EHR and Health IT...
Follow
Find
1.8K views | +0 today
Scoop.it!

The doctor will e-mail you now. And then see you later.

The doctor will e-mail you now. And then see you later. | EHR and Health IT Consulting | Scoop.it

When Ted Palen, a Kaiser Permanente researcher, started investigating what happens when doctors begin e-mailing with patients, he thought he would see the practice lighten workloads. Patients would get their questions answered remotely, with no need to turn up in person.


Palen just finished a five-year retrospective study of what happened when Kaiser Permanente in Colorado began allowing e-mail access to doctors in 2006. The outcome, as Palen notes in this week’s Journal of the American Medical Association, was “contrary to our expectations”: Online access to doctors was associated with more doctor visits, not fewer.

 

There was a big spike in visits and phone calls to doctors’ offices right when the new e-mail access, called MyHealthManager, came online. The graph displayed divides the Kaiser Permanente population into those who were using the online access program, and those who were not:


That initial spike did taper off with in a few months. Even a year later, however, those who utilized the online access to doctors still had higher rates of doctor visits per month

 

There are a few possible explanations of what is happening here. One that the researchers discuss is an issue of self-selection: Those who would sign up for the online health manager might be more inclined to take a greater role in managing their own health. “Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system,” the researchers write.


Via nrip
more...
No comment yet.
EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
Your new post is loading...
Scoop.it!

Obama and Congressional Leaders Can’t Overlook EMR Failure Rates | EMR and HIPAA

Obama and Congressional Leaders Can’t Overlook EMR Failure Rates | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

“If it’s [EMR investment and implementation] too hasty, you can create so many bad experiences that people say…’My data’s a mess and my patients are angry,’” Mr. Glaser said in a recent Wall Street Journal article on the possible wasted investment in EMR. 


The scary thing is that John Glaser, chief information officer for Partners Healthcare, is probably right.  I know that President Barack Obama wants to “wield technology’s wonders to raise health care’s quality and lower its costs.”  I want to do that too.  In fact, I think we’d all like for that to happen.  Unfortunately, I think we have to seriously ask ourselves if the current electronic medical records offerings can raise health care’s quality and lower its costs.


I think there are two points that have been proven time and time again in implementing an electronic medical record in a doctor’s office.


Point 1: A Well Implemented EMR Yields Great Results – Hundreds (possibly thousands) of doctors can attest to how happy they are using an EMR.  My personal finding is that the key to a successful EMR implementation is deeply related to how well a clinical practice is run before implementing an EMR.  In fact, I believe an EMR will exacerbate any problems a clinic may have been experiencing pre-EMR.  However, many clinics have shown that when done right there are tremendous benefits associated with an EMR.


Point 2: A Poorly Implemented EMR Causes More Harm Than Good – Blame it on the software.  Blame it on the clinic.  Blame it on the technology.  Blame it on the health care culture.  It’s probably a mixture of all of these things that has caused so many EMR implementations to fail.  Regardless of the reason, all of these failed EMR implementations have shown the damage that can be done to a practice that fails in their implementation.  Unhappy patients.  Unhappy and frustrated doctors.  Thousands of hours evaluating, learning, training, testing and implementing down the drain.


It’s no wonder that the New England Journal of Medicine found that only 4% of U.S. physicians were using a “fully functional” electronic health record system.  The huge failure rate among physicians has created a fear in doctors that’s difficult to overcome.  Sadly I think it might take a generation for doctors to overcome this bias.


The reality is that implementation of an EMR CAN increase health care’s quality and lower its costs.  The problem is that most clinics haven’t yielded these promised benefits and most are living with failed EMR implementations.  The huge numbers of failed implementations can not be ignored.  Ignoring this will lead to even more failed implementations which could set the movement to digitizing patient records back years.

It’s not enough to poor money onto something without looking at and solving the reasons why so many people have failed in their implementation of electronic medical records.


I don’t want to give the impression that I’m not for investment in EMR and health care IT.  I think that help is needed and could be beneficial to the future of health care in the US.  I also really believe that EMR does open up a whole world of opportunities that we couldn’t consider without broad adoption of electronic medical records.  However, I don’t think enough attention is being paid to understanding what factors are important to implementing an EMR successfully.  By understanding these facets of implementation we can invest in electronic medical records that are actually being used and effective.  Otherwise, we’re just lining the pockets of the EMR vendors without any benefits



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

The causes of digital patient privacy loss in EHRs and other health IT systems

The causes of digital patient privacy loss in EHRs and other health IT systems | EHR and Health IT Consulting | Scoop.it


This past Friday I was invited by the Patient Privacy Rights (PPR) Foundation to lead a discussion about privacy and EHRs. The discussion, entitled “Fact vs. Fiction: Best Privacy Practices for EHRs in the Cloud,” addressed patient privacy concerns and potential solutions for doctors working with EHRs.

While we are all somewhat disturbed by the slow erosion of privacy in all aspects of our digital lives, the rather rapid loss of patient privacy around health data is especially unnerving because healthcare is so near and dear to us all. In order to make sure we provided some actionable intelligence during the PPR discussion, I started the talk off giving some of the reasons why we’re losing patient privacy in the hopes that it might foster innovators to think about ways of slowing down inevitable losses.

Here are some of the causes I mentioned on Friday, not in any particular order:

  • Most patients, even technically astute ones, don’t really understand the concept of digital privacy. Digital is a “cyber world” and not easy to picture so patients believe their data and privacy is protected when it may not be. I usually explain patient privacy in the digital world to non-techies using the analogy of curtains, doors, and windows. The digital health IT world of today is like walking into a patient’s room in a hospital in which it’s a large shared space with no curtains, no walls, no doors, etc. (even for bathrooms or showers!). In this imaginary world, every private conversation occurs so that others can hear it, all procedures are performed in front of others, etc. without the patient’s consent and their objections don’t even matter. If they can imagine that scenario, then patients will probably have a good idea about how digital privacy is conducted today — a big shared room where everyone sees and hears everything even over patients’ objections.
  • It’s faster and easier to create non-privacy-aware IT solutions than privacy-aware ones.  Having built dozens of HIPAA-compliant and highly secure enterprise health IT systems for decades, my anecdotal experience is that when it comes to features and functions vs. privacy, features win. Product designers, architects, and engineers talk the talk but given the difficulties of creating viable systems in a coordinated, integrated digital ecosystem it’s really hard to walk the privacy walk  Because digital privacy is so hard to describe even in simple single enterprise systems, the difficulty of describing and defining it across multiple integrated systems is often the reason for poor privacy features in modern systems.
  • It’s less expensive to create non-privacy-aware IT solutions. Because designing privacy into the software from the beginning is hard and requires expensive security resources to do so, we often see developers wait until the end of the process to consider privacy. Privacy can no more be added on top of an existing system than security can — either it’s built into the functionality or it’s just going to be missing. Because it’s cheaper to leave it out, it’s often left out.
  • The government is incentivizing and certifying functionality over privacy and security. All the meaningful use certification and testing steps are focused too much on prescribed functionality and not enough on data-centric privacy capabilities such as notifications, disclosure tracking, and compartmentalization. If privacy was important in EHRs then the NIST test plans would cover that. Privacy is difficult to define and even more difficult to implement so the testing process doesn’t focus on it at this time.
  • Business models that favor privacy loss tend to be more profitable. Data aggregation and homogenization, resale, secondary use, and related business models tend to be quite profitable. The only way they will remain profitable is to have easy and unfettered (low friction) ways of sharing and aggregating data. Because enhanced privacy through opt-in processes, disclosures, and notifications would end up reducing data sharing and potentially reducing revenues and profit, we see that privacy loss is going to happen with inevitable rise of EHRs.
  • Patients don’t really demand privacy from their providers or IT solutions in the same way they demand other things. We like to think that all patients demand digital privacy for their data. However, it’s rare for patients to choose physicians, health systems, or other care providers based on their privacy views. Even when privacy violations are found and punished, it’s uncommon for patients to switch to other providers.
  • Regulations like HIPAA have made is easy for privacy loss to occur. HIPAA has probably done more to harm privacy over the past decade than any other government regulations. More on this in a later post.

The only way to improve privacy across the digital spectrum is to realize that health providers need to conduct business in a tricky intermediary-driven health system with sometimes conflicting business goals like reduction of medical errors or lower cost (which can only come with more data sharing, not less). Digital patient privacy is important but there are many valid reasons why privacy is either hard or impossible to achieve in today’s environment. Unless we intelligently and honestly understand why we lose patient privacy we can’t really create novel and unique solutions to help curb the loss.

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

On the March Towards Stage 2 | EHR Blog | AmericanEHR Partners

On the March Towards Stage 2 | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

Instead of a blog,
Written one word at a time,
I offer these MU observations,
Written in rhyme.

