iOS 8 mobile application into its Epic EHR, which was actually the end result of many months of the health system’s own work to integrate patient-generated data into the EHR.
Why Interoperability Is Necessary for Health IT Innovation
Despite their work accommodating common nomenclature and standards, companies like Philips Healthcare are still waiting on their counterparts in EHR design to enable bidirectional health information exchange and in doing so foster the next wave of innovators.
How HIE Helped One Health System Meet Stage 2 Meaningful Use
Martin Kleinbart, Chief Strategy Officer at Citrus Valley Health Partners, explains how the organization has focused on making sure that population health management, health information exchange and Stage 2 can work together to foster data exchange while achieving patient engagement.
Stage 2 Meaningful Use Should Be about Improving Patient Care
Christine Stiegerwald, Senior Director of HIMS at Banner Health, believes that implementing the requirements of the EHR Incentive Programs is about more than just avoiding financial penalties in the next few years.
Leveraging the Patient Portal for Stage 2 Meaningful Use
Encouraging patients to take charge of their own health is one of the major problems facing the industry, but providers who have their EHRs in place also have many of the patient engagement tools they need to meet – and maybe even beat – the 5% requirement.
Stage 2 Meaningful Use Is Driving HIE, EHR Data Exchange
Stage 2 Meaningful Use is one of the primary drivers of improved HIE and interoperability, according to the eHealth Initiative’s 11th annual survey. In turn, improved data exchange is accelerating the shift towards value-based payment models.
71% of Hospitals Plan to Have CDI Partner for ICD-10 by 2015
Seventy-one percent of hospitals plan to enlist an ICD-10 clinical documentation improvement (CDI) services partner by the third quarter of 2015 to help them meet more stringent documentation requirements ahead of the October 1, 2015 switch to the new code set, a new report reveals.
Achieving EHR Optimization alongside Meaningful Use of HIT
Health IT is essential to achieve financial success in today’s environment of regulatory reporting and federal and state requirements. Less realized ― but equally important ― is its potential value to patients, physicians, and other clinicians, writes contributor Debbie Martin of CTG Health Solutions.

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Driving EHR Value with Clean Item Master Data |

Driving EHR Value with Clean Item Master Data | | EHR and Health IT Consulting |

Healthcare organizations are turning a critical eye to the integrity of their item masters as they plan EHR implementations. To do so, they are executing master data management strategies designed to clean up their data and maintain it over time so that they can derive the greatest value from this significant IT investment.

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Electronic Health Records and Meaningful Use Video

Electronic Health Records and Meaningful Use Video | EHR and Health IT Consulting |

If you are like most doctors you’ve probably heard something about a government incentive program encouraging physicians to implement electronic health records, however you’re probably a little fuzzy on the details. Well,you’re not alone the let’s take a closer look and see if we can help you make sense of it all.

On February seventeenth two thousand nine, the American Recovery and Reinvestment Act also known as the Stimulus Package was signed by President Obama into law. Contained within it’s pages is new legislation known as the Health Information Technology for Economic and Clinical Help Act That’s a mouthful so we’ll just call it the HITECH Act.

So what exactly is the HITECH Act; and how does it affect you, a physician? Well very simply it uses financial incentives to encourage physicians to adopt Certified Electronic Health Records or EHRs. Through the increased use of EHRs the government hopes to achieve the goal of a national health information network that will result in improved quality of care, patient safety and lower costs.

What kind of financial incentives are we talking about here? Perhaps as much as thirty four billion dollars. So now you’re probably asking yourself two questions. One, how do I qualify for this money? And two, just how much of that thirty four billion is available to me? Well the answers to both of these questions are actually quite simple.

To qualify for a piece of the HITECH money there are two things you will need to do. First your practice must purchase and use a government certified EHR. Secondly your practice will need to demonstrate meaningful use of this EHR. This means that you will have to prove to the government that the EHR is being properly implemented according to their criteria.

This meaningful use criteria is detailed in a list of twenty five requirements issued by the Department of Health and Human Services. It is broken down into two sets of objectives and measures; a core set and a menu set. A core set consists of fifteen non-negotiable objectives that all physicians must comply with. In the menu set however, providers are free to choose five items from among a menu of ten to implement.

In all this means physicians must meet twenty total objectives in order to demonstrate meaningful use. Fail to meet even one of these meaningful use requirements and you become ineligible for the incentives. Now that you know how to qualify, let’s find out how much of that thirty four billion you can get your hands on. The answer to this depends on which incentive program you’re eligible for.

