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Health care providers leave patients' data vulnerable

Health care providers leave patients' data vulnerable | EHR and Health IT Consulting | Scoop.it

Data breaches plague the vast majority of health care providers, with 94 percent of health organizations reporting at least one breach of patient information in the past two years, a new survey shows.

In addition, 45 percent of 80 organizations that responded to the Ponemon Institute Patient Privacy & Data Security survey reported more than five data breaches during the same two-year period. Slightly more than half of the organizations said the compromised information involved medical identity, with a quarter of those saying the theft affected a patient’s medical treatment.

 

More than half of the organizations said they have little or no confidence in their ability to detect all breaches, according to a news release. Data breaches cost the U.S. health-care industry an average of $7 billion per year, or $1.2 million per organization, the study finds.

 

Most of the breaches resulted from lost electronic devices, employees’ mistakes, technology glitches, third-party errors and criminal attacks. The survey also found that 69 percent of surveyed organizations do not secure devices such as insulin pumps that hold protected health information.

 

The risks will increase with the growing use of mobile and cloud technologies, the study concludes.

 

For example, 81 percent of the organizations surveyed allow employees to use their own mobile devices, but 54 percent can’t guarantee the security of those devices. And while 91 percent of hospitals in the survey use cloud-based services, 47 percent are unsure that the cloud data are secure.

Nearly three out of four hospitals surveyed said they don’t have the resources to detect or prevent data breaches.

 

“Clearly, in order for the trend to shift, organizations need to commit to this problem and make significant changes,” said Rick Kam, president and co-founder of Portland, Ore.-based ID Experts, which sponsored the study. “Otherwise, as the data indicates, they will be functioning in continual operational disruption.”

 

The Ponemon Institute conducts independent research on data privacy and information security.

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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Do Stage 3 Meaningful Use Requirements Need More Flexibility?

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

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


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


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


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


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

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

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


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


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

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

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

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


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


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


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

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


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


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

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

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Specialty Specific EHR

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

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


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


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


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

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


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


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

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

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

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


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


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


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


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


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

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


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


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


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

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The Internet of Things: a $117B opportunity for Healthcare

The Internet of Things: a $117B opportunity for Healthcare | EHR and Health IT Consulting | Scoop.it

The Internet of Things, also known as IoT, will radically change the appearance of several industries, above all the healthcare. According to a recent post“The use of IoT is expected to grow fastest in healthcare over the next five years, to the tune of $117 billion by 2020”.


As we already noticed ‘New wearables are emerging rapidly This revolution is likely to create a huge impact on mhealth’.


Which are the areas where the use of IoT will reshape medical care?

Wearable technology

The easiest way of patient monitoring. Wearable technology gadgets are very popular at the time. They are able to monitor a vast range of health markers, such as brainwaves, breathing patterns, blood pressure, calories burned, footsteps, heart rhythms, physical position and balance, and temperature, to name just a few.

Wearables can also remind you, or you family, to take medication.

Telemedicine

All you need is a mobile device. The Internet of Things, through the advancements in telemedicine, let healthcare professionals (HCPs) interact with patients virtually. In other words, physicians can ‘visit’ their patients always and everywhere, avoiding the travel time required to meet faraway patients.


According to Wired, “There are a lot of pros to telemedicine. Convenience is one. Access is another. Then there’s the immediacy of it, too.”

Medical device information system

Recording, Merging and analyzing medical data.

Traditionally HCPs have to record a large quantity of data about their patients.


It takes a long time, and what is worse, it could generate errors. Thanks to IoT, patient data is automatically transmitted to electronic health record (EHR) systems. This will increase accuracy and further will allow caregivers to spend more time providing care.

Doctors still have to analyze all that data, but the Internet of Things allows them to merge digital medical data from vastly different medical devices.


Medical device information system will help improving the delivery of patient care.

Intelligent Hygiene Systems

Hospitals are going to be healthier places. The Internet of Things is going also to increase the quality of care hospitals provide. Even if (public or private) hospitals are the place where you should cure you of a disease, it is a fact that each year more than 2 million patients catch infections during hospital stays!


Recent studies as already proved that Hospitals using the system had an average 105.6% increase in hand hygiene solution dispenses and a decrease in healthcare associated infections (HAI) by more than 24%.

 

IoT has already changed healthcare

But that is just the beginning.


Thanks to the Internet of things Doctors and patients already feel closer than ever. On the other hand, IoT represents also a not to be missed opportunity for Pharma industry. An opportunity that in only five years will make Pharma gain over $117 billion.

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Why Practice Fusion Is The Dominant Player In Cloud-Based Electronic Health Records

Why Practice Fusion Is The Dominant Player In Cloud-Based Electronic Health Records | EHR and Health IT Consulting | Scoop.it

San Francisco-based Practice Fusion, the largest U.S. cloud-based electronic health record (EHR) platform for doctors and patients, on June 18th launched a native version of its EHR optimized for iOS and Android based tablets.


This expansion of technology will allow the 112,000 active health care professionals to securely access their EHR and medical records. Practice Fusion is already regarded as an innovator and trailblazer in the industry, since it is the only Meaningful Use certified EHR with complete continuity and functionality across three separate platforms: desktop, iOS and Android. Beyond that, the platform is free—without monthly fees and does not require any special training for adoption into practice.


“This launch further extends our position as the most dominant, fastest innovating EHR,” said Ryan Howard, Practice Fusion, CEO and Founder. “In addition to having the largest patient-provider community in the country, Practice Fusion is the only EHR available where providers have the ability to quickly and securely access their free EHR on a variety of platforms. This independence empowers providers to use whichever device or platform helps them provide the best possible patient care.”


As the fastest growing EHR in the U.S., Practice Fusion now has over 100 million patient records under active management. In 2014 alone, Practice Fusion’s EHR was utilized to record over 56 million patient visits–nearly 6% of all ambulatory visits in the U.S.