While I tried to be thorough,
There’s much more I could say.
For now this is it…
Until another day.

On the March Towards MU Stage 2

The day we have dreaded,
Is where we are headed.
Though many have written to express reservation,
ONC and CMS have been resistant to persuasion.

January is just around the bend,
When for many, Stage 1 will end.
And every EP will need to possess,
A certified Stage 2 EHR — and no less.

You may want to worry,
And tell your EHR vendor to hurry.
Because if your vendor isn’t on time,
Surprise! It will be your “dime.”

Even if your system is upgraded and steady,
And your team’s primed and ready,
There’s so much in Stage 2 that is new.
It will change what, when, and how you do what you do.

From documentation and note-taking,
To CPOE and decision-making.
Your clinicians may quit,
And don’t forget view, download, and transmit.

While you may experience some frustration,
When completing medication reconciliation,
MU doesn’t get any kinder,
’Cause you need to send each patient a preventive care reminder.

The summary of care should help with transitions,
For patients with complex conditions.
But the clinical summary handed out in haste,
Often winds up as HIPAA-containing paper waste.

The measures of clinical care,
On the surface seem pretty fair.
But the exceptions and specs are so confusing,
That if it weren’t so sad, it would be amusing.

ONC keeps up a positive spin,
No matter the situation we’re in.
True in Stage 1 the numbers did grow,
But with Stage 2 will the growth start to slow?

So on with the march to Stage 2.
Will it be for the proud and the few?
That may well be the case,
In this invent, build, and implement (no test) race.

But do your best and be inventive,
If you’re lucky, there’s the incentive.
So proud will your practice be,
And just think — in 2 years you can do Stage 3!

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP).

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

Eligible Professionals for 2013 EHR Incentive Program: Hardship Exemptions | EHR Blog | AmericanEHR Partners

Eligible Professionals for 2013 EHR Incentive Program: Hardship Exemptions | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

At our most recent  HIMSS “Beyond Stage One Meaningful Use “ Education HIMSS Regional Event for Eligible Providers and Health IT Staff in Dover Delaware several Eligible Professionals have expressed to me that they have had difficulty meeting the Medicare and Medicaid EHR Incentive Programs  criteria. Many complained that their vendors for example have not provided the appropriate functionality in their products to assist them meet the criteria in time for them to attest to meeting one or more of the requirements.
Dr. Connors, CMS.  Medical Director Region III shared with the audience that many Medical Practices and Eligible Providers are not aware that any Eligible Professional who experienced difficulty achieving the meaningful use criteria for 2013 have an opportunity to file for a hardship exemption.

CMS recently announced that Eligible Professionals who were unable to successfully meet the meaningful use criteria for 2013 due to a hardship can file for an exemption to avoid the impending Medicare penalty “Payment adjustment” for the 2013 reporting year.  Payment adjustments for the Medicare EHR Incentive Program will begin on January 1, 2015 for eligible professionals.

CMS advises Eligible Professionals that they can avoid the adjustment if they complete a hardship exception application and provide supporting documentation that proves demonstrating meaningful use would be a significant hardship for them. CMS will then review applications to determine whether or not the eligible professional will be granted a hardship exception.

CMS has posted hardship exception applications on the EHR website for:

Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals. If approved, the exception is valid for one year.

To Learn More
CMS has issued a New Hardship Exception resource for you. You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

HIMSS next “Beyond Stage One Meaningful Use   “ Education program will be held on May 8, 2014 in Denver, Colorado.

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

Athenahealth Posts Loss, Misses Street; Stock Down 10% - Quick Facts

Athenahealth Posts Loss, Misses Street; Stock Down 10% - Quick Facts | EHR and Health IT Consulting | Scoop.it


(RTTNews.com) - athenahealth Inc ( ATHN) Thursday reported first-quarter net loss of $8 million or $0.21 per share, compared with net earnings of $0.07 million or $0.02 per share last year.

Excluding items, adjusted earnings for the quarter were $4.4 million or $0.12 per share, compared with $14 million or $0.38 per share a year ago.

On average, 26 analysts polled by Thomson Reuters estimated earnings of $0.17 per share for the quarter. Analysts' estimates typically exclude special items.

Revenues for the quarter were up 30 percent at $163 million, compared with $125.6 million in the prior year.


Twenty-two analysts had a consensus revenue estimate of about $170 million for the quarter.

Results for the recent quarter included income tax benefit of $4.5 million, compared with $12.7 million a year ago.

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

UMass Memorial to Integrate End-Of-Life Care Directives Into EHR

UMass Memorial to Integrate End-Of-Life Care Directives Into EHR | EHR and Health IT Consulting | Scoop.it

UMass Memorial Health Care, Worcester, Mass., and advance care planning technology developer Luminat, Minneapolis, will fully integrate patients’ end-of-life directives into their electronic health records.

The partnership will enable physicians to consistently document the end-of-life wishes from patients – from palliative care preferences and specific spiritual beliefs, to identifying the individuals who should be involved and informed in the decision-making process.


The data is then fed into the patient’s electronic medical record via cloud-based technology, giving the entire provider system the same information and instructions, and helping family members understand the patient’s end-of-life preferences.


“Unless communicated in advance, many medical treatments provided at the end of life are inconsistent with patients’ wishes,” David Fairchild, M.D., senior vice president of clinical integration at UMass Memorial, says. “As UMass Memorial transitions to being an accountable care organization, we recognized the opportunity to use Luminat technology to enable and support conversations about end of life.”

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

Taking a Second Look: Accessing Your Data beyond the PM or EMR | EMR and HIPAA

Taking a Second Look: Accessing Your Data beyond the PM or EMR | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

Editor’s Note: The following is an update to a previous EMR and HIPAA blog post titled “EMR Companies Holding Practice Data for “Ransom”.” In this update, James Summerlin (aka “JamesNT”) offers an update on EHR vendors willingness to let providers access their EHR data.

Over the years I have been approached with questions by several solo docs and medical groups about things such as the following:

  • Migrating to a different PM or EMR system.
  • Merging PM’s or EMR’s such as when a practice buys out another practice.
  • Interfacing the EMR and PM.
  • Custom reports.
  • More custom reports.
  • LOTS MORE CUSTOM REPORTS!!!

And there have been plenty of times I’ve had to give answers to those questions that were not favorable.  In many cases, it was with some online EMR or PM and the fact that I could not get to the database and the vendor refused to export a copy to me or the vendor wanted thousands of dollars for the export.  With the on-premises PM and EMR systems, getting to the data was a matter of working my way around whatever database was being used and figuring out what table had what data.  Although working with an on-premises PM or EMR may sound easier, it too often isn’t.  The on-premises guys have some tricks up their sleeves to keep you away from your data such as password protecting the database and, in some cases, flat out threatening legal action.

A few years back, I wrote a post on a forum about my thoughts on how once you entered your data into a PM or EMR, you may never get it back.  You can see John Lynn’s blog post on that here.

My being critical of EMR and PM software vendors is nothing new.  I’ve written several posts on forums and blogs, even articles in BC Advantage Magazine, about how hard it can be to deal with various EMR and PM systems.  Much of the, at times, downright contemptuous attitudes many PM and EMR vendors have towards their own clients can be very harmful.  Let’s consider three aspects:

  • Customization.  Most of the PM/EMR vendors out there would love to charge mega-bucks to write custom reports and so forth for clients.  However, this isn’t all it’s cracked up to be.  First, most clients simply aren’t going to pay the kind of money many PM or EMR companies want to charge.  Second, custom reports have to be maintained.  Eventually, you have all these clients running around needing changes to their reports and the PM or EMR vendor simply can’t get to them all in a timely manner without hiring lots of technical (read: EXPENSIVE) staff which turns what was once a money-making ordeal into a money losing one.  And, of course, the client’s suffer since they can’t fine-tune their practice to the degree needed in today’s challenging economy.
  • Interfacing.  What happens if a client wants to interface encounters and demographics from their EMR to their PM system and then interface dollar amounts and so forth from the PM system with receivables and expenditures in Quickbooks or other financial software into a series of reports that give a total view of how the practice is doing?  We are talking about the ability to, day-by-day, forecast incoming receivables from carriers and patient payments (within certain limits, of course), with expected expenditures (payroll, taxes, etc.) from the accounting software to get a financial outlook for the practice for the next few weeks or even months for long-term planning.  A PM or EMR vendor, already dealing with HIPAA or meaningful use, may not want to get involved in that kind of hard-core number crunching, yet the practice is demanding it.
  • A second part to interfacing.  Getting the EMR and PM vendors to get along.  Often what you see is the EMR vendor has a certain way they do an HL7 interface and the PM vendor has a certain way they do an HL7 interface and if they don’t line up properly, you’re just out of luck.  Either it works with reduced functionality or it doesn’t work at all and neither vendor will budge to change anything.  And that’s assuming they both use HL7!