HITECH provides two separate programs, one for Medicare and one for Medicaid. With Medicare physicians can earn up to seventy five percent of their Medicare allowable charges up to a maximum of forty four thousand dollars. With Medicaid close to sixty four thousand is available to physicians who see more than thirty percent of Medicaid patients. That number is reduced to twenty percent if you’re a pediatrician.

Keep in mind this incentive is for each eligible provider within a practice. For example; have five providers on the Medicaid program and your practice can receive up to three hundred and twenty thousand dollars in incentive funds.

Unfortunately though the HITECH Act is not just about handing out free money. Delay or even decide not to implement a certified EHR and you will be penalized. Not only will you lose out on the incentives, but the government will also begin decreasing your reimbursement rates by as early as twenty twelve.

So as you can see at its core the HITECH Act is not that complicated at all. Simply purchase and use a government certified EHR, meet all the meaningful use requirements and you’ll be eligible for the HITECH incentives.

And on a final note beaware of the fact that commercial insurance carriers are already talking about jumping on the meaningful use bandwagon and requiring providers to meet the same criteria for their pay for performance programs. Hopefully this has given you a clear understanding of the HITECH Act and what it means to you and your practice.

Over the next several years EHRs will change the way we as health providers keep patient records. Change is coming fast; act now to make sure that you don’t miss out on your portion of the HITECH money.

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Making Readmission Data Actionable for Physician EHR Users |

Making Readmission Data Actionable for Physician EHR Users | | EHR and Health IT Consulting |
Reducing avoidable hospital readmissions is a goal of accountable care and risk-based agreements between healthcare providers and payers, but how is readmission data made actionable for physician EHR users at the point of care?
“As a practicing physician and this is something I still do as much as almost any doctor country, you understand what you need and don’t need. Until you can impact the way a provider impact patients in that 10′ x 10′ room, you haven’t taken technology to the point where it is useful,” says Clive Fields, MD, Co-Founder of VillageMD and President of Village Family Practice in Houston.
In his role at VillageMD, an organization specializing in helping physician practices implement patient-centered, value-based models of care, Fields has recognized the need for information that gives deeper insight into the potential for readmissions patients with varying conditions present.
“Say I have a readmission of 12 percent,” he explains. “That sounds like a good thing — my readmission rate is lower than anyone else’s. But if 12 percent of the patients over the age of 65 are still being readmitted over the next 30 days, that doesn’t really sound like a good thing.”
Without more detail, physicians are left without the tools allowing them to adapt their care even after an EHR adoption.
“As physicians, we’re interested in how to actually change those things in a positive way,” Fields continues. “We need to get beyond simply reporting the number. It’s a good number to know, but that’s the number to know to drive you to action.”
According to Fields, health information technology can guide physicians in the right direction, but much of the technology currently on the market is ill-suited to the task.
“To say that there is no shortage of technology in the healthcare space right now would be an understatement,” he maintains. “Unfortunately, most of the technology is driven by people who either aren’t doctors, don’t think like doctors, or don’t understand what doctors do. And most the technology is out-of-date or more for a CFO than physicians.”
In fact, the best solution is the simplest — the integration of readmission ratings in the physician EHR that signals clinicians to take corrective action. “When you look at readmissions, something as simple as a one to five rating score for highest risk for readmission shows up in the EMR in a pop-up screen would be enough to trigger clinicians thinking,” claims Fields.
The simple approach is what led VillageMD to partner with Healthline to make these rating tools available to the practitioners the consultancy works with. What might appear on the surface to be additional step in a provider’s workflow is a relatively straightforward task.
“It doesn’t have to be terribly complicated because there are not that many fives,” says Fields. “If you have a hundred Medicare patients submitted to the hospital, 15 percent were to be readmitted in the next 30 days, and 50 percent of the readmissions are fives, then you only need to spend time focusing on 7 patients per hundred admissions. You get a lot of bang for your buck.”
With population health management becoming a focal point of value-based care, it requires an efficient array of tools for providers to address at-risk patients quickly and well in advance of an admission, let alone a readmission, occurring. While the task of transforming unstructured data into actionable information is complex for developers, its end-use needs to simple enough for providers and patients to use these tools in a positive way.
“It has to be brought down to a place where physicians can take or get data that is actionable and patients can access the data that is written at an appropriate level for them to become engaged in their own care,” Fields observes.
A readmission rating score is just one approach that draws its insights from structured and unstructured sources. Given the amount of data currently resting in EHR and other health information systems, plenty of other innovative manipulations of this information will continue to emerge but will only be effective if usability is a priority.

