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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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CIO one-on-one: patient engagement

CIO one-on-one: patient engagement | EHR and Health IT Consulting | Scoop.it

For the folks at Miami Children’s Hospital, patient engagement is far more than a Stage 2 meaningful use hurdle. On the contrary. Rather, it’s regarded as an opportunity, an organization-wide lifestyle that has huge implications for clinical care and the hospital’s bottom line.


Edward Martinez, the hospital’s chief information officer, has made patient engagement and care coordination a top priority at the 289-bed Miami Children’s in southern Florida – for good reason.

We caught up with Martinez, who is among 30 industry leaders speaking at the Healthcare IT News and HIMSS Media Patient Engagement Summit, February 9-10 in Orlando, to hear more about how Children’s is leveraging mobile health and care coordination initiatives to improve outcomes. And, as Martinez points out, it’s not just about developing the technology; it’s about embracing a new way of doing business across the enterprise.


Q: Talk a little bit about what you’ll be speaking about at the Patient Engagement Summit next month.

A: I am going to start off talking about how we used to run the hospital business and how the business has changed, and you have to engage the patient in order to improve outcomes and reduce costs. I am going to show basically how we used to work a business – if you want to call a hospital a business – we used to run it as, 'you had an appointment; you showed up for the appointment; the doctor saw you; they gave you the medication; you go home, and you're done.' And now, with mobile technology, we're able to engage with that patient well before they show up at a doctor, provide educational materials, provide updates, provide text, provide a lot of different content that wasn't available at one point. And if it happens to be an admission to the hospital, the interesting thing is that whole process can also occur during the hospital stay, so you or a family member – in our case, we're a children's hospital, so mom and the dad is a critical element here – is engaged in the care of the child, and we're informing them throughout the stay, whether it's an outpatient visit or an inpatient visit, what are we doing to them, what kind of medications we're giving to them, what do they do, what are they for.

I'll talk a bit about the variation on how technology moves from point of care to virtual point of care, where there's telemedicine technology, where there's other things that engage the patient from different perspectives to make sure we’re connected to the patient almost, relatively speaking, on a 24/7 basis.


Q: Is patient engagement more difficult at a children's hospital? Or is it a little bit easier in some sense because it relies significantly on the parents?

A: The pediatric world has different challenges. It’s definitely not about the engagement of the parent with a kid or a child. Most parents will do everything for their child. There's more of that. I think the issue we have with children’s hospitals is we have younger parents, less structured, less educated about certain issues and conditions, and it may be their first child, and it all adds to a little bit more complexity in the education process. …We do know one thing for sure: This generation that we're in today, predominantly the mom and dad in the pediatric world, definitely are mobile savvy and mobile aware. They want to have their information, and they want to have it now. So we feel that the engagement from that perspective – getting them engaged that early on – will get us a much better outcome earlier because they like the idea of being engaged on mobile and not face-to-face. They don’t like the face-to-face. They like texting, and they like to look it up on a handheld.

Q: What does patient engagement look like at Miami Children's? Talk a bit about what you've been working on at the hospital.

A: We have things like (a) discharge application. It's a mobile app. In the past, you'd get a ton of paperwork when you go home, and then you'd go home and you'd read it – if you did read it – or you forgot it in the car. Now, the moment you're discharged from one of our facilities, you'd get automatic discharge instructions, which (are) the same thing you would have gotten on paper but in a mobile format. And you're able to review this discharge and know what the doctor said. The cool thing about that is we're very close to a virtual discharge, which means we will actually videotape the discharge process, especially for a pediatric encounter, and show what the nurse told the parent at the time of discharge to the parent, so they can remember, ‘oh, yes, put the needle in this way, not that way.’ The thing about pediatric care is that mostly moms – dads sometimes but mostly moms – are highly responsible for the care of the kid when they go home. You make sure they get the injections, if it's diabetes. If they're on a pulmonary machine, they have to make sure the ventilator is working correctly, so they become very, very good at caregiving, and the fact that we’re giving them instructions has made it much better.