In situations like those above, the best way to resolution is for the practice to perhaps obtain its own technical talent and build its own tools to extend the capabilities of the data contained within the various databases and repositories it may have such as the databases of the PM and EMR.  Unfortunately, as I have reported before, most PM and EMR systems lock up the practice’s data such that it is unobtainable.

At long last; however, there appears to be a light at the end of the tunnel that doesn’t sound like a train.  Some of the EMR systems that doctors use are beginning to realize that creating a turtle shell around a client’s data, in the long run, doesn’t do the client nor the PM/EMR vendor any good.  One such EMR I’ve been working with for a long time is Amazing Charts.  Amazing Charts has found itself in a very unique situation in that many of its clients are actually quite technical themselves or have no problem obtaining the technical talent they need to bend the different systems in their practices to their will.  The idea of having three or four databases, each being an island unto itself, is not acceptable to this adventurous lot.  They want all this data pooled together so they can make real business decisions.

Amazing Charts; therefore, has decided to be more open regarding data access.  Read only access to the Amazing Charts database is soon to be considered a given by the company itself.  Write access, of course, is another matter.  Clients will have to prove, and rightly so, that they won’t go spelunking through the database making changes that do little more than rack up tech-support calls.  Even with the caution placed on write access this is a far jump above and beyond the flat out “NO” any other company will give you for access to their database.  I consider this to be a great leap forward for Amazing Charts and, I’m certain, will set them apart from competition that still considers lock-in and a stand-offish attitude the way to treat clients who pay them a lot of money.

Perhaps one day other PM and EMR vendors will see the light and realize the data belongs to the practice, not the vendor, and will stop taking people’s stuff only to rent access to it back to them or withhold it altogether.  Until then, Amazing Charts seems to be leading the way.


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

athenahealth - Press Releases - athenahealth Announces 2013 Meaningful Use Attestation Rate and Early Stage 2 Performance Data

athenahealth Announces 2013 Meaningful Use Attestation Rate and Early Stage 2 Performance Data

Apr 22, 2014


WATERTOWN, Mass., April 22, 2014 (GLOBE NEWSWIRE) -- athenahealth, Inc. (Nasdaq:ATHN), a leading provider of cloud-based services for electronic health record (EHR), practice management, and care coordination, today announced its 2013 Medicare Meaningful Use Stage 1 attestation rate among providers who use athenaClinicals®, athenahealth's award-winning EHR. 95.4 percent of the company's participating providers successfully attested for Meaningful Use Stage 1 in 2013, showing athenahealth's continued execution against the industry's only Meaningful Use Guarantee for successful attestations.

The company's online Meaningful Use dashboard, a visibility tool showing the performance of health care providers on the athenahealth network against all Meaningful Use measures, has been updated to include Meaningful Use Stage 2 measure performance and will be updated monthly through the end of the calendar year.

"athenahealth's unique combination of cloud-based software, network knowledge, and back-office work means our providers are supported every step of the way," said Todd Rothenhaus, M.D., chief medical officer and senior vice president of network knowledge, athenahealth. "We make Meaningful Use simple by embedding measures right into the EHR workflow, coaching, and even attesting on our clients' behalves—something no other vendor does—so they can focus on patient care and receive their incentive payments as quickly as possible. We are proving once again that technology doesn't have to slow health care providers down. Our clients are thriving despite change, earning incentive dollars, avoiding looming penalties, and improving the delivery of care for millions of patients across the United States."

athenahealth's ONC 2014 Edition Certified Complete EHR, athenaClinicals 14.3, provides a highly-nimble and future-proof service to health care providers at organizations of all sizes. To ensure its clients' success, athenahealth introduced Meaningful Use Stage 2 workflows in athenaClinicals beginning in October 2013, along with updated training materials, so clients could prepare in advance of the January 1, 2014, start date. These early preparation measures, as well as athenahealth's unique ability to monitor real-time client performance and provide live coaching, have proven highly effective, as indicated by athenahealth clients' strong overall performance on the Meaningful Use Stage 2 dashboard.

"One of the things athenahealth does best is facilitate compliance with government requirements for Meaningful Use," said Suzin Hagar, M.D., a family practitioner with Medford Medical Clinic in Medford, Oregon. "athenahealth manages to collect and document the necessary information for Meaningful Use in the background so that practices can meet their goals almost effortlessly. By providing tracking of these requirements, a provider can see at any time if there are outstanding items that need to be addressed. Because of how athenahealth works within my practice, I need to dedicate only about five minutes a year to Meaningful Use in order to meet government standards. What's more, athenahealth successfully mines data that would be extraordinarily complex and labor intensive for a provider or practice to collate—something that was impossible for us in our legacy system—and makes this data collection and reporting a background process."

"athenahealth makes Meaningful Use so simple," said Amber Shamburger, M.D., an obstetrician and gynecologist at Friendswood Women in Friendswood, Texas. "I simply follow prompts from an intuitive dashboard built right into the EHR—which takes next to no time—and then my Meaningful Use dollars arrive. Because of this simple process, I have much more time to focus on patient care, where my time belongs. athenaCommunicator®, the patient portal, is also a huge time-saver that not only makes the patient experience more seamless, but also helps engage patients before and after they come to my office. My patients schedule their appointments online and fill out pre-check-in forms ahead of their visit, something they find far better than phone tag; it also reduces miscommunications. Using the portal after the visit, they can email me directly to ask any follow-up questions, view their care summaries, and keep their health information electronically rather than on paper—all of which are requirements for Meaningful Use."

Since the 2009 introduction of the Health Information Technology for Economic and Clinical Health (HITECH) Act, athenahealth has been working closely with its clients to help ensure their full compliance with the requirements of the Medicare and Medicaid incentive program. Through its single instance, cloud-based EHR, athenahealth has a real-time view into how its providers are performing. This enables the company to identify client pain points and focus its array of client services on addressing these challenges across its network.

athenahealth is the only service to offer eligible providers a Meaningful Use guarantee for either Stage 1 or Stage 2 attestations.

Visitors to http://www.athenahealth.com/meaningful-use.php can explore all Meaningful Use Stage 1 and Stage 2 measures, view the up-to-date performance of athenahealth's physicians on each measure, and learn what steps athenahealth is taking, measure by measure, to help its clients achieve success.

About athenahealth, Inc.

athenahealth is a leading provider of cloud-based services for electronic health record (EHR), practice management, and care coordination. athenahealth's mission is to be caregivers' most trusted service, helping them do well doing the right thing. For more information, please visit www.athenahealth.com.

Forward-Looking Statements

This press release contains forward-looking statements, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding the benefits of athenahealth's services and their ability to meet future requirements. These statements are neither promises nor guarantees, and are subject to a variety of risks and uncertainties, many of which are beyond our control, which could cause actual results to differ materially from those contemplated in these forward-looking statements. Existing and prospective investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. athenahealth undertakes no obligation to update or revise the information contained in this press release, whether as a result of new information, future events or circumstances, or otherwise. For additional disclosure regarding these and other risks faced by athenahealth, please see the disclosure contained in our public filings with the Securities and Exchange Commission, available on the Investors section of our website at http://www.athenahealth.com and on the SEC's website at http://www.sec.gov.

Disclaimer

athenaClinicals 14.3 is ONC 2014 Edition compliant and has been certified by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ACB, in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services for Complete EHRs used by physicians. This certification does not represent an endorsement by the U.S. Department of Health and Human Services.

athenaClinicals has been certified on 63 of the 64 Clinical Quality Measures (CQM). A full list of the CQMs to which athenaClinicals has been certified can be found here. The public test report is available here.

athenahealth's online implementation service is free for practices with one to six physicians. The on-site implementation fee for larger practices and organizations is based on the number of providers who will be using the athenaClinicals service. All athenaClinicals clients pay a monthly service fee, which covers all features, functionality, and services required to meet Meaningful Use objectives and measures.

athenahealth does not charge additional fees for the development or configuration of interfaces or health information exchange integration that are required to meet Meaningful Use requirements. Other health care trading partners and vendors may charge athenahealth clients for the creation, development, and maintenance of interface or health information exchange integration. athenaClinicals clients that elect to use services above and beyond requirements to meet Meaningful Use may pay additional fees.

CONTACT: Holly Spring athenahealth, Inc. (Media) media@athenahealth.com 617-402-1631 Dana Quattrochi athenahealth, Inc. (Investors) investorrelations@athenahealth.com 617-402-1329
Contact Information
Name
Holly Spring
Job Title
Director, Public Relations & Corp. Communications
Division
athenahealth
Phone
617-402-1631
Email
hspring@athenahealth.com



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

“The medical marketplace is broken” « Healthcare Economist

This quote is from David Blumenthal, a physician and former Harvard Medical School professor, who was the national coordinator for health information technology between 2009-2011.  He describes in an interview for the Atlantic why adoption of electronic medical records has been so slow in the U.S.