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Choosing the Right EHR Vendor in 2014 and Beyond |

Choosing the Right EHR Vendor in 2014 and Beyond | | EHR and Health IT Consulting |
Software goes through iterations as a natural part of its lifecycle, and EHR technology is no different. Beyond its initial implementation, EHR software undergoes updates, patches, and upgrades to ensure that the system is functioning appropriately and efficiently for end-users. The continuous nature and development of EHR technology should lead EHR adopters to consider the longevity of both the software and vendor they are choosing, which are in many cases one and the same.
Given the numerous changes to the EHR Incentive Programs and EHR certification criteria, the EHR selection process of choosing the right EHR vendor and software is worth revisiting.
The following areas are just a starting point. Based on the end-goals of a clinical practice, other EHR requirements will factor in to the EHR selection process. Accountable care and value-based payment models require care coordination and patient engagement tools that some providers will find little use for. Additionally, not all providers are eligible for the EHR Incentive Programs, so EHR certification for meaningful use pales in comparison to a product being more customizable for their specific environment.
Here are several factors healthcare organizations and providers ought to consider before making their decision:
Costs of Ownership
How much does and will it cost? That question is likely foremost in the minds of those decision-makers tasked with justifying the purchase of a particular EHR technology. Cost, however, extends beyond the price tag assigned to an EHR system.
Certain kinds of EHR software require certain kinds of hardware, interfaces, networking, training, and go-live support resources. Until EHR purchasers account for all of these additional costs and fees, the total cost of an EHR system cannot be determined. If a health system, hospital, or physician practice has its sights set on meaningful use, costs for connecting to a health information exchange (HIE) or similar health information networks (HINs) should also factor in.
Before signing a contract with an EHR vendor, healthcare organizations and providers would do well to seek legal advice to ensure that they are getting what they are paying for and no less.
Return(s) on Investment
Generally, return on investment (ROI) falls under the category of cost, but the presence of various incentive programs, namely the EHR Incentive Programs, provides a unique opportunity for eligible providers to receive federal funding through the meaningful use of certified EHR technology (CEHRT). The amount of these incentives, however, depends on when an eligible hospital or professional begins their meaningful use journey. As such, if a vendor cannot deliver their products and services within tight windows, EHR adopters stand to lose dollars.
Similarly, many EHR technologies come with practice management functionalities tied to billing and reimbursement. If the EHR system improves clinical efficiency but leads to poorly managed claims and denials, then the whole organization is not benefiting from the EHR adoption.
Usability and Customization
No two clinical settings are exactly alike even in a single health system, so one sizes definitely does not fit all. Clinicians, physicians especially, are sensitive to changes in their workflows and some of these workflows vary dramatically depending on a provider’s specialty. To ensure that all EHR users benefit from the selected EHR technology, adopting organizations need to look closely at the user-friendliness of the technology as is and opportunities for customizing the EHR to suit the needs their providers.
The Office of the National Coordinator for Health Information Technology (ONC) has identified several specific areas worthy of attention:
• Understand if and how a vendor’s product will accomplish the key goals of the practice. Test-drive your specific needs with the vendor’s product. Provide the vendor with patient and office scenarios that they may use to customize their product demonstration.
• Conduct a site visit. Pair up practice manager with practice manager, physician with physician and ask about workflow changes.
• Consider whether you will replace your practice management system and how you will handle the conversion or interface.
Vendor Reputation, Support, and Availability
Here today, gone tomorrow: The number of EHR vendors and products has decreased since the EHR Incentive Programs transitioned from Stage 1 to Stage 2 Meaningful Use. Not to name names, but some companies and technologies present in 2011 are no longer in existence in 2014.
Because of new flexibility rules in 2014 and 2015, eligible providers have no less than three options for meaningful use reporting year in 2014 using a mixture of 2011 and 2014 Edition EHR certification criteria to achieve meaningful use and avoid penalties.
In this dynamic environment, EHR adopters must know what they are getting and when they are getting it. A taxed EHR vendor community is one of the major reasons behind changes to meaningful use over the next few years.
If EHR data migration is necessary, the responsibilities and costs for moving data should be well-established before these activities are scheduled to occur. If EHR adopters are choosing a product because of meaningful use, they should get assurances from the EHR vendor that the latter will continue seeking certification and compliance with future EHR certification criteria.
Privacy and security are two criteria essential to not only surviving a meaningful use audit but also avoiding fines for HIPAA violations. EHR vendors need to be able to document their EHR certification as well as their product’s privacy and security capabilities.