As the transition to mobile devices has been rapidly occurring over the past five years or so, Practice Fusion has responded with clear plans to help expand the user experience. And with nearly 43% of physicians currently using a mobile device in their medical practice, Practice Fusion allows providers to choose which platform best fits in to their workflow.


“As numerous studies show that the adoption of mobile devices by health care professionals increases every year,” explains Howard, “having a secure, mobile EHR is becoming increasingly crucial to providers.”


“With over 20,000 requests within the Practice Fusion community alone, the launch of native iOS and Android based applications demonstrates Practice Fusion’s commitment to empower providers with the latest tools to help them provide quality patient care.”

Howard explains that “the flexibility and connectivity options of our free platform has led to Practice Fusion being confirmed in a recent study by AmericanEHR as the de facto EHR for solo and 1-3 provider clinician offices.”


“With optimized navigation for landscape and portrait devices, the new iOS and Android based applications feature all the same capabilities already valued by Practice Fusion users such as e-prescribing to over 70k pharmacies and connecting with over 550 labs/imaging partners.”

Data from the recent AmericanEHR study in partnership with the American College of Physicians (ACP) demonstrated that Practice Fusion is the clear leader for solo and practices with 1-3 medical providers. The study found that for solo providers, Practice Fusion has 40% greater market share than eClinicalWorks, the next largest competitor in this category. And for small offices with 1-3 medical providers, Practice Fusion also garnered 25% more market share than eClinicalWorks, the next largest competitor in this category. The survey concluded that Practice Fusion is the dominant player in the market of 1-3 member clinician practices. And based on data from the American Medical Association (AMA), almost 60 percent of physicians are members of practices made up of 10 physicians or less, with over 53% of physicians self-employed.


According to Healthit.gov, a federal website that provides comprehensive up-to date information regarding EHRs, the average upfront cost of implementation of an EHR is $33,000 per provider, along with an annual maintenance fee of $4,000. For many smaller practices, this may not be feasible—thus making the case for implementing Practice Fusion, a completely free, Meaningful Use certified EHR.


“With this launch” said Howard, “Practice Fusion becomes the only EHR available that has complete continuity and functionality between a variety of platforms enabling providers to securely access their patients’ medical records.”


“Whether a provider is on their computer or tablet, they will have a completely streamlined and consistent user experience.”

Howard also explained that “For providers who are just adopting an EHR or are looking to use a mobile solution, the ability to not have to learn a new layout or system based on device is invaluable for saving provider time, which is increasingly becoming in short supply.”


As healthcare providers have increasingly grown frustrated with using EHRS in their daily practice, functionality and mobile access are key drivers of what seems to stick. While medical scribes have certainly helped to free providers from data entry during daily clinical activities, being able to access records with ease and confidence–and at low or no cost– are important factors which retain providers going forward.

Howard sums it up this way: “By leveraging the agility of our platform, Practice Fusion is able to adopt solutions in response to industry trends and provider needs. With functionality now across three platforms, providers have the option to choose which solution best suits their workflow preferences and needs, allowing them to focus on what’s most important –treating patients and saving lives.”

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

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

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


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


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


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


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


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

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


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


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


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

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Staff Training Crucial in ICD-10 Conversion Preparations

Staff Training Crucial in ICD-10 Conversion Preparations | EHR and Health IT Consulting | Scoop.it

Healthcare providers who are behind in their ICD-10 conversion preparations may benefit from following the ICD-10 Quick Start Guide provided by the Centers for Medicare & Medicaid Services (CMS).


The five steps that providers will need to take when it comes to their ICD-10 conversion preparations are the following: (1) developing a plan, (2) training the healthcare staff, (3) updating system processes, (4) working with vendors and health insurers, and (5) testing workflow processes and systems.


When it comes to training the clinical staff (including nurses, doctors, and medical assistants) and moving forward with ICD-10 conversion preparations, it’s vital to focus on new clinical concepts and documentation obtained through ICD-10 codes. When training coding and administrative staff including coders, billers, and practice management employees, the focus should be on ICD-10 fundamentals.


CMS provides a variety of resources including webinars, national provider calls and presentations, the Road to 10 website, and email updates. Physician groups, healthcare organizations, hospitals, payers, and vendors also offer a variety of resources for medical providers who are still behind with some common ICD-10 conversion preparations.


The very first step to take is to identify the top 25 most common ICD-9 codes used in one’s medical facility. Common diagnosis codes are also available on the Road to 10 website and other resources.


Teach your healthcare and coding staff how to code the most common cases using the ICD-10 coding set. Using reports via one’s practice management software and billing documents, providers can better identify the most commonly used ICD-9 codes.


Once the top 25 codes are gathered and there is still time before the ICD-10 implementationdeadline, providers are encouraged to expand ICD-10 coding of typical cases past an additional 50 or more codes. This would ensure the majority of a provider’s cases are managed effectively under ICD-10.


Even though the ICD-10 coding set has expanded to more than 68,000 codes, providers will only need to use a small section of the set. Along with training staff, updating system processes is vital for one’s ICD-10 conversion preparations. All hardcopy and electronic forms need to be updated while information gaps should be resolved before the October 1 deadline.


Clinical documentation will need to include laterality, the number of encounters (initial or subsequent), kinds of fractures, and other information about related complications. It is useful to put together a documentation checklist detailing new concepts that should be captured with ICD-10 codes. Once systems are in place, ICD-10 end-to-end testing is crucial to ensure a healthcare facility is prepared for the October 1 deadline.


“With four months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since half the claims submitted for end-to-testing were professional claims,” the Coalition for ICD-10 commented on CMS’ latest ICD-10 end-to-end testing results. “These results indicate that significant progress has been made since the January end-to-end testing with the overall rejection rate dropping from 19 to 12 percent and ICD-10 rejections dropping from 3 to 2 percent.”