From the patient’s perspective, this is a no-brainer. The benefits are substantial. But from the provider’s perspective, there are substantial costs in setting up and using the systems. Until now, providers haven’t recovered those costs, either in payment or in increased satisfaction, or in any other way. Ultimately, there are of course benefits to the professional as well. It’s beyond question that you become a better physician, a better nurse, a better manager when you have the digital data at your fingertips. But the costs are considerable, and they have fallen on people who have no economic incentive to make the transition. The benefits of a more efficient practice largely accrue to people paying the bills. The way economists would describe this is that the medical marketplace is broken.

Are we beyond hope? The answer is no.

When the benefits of using better technology are “internalized,” as the economists would say, there has been much more rapid, complete, and effective adoption of electronic medical records. So, the VA: the benefits are internalized, because the VA has to live within a budget. In private health-care organizations like Kaiser or the Geisinger plan in Pennsylvania, or the Group Health Cooperative in Puget Sound, electronic medical records were adopted decades ago, and are widely used and highly effective. You don’t need a thought experiment to find living, breathing examples of what happens when the incentives work right.

ACOs can help in this area. By increasing provider size, providers will be able to internalize more benefits and also benefit from economies of scale. On the other hand, ACOs may decrease competition. Large providers–with EMRs–may dominate the market and work to increase pricing power. Higher prices are passed on to consumers in the form of higher premiums. Thus, ACOs may offer higher quality care, EMRs, and integrated services, but it remains to be seen if they can–or will want to–hold down prices.

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

eHealth University from CMS Launched | EHR Blog | AmericanEHR Partners

eHealth University from CMS Launched | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

eHealth University, A Go-To Resource for eHealth Programs
CMS launched eHealth University, a new resource that helps providers find information and materials on each of the eHealth programs in one location.

Resources are available to help providers understand and prepare for eHealth programs such as Administrative Simplification, ICD-10, quality measurement, and the EHR Incentive Programs.

Providers can use eHealth University to navigate the requirements of the eHealth programs with education modules tailored to their participation level, whether it’s beginner, intermediate, or advanced. The education modules include resources that simplify complex program information in a variety of different formats, such as videos, fact sheets, checklists, and guides. CMS will continue to add to eHealth University as new resources become available.

The above information was provided by CMS and is reproduced here in its entirety.

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

Lack of Interoperability Holding Back Robust Health Data Infrastructure

The lack of interoperability is a major impediment to the development of a robust health data infrastructure, according to an independent report commissioned by the Agency for Healthcare Research and Quality (AHRQ), with input from the Office of the National Coordinator for Health IT (ONC).

 

The report was conducted by JASON, an independent group of scientists that advises the U.S. Government on matters of science and technology. Researchers looked at current challenges that must be overcome in enabling progress in creating a health data infrastructure that can live up to the promise of its many benefits, which include improved care and lowered costs.

 

More than anything, the researchers say that lack of interoperability among data resources for electronic health record (EHR) systems is holding the industry back. This can only be overcome, the researchers say, by establishing a comprehensive, transparent, and overarching software architecture for health information. They also say that the current criteria for Stages 1 and 2 of meaningful use fall short of meaningful use in any practical sense.

 

"At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records. Most patients still cannot gain electronic access to their health information," the researchers write. The researchers say that current efforts to define standards for EHRs and to certify HIT systems are useful, but lack a unifying architecture to support broad interoperability.

 

The researchers recommend that the Centers for Medicare & Medicaid Services (CMS) embrace Stage 3 meaningful use as an opportunity to create a true interoperable health data infrastructure. Also, Stage 3 should enable entrepreneurship, by making EHR software vendors develop and publish APIs. They say that within 12 months, ONC should define an overarching software architecture for health data. This infrastructure should not only allow for interoperability, but protect patient privacy and facilitate access between clinical care and biomedical research.

 

For its part, ONC has responded in kind with the JASON report. In a Buzz Blog post, Karen DeSalvo, M.D., the National Coordinator for Health IT, said she agreed with the findings of this report.

 

"I am pleased that this report is consistent with our intent to support nationwide interoperability in a way that supports care, health and is flexible enough to meet the challenges of the future. The ONC and the Centers for Medicare & Medicare Services (CMS) have already begun to work on many of the recommendations cited in the report–although this represents the beginning, not the end of our efforts. The JASON recommendations continue to challenge us to stay focused on the path ahead," Dr. DeSalvo wrote.

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

The causes of digital patient privacy loss in EHRs and other health IT systems

The causes of digital patient privacy loss in EHRs and other health IT systems | EHR and Health IT Consulting | Scoop.it

This past Friday I was invited by the Patient Privacy Rights (PPR) Foundation to lead a discussion about privacy and EHRs. The discussion, entitled “Fact vs. Fiction: Best Privacy Practices for EHRs in the Cloud,” addressed patient privacy concerns and potential solutions for doctors working with EHRs.

While we are all somewhat disturbed by the slow erosion of privacy in all aspects of our digital lives, the rather rapid loss of patient privacy around health data is especially unnerving because healthcare is so near and dear to us all. In order to make sure we provided some actionable intelligence during the PPR discussion, I started the talk off giving some of the reasons why we’re losing patient privacy in the hopes that it might foster innovators to think about ways of slowing down inevitable losses.

Here are some of the causes I mentioned on Friday, not in any particular order:

  • Most patients, even technically astute ones, don’t really understand the concept of digital privacy. Digital is a “cyber world” and not easy to picture so patients believe their data and privacy is protected when it may not be. I usually explain patient privacy in the digital world to non-techies using the analogy of curtains, doors, and windows. The digital health IT world of today is like walking into a patient’s room in a hospital in which it’s a large shared space with no curtains, no walls, no doors, etc. (even for bathrooms or showers!). In this imaginary world, every private conversation occurs so that others can hear it, all procedures are performed in front of others, etc. without the patient’s consent and their objections don’t even matter. If they can imagine that scenario, then patients will probably have a good idea about how digital privacy is conducted today — a big shared room where everyone sees and hears everything even over patients’ objections.
  • It’s faster and easier to create non-privacy-aware IT solutions than privacy-aware ones.  Having built dozens of HIPAA-compliant and highly secure enterprise health IT systems for decades, my anecdotal experience is that when it comes to features and functions vs. privacy, features win. Product designers, architects, and engineers talk the talk but given the difficulties of creating viable systems in a coordinated, integrated digital ecosystem it’s really hard to walk the privacy walk  Because digital privacy is so hard to describe even in simple single enterprise systems, the difficulty of describing and defining it across multiple integrated systems is often the reason for poor privacy features in modern systems.
  • It’s less expensive to create non-privacy-aware IT solutions. Because designing privacy into the software from the beginning is hard and requires expensive security resources to do so, we often see developers wait until the end of the process to consider privacy. Privacy can no more be added on top of an existing system than security can — either it’s built into the functionality or it’s just going to be missing. Because it’s cheaper to leave it out, it’s often left out.
  • The government is incentivizing and certifying functionality over privacy and security. All the meaningful use certification and testing steps are focused too much on prescribed functionality and not enough on data-centric privacy capabilities such as notifications, disclosure tracking, and compartmentalization. If privacy was important in EHRs then the NIST test plans would cover that. Privacy is difficult to define and even more difficult to implement so the testing process doesn’t focus on it at this time.
  • Business models that favor privacy loss tend to be more profitable. Data aggregation and homogenization, resale, secondary use, and related business models tend to be quite profitable. The only way they will remain profitable is to have easy and unfettered (low friction) ways of sharing and aggregating data. Because enhanced privacy through opt-in processes, disclosures, and notifications would end up reducing data sharing and potentially reducing revenues and profit, we see that privacy loss is going to happen with inevitable rise of EHRs.
  • Patients don’t really demand privacy from their providers or IT solutions in the same way they demand other things. We like to think that all patients demand digital privacy for their data. However, it’s rare for patients to choose physicians, health systems, or other care providers based on their privacy views. Even when privacy violations are found and punished, it’s uncommon for patients to switch to other providers.
  • Regulations like HIPAA have made is easy for privacy loss to occur. HIPAA has probably done more to harm privacy over the past decade than any other government regulations. More on this in a later post.

The only way to improve privacy across the digital spectrum is to realize that health providers need to conduct business in a tricky intermediary-driven health system with sometimes conflicting business goals like reduction of medical errors or lower cost (which can only come with more data sharing, not less). Digital patient privacy is important but there are many valid reasons why privacy is either hard or impossible to achieve in today’s environment. Unless we intelligently and honestly understand why we lose patient privacy we can’t really create novel and unique solutions to help curb the loss.

What do you think? What other causes of digital patient privacy loss would you add to my list above?