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EHRs: The new lightning rod in healthcare | Healthcare IT News

EHRs: The new lightning rod in healthcare | Healthcare IT News | EHR and Health IT Consulting |

When Texas Health Presbyterian Hospital failed to diagnose the first known case of Ebola in the U.S., the hospital initially blamed its electronic health record (EHR). As it turned out, the problem was the humanware, not the software. The culprit was a mundane and all-too-common failure by people to communicate in a fast-paced and stressful medical setting.

For those who follow the ongoing conversion of U.S. healthcare from paper to electronic information systems, Texas Health Presbyterian's reflex to blame its EHR was revealing at many levels.

First, it showed that, in the face of error, health are providers often look for scapegoats. This is a long, inglorious pattern in human behavior, to which health care officials are evidently not immune.

The hospital's decision to finger its EHR also showed how tempting a target EHRs have become as providers try to deal with a multitude of challenges. Mostly, these arise not from EHRs but from the deep crises facing our health care system: high costs, deficiencies in quality, and profound disparities in the care available to people of different income levels, races, and ethnicities. These problems have led to reforms that are profoundly disruptive to providers, threatening the bottom lines of hospitals and the cherished autonomy of physicians. The pressures on physicians and hospitals go by many names: pay for performance, risk-sharing, reduced Medicare payments for high-cost procedures, accountable care organizations, bundled payments, hospital purchases of physician practices, and more.

One facet of society's effort to improve our health system's performance is the Health Information Technology for Economic and Clinical Health (HITECH) Act, a major federal investment in EHRs that began in 2009 and has rolled out in phases. In 2009, 83 percent of U.S. physicians and 90 percent of hospitals were managing patient information on paper. This was at a time when the Internet, smartphones, iPads, and the cloud were revolutionizing virtually every other sector in our economy, including the non-medical lives of many health professionals and their families. That one of our most information-intensive industries—accounting for 18 percent of gross domestic product—has so steadfastly resisted the modernization of its information management practices is puzzling to say the least.

Nevertheless, the economic incentives created under the HITECH Act have profoundly changed the information management landscape in the U.S. Five years after its passage, 81 percent of physicians and 97 percent of hospitals have EHRs that qualify for incentive payments from the federal government.

An interesting question is why, as Texas Presbyterian illustrated, so many providers seem to attribute so many of their current discontents to EHRs, rather than to any of the many other changes that are jarring their equilibrium. I think the answer is severalfold. First, EHRs are in clinicians' faces in unique ways. For providers to do their jobs, they have to access and record patient data through their EHR dozens, even hundreds of times a day. By comparison, all the other intrusions roiling the health care world can seem like so much distant thunder: distressing but more easily ignored or forgotten in the press of daily work.

Second, current EHRs are imperfect. They are harder to use than they should be, and the infrastructure to support their interoperability is underdeveloped. Providers are absolutely right to be unhappy about these aspects of the electronic health information revolution—and to demand improvements from vendors. Those improvements will come, but will take time.

Third, providers' unhappiness with EHRs reflects profound underlying dysfunctions in our healthcare system. Surveys of physicians reveal that some (but by no means all) are dissatisfied with their EHRs, but large majorities also report that they observe clinical value for their patients: mistakes avoided, drug interactions detected, preventive services delivered that might have been overlooked. That physicians see the value but still have negative feelings about EHRs speaks to an asymmetry of benefits and costs. Patients gain, but clinicians and hospitals incur costs—in dollars, time, and disrupted routines—that current payment systems (federal incentives included) only partly cover. The problem is an old one. Fee-for-service compensation rewards volume, but not any added value that health care innovations, like EHRs, create. Prepaid group practices like Kaiser, Geisinger, Group Health, and Atrius Health Care long ago adopted EHRs and put them to effective use. They didn't need federal incentives to push them over the electronic hump, because their financial accountability created its own business case for EHR adoption.

There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system. In the meantime, blaming EHRs for whatever ails American health care is an understandable, if not wholly justifiable, reaction to the dramatic changes with which providers are grappling.

Greg Judd's curator insight, October 21, 1:02 PM

David Blumenthal's been around the block, and is not a reflexive health-tech apologist, all of which makes his comments on 'EHR-as- lightning rod' especially worth noting, in our book.!