In addition to that, we've created an application called the ‘handoff app,’ which is actually for the clinical side – not so much for the patient side – but it has a huge implication on the patient side. It's tied to an application on the patient side called ‘Care Notes.’ Care Notes gives the parent an absolute, exactly-what's-happening-in-the-electronic-medical-record view into the world of what we're doing to take care of the kid at any time. And the handoff app gives the caregivers complete handoff – from caregiver to caregiver – information.

So in the past, one of the biggest errors in medicine has been – in addition to medication errors – has been the handoff opportunity, so what happens is: I'm the provider of a patient, and at 6 o'clock I go home, and someone else takes over for me. If I don't sit down and explain to them, 'Look, the patient's been throwing up every two hours, and here's what's going on, and here's what I did,' I have to make sure I write that in the chart, but sometimes that doesn't get to the chart. What normally happens is there is a handoff process that occurs verbally that says, ‘hey, remember to do this,’ or ‘hey, remember to do that.’…very key and factual data that allows the next caregiver to take care of the patient better. Well, that's missed in the translation all the time, so what we've created is an app that allows the caregiver to enter that information quickly on a mobile device and pass it to the next caregiver, and it can even record a video that can record voice notes. It can make it very, very easy for the next caregiver to know what's going on with the kid, especially with the more chronic condition kids.

We've created an app, for example, for medication reminders and adherence – which is tied to the Surescripts clearinghouse – so we know when you don't take your medication, and it's tied back to our electronic medical record, so when you show up in the ED with your child and say, 'My child is still coughing, and I was here two days ago,' we look and say, 'Well you haven't taken your medication in two days. You never went to the pharmacy to take the medication,' we know where to target. That happens frequently for us because a lot of these kids are on Medicaid, and what happens is their parents don't have the money for the prescription, and as a result they're embarrassed to say it. ...

Then we have apps that are a little bit more non-clinical. For example, we have the world's first hospital with Wi-Fi triangulation navigation, which means, that I can actually walk into the hospital, say I want to go to pulmonary, and I’m sitting in one location, and I press my app, and it walks me right to that pulmonary location because it actually knows where I’m physically at in the hospital.

Q: Regarding the meaningful use Stage 2 view, download, transmit requirement, we’ve seen that the real challenge is not necessarily on the technology side of things, but rather it's how does the provider control, in a sense, patient behavior. Is that a difficulty for folks at Miami Children's?

A: No, I don't say so. I can't say without a doubt that it is or it isn't. I think there's probably a little bit of that, but for the most part. …The thing is most parents are really involved in the care of their child. …Most parents will want to do the extra thing, so for example we rolled out our discharge application; we're getting 98 percent compliance in terms of utilization, so everybody is using the apps.

Q: What is patient engagement's biggest roadblock right now? Is it that much of the technology is still immature? Is it lack of standards, unwillingness of the patients, etc.?

A: I think the patient engagement piece has a lot to do with the culture in the organization, so the processes have to become aligned with the technology world. You can't continue the old way of doing business when you're bringing in these new ways of doing business.

A very basic example: If I'm using a discharge app that’s electronic, why am I still providing paper? Or what time do you want to stop providing paper so that people are more geared toward, 'forget about this bulk of paper. Look at this video, it will tell you everything you need to know.’ As you move into that direction, you have to abandon old ways, and (for) hospitals, we don’t do that really well; we wind up adding complexity because we keep adding one process over another process over another process, and it’s just the way it’s always been forever.

So the big challenge I think is organizationally how do you adapt to a new way of doing business, and if you’re able to do that as an organization, then the success is greater.


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Effective E-mails: 3 Tips for Physicians, Managers

Effective E-mails: 3 Tips for Physicians, Managers | EHR and Health IT Consulting | Scoop.it

As medical practice managers and recruiters, we hear the constant refrain of over-communicate versus under-communicate.  But how much communication is too much?

We find that many practice staff members, managers, and physicians struggle when attempting to communicate effectively via e-mail. As I’m sure my fellow over-communicators can also attest, there is nothing more frustrating than putting together a carefully crafted email with all necessary information, only to have the recipients come back with a litany of questions that are all answered in the e-mail itself.