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

Morning Headlines 4/10/14 | HIStalk

Morning Headlines 4/10/14 | HIStalk | EHR and Health IT Consulting | Scoop.it

DeSalvo proposes new direction for ONC

Speaking at a Health Information Policy Committee on Tuesday, Karen DeSalvo, MD, proposed dismantling the ONC’s existing HIT workgroups and forming new ones that would address: HIT strategic planning; Advanced health models and meaningful use; HIT implementation, usability and safety; and Interoperability and health information exchange. Paul Tang, vice-chair of the HITPC said, "This is a nice step-back point. Now that we’ve finished wrapping up our comments and advice on Stage 3, we will begin to look a lot toward how are we getting the value from meaningful use.”

Final Notice of Termination of OIG Advisory Opinion No. 11-18

The HHS’s Office of Inspector General has reversed its 2011 decision on the Federal anti-kickback statute as it applies to transmitting patient referrals through an unnamed ambulatory EHR vendor’s "trading partner" network. The OIG originally approved of the network, but has since decided that it creates a situation in which transaction fees may be financially influencing referral decisions.

Lincoln Health Center request gives county pause

In North Carolina, Lincoln Community Health Center is looking to local county commissioners to pick up half of the $2 million it will cost to implement Duke University’s Epic system. The county thinks that Duke, which is paying the other half, should be on the hook for more.



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

Why Is It So Difficult To Reduce The Cost Of Care? | EMR and HIPAA

Why Is It So Difficult To Reduce The Cost Of Care? | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

By refusing to pay for readmissions within 30 days of discharge from a hospital, Medicare has sent a strong message across the healthcare industry: < 30 day readmissions should be avoided at all costs. As a result, providers and vendors are doing everything in their power to avoid < 30 day readmissions.

This seems like a simple way to reduce costs, right? Well, not quite…

The vast majority of costs of care delivery are fixed: capital expenditures, facilities and diagnostics, 24/7 staffing, administrative overhead, etc. In other words, it’s extremely expensive just to “keep the lights on.” There are some variable costs in healthcare delivery – such as medications and unnecessary tests – but the marginal costs of diagnostics and treatments are small relative to the enormous fixed costs of delivering care.

Thus, Medicare’s < 30 day readmission policy doesn’t really address the fundamental cost problem in healthcare. If costs were linearly bound by resource utilization, than reducing readmissions (and thus utilization) should lead to meaningful cost reduction. But given the reality of enormous fixed costs, it’s extremely difficult to move down the cost curve. To visualize:

Medicare’s < 30 day readmission policy is a bandaid – not a cure – to the underlying cost problem. The policy, however, reduces Medicare’s outlays to providers. Rather than reduce (or expand, depending on your point of view) the size of the pie, Medicare has simply dictated that it will keep a larger share of the metaphorical pie for itself. Medicare is simply squeezing providers. One could argue that providers are bloated and that Medicare needs to squeeze providers to drive down costs. But this is intrinsically a superficial strategy, not a strategy that addresses the underlying cost problems in healthcare delivery.

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

eHealth University from CMS Launched | EHR Blog | AmericanEHR Partners

eHealth University from CMS Launched | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

eHealth University, A Go-To Resource for eHealth Programs
CMS launched eHealth University, a new resource that helps providers find information and materials on each of the eHealth programs in one location.

Resources are available to help providers understand and prepare for eHealth programs such as Administrative Simplification, ICD-10, quality measurement, and the EHR Incentive Programs.

Providers can use eHealth University to navigate the requirements of the eHealth programs with education modules tailored to their participation level, whether it’s beginner, intermediate, or advanced. The education modules include resources that simplify complex program information in a variety of different formats, such as videos, fact sheets, checklists, and guides. CMS will continue to add to eHealth University as new resources become available.

The above information was provided by CMS and is reproduced here in its entirety.

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

EHR Feedback and Verified Physician Discussions | EHR Blog | AmericanEHR Partners

EHR Feedback and Verified Physician Discussions | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

We relaunched AmericanEHR.com this week from the Health 2.0 conference in the Silicon Valley. Users of AmericanEHR will notice several new community features, including the ability for verified physicians and EHR vendors to interact and participate in discussions. We’ve also released over three years of EHR Feedback that has never before been published.

This EHR user commentary provides a window into the challenges and frustrations that medical practices are experiencing with their EHR systems. Several common frustrations are trending in the comments, including frustration with decreased productivity, decreased time for patient engagement, and increases in administrative workload with their EHRs:

  • “Too much time with the mouse, means looking at a screen not your patient.”
  • “Extremely frustrating. Promised many things which were either late or never delivered.”
  • “EHR has decreased productivity, decreased efficiency, increased frustration, and made the doctor patient relationship much less personal.”
  • “My charting time increased from 1 hour a day to 3 hours a day and over 4 years has improved minimally.”

AmericanEHR collects EHR feedback during its “EHR Satisfaction Survey,” which is open to all physicians, physician assistants, and nurse practitioners. Users are able to sort EHR feedback by EHR product and each submission is tagged with the specialty and clinical setting of the rater. Over 4,800 EHR ratings have been published on AmericanEHR.com to date, and new ratings are constantly added as new users register and participate.

With the launch of our new EHR feedback and community features, AmericanEHR is the unbiased, transparent platform that clinicians can use to get a real sense of how commercial technology is performing in a clinical setting.

Physicians and health care professionals are invited to join the conversation now, and tap into the collective knowledge of America’s largest online community dedicated to health IT. Physicians logging into AmericanEHR have their credentials checked in real time against the AMA Masterfile. Once verified, they are immediately able to post comments and interact with their peers.

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

Epic wins tender for Royal Children's EMR

Pulse+IT Magazine - Australasia's First and Only eHealth and Health IT Magazine
more...
No comment yet.
Scoop.it!

Nuance PowerShare Network Unveiled for Cloud-Based Medical Imaging and Report Exchange | Business Wire

Nuance PowerShare Network Unveiled for Cloud-Based Medical Imaging and Report Exchange | Business Wire | EHR and Health IT Consulting | Scoop.it

BURLINGTON, Mass.--(BUSINESS WIRE)--Nuance Communications, Inc. (NASDAQ: NUAN) announced today the immediate availability of Nuance PowerShare™ Network, the industry’s largest cloud-based network for securely connecting physicians, patients, government agencies, specialty medical societies and others to share essential medical images and reports as simply as people exchange information using social networks. Nuance PowerShare Network promotes informed and connected physicians and patients who can instantly view, share and collaborate while addressing patients’ healthcare needs.

“By integrating this with our EHR, PowerShare will enable physicians to manage inbound imaging through one point of access and login. Physicians in our 11 hospitals and 100-mile radius referral network see this cutting-edge technology as a way to deliver the highest level of patient care”

“Organizations are being tasked to communicate efficiently both in and out of their networks to provide clinical insight to physicians beyond one person or office to a much broader team involved in the continuum of care,” said Keith Dreyer, DO, PhD, FACR, vice chairman of radiology at Massachusetts General Hospital and Chair of the American College of Radiology (ACR) IT and Informatics Committee. “Nuance PowerShare Network addresses the information sharing challenge physicians face today with a network that supports things we’ve dreamed of doing for years,” he adds.

Fully Connected Patients & Providers
Nuance PowerShare Network is already used by more than 1,900 provider organizations for sharing images via the cloud using open standards. Made possible through the acquisition of Accelarad, this medical imaging exchange eliminates the costly and insecure process of managing images on CDs and removes silos of information in healthcare that inhibit providers from optimizing the efficiency and quality of care they provide. Anyone can join the network regardless of IT systems in place to instantly view and manage images needed to consult, diagnose or treat patients, enabling clinicians to more seamlessly evaluate and deliver care for patients who transition between facilities or care settings.

Nuance is already used by more than 500,000 clinicians and is a critical component within the radiology workflow and a trusted partner for 1,600+ provider organizations that rely on Nuance PowerScribe for radiology reporting and communications. Healthcare organizations that use Nuance PowerScribe, a group that produces more that 50 percent of all radiology reports in the U.S., can immediately leverage their existing investment and begin sharing radiology reports along with images, such as X-rays, MRIs, CT scans, EKGs, wound care images, dermatology images or any other type of image. This simplifies secure health information exchange between multiple providers, patients and disparate systems without costly and time-consuming interfaces, CD production or the need to install additional third-party systems.

“The challenge of sharing images with interpretive reports is something we’ve heard about consistently from our customers and EHR partners, and we know Nuance PowerShare Network will overcome this major obstacle, helping physicians treat patients more efficiently and effectively,” said Peter Durlach, senior vice president of marketing and strategy, Nuance Communications. “This nationwide network, one that is fully integrated into the EHR workflow and already connected to approximately half of all clinicians producing diagnostic imaging information, is a ground breaking solution that delivers immediate benefits at an unprecedented scale to our healthcare system.”