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Direct Reimbursement Solutions's curator insight, July 1, 10:10 AM

Excellent advice for ICD-10 preparedness.

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10 Reasons to Outsource Medical Billing

10 Reasons to Outsource Medical Billing | EHR and Health IT Consulting | Scoop.it

Several years ago, based upon a thorough review of the facts, I recommended a client outsource his practice's billing. It was a peculiar conversation:

Me: You could successfully address a number of issues by outsourcing your billing.


Client: I learned in medical school that it is important to keep billing in-house.


Me: That may have been true at the time. Your current situation is different. Let's talk about it.


Client: I learned in medical school that it is important to keep billing in-house.


That old advice, based on who knows what set of facts, was as universal and unchanging for that physician as "Do no harm" or "When you hear hoof beats, think horses not zebras." Unquestioning loyalty to that premise cost him a lot of money.


Here are some of the benefits that can be achieved with outsourcing billing:


1. Free up office space

If the billing is outsourced, the biller does not need a place to sit and the billing records are somewhere else.


2. Make some employee turnover irrelevant

Make employee turnover in the billing department someone else's problem. Unless your practice is big enough to justify a billing department, with a set of employees with varying skills and levels of sophistication, high turnover is almost inevitable. Some billing work can be mind-numbingly dull and some requires sophisticated skills in analysis, synthesis, and communication. Very few people capable of these higher-level requirements will be satisfied for long with dull routine work.


3. Cut down on incoming phone calls

Office staff is relieved of calls that go directly to the billing service. The biggest benefit, however, is the calls that are never made because billing and claims errors are more often avoided in the first place.


4. Turn a fixed expense into a variable one

Staff and office space are fixed expenses. They cannot go below a certain level no matter how low the volume of billing is. When they go up, they go up in stair steps. If the practice is paying a percentage of collections for the billing service, there is a perfect correlation between collections and cost.


Another benefit is that the interests of the practice and the billing service are aligned. If the billing service increases collections and their rate is anything less than 100 percent of collections, the practice is money ahead.


5. Know what is going on in the marketplace

Access a broader perspective of what's going on in the healthcare marketplace. This is one of the most valuable intangibles. An in-house biller cannot know what other practices in the same specialty are doing and what their outcomes are.


6. Anticipate payer rule changes

Avoid being caught flat-footed when payers' rules change. A good billing service is always aware of proposed and pending changes that can have an impact on the revenue cycle, especially technical changes that seldom hit the radar of a medical practice until reimbursements are impacted.


7. Access solid data analytics

A billing service can help your practice identify what the practice is doing well and poorly, in terms of maximizing legitimate reimbursements. The service will identify bottlenecks in the flow of billing documentation and be able to teach providers and staff how to avoid errors that negatively impact claims.  A really good billing service will also share information about alternative ways to code that result in more favorable reimbursements.


8. Know your accounts receivables

Enjoy the benefit of knowing exactly where you stand in terms of receivables. Any service worth its salt will be able to tell you, at least monthly, the percentage of claims that are paid from the initial submission, how many are 30 days, 60 days, and 90 days outstanding, and which payers are most important to the practice. It's valuable information that an internal billing person almost never has the time to provide.


9. Have a resource at payer offices

The biller in an individual practice deals with all the payers, and is essentially anonymous to all of them. A biller at a billing service typically deals with a subset of payers, and often with a single payer. That allows him to develop personal relationships that expedite problem resolution.


10. Be prepared for a payer audit

You will have an expert advocate in case of a payer's audit. A payer's audit is in the ordinary course of business for a billing service. They know the process and the vocabulary, and they have all the documentation at hand.


In general, it makes good business sense to outsource the billing for most medical practices. That said, the outsourcing must be done to a competent billing service and the relationship must still be managed by the medical practice.

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Physician Organizations Fear ICD-10 Integration Disruptions

Physician Organizations Fear ICD-10 Integration Disruptions | EHR and Health IT Consulting | Scoop.it

While the Centers for Medicare & Medicaid Services (CMS) continue to urge healthcare providers to prepare for the coming ICD-10 integration, many stakeholders are concerned that the healthcare industry will encounter large disruptions to patient care services and financial reimbursements if the ICD-10 compliance deadline remains steadfast.


In its latest mailing, CMS encourages providers to train their staff on ICD-10 coding with the Quick Start Guide. In the meantime, representatives from the California Medical Association, Florida Medical Association, Medical Society of the State of New York, and the Texas Medical Association sent a letter to Andy Slavitt, Acting Administrator at CMS, asking for additional assistance with the ICD-10 integration.


In particular, the organizations are asking CMS to develop a two-year ICD-10 integration period during which doctors will not be penalized for any coding mistakes or system malfunctions. Additionally, the letter asks for a two-year ICD-10 transition period that prevents audits from taking place due to ICD-10 coding errors. The medical organizations are urging CMS to prevent physician payment reductions due to ICD-10 coding mistakes throughout the two-year period.


“The Oct. 1 mandatory implementation of the ICD-10-CM coding system is a looming disaster,” the letter to CMS exclaimed. “The results of the recent end-to-end tests give us little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we ‘throw the switch’ to ICD-10.”


“The voluminous technical problems associated with the far simpler adoption of the National Provider Identifier and the HIPAA 5010 transaction standards give us even further cause for concern,” the letter continues. “Even those practices that are most prepared for this transition tell us they worry about the confusion and reduced productivity they expect to accompany ICD-10.”


Since many physician organizations and healthcare providers are concerned with meeting the deadline for the ICD-10 integration and a multitude of bills are coming out to support a modified transition period, the American College of Rheumatology created a policy brief that outlines six myths and facts about the ICD-TEN Act (H.R. 2247).