While these aren’t completely foolproof, here are some effective e-mail tips that I have found to be helpful:

• Be thoughtful with your formatting.  Bold, italics, and ALL CAPS can be useful, especially if you are crafting a long e-mail.  Use them to draw attention to key points. Ask yourself, “If they only read one section of this, which section do I want it to be?”  And then make that part stand out.

• Edit, edit, edit.  This will get easier with time and, at first, is downright painful.  But you’ll be surprised how a few simple edits (taking out superfluous words, removing sentences/paragraphs that don’t actually add anything) can cut your document in half and make it twice as readable.

• Set expectations and deadlines — but make sure they’re always relevant.  If every e-mail you send requests a response immediately, then the term “immediately” begins to lose meaning for your recipients.  Begin your e-mails by giving a realistic timeframe in regard to expected responses, and also let your readers know what you want from them, whether that’s a quick skim and basic feedback or detailed analysis.

What are some methods you find helpful when sending out e-mails to staff, managers, and/or physicians?


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Effect of Meaningful Use on Hospital EHR Functionality

Effect of Meaningful Use on Hospital EHR Functionality | EHR and Health IT Consulting | Scoop.it

A study of hospital EHR use shows a pattern of EHR functionality implementation influenced by hospital type and its participation in Stage 1 Meaningful Use.

“We find stronger homogeneity among small, rural, and non-teaching hospitals, which is likely driven by greater reliance on vendors and less variation in the types of care that they deliver compared to larger, urban, teaching hospitals,” write Adler-Milstein et al. “Perhaps most importantly, we find that stage 1 meaningful use may change how hospitals sequence EHR adoption.”

The study uses data on nearly 2800 hospitals in the United States, supplemented with information from the 2008 American Hospital Association (AHA) annual survey.

Of the top-ten EHR functionalities listed in the study, half play an essential role in the first phase of the EHR Incentive Programs:

  • Patient demographics (1)
  • Medication lists (5)
  • Drug-drug interaction alerts (6)
  • Drug-allergy alerts (7)
  • Discharge summaries (9)

Of the top-20 EHR functionalities, five fall into the category of clinical decision support (CDS), which the authors contend bears the mark of meaningful use. “This suggests that meaningful use may cause hospitals to change their planned order of EHR function adoption, and move these functions ahead in sequence,” they maintain.

Given the value of EHR incentives to small and rural hospitals, these facilities must abide by meaningful use requirements or risk losing out on millions of dollars. However, this pursuit of incentive payments could lead to poorly sequenced EHR technology.

“Each of these functions must work with others to create a functional system, and the interdependencies between them require complex decisions regarding which functions to adopt, and in what order,” Adler-Milstein et al. observe.

According to the authors, the incentivized adoption of certain EHR functionalities could negatively influence the features hospitals are willing to choose and implement:

For example, nursing assessments—important for patient handoffs and care continuity—are typically adopted in the middle of the sequence, but ahead of clinical reminders and medication CPOE. Since such assessments are not part of stage 1 meaningful use, hospitals may deprioritize their implementation, dampening their effort to improve the quality of care coordination.

Ultimately, the study emphasizes the need for policymakers and stakeholders to consider the downstream implications of meaningful use incentives or payment adjustments (i.e., penalties) on hospital EHR adoption strategies. Having all the right components in place does not guarantee that they are being used meaningfully or at the very least appropriately to deliver safe and effective patient care.



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Are Meaningful Use Incentives Worth a Provider's Investment?

Are Meaningful Use Incentives Worth a Provider's Investment? | EHR and Health IT Consulting | Scoop.it

Recent reports show that physician EHR adoption is increasing but that the implementation and use of this EHR technology will not be directed toward the EHR Incentive Programs and receiving meaningful use incentives.

As reported earlier this month, a survey of more than 2000 members of SERMO showed that 55 percent would not be demonstrating Stage 2 Meaningful Use in 2015. Meanwhile, an ongoing study by SK&A indicated a ten-percent increase in EHR adoption among physician offices.

These findings led to a question for our readers: If EHR adoption is increasing among physician offices, then why is meaningful use non-participation trending downward?