“Integrated image and report sharing helps us deliver quality care and drive down costs especially when patients transfer from one facility to another. Whether at their desktop or on their mobile device, our physicians can see the study that was done along with the interpretive report, which provides the information they need to treat the patient and avoid duplicate testing,” says Deborah Gash, vice president and CIO, Saint. Luke’s Health System in Kansas City. “By integrating this with our EHR, PowerShare will enable physicians to manage inbound imaging through one point of access and login. Physicians in our 11 hospitals and 100-mile radius referral network see this cutting-edge technology as a way to deliver the highest level of patient care,” she adds.

To learn more about the PowerShare Network and the new image sharing solution, visit www.nuance.com/products/PowerShareNetwork to join one of our webinars. Connect with Nuance on social media through the healthcare blog, What’s next, as well as Twitter and Facebook.

About Nuance Communications, Inc.
Nuance Communications, Inc. (NASDAQ: NUAN) is a leading provider of voice and language solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with devices and systems. Every day, millions of users and thousands of businesses experience Nuance’s proven applications. For more information, please visit: www.nuance.com.

Nuance and the Nuance logo are trademarks or registered trademarks of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. All other company names or product names may be the trademarks of their respective owners.

The statements in this press release relating to future plans, events or services, are forward-looking statements which are subject to specific risks and uncertainties. There are a number of factors which could cause actual events or results to differ materially from those indicated in such forward looking statements, including fluctuations in demand for the Nuance products, and the continued development of Nuance products. The reader is warned not to rely on these forward-looking statements without reservation, since these are simply reflections of the current situation. Nuance disclaims any obligation to update any forward-looking statements as a result of developments occurring after the date of this document.


Contacts

Nuance Communications, Inc.
Media Relations:
Ann Joyal, 781-565-4155
ann.joyal@nuance.com

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

Lack of 2014 Certified EHRs | EMR and HIPAA

Lack of 2014 Certified EHRs | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

I was asked recently by an EHR vendor about the disconnect between the number of 2011 Certified EHR and the number of 2014 Certified EHR. I haven’t looked through the ONC-CHPL site recently, but you can easily run the number of certified EHR vendors there. Of course, there’s a major difference in the number of 2011 certified EHR versus 2014 certified EHR. However, I don’t think it’s for the reason most people give.

Every EHR vendor that gets 2014 Certified likes to proclaim that they’re one of the few EHR vendors that was “able” to get 2014 Certified. They like to point to the vast number of EHR that haven’t bridged from being 2011 Certified to being 2014 Certified as a sign that their company is special because they were able to complete the “more advanced” certification. While no one would argue that the 2014 Certification takes a lot more work, I think it’s misleading for EHR companies to proclaim themselves victor because they’re “one of the few” EHR vendors to be 2014 Certified.

First of all, there are over 1000 2014 Certified EHR products on ONC-CPHL as of today and hundreds of them (223 to be exact – 29 inpatient and 194 ambulatory) are even certified as complete EHR. Plus, I’ve heard from EHR vendors and certifying bodies that there’s often a delay in ONC putting the certified EHR up on ONC-CPHL. So, how many more are 2014 Certified that aren’t on the list…yet.

Another issue with this number is that there is still time for EHR vendors to finish their 2014 EHR certification. Yes, we’re getting close, but no doubt we’ll see a wave of last minute EHR certifications from EHR vendors. It’s kind of like many of you reading this that are sitting on your taxes and we’ll have a rush of tax filings in the next few days. It’s not a perfect comparison since EHR certification is more complex and there are a limited number of EHR Certification slots from the ONC-ATCB’s, but be sure there are some waiting until the last minute.

It’s also worth considering that I saw one report that talked about the hundreds (or it might have been thousands) of 2011 Certified EHR that never actually had any doctors attest using their software. If none of your users actually attested using your EHR software, then would it make any business sense to go after the 2014 EHR certification? We can be sure those will drop out, but I expect that a large majority of these aren’t really “EHR” software in the true sense. They’re likely modularly certified and add-ons to EHR software.

To date, I only know of one EHR software that’s comes out and shunned 2014 Certified EHR status. I’m sure we’ll see more than just this one before the deadline, but my guess is that 90% of the market (ie. actual EHR users) already have 2014 Certified EHR software available to them and 99% of the market will have 2014 certified EHR available if they want by the deadline.

I don’t think 2014 EHR certification is going to be a differentiating factor for any of the major EHR players. All the major players realize that being 2014 Certified is essential to their livelihood and a cost of doing business.

Of course, the same can’t be said for doctors. There are plenty of ways for doctors to stay in business while shunning 2014 Certified EHR software and meaningful use stage 2. I’m still really interested to see how that plays out.



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

Readers Write: Addressing Data Quality in the EHR | HIStalk

Readers Write: Addressing Data Quality in the EHR | HIStalk | EHR and Health IT Consulting | Scoop.it

Addressing Data Quality in the EHR
By Greg Chittim

What if you found out that you might have missed out on seven of your 22 ACO performance measures, not because of your actual clinical and financial performance, but because of the quality of data in your EHRs? It happens, but it’s not an intractable problem if you take a systematic approach to understanding and addressing data quality in all of your different ambulatory EHRs.

In HIStalk’s recent coverage of HIMSS14, an astute reader wrote:

Several vendors were showing off their “big data” but weren’t ready to address the “big questions” that come with it. Having dealt with numerous EHR conversions, I’m keenly aware of the sheer magnitude of bad data out there. Those aggregating it tend to assume that the data they’re getting is good. I really pushed one of the major national vendors on how they handle data integrity and the answers were less than satisfactory. I could tell they understood the problem because they provided the example of allergy data where one vendor has separate fields for the allergy and the reaction and another vendor combines them. The rep wasn’t able to explain how they’re handling it even though they were displaying a patient chart that showed allergy data from both sources. I asked for a follow up contact, but I’m not holding my breath.

All too often as the HIT landscape evolves, vendors and their clients are moving too quickly from EHR implementation to population health to risk-based contracts, glossing over (or skipping entirely) a focus on the quality of the data that serves as the foundation of their strategic initiatives. As more provider organizations adopt population health-based tools and methodologies, a comprehensive, integrated, and validated data asset is critical to driving effective population-based care.

Health IT maturity can be defined as four distinct steps:

  1. EHR implementation
  2. Achievement of high data quality
  3. Reporting on population health
  4. Transformation into a highly functioning PCMH or ACO.

High-quality data is a key foundational piece that is required to manage a population and drive quality. When the quality of data equals the quality of care physicians are providing, one can leverage that data as an asset across the organization. Quality data can provide detailed insight that allows pinpointing opportunities for intervention — whether it’s around provider workflow, data extraction, or patient follow-up and chart review. Understanding the origins of compromised data quality help recognize how to boost measure performance, maximize reimbursements, and lay the foundation for effective population health reporting.

It goes without saying that reporting health data across an entire organization is not an easy task. However, there are steps that organizations must take to ensure they are extracting sound data from their EHR systems.

Outlined below are the key issues that contribute to poor data quality impacting population health programs, how they are typically resolved, and more optimal ways organizations can resolve them.

 

Variability across disparate EHRs and other data sources

EHRs are inconsistent. Data feeds are inconsistent. Despite their intentions, standardized message types such as HL7 and CCDs still have a great deal of variability among sources. When they meet the letter of national standards, they rarely meet the true spirit of those standards when you try to use.

Take diagnoses, for example. Patient diagnoses can often be recorded in three different locations: on the problem list, as an assessment, and in medical history. Problem lists and assessments are both structured data, but generally only diagnoses recorded on the problem list are transported to the reports via the CCD. This translates to underreporting on critical measures that require records of DM, CAD, HTN, or IVD diagnoses. Accounting for this variability is critical when mapping data to a single source of truth.

Standard approach: Most organizations try to use consistent mapping and normalization logic across all data sources. Validation is conducted by doing sanity checks, comparing new reports to old.

Best practice approach: To overcome the limitations of standard EHR feeds like the CCD, reports need to pull from all structured data fields in order to achieve performance rates that reflect the care physicians are rendering– either workflow needs to be standardized across providers or reporting tools need to be comprehensive and flexible in the data fields they pull from.

The optimal way to resolve this issue is to tap into the back end of the EHR. This allows you to see what data is structured vs. unstructured. Once you have an understanding of the back-end schema, data interfaces and extraction tools can be customized to pull data where it is actually captured, as well as where it should be captured. In addition, validation of individual data elements needs to happen in collaboration with providers, to ensure completeness and accuracy of data.

 

Variability in provider workflows

EHRs are not perfect and providers often have their own ways of doing things. What may be optimal for the EHR may not work for the providers or vice versa. Within reason, it is critical to accommodate provider workflows rather than forcing them into more unnatural change and further sacrificing efficiency.