First, there is a general misconception that the ICD-TEN Act will undermine coverage and healthcare quality, the organization explained. However, the bill made a “distinction between diagnosis code errors and sub-code errors.”


Additionally, many believe that the ‘Safe Harbor’ provisions discount the fact that CMS must make sure providers are paid appropriately for their services. However, medical coverage and medical necessity can be assessed using the correct ICD-10 diagnosis codes instead of the sub-codes, which is what the ICD-TEN Act focuses on.

Along with these potential myths, many feel that the ‘Safe Harbor’ provisions could lead to incomplete documentation. However, the American College of Rheumatology explains that the ICD-TEN Act will remain accountable for ensuring “coding specificity is achieved without disrupting patient care.”


“Sub-codes most often indicate subtypes or locations of disease. While this specificity is beneficial for disease surveillance and some treatment decisions, it is not relevant to determination of coverage or medical necessity, and should not be used to deny payment for services rendered,” Dr. William Harvey, a practicing rheumatologist and chair of the ACR Government Affairs Committee, said in a public statement. “The ICD-TEN Act is carefully worded to allow Medicare to continue to accurately determine medical coverage and medical necessity using the new base ICD-10 diagnosis codes.”   

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The ICD-10 Coding Transition Deadline is Only 99 Days Away

The ICD-10 Coding Transition Deadline is Only 99 Days Away | EHR and Health IT Consulting | Scoop.it

The deadline for the ICD-10 coding transition is only 99 days away and healthcare providers are scrambling to finish preparing for the implementation. The Centers for Medicare & Medicaid Services (CMS) continues to stress the need to be as prepared as possible for the coming ICD-10 coding transition.


Even though providers and payers have only 99 days left, there is still time to get ready if one gets started immediately. CMS is helping providers who are behind in their ICD-10 coding transition preparations by offering the ICD-10 Quick Start Guide.


The five steps a provider needs to take right now if they haven’t begun preparing for the ICD-10 coding transition are:


1) Develop a plan


2) Train healthcare and coding staff


3) Update system processes and workflows


4) Discuss issues with vendors and health payers


5) Perform system and processing testing


With only 99 days left until the ICD-10 coding transition, it’s vital to set target dates for completing the steps outlined above. At the very beginning stages of making a plan, providers would benefit from downloading and obtaining ICD-10 codes via the CMS website. These codes are available in a multitude of formats including print and electronic either through practice management systems or upgraded EHR products.


CMS encourages providers to obtain access to the ICD-10 codes. Other formats that the ICD-10 codes can be retrieved through include code books, digital media like compact discs or digital video discs, online at cms.gov/ICD10 under the “2016 ICD-10-CM and GEMS” category, or even via smartphone applications.


Some common workflows and system processes that will be affected by the ICD-10 coding transition include patient registration or scheduling, clinical documentation, billing, coding, public health reporting, order entry, authorizations, and referrals.


Additionally, it’s vital to decide how one’s clearinghouse will assist in preparing providers for the ICD-10 coding transition. It may benefit some providers who are behind in their preparations to contract with a clearinghouse in order to test submitting the ICD-10 code claims. A clearinghouse can be useful when it comes to helping identify why claims were rejected as well as offering assistance in how to revise rejected claims.


“Practices preparing for the October 1, 2015, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade,” CMS stated in a pamphlet. “As you prepare for the October 1, 2015, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed and for identifying and helping to remedy any problems with your test ICD-10 claims.”


In order to be properly reimbursed, healthcare providers will need to be ready for the ICD-10 coding transition by October 1. In the meantime, it’s important to continue using ICD-9 codes for all services rendered before the deadline.

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EXTREME essentials for interoperability

EXTREME essentials for interoperability | EHR and Health IT Consulting | Scoop.it

Writing in the Journal of the American Medical Informatics Associationthis past week, two health IT researchers put forth five use cases that help define what an "open" electronic health record should really look like.

Dean F. Sittig, professor of biomedical informatics at the University of Texas Health Science Center at Houston, and Adam Wright, medical informatics researcher in the Department of General Internal Medicine, Brigham & Women’s Hospital, use the term EXTREME – it stands for EXtract, TRansmit, Exchange, Move, Embed – to shape a definition of usefulinteroperability.

  • An organization should be able to securely extract patient records while maintaining granularity of structured data.
  • An authorized user can transmit all or a portion of a patient record to another clinician who uses a different EHR or to a personal health record of the patient’s choosing without losing the existing structured data.
  • An organization in a distributed/decentralized health information exchange can accept programmatic requests for copies of a patient record from an external EHR and return records in a standard format.
  • An organization can move all its patient records to a new EHR.
  • An organization can embed encapsulated functionality within their EHR using an application programming interface. Goals: access specific data items, manipulate them, and then store a new value.


The five EHR use cases are similarly meant to help five distinct types of people: clinicians (enabling the delivery of safe and effective health care); researchers (helping advance understanding of disease and healthcare processes); administrators (reducing the need to rely on specific EHR vendors); software developers (so they can develop innovative applications); and patients (so they can access their personal health information anywhere).

Widespread access to EHRs that conform to the five EXTREME use cases "is necessary if we are to realize the enormous potential of an EHR-enabled health care system," Sittig and Wright contend.

"Health care delivery organizations should require these capabilities in their EHRs. EHR developers should commit to providing them," they write. "Health care organizations should commit to implementing and using them. In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers to widespread health information exchange that is required to transform the modern EHR-enabled health care delivery system."

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Health Information Exchange Should Extend Past Meaningful Use

Health Information Exchange Should Extend Past Meaningful Use | EHR and Health IT Consulting | Scoop.it

The efficient sharing of medical data is key to improving patient care across the country, which is why the federal government has pushed forward the development of the state health information exchange (HIE). Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the healthcare industry has been adopting certified EHR technology and attempting to improve connectivity among healthcare IT systems as well as develop effective medical data exchange.