According to respondents, the answer to that question simply comes down to mathematics:

I was at a healthcare conference recently and a panel of four hospitals that were going gung-ho for Stage 2 Meaningful Use but did not know their costs to implement and continue to meet meaningful use requirements. Now, they were pretty big and had lots of Medicare patients so it “probably” makes sense ROI-wise, but I disagree that most providers have done the math — at least I see no evidence that there is a preponderance of providers that really know their costs — for anything.

In the case of meaningful use, there is a lot more to it than having a meaningful use-certified EHR. But it does not take a CPA to tell you that if you are doing $500,000 in billing and 50/50 Medicare, the penalty is $2500. However, I sort of see how some people can get suckered into this thinking they are recovering their EHR (sunk) costs, but you really need to look at other costs (including hidden and opportunity costs) and balance that against the revenue (incentive).
—Healthcare IT Consultant

The ROI is negative. Meaningful use requires a compliant software platform and too many of the gorilla’s didn’t get their reporting together on time for practices to react to and attest to Stage 2 requirements.

My experience is that on the front end. Providers go into meaningful use hopeful and clueless as to the value, cost, and ROI and over the course of time realize they are drilling holes in the bottom of their boat to let water out. I agree — most practices don’t have the information and too many are not sophisticated enough to discern the hidden and opportunity costs those of us in the industry are aware of.
—Informaticist & Healthcare Consultant

From the provider’s perspective, return-on-investment is about more than money — it is also a matter of quality. Meaningful use could prevent physician office EHR selection from running its full course and finding the right product at the right price:

EMRs have mixed (at best) popularity among physicians, but they are gaining some traction. Meaningful use, and especially Stage 2 Meaningful Use, provides no noticeable benefit with regard to patient care but requires a major investment of time and energy. The hours spent understanding and keeping up with the ever-changing requirements and deadlines are significant, let alone the hours spent meeting them. The financial penalty is judged to be the smaller and less painful option.

The choice of an EMR and the decision to participate in MU is often made by administrators in large, hospital-owned practices. Alternatively, lead physicians more often make that call in doctor-owned groups. That often leads to a different choice of EMRs, and, in my opinion, is likely to lead to a higher meaningful use participation rate in the big, hospital-owned Epic/Allscripts practices.
—Physician

You simply have to look at the complexity and the time spent in meeting Stage 2 Meaningful Use standards. As we move forward the end simply doesn’t justify the means. This is a hoop jumping contest at best and any physician can see that the “initiatives” will have very little impact on saving money or improving care.

I had to hire a consultant like many providers to make sure all the boxes were checked properly. Two providers in my office attested to Stage 1 Meaningful Use in March 2014 and we still have yet to be reimbursed. I get a plethora of excuses at the state CMS office that they are simply overwhelmed and working on hospitals that attested last year. I am curious if this is a state-by-state phenomena. I suspect the infrastructure was not in place to provide timely payments.
—Healthcare CEO

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Latest MU Results Offer Something to Ponder

Latest MU Results Offer Something to Ponder | EHR and Health IT Consulting | Scoop.it

When is a surprise not a surprise? That might be a question to ask some of the Doubting Thomases in healthcare and healthcare IT these days. Because, honestly, when the initial meaningful use Stage 2 attestation numbers came out late last fall, the sense of “I told you so” was fairly strong among many in healthcare. As our Senior Editor, David Raths, reported in November, a number of healthcare association leaders noted that the fact that only 840 hospitals had attested to Stage 2 at that point, and many were ready to declare the entire meaningful use process a failure.

And many had very legitimate concerns, given the level of challenges providers have been facing going into and through Stage 2. But I will say that I, for one, had always trusted the industry observers who had expected most attestations to come at the very last moment. And that is exactly what’s happened.

As David Raths reported on Jan. 14, “With one month left in the 2014 reporting period, 77 percent of hospitals eligible to attest to Stage 2 of the meaningful use program have already done so, according to figures presented at the Jan. 13, 2015, HIT Policy Committee meeting.” As he further reported, “Concerns about low attestation rates earlier in 2014 may have been mitigated by two factors, explained Elisabeth Myers from the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid. First, most eligible hospitals tend to attest after their fiscal report year closes, and that held true this year… Second is the fact not all hospitals and providers are eligible for Stage 2 in 2014.” And as Paul Tang, M.D., the committee’s co-chair, noted, the phenomenon of hospitals waiting until the end of the fiscal year is tracking with a pattern from previous years.