Standard approach: Most organizations ignore this and go to one extreme or another: (1) use consistent mapping and normalization logic across all data sources and user workflows, making the assumption that all providers use the EHR consistently, or (2) allowing workflows to dictate all and fight the losing battle to make the data integration infinitely adaptable. Again, validation is conducted using sanity checks, comparing new reports to old.

Best practice approach: Understand how each provider uses the system and identify where the provider is capturing all data elements. Building in a core set of workflows and standards dictated by an on-the-ground clinical advisory committee, with flexibility for effective variations is critical. With a standard core, data quality can be enhanced by tapping into the back end of the EHR to fully understand how data is captured as well as spending time with care teams to observe their variable workflows. To avoid disruption in provider workflows, interfaces and extraction tools can be configured to map data correctly, regardless of how and where it is captured. Robust validation of individual data elements needs to happen in collaboration with providers to ensure completeness and accuracy of data (that is, the quality of the data) matches the quality of care being delivered.

 

Build provider buy-in/trust in system and data through ownership

If providers do not trust the data, they will not use population health tools. Without these tools, providers will struggle to effectively drive proactive, population-based care or quality improvement initiatives. Based on challenges with EHR implementation and adoption over the last decade, providers are often already skeptical of new technology, so getting this right is critical.

Standard approach: Many organizations simply conduct data validation process by doing a sanity test comparing old reports to new. Reactive fixes are done to correct errors in data mapping, but often too late, after provider trust has been lost in the system.

Best practice approach: Yet again, it is important to build out a collaborative process to ensure every single data element is mapped correctly. First meetings to review data quality usually begin with a statement akin to “your system must be wrong — there’s no way I am missing that many patients.” This is OK. Working side by side with the providers to ensure they understand where data is coming from and how to modify both workflow and calculations ensure that they are confident that reports accurately reflect the quality of care they are rendering. This confidence is a critical success factor to the eventual adoption of these population health tools in a practice.

 

Missed incentive payments under value-based reimbursement models

An integrated data asset that combines data from many sources should always add value and give meaningful insight into the patient population. A poorly mapped and validated data asset can actually compromise performance, lower incentive reimbursements, and ultimately result in a negative ROI.

Standard approach: A lackluster data validation process can result in lost revenue opportunities, as data will not accurately reflect the quality of care delivered or accurately report the risk of the patient population.

Best practice approach: Using the previously described approach when extracting, mapping, and validating data is critical for organizations that want to see a positive ROI in their population health analytics investments. Ensuring data is accurate and complete will ensure tools represent the quality of care delivered and patient population risk, maximizing reimbursement under value-based payments.

 

We have worked with a sample ACO physician group of over 50 physicians to assess the quality of data being fed from multiple EHRs within their system into an existing analytics platform via CCDs and pre-built feeds. Based on an assessment of 15 clinically sensitive ACO measures, it was discovered that the client’s reports were under-reporting on 12 of the 15 measures, based only on data quality. Amounts were under-reported by an average of 28 percentage points, with the maximum measure being under-reported by 100 percentage points.

Reports erroneously reported that only six of the 15 measures met 2013 targets, while a manual chart audit revealed that 13 of the 15 measures met 2013 targets, indicating that data was not being captured, transported, and reported accurately. By simply addressing these data quality issues, the organization could potentially see additional financial returns through quality incentive reimbursements as well as a reduced need for labor-intensive intensive chart audits.

As the industry continues to shift toward value-based payment models, the need for an enterprise data asset that accurately reflects the health and quality of care delivered to a patient population is increasingly crucial for financial success. Providers have suffered enough with drops in efficiency since going live on EHRs. Asking them to make additional significant changes in their daily workflows to make another analytics tool work is not often realistic.

Analytics vendors need to meet the provider where they are to add real value to their organization. Working with providers and care teams not only to validate integrity of data, but to instill a level of trust and give them the confidence they need to adopt these analytics tools into their everyday workflows is extremely valuable and often overlooked. These critical steps allow providers to begin driving population-based care and quality improvement in practices, positioning them for success in the new era of healthcare. 

Greg Chittim is senior director of Arcadia Healthcare Solutions of Burlington, MA



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

15-Minute Visits Take A Toll On The Doctor-Patient Relationship - WebMD

15-Minute Visits Take A Toll On The Doctor-Patient Relationship - WebMD | EHR and Health IT Consulting | Scoop.it
By Roni Caryn Rabin

Fri, Apr 18 2014

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.”

These days, stories like Eisenstodt’s are increasingly common. Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. 

It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. 

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.

Shorter visits also increase the likelihood the patient will leave with a prescription for medication, rather than for behavioral change -- like trying to lose a few pounds, or going to the gym.

Physicians don’t like to be rushed either, but for primary care physicians, time is, quite literally, money. Unlike specialists, they don’t do procedures like biopsies or colonoscopies, which generate revenue, but instead, are still paid mostly per visit, with only minor adjustments for those that go longer.

And many doctors may face greater financial pressure as many insurers offering new plans through the health law’s exchanges pay them even less, offering instead to send them large numbers of patients. 

This fee-for-service payment model, which still dominates U.S. health care, rewards doctors who see patients in bulk, said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians, who practices in Kingsport, Tenn.



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

Guest Article: Secure message exchange using the Direct Protocol is not a myth, there really are people using it

Guest Article: Secure message exchange using the Direct Protocol is not a myth, there really are people using it | EHR and Health IT Consulting | Scoop.it

I recently chaired a couple of conferences and my next HealthIMPACT event is coming up later this month in NYC. At each one of the events and many times a year via twitter and e-mail I am asked whether the Direct Project is successful, worth implementing in health IT projects, and if there are many people sending secure messages using Direct. To help answer these questions, I reached out to Rachel A. Lunsford, Director of Product Management at Amida Technologies. Amida has amassed an impressive team of engineers to focus on health IT for patient-centered care so their answer will be well grounded in facts. Here’s what Rachel said when I asked whether Direct is a myth or if it’s real and in use:

Despite wide adoption in 44 States, there is a perception that Direct is not widely used. In a recent conversation, we discussed a potential Direct secure messaging implementation with a client when they expressed concern about being a rare adopter of Direct messaging.  While the team reassured them that their organization would in fact be joining a rich ecosystem of adopters, they still asked us to survey the market.

In 2012, the Officer of the National Coordinator for Health Information Technology (ONC) awarded grants to State Health Information Exchanges to further the exchange of health information. There are two primary ways to exchange information: directed and query-based. ‘Directed’ exchange is what it sounds like – healthcare providers can send secure messages with health information attached to other healthcare providers that they know and trust. The most common type of ‘Directed’ exchange is Direct which is a secure, scalable, standards-based way to send messages. Query-based is a federated database or central repository approach to information exchange which is much harder to implement and growth in this area is slower.  Thanks in part to the grants and also in part to the simplicity of the Direct protocol, 44 States have adopted Direct and widely implemented it. And yet the myth persists that Direct is not well adopted or used.

As with other new technologies, it may be hard to see the practical applications. When Edison and Tesla were dueling to find out which standard – direct or alternating current – would reign supreme, many were unsure if electricity would even be safe enough, never mind successful enough, to replace kerosene in the street lamps. It was impossible for people to foresee a world where many live in well-lit homes on well-lit streets, and none could have imagined using tools like the computer or the Internet. Thankfully, the standards debate was sorted out and we continue to benefit from it today.

There are two groupings of data we can look towards for more detail on use of Direct. The first are the States themselves; they self-report transaction and usage statistics to the ONC. It was reported in the third quarter of 2013 that the following were actively exchanging some 165 million ‘Directed’ messages:

  • 20,376 Ambulatory entities (Entities/organizations that provide outpatient services, including community health centers, independent and group practice, cancer treatment centers, dialysis centers, etc.)
  • 738 Acute Care Hospitals (Hospitals that provider inpatient medical care and other related services for surgery, acute medical conditions or injuries)
  • 157 Laboratories (Non-hospital clinical)
  • 16,329 other health care organizations (Home health care, long-term care, behavioral health programs/entities, psychiatric hospitals, payers, release of information vendors, health care billing services, etc.)

Another organization collecting data on Direct implementation is DirectTrust.org. Charged by ONC, DirectTrust.org oversees development of the interoperability framework and rules used by Direct implementers, works to reduce implementation costs, and remove barriers to implementation. Additionally, DirectTrust supports those who want to serve as sending and receiving gateways known as health information service providers (HISPs). By DirectTrust.org’s count, the users number well over 45,000 with at least 16 organizations accredited as HISPs. Further, over two million messages have been exchanged with the roughly 1,500 Direct-enabled sites. With Meaningful Use encouraging the use of Direct, we can expect even more physicians and healthcare organizations to join in.