To learn more about the progress of health information exchange developments, the Office of the National Coordinator for Health IT (ONC) has worked with NORC at the University of Chicago to evaluate the program over a handful of years.


In a finalized report called “Provider Experiences with HIE: Key Findings from a Six-State Review,” a summary of healthcare provider interviews detail the priorities and needs of the medical industry, case studies of health information exchange systems, and the challenges overcome during HIE program development.


Between March and May of 2014, the organization conducted site visits as well as general provider interviews and discussions throughout six states, which included Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming. The discussions revolved around viewpoints on state health information exchange programs as well as general attitudes toward medical data exchange.


A wide variety of medical facilities were visited such as long-term care centers, hospital associations, critical access hospitals, and physician organizations. Several key findings were uncovered. For example, HIE needs go beyond meeting meaningful use regulations or system connectivity. Providers now needs HIE systems to proffer important clinical data at the point of care to enhance the delivery of medical services along with care coordination.


“Meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care,” the report stated. “Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift.”


The provider interviews also found that healthcare professionals encountered a variety of obstacles when it comes to advancing health information exchange at their facility. These challenges include competing priorities, difficulty managing the revenue cycle, lack of training or experienced staff, and insufficient support from their EHR or HIE vendors.


Some positive findings from the discussions revolve around the bringing of awareness for state health information exchange programs and the benefits of data sharing. Essentially, providers see the need for health information exchange. While the EHR Incentive Programs may not have targeted long-term care and behavioral health facilities, state HIE programs did further involve the participation of these providers.


“Awareness of and demand for HIE has been steadily increasing throughout the life of the program,” the report concluded. “Providers we spoke with in previous and current activities reported an appreciation for the State HIE Program’s role in communicating with providers of all types, bringing together stakeholders, and communicating the value of HIE. Now that HIE is better established—both in terms of visibility and available services—providers have identified new priorities and challenges. These have evolved from early issues surrounding basic implementation and awareness of the benefits of HIE into a search for solutions to meet greater demand for information, while balancing cost and multiple information exchange priorities.”

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

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

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

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


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


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

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


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

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A better road to information interoperability?

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

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


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

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


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


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


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

Eclectic collective

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


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


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

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


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


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

An industry misguided?

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

  

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

Baxley didn't pull punches either.


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

Inching closer

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


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


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

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

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Lack of Certified EHR Technology in ASCs Fixed by Congress

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

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


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


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


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


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


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


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

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4 Signs Your Agency Needs EHR Software

4 Signs Your Agency Needs EHR Software | EHR and Health IT Consulting | Scoop.it

Tens years ago, electronic health records seemed like a luxury for medical practices, but today, making the leap to EHR is more of a necessity. Healthcare reform is changing the way the medical community does business and switching to digital records is part of the process. The first generation of EHR software was problematic and cumbersome, but the modern versions offer real advantages to both patients and staff. Consider four reasons it is past time to get EHR software.

1. Inefficient Audit Trails

Whether you are attesting for meaningful use incentives and Medicare payments or going through a routine accounting audit, proper EHR software makes the process that much cleaner. Without EHR, there is no possibility of getting federal incentives, but the auditing benefits do not stop there.


Electronic record systems automate everything from billing to scheduling to general accounting processes. This means more accurate billing with proper coding – with ICD-10 on the horizon, coding will only get more complex, too. When tax time comes around, you have all the documentation necessary to file effortlessly.


EHR opens the lines of communication with insurance companies and federal agencies. When filing a claim or facing a request for repayment, you have a digital record necessary to prove your case.

2. Poor Productivity

EHR software is critical to improving staff performance, as well as the patient’s view of the medical service. A national survey of doctors found that after implementing EHR:

  • The practice functioned more efficiently
  • They could improve staff and stakeholder recruiting
  • It fostered better patient relationships


The little things like not having to hand write notes or prescriptions add up to more time with patients.


EHR improves scheduling by linking appointments directly to patient records and creates communication shortcuts for labs and consultations. Essentially, the workflow of the practice was better with electronic health records.

3. Wasted Space

Physical record storage wastes space that could be used for more practical and revenue-generating purposes. With EHR, you eliminate the need for paper records, opening up that storage area for new exam rooms, imaging equipment or to add another specialty to the practice.


With EHR, physicians can access patient information remotely, as well, making telemedicine a practical option. A doctor is available to answer staff or patient questions whether standing in line at the grocery store or doing rounds at the hospital, because he or she can see the patient records outside of the central storage area. That type of flexibility translates to better patient service and care.

4. Excessive Operating Expenses

An EHR system adds to the bottom line. Paper-driven systems are labor intensive. With the implementation of electronic health records, the agency no longer needs to pay filing clerks to pull and store charts, for example. There is no need to purchase or maintain elaborate retention and retrieval systems.


Other cost saving benefits of EHR include:


  • Reduced transcription costs – physicians and staff do updates as they go instead of dictating notes to be transcribed later
  • Improved reimbursements due to more accurate coding and better documentation
  • Lower risk of medical errors due to missing chart information – with a paper chart critical information like allergies can be misfiled
  • Enhanced wellness care and patient education opportunities – this is especially critical with the new healthcare reform practices focusing on quality not quantity. Practices are not getting paid for services rendered anymore, but for better patient outcomes. This is a factor for patients with chronic illnesses like heart disease or diabetes.


What does EHR bring to the table? Efficiency, productivity, better patient care and cost savings – all essential for agency success.

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Top things providers need to know about interoperability

Top things providers need to know about interoperability | EHR and Health IT Consulting | Scoop.it

It seems that interoperability is the biggest buzzword in health IT right now, and for good reason. Too much money is lost by both providers and patients due to a lack of data sharing and communication between doctors. However, with optimized medical software and implementation and standards outlined by the meaningful use program, nationwide interoperability is a goal that could actually be met in U.S. health care over the next few years.