So the plain fact is that more than three-quarters of the hospitals eligible to attest in 2014 have now done so. And that’s a good thing. Are they facing an uphill battle going into 2015? Absolutely. Will some fail to make it successfully to and through Stage 3? Quite possibly.

But it’s important to consider that, in the context of this arduous journey of meaningful use, this 77 percent statistic is significant, and should not be minimized.

Meanwhile, it is interesting to note that only 200 hospitals will see payment adjustments as of this moment, and the number set to get adjustments of more than $5,000 is going to be quite small.

So as challenging as everything looks right now, there is definitely reason for a very cautious flavor of optimism. While this is no time for early victory laps, perhaps things in MU Land are not as dire as some of the Debbie Downers might have led us to believe, either.

And then of course, Stage 3 is now very much on the horizon. As Jeff Smith of CHIME noted earlier this week, “Stage 3 proposed rules are currently under review at the Office of Management and Budget (OMB)—the last step before being released for public comment.” And, Smith noted, “The Stage 3 Notice for Proposed Rulemaking (PRM) process is the most likely vehicle CMS and the Office of the national Coordinator for Health IT (ONC) could use to make changes that CHIME and other stakeholders have been advocating. This is the best chance,” he added, “to make substantive changes to meaningful use and revive an ailing program.”

So we’ll see what happens. Doubtless, the next several months will be pivotal for the meaningful use program going forward. So stay tuned. And keep your powder dry.


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ICD-10 Prep for Small Practices: 5 Ways to Get on Track

ICD-10 Prep for Small Practices: 5 Ways to Get on Track | EHR and Health IT Consulting | Scoop.it

Small medical practices have felt the ripple effect of the ICD-10 delay  in different ways, depending on how close to readiness they were at the time the new date was announced.

Recently, the Workgroup for Electronic Data Interchange released findings from an ICD-10 readiness survey that demonstrated a high degree of procrastination in how actively health organizations were working toward compliance with ICD-10.

If your practice is among those only partially ready or just in the initial stages of a transition plan, here are five key tips to keep moving forward toward compliance:

1. Make sure trading partners are on track. The most important step to a smooth ICD-10 transition is to look closely at trading partners. It’s important to focus first on your biggest payers. Will they be able to support your practice after the conversion deadline? Do they have a clear transition plan with milestones that are already being met? If not, your practice needs to understand why. Achieving compliance requires a cooperative effort among entities, and any trading partner showing signs it may not meet the deadline may require your practice to seek alternative partners. What would it take (in time and money) to transition to working with these new partners should the need arise?

2. Test systems for process flow. Start testing your practice’s internal systems, such as its information management, billing, and scheduling systems. Simulate a typical patient visit to the office and send data from each step to test the viability of work flows and flush out where bottlenecks occur. Remember that with each identified disruption, there is likely a correlated negative impact on revenue that should be calculated and rolled back into the plan (see Step #5: Revisiting the plan).

3. Test with trading partners. Once your practice’s internal systems pass your tests with flying colors, conduct end-to-end testing in cooperation with your external partners. An AHIMA/eHealth Initiative survey reveals that 65 percent of organizations will be able to begin testing before the 2015 deadline; 63 percent will begin those tests this year. That’s good news for some of the industry, but your practice’s entire ecosystem will succeed or fail based on how well the collective functions together. Start by sending the most common types of test claims using ICD-10 codes. You may need to shift timelines to include the use of testing environments and the additional time that may be required to adjust to processing the test claims. If your practice has a large number of trading partners, test with the biggest ones first.

4. Survey your practice management vendor. Your practice management vendor is one of the most important pieces of the process. Review the CMS checklist of questions and the recently released list of 15 ICD-10 readiness questions. Will your PM vendor’s software require any hardware upgrades? Can its solution handle both ICD-9 and ICD-10 codes? Dual coding is important to mitigate the risks of being totally down should something go deeply wrong with using ICD-10 coding. What resources are available to help with test transactions? Review the vendor contract and examine the cost/benefit of any changes that will cost time or money.