Are Researchers Ready to Use Patient Health Records?

Are Researchers Ready to Use Patient Health Records? | EHR and Health IT Consulting |

There’s a groundswell of opinion throughout health care that to improve outcomes, we need to share clinical data from patients’ health records with researchers who are working on cures or just better population health measures. One recommendation in the much-studied JASON report–an object of scrutiny at the Office of the National Coordinator and throughout the field of health IT–called on the ONC to convene a conference of biomedical researchers.

At this conference, presumably, the health care industry will find out what researchers could accomplish once they had access to patient data and how EHRs would have to change to meet researchers’ needs. I decided to contact some researchers in medicine and ask them these very questions–along with the equally critical question of how research itself would have to evolve to make use of the new flood of data.

Results of the interviews suggest that systems will have to change on many levels to reap the rich harvest promised for research. Doctors and their EHRs must both tighten up their methods of collecting and recording data. Researchers need to learn what’s popularly called Big Data techniques. And the computer systems that store and process the data have to adapt to the enormous sizes of “omics” data they are receiving.

Byron J. Ruth is one of the researchers already cavorting in the lush fields of EHR data. He is a Lead Analyst/Programmer in the Center for Biomedical Informatics at the Children’s Hospital of Philadelphia (CHOP). Ruth assigns to EHR vendors the primary task of data exchange, a big push by the ONC. He points out that data sharing can lead to larger cohorts–regional or national data instead of data from a single institution–and thereby benefit from bigger data sets, which mean less bias.

For instance, there are few samples of rare conditions in any one region, but a clinical decision system can store information on diseases from far-flung areas and warn doctors of risks such as Ebola outbreaks.

John Wilbanks, who promotes the sharing and advanced processing of health care data through Sage Bionetworks, reports hearing several common objections from researchers he is trying to persuade to take EHR data into account. These are all valid, but there are ways to compensate for them.

  • EHR data is not specific enough (except genomic data).

  • EHRs contain too many errors.

  • EHR data is aimed at treatment and billing rather than research.

  • Most EHRs are still incapable of generating structured, well-coded data that is useful to researchers. The ONC has made great strides in promulgating structured data exchange standards–Blue Button for structured data and Blue Button Plus for an API–but these are only beginning to be adopted in scattered places.

Wilbanks thinks EHR data is still invaluable, because it contains hard facts such as lab reports as well as expert opinions. Statistical techniques can compensate somewhat for the weakness, but clinicians need workflows more conducive to accurate data collection. The single change that would most reduce errors would be to keep data in the hands of the patients. They are the ones who most often discover and fix errors.

More generally, researchers’ objections reflect the challenge of using Big Data: one has to search through a diverse, inconsistently coded, dirty agglomeration of facts and use statistical techniques to do such things as eliminate outliers and find data sharing common charactertistics. Data scientists with these skills are entering the health field and generating useful findings, so eventually the more traditional clinical researchers will learn these techniques or hook up with those who know them.

Dr. Maxim Mikheev, CTO and co-Founder of BioDatomics, highlighted the computer networking problems created by the size of genomes. He’s glad to see repositories swell with genomic data, but they are far too large to download over the networks available to most researchers. Storage is also a problem.

Ruth encountered this problem on a project called the HeartSmart Pediatric Cardiac Genomics Consortium (PCGC). They were able to continue exchanging data by upgrading their Internet connections. But Ruth and Dr. Mikheev both recognize that a more robust solution is to keep data on the system where it was generated and bring the program to the system. The National Cancer Institute has started a Cancer Genomics Cloud Pilots project that runs three data centers hosting the genomic data and running programs uploaded by researchers.

The final hurdle to data sharing is the willingness of researchers to do so. Wilbanks is dealing with this at Sage Networks on a daily basis. Ruth says it is hard to achieve even within CHOP. “One of the other challenges with any kind of data sharing among researchers is that no one really trusts anyone else,” he writes.”Basing studies on other people’s work is a relatively bold move, especially if you do not have access to the data used for that previous work.” Part of the solution, Ruth says, is to record data provenance, “which can be summed up as the who, what, where, why, and how some data came to be.”

Dr Martin Wale's curator insight, October 24, 12:51 AM

Apart from the florid description of researchers "cavorting in the lush fields of EHR data", this is quite interesting.  It addresses the typical problems of routinely-collected data, particularly data quality.