If you're unsure about what interoperability means, or want to know how you can bring data sharing to your health system, here are some of the top facts you'll need to know:


"The U.S. could save around $30 billion annually with interoperability."


Interoperability saves big


According to an analysis by the West Health Institute, the U.S. health care system has the potential to save more than $30 billion each year with an interoperable platform. Having an electronic health record that travels with the patient not only prevents readmissions and duplicate treatments, but it also saves precious time and resources.


Congress is interested in interoperability


Another story making headlines is interoperability on Capitol Hill. For the past several months, Congress has been taking a serious look at interoperability and the way that organizations and legislation can work together to make this happen.


Cloud computing is driving interoperability


Medical devices are growing increasingly sophisticated in the health care environment, and doctors are relying on smartphones and tablets for diagnoses and treatments more than ever before. In busy medical settings, having cloud access to patient information alongside interoperable systems could make these clinical tasks even easier.


Experts have broken down five main use cases for interoperability


According to a recent study published in the Journal of the American Medical Informatics Association, there are five main use cases that make up an interoperable EHR. They are as follows:

1. Organizations must be able to extract patient data while still maintaining their own structured data.

2. Users must have the ability to transmit the entirety of a patient's EHR, or portions of the EHR, to another doctor.

3. The organization's health information exchange can receive requests for copies of a patient's EHR from providers outside of their system in a standard format.

4. Providers must have the ability to move all patient data from an old EHR into a new EHR.

5. Organizations must have the tools to embed EHR data into a health care system's operating API. This increases the value of data capture and transmission.


The ONC's Interoperability Roadmap is a broad vision


Perhaps the biggest revelation about interoperability is the Office of the National Coordinator for Health Information Technology's Interoperability Roadmap, which outlines a long-term, 10-year plan for the future of interoperability in the U.S. Not only does the roadmap address barriers to interoperability, but it also shows how optimized EHR systems can push interoperability toward patient-centered care over the next decade.


Organizations pushing for interoperability


There are several leading nonprofits you might want to be aware of that are making interoperability a priority, according to Becker's Hospital Review. Some of these include the Argonaut Project, IHE USA (which is partly responsible for ConCert, an interoperability testing program), JASON (a group of independent scientists that advises lawmakers and other government officials about health IT) and the CommonWell Health Alliance. Many of these stakeholders are some of the most influential in health IT, so it's clear that interoperability is a major goal moving forward.


As interoperability becomes more of a focus in health care, providers need to think about ways that they can promote data sharing and health information exchange. With Intelligent Medical Software, clinicians can worry less about whether the health data is accurate on the EHR, and can instead focus more on their patients and save resources.

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Do Meaningful Use Requirements Need the 5% Objective Back?

Do Meaningful Use Requirements Need the 5% Objective Back? | EHR and Health IT Consulting | Scoop.it

Ever since the proposed modifications to Stage 2 Meaningful Use requirements were announced, a wide variety of opinions and objections surfaced throughout the healthcare industry. For instance, patient engagement advocates are calling for a Data Independence Day. Other medical societies are sending forward their comments about both the proposed Stage 3 Meaningful Use requirements as well as the potential modifications to Stage 2.


HIMSS is one organization that supports some aspects that the Centers for Medicare & Medicaid Services (CMS) is pushing forward in the latest proposals for Stage 3 Meaningful Use requirements. For instance, reducing redundant reporting is very beneficial for the healthcare industry, according to a letter HIMSS representatives sent forward to CMS.


For example, HIMSS is supportive of the new 2015 Stage 2 Meaningful Use change to a 90-day reporting period. However, HIMSS is also looking to encourage CMS to develop a phased-in approach to meeting the Patient Electronic Access objectives under meaningful use requirements.


“HIMSS recommends a balanced approach for meeting this objective that recognizes the challenges that some providers are encountering as they try to get their patient population more engaged on viewing, downloading, or transmitting their information to a third party,” the letter stated. “As a part of this approach, given the tight timeline between the publication of this Final Rule and the end of calendar year 2015, CMS could leave the proposed measures in place for 2015, and then phase-in increased threshold requirements for 2016 and 2017, increasing each 1%, 2% to 3% per year to propel the field forward... Overall, HIMSS believes a phased-in approach for the patient electronic access objective to be an appropriate and balanced step forward.”


The Consumer Partnership for eHealth (CPeH), the Consumer-Purchaser Alliance (C-P Alliance), and other organizations sent a letter to CMS expressing their concern over a specific modification on patient engagement objectives under Stage 2 Meaningful Use requirements. Now that CMS intends to only have one patient view, download, and transmit their information under Stage 2 Meaningful Use, many organizations are pushing for bringing back the prior 5 percent requirement.


“CPeH, C-P Alliance, and the undersigned organizations and individuals are dismayed that CMS intends no longer to require that five percent of patients1 view, download or transmit their health information or send a secure message to their providers,” The letter from the Consumer Partnership for eHealth states. “Instead, CMS proposes that doctors and hospitals merely show that just one patient used online access to their health information, and that secure messaging was merely turned on, not whether any patient has actually used it. We are deeply disappointed in CMS’s reversal of these essential commitments to patient and family engagement.”


Healthcare providers should be able to meet the 5 percent requirement and better engage patients with their medical information, according to the letter. Additionally, prior analysis shows that this should be achievable, which is why the new CMS modification is causing such an uproar in the medical community. Research shows that more than half of patients want to be able to email their healthcare provider, which is why the secure messaging aspect of a patient portal should increase patient engagement if properly leveraged. CMS would be wise to take these comments under advisement as they continue to develop meaningful use requirements.