As more doctors are able to exchange records, everyone will benefit. When a provider can receive notes and records from other providers to see a fuller, more complete view of her patient’s health, we have a greater possibility of lowering healthcare costs, improving health outcomes, and saving lives.  Once we open up the exchange to patients through things like the Blue Button personal health record, the sky is the limit.



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

Scribes Are Back, Helping Doctors Tackle Electronic Medical Records

Scribes Are Back, Helping Doctors Tackle Electronic Medical Records | EHR and Health IT Consulting | Scoop.it

Like many other doctors across the country, , a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record.

"I was really focused on just trying to get the information in, and not really focusing on the patient anymore," Ramnath says.

In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a handheld microphone. Once she's finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients.

"I would more than happily sacrifice a significant chunk of my income for the improved quality of life I have," Ramnath says.

Medical scribes are in high demand nationally. Any doctor who doesn't make the switch from paper to electronic records by 2015 will face Medicare , and this deadline is fueling the demand.

As the doctor examines a patient, medical scribe Connie Gayton records the visit using a microhone tethered to her laptop.

Brandon Thibodeaux for NPR

, the country's first scribe staffing company, is on the second expansion of its Fort Worth, Texas, headquarters and has opened another office in Chicago. , the company's CEO, says the firm is growing by 46 to 50 percent every year. In 2008, PhysAssist had 35 scribes; now it has 1,400. The other big scribing companies — and — each have thousands more, and the demand keeps growing.

PhysAssist trains scribes from across the country every week in its Fort Worth mock emergency department, where instructor Brandon Torres shows students the right way to fill out an electronic medical record. There are thousands of record systems, and scribes need to know how to put in the right billing codes and medical terminology at lightning speed. Torres says it's important not just to be able to multitask, but also to be able to listen to multiple things at the same time.

"You're listening to the physician, you're listening to the nurse, you're listening to the patient," Torres says. "And you're gathering all that information and presenting it back to the physician."

That last part's crucial. The physician has to approve the scribe's notes, because ultimately the doctor is responsible for the record.

Medical scribes make $8 to $16 an hour. Many of them are medical students who say they find it an invaluable experience. But it's not clear that scribes make things better for patients.

with in Washington, D.C., points to one done in an emergency department in New Jersey that found that doctors with scribes were able to see more patients on average — which means more money for the institution. But that same study found that the amount of time a patient spent in the emergency department didn't decrease. Medical scribing also raises some privacy concerns, O'Malley says. Some patients may not like having an extra person in the exam room.



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

Medicare's Big Data Dump Is Just That - A Dump

Medicare's Big Data Dump Is Just That - A Dump | EHR and Health IT Consulting | Scoop.it

Based on the headlines, many might think that the sole purpose of the Medicare data (released last week) was a scavenger hunt for the "Medicare Millionaires." There was certainly no shortage of headlines with that exact phrase. Medicare Millionaires Emerge in Data on Doctor Payments (Bloomberg) Medicare millionaires: Florida eye doc got $21 million from Medicare in 2012 (NY Daily News) Medicare millionaires: Who are the top paid doctors? (The Christian Science Monitor) Who are the Medicare millionaires? (MSNBC) Medicare millionaires (CNBC) Medicare millionaires emerge in data on physician payments (Providence Business News) 340 Texas doctors among Medicare's millionaires (Dallas News) First Data Detail in 33 Years Shows 4,000 Medicare Millionaires (MoneyNews)



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

Curbside Consult with Dr. Jayne 4/7/14 | HIStalk

Curbside Consult with Dr. Jayne 4/7/14 | HIStalk | EHR and Health IT Consulting | Scoop.it

I renewed my battle today with Big University Medical Center in trying to get my information corrected on its patient portal. Unfortunately, my efforts were derailed by a much more sinister problem – basic office chaos.

Luckily I’m a nice, stable patient so I only have to visit Big University’s outpatient clinic once a year. They run chronically late. I’ve learned to always schedule the first appointment of the morning so I can have a chance to make it to my own office before noon. I make sure to arrive on time if not early because they tend to triple (if not quadruple) book appointments and I want to be the first of the cohort to be roomed. I also bring plenty of reading material so I don’t go out of my mind when I inevitably end up waiting.

I shared the elevator with a member of the office staff who was reviewing a printed patient appointment schedule (including names, appointment reasons, and dates of birth.) I’m not sure why anyone would need to take home a printed schedule since they have a big-time EHR system with remote access and plenty of redundancy and they definitely shouldn’t have been reviewing it openly in the elevator.

I hit the floor 15 minutes early (as instructed by my appointment reminder that came through the patient portal) only to find the doors locked and six patients standing in the hallway. The weather was decent, so bad roads or traffic weren’t a viable excuse. They finally opened the doors just a few minutes before my appointment time and all the patients hustled to the check-in desk.

Since the office doesn’t use sign-in sheets (purportedly for HIPAA purposes) they told everyone to sit down and they would call us up in appointment order. Most of the patients were retirees and began grumbling. While we were waiting, we were treated (via the open floor plan check-in desk) to one of the receptionists chatting about some birthday party she was invited to.

By now, it was past the first appointment time and we got to watch her start up her computer, stow her personal items, then walk away. 

My process improvement brain had engaged. I decided to do an impromptu time and motion study. She was gone four minutes and came back with an open cup of coffee. I know there are no OSHA requirements about coffee at a desk, but there ought to be some rules about open liquids and eating around computers. Not to mention that slurping coffee in front of patients is unprofessional. 

The first receptionist had checked in two patients and had called me up before the second one was ready to start working. The receptionist apologized about my wait. I mentioned that their reminders tell everyone to come early. She said she knew it was a problem and they’ve asked to have the message modified several times because they don’t open early. They didn’t have a printed patient information form to verify, but rather read all our demographics aloud and asked for verbal verification.

I felt bad asking her about my patient portal problem and spared her the long story. I simply asked if they had a help desk number I could try before I left the office since all the demographics are correct at the practices where I’m seen but are wrong on the portal. The only advice she could offer was to try the help feature from within the portal.

By this time, they had four patients checked in. It was 15 minutes after the first appointment time (assuming I was actually in the first slot as I had requested) and not a single patient had been called back by the clinical staff.

I was placed in an exam room with the door left open. While waiting for the patient care technician to start my visit, I was treated to conversations about other patients coming later in the day, various people walking back and forth chatting about their weekend activities, and a physician who normally doesn’t work at the satellite location who didn’t know what exam rooms he should work from or who his assistant would be. Not exactly a vote of confidence for patient privacy or engagement.

Last year my physician had used a scribe to document my visit in the EHR. I figured at least once they would try to blame the EHR for the delays. As they started my visit, I realized they wouldn’t be scapegoating the EHR – the office had gone back to paper. The tech started documenting my visit on a photocopied paper template. She did reference the electronic allergies documented in the EHR and re-documented them on paper, so score one for patient safety. She also reviewed the previous note input by the scribe as well as a “backup” paper note that apparently was documented during my last visit.

I let her know I wanted to talk about a new concern that popped up in the three months I waited for my appointment. She responded by letting me know my physician was no longer caring for “routine follow up” patients and I would have to find a new doctor if the new concern didn’t turn out to be anything serious. I’ve already been handed off multiple times within this practice, so I’m no stranger to starting over, but I thought the timing was poor.

I finally saw the physician 45 minutes after my scheduled appointment. She remembered that I’m a member of the community teaching faculty for Big University and offered to keep me as a patient even though my new concern turned out to be nothing. I should probably feel grateful to not have to change physicians again, but I think I’m going to anyway. Their office is a mess and I get aggravated every time I go. Simple things like a) cutting the personal chatter while there are multiple patients waiting; b) being vigilant about behavior when the practice has an open floor plan; and c) manifesting obvious “hustle” when you know you’re late opening would go a long way towards reducing that aggravation.

Now they’re not using EHR any more, so my data isn’t available to share with other physicians. There’s not an advantage of staying there vs. finding a physician at one of the other institutions in town. If my records are going to be in silos, it doesn’t really matter if the silos are 20 miles apart or right next door. The clinic always posts a loss and blames it on the number of Medicaid and charity patients they see, but after several years of this routine, I’m fairly convinced that poor management has as much to do with it as patient mix.

I’ve never received a patient satisfaction survey from this location, but hope I get one today. I’ve got some choice recommendations to share with them, although I don’t think it will make much of a difference. It doesn’t matter how much we spend on IT or whether the systems have outstanding usability if we can’t get back to the basics and actually manage our offices, whether they’re academic clinics, private practices, or hospital outpatient departments.

Making sure that IT functions support our mission by synchronizing automated reminder messages with actual office practice, having help desk support for patient-facing systems, and ensuring staff come in early enough to turn their computers on before they start assisting patients are a must as well. There are numerous stressors on all our healthcare systems and personnel. We have to come up with ways to fix them.

Have any creative ideas? Email me.

Email Dr. Jayne.



more...
No comment yet.