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Some Methods For Improving EMR Alerts

Some Methods For Improving EMR Alerts | EHR and Health IT Consulting | Scoop.it

A new study appearing in the Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.


Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.


Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.


The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.


For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.


While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:


  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.


The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.


When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.


The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.


But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

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Four Medical Practice Embezzlement Red Flags

Four Medical Practice Embezzlement Red Flags | EHR and Health IT Consulting | Scoop.it

Keep an eye out for these red flags for possible embezzlement at your medical practice:

• Carl Frost, founder of Frost & Co., a healthcare consulting and accounting firm, advises physicians to keep an eye on the office manager who writes all the checks and makes all the deposits, in addition to other factors. "Collections aren't on an automated billing system. The same manager [who] handles all payroll functions and has a home computer for doing work from home," is a recipe for trouble, he says. "I've never had a client practice that had all those things going on and not been the victim of embezzlement."


• If your billing staffer refuses to take a vacation, be aware that this is a common trait among employees who embezzle, experts say. Insist on a vacation, and use the time to check over the employee's work.


• Watch and listen to your employees on a daily basis. Pay attention to sudden displays of wealth or, conversely, admissions about major financial setbacks, such as a spouse losing a job.


• Staffers who recommend friends or family for jobs in the practice. Though some companies actually encourage staff referrals, many practice experts say it's a bad idea because the pair could work together to embezzle, or because one relative might be reluctant to turn in another.

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Becoming a Successful Practice Manager

Becoming a Successful Practice Manager | EHR and Health IT Consulting | Scoop.it

The charismatic practice manager starts out by knowing her job and the staff assigned to her, and by planning, setting priorities, and meeting deadlines. But she also is able to communicate what her goals are for the practice and takes the time to explain why certain tasks are required, where the practice is headed, and how it is going to get there. Accomplishing the mission within the capabilities of the practice and the resources allowed, while maintaining high morale, is the goal of every practice manager. An astute practice manager can become a high achiever by applying basic management and leadership principles to the practice of which she is a part. The manager begins this process by becoming as professional in her duties as she can. Here are five aspects of this process:

1. Knowing the job


The basis of successful leadership is making things happen through people, but first a practice manager must know her job. The team she is working with will give her some slack when she is new to the practice, but that slack is rapidly used up if she does not seek to learn all she can about the practice operations. In the long run, staff will care only whether she knows what she is doing, especially in difficult tasks.


2. Planning


Accomplishing the mission requires planning and monitoring. Planning is the development of action steps needed to achieve an objective or goal. The Ability to plan is closely related to the other skills required of practice managers, such as anticipating requirements, establishing priorities, and meeting deadlines. The plan should be flexible enough to handle the changes that inevitably will occur.


3. Implementation


Once the plan is set, the practice manager has to consider priorities and prepare to meet deadlines, because she will never have the luxury of working on only one task at a time. A physician practice is much too dynamic an organization to permit single task operations, and the practice manager has to learn how to keep several balls in the air simultaneously. It is a skill that starts with a plan, just like organizing homework and professional responsibilities at school. Last-minute preparations rarely camouflage the lack of a routine approach to tasks. A methodical daily effort will produce well-qualified and motivated team members as well as an efficient practice. Crisis management and its negative impact on morale must be averted wherever possible.


4. Monitoring progress


A good plan must continually be monitored. There is a military adage that "you get what you inspect, not what you expect." Practice managers should never just assume that a plan is working. Rather, managers must monitor effectiveness by following up on it by becoming personally involved.


5. Motivation


Mission accomplishment and high morale occur in tandem. In other words, good practice managers get the job done and maintain high morale. The ability to get others to respond is a primary leadership requisite. The least a practice manger can learn to do is to delegate effectively. The ability to inspire others to perform is more difficult.

A practice manager must apply fundamental principles of administration and leadership as she learns how to accomplish tasks with her staff. Effective practice management is the ability to influence people so that they willingly and enthusiastically strive toward the achievement of practice goals. Hard work and high morale are compatible and good practice managers can inspire and direct their people under both normal and adverse conditions.

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Help Your Medical Practice Hire Well: 15 Tips

Help Your Medical Practice Hire Well: 15 Tips | EHR and Health IT Consulting | Scoop.it

Busy physicians and office managers usually don't look forward to going through the hiring process. Not only are they concerned about finding the right candidate for the position, but it is an arduous process that can drag on and impact their ability to keep the practice running smoothly during the interim.

Here are fifteen tips on what you can do to hire right, the first time.


Before the interview


1. Review the job description.

To determine whether or not the job description needs to be revised, review the job description with the employee who is leaving to learn if the job responsibilities have changed. In the process you may discover that some tasks listed are redundant or can be automated.


2. Look for internal candidates.

Let staff know you are on the search and ask if they know someone who might be a suitable fit. You'll also want to open the position to internal staff that may be qualified and looking to climb the ranks. Just be sure they go through the same process as outside candidates to ensure you get the best person for the job.


3. Post the position as soon as possible.

Electronic job postings are quicker and cheaper, and tend to draw the best results. Your hospitals and medical societies may have job boards on their websites. The costs to post on Craigslist, LinkedIn, Indeed, and other classified job search websites is reasonable and yields an immediate posting.


4. Use employment applications.

Require applicants to complete an employment application that asks questions not answered in a resume, such as ending pay rate and the reason the applicant left each position. You can also ask for a list of professional and personal references, and require a signature allowing you to contact past employers.


5. Act quickly.

When candidates with impressive resumes respond to your ad, cull them quickly and don't postpone the interview. Applicants are on the move and the good ones get snapped up quickly. Also, you want to get someone hired as soon as possible, to allow time for proper orientation and training.


During the interview


1. Review job applications prior to interviewing.

Jot down any employment voids or other questions that come to mind when reviewing the applicant's resume, and be sure to address them during the interview.


2. Ask open-ended questions.

The results of the interview itself will be more effective if you allow the employee to relax and become engaged. Ask open-ended questions and pose problem-solving scenarios to identify their approach to resolving conflicts and determine how well they communicate.


3. Ask about strengths and weaknesses.

Ask job candidates what they see as their greatest strengths, what areas they feel they may need to improve on, and what makes them unique as a candidate.


4. Discuss salary with strong candidates.

For those candidates that are rating well during the interview, review the job description and discuss their salary expectations.


5. Communicate follow-up process.

End with letting candidates know what your follow-up process will be and when you will be making a decision.


After the interview


1. Don't skip reference checks.

Do not assume conducting past performance reference checks are a waste of time. Human resource departments may refuse to answer many of your questions, but if you obtain the applicant's permission to contact previous immediate supervisors you can learn a lot. Make the phone call efficient: verify dates of employment, pay rate, title of position, attendance record, and ask the key question, "Would you rehire this person?"


2. Don't ignore red flags.

If candidates don't interview well or if they give vague or contradictory information they should not be considered for employment.


3. Don't postpone the essentials.

Be sure all human resource details are handled the first day of work: hiring forms signed, benefits explained, policies reviewed, etc.


4. Address training needs upfront.

Failure to establish training goals and assign a trainer, or failing to meet with new employees regularly (during their first month) to discuss their progress or assuage their concerns, can sabotage results.


5. Roll out the welcome mat

Your medical practice is a thriving and busy environment. Don't let a new employee feel like he has been thrown in the lion's den. Start off by announcing the new person to existing staff members. Ask every one of your providers to introduce themselves to a new employee, during their first encounter. Keep communication open and give your new staff members the training, respect, and support they need to succeed.

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Health and Electronic Security

Health and Electronic Security | EHR and Health IT Consulting | Scoop.it

The rapid adoption of electronic health records (“EHR”) and other new technology in healthcare has resulted in the introduction of serious security threats. Numerous stories and reports have made it clear that hackers, criminals and others view the healthcare industry as a ripe target due to security vulnerabilities. This issue is exacerbated by the high value placed upon medical records in the black market.


The question that many are asking is was all of the money spent on acquiring EHRs misspent now that security flaws or issues are popping up with such frequency. Namely is healthcare throwing good money after bad. To some degree it may be a misplaced accusation. Any adoption of newer technologies will lead to issues, including exploitation of flaws that may not be expected. Unfortunately, it is also likely that bad actors will be ahead of the field when it comes to finding weaknesses or ways to get at data. Such a scenario should be viewed as an inherent risk in implementing technology. That being said, it is likely an unavoidable risk in this day and age. It is simply too difficult and against expectations to remain on the digital sidelines.


The increase in attacks against healthcare entities should appropriately raise alarm bells and spur action. Medical information is very sensitive on many levels and needs to be protected. One place to look for a solution is HIPAA. As is well-known, the HIPAA Security Rule sets standards for protecting health information. The technical, physical, and administrative safeguards define certain minimum standards to follow. In the current day and age though, the HIPAA standards by themselves are probably not enough. From this perspective, it is important to remember that HIPAA only sets a floor, not a ceiling. Best practices may well require actions beyond those proscribed by HIPAA. The healthcare industry needs to evolve and adapt to new realities.


The speed with which adaptation can occur will dictate how secure medical information remains. While much money was and is being spent in connection with new digital and technological solutions, the expense is not going to end as long as threats remain. Technology takes investment, time and attention, all of which are ongoing and recurring obligations.

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Physician Practices Still Lagging With ICD-10 Prep, Testing

Physician Practices Still Lagging With ICD-10 Prep, Testing | EHR and Health IT Consulting | Scoop.it

Provider organizations have completed many key steps in the ICD-10 implementation process, but are still lag behind in testing, according to a new survey from the eHealth Initiative and the American Health Information Management Association (AHIMA).


The survey, which is done annually, polled 271 providers, and was conducted between May and June of this year. Overall, 78 percent of those surveyed said they are providing ICD-10 resources and educational materials to their staff; 73 percent said they are creating teams to assess readiness and make implementation preparations; 72 percent said they are training staff on ICD-10 use; 66 percent said they are updating their systems to support ICD-10 codes; and 64 percent reported they are reviewing internal processes and workflows.


In terms of preparation for the ICD-10 transition, 50 percent of respondents said they have conducted test transactions with payers and clearinghouses; 34 percent said they have completed all internal testing; and 17 percent said they have completed all external testing. Only 19 percent of respondents reported having no plans to conduct end-to-end testing.


However, the results differed when broken down into hospitals and physician practices. Most hospitals (85 percent) have trained their staffs on using ICD-10, compared with 41 percent of physician practices. Sixty-four percent of hospitals have budgeted for time and costs associated with the transition, while just 19 percent of practices have done the same. Seventy-two percent of hospitals said they performed the necessary system upgrades and updates to support ICD-10, compared with 36 percent of physician practices. And six in 10 hospitals said they conducted test transactions using ICD-10 codes with payers and clearinghouses, compared with just 17 percent of practices. The research also found that the larger the organization, the more prepared it was.


What’s more, despite limited testing and evaluation, organizations generally believe ICD-10 will reduce revenues: 38 percent of those surveyed said that revenue will decrease; 21 percent said revenue won’t be affected; 6 percent said revenue will increase; and 34 percent said that his or her organization has not conducted a revenue impact assessment. The biggest reasons for why there would be a decrease in revenue were: transition will result in increased number of denied claims or decreased reimbursement (78 percent); and reduced coding productivity or accuracy will increase costs (80 percent).


However, organizations recognize many long term benefits of ICD-10, a growing sentiment since last year’s survey, according to the research. Also, most respondents expect to continue managing the impact of ICD-10 following the deadline, the data revealed.

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