5. Revisit the budget and implementation plan. After you take the above steps, revisit the budget and re-assess existing implementation plans. The e-Health/AHIMA survey reveals 35 percent of practices believe their revenue will go down after October 2015. Expected areas of difficulty include coding, documentation, and reimbursement.

While getting ready for ICD-10 is a massive process for a practice, the challenges are not insurmountable. Sharing and collaboration of best practices among organizations is a wise use of effort, and trading partners may already have dedicated resources to test the claims process with a variety of partners simultaneously.

Most importantly, don’t lose sight of the fact that beyond compliance, there is an industry upside to using ICD-10. The new codes are superior and in the end, it’s all about increasing the quality of care.


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HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model

HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model | EHR and Health IT Consulting | Scoop.it

EMRAM is an eight-step process that allows healthcare provider organizations to analyze their level of EMR adoption, chart accomplishments, and benchmark progress against other healthcare organizations across the country. Each of the stages is measured by cumulative capabilities and all capabilities within each stage must be reached before progressing.

“We’re happy to be able to confirm eClinicalWorks as an EMRAM Certified Educator,” said Blain Newton, COO, HIMSS Analytics. “EMRAM allows organizations to align IT initiatives and overall business strategy, which is essential to shaping future direction and moving the industry forward.”

Vendors achieving HIMSS Analytics Certified Educator status must pass an annual certification exam and commit to an annual educator program. This ensures they stay current with trends within the model and are equipped with the necessary knowledge to help their clients advance through the various stages.

“A major goal is having our customers utilizing the EMR the most beneficial way possible for both providers and patients,” said Girish Navani, CEO and co-founder of eClinicalWorks. “This certification will benefit organizations looking to analyze their adoption of EMR technology. We welcome being part of the program.”


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HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model

HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model | EHR and Health IT Consulting | Scoop.it

EMRAM is an eight-step process that allows healthcare provider organizations to analyze their level of EMR adoption, chart accomplishments, and benchmark progress against other healthcare organizations across the country. Each of the stages is measured by cumulative capabilities and all capabilities within each stage must be reached before progressing.

“We’re happy to be able to confirm eClinicalWorks as an EMRAM Certified Educator,” said Blain Newton, COO, HIMSS Analytics. “EMRAM allows organizations to align IT initiatives and overall business strategy, which is essential to shaping future direction and moving the industry forward.”

Vendors achieving HIMSS Analytics Certified Educator status must pass an annual certification exam and commit to an annual educator program. This ensures they stay current with trends within the model and are equipped with the necessary knowledge to help their clients advance through the various stages.


“A major goal is having our customers utilizing the EMR the most beneficial way possible for both providers and patients,” said Girish Navani, CEO and co-founder of eClinicalWorks. “This certification will benefit organizations looking to analyze their adoption of EMR technology. We welcome being part of the program.”


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Hospital Stage 2 Meaningful Use Attestations Near 77 Percent

Hospital Stage 2 Meaningful Use Attestations Near 77 Percent | EHR and Health IT Consulting | Scoop.it

The most recent update from the Centers for Medicare & Medicaid Services (CMS) puts the percentage of hospitals eligible having successfully attested to Stage 2 Meaningful Use at 77 percent.

In latest monthly meeting of the Health IT Policy Committee, Elisabeth Holland of the CMS Office of E-Health Standards and Services (OESS) reported that 1814 of 2115 eligible hospitals (EHs) had attested to Stage 2 Meaningful Use during the 2014 period as of the first of the year.

In late November, the federal agency extended the 2014 meaningful reporting deadline until December 31, giving these eligible providers an additional month to complete their 2014 meaningful use attestation.

Over that one-month period, the number of EHs successfully attesting for meaningful use reporting year 2014 rose from 3696 to 4093, with the EHs successfully attesting to Stage 2 Meaningful Use increasing from 1681 to 1814.

The total number of hospital attestations is slightly less than last year’s mark of 4112 total attestations for this portion of eligible providers.

During December’s meeting, the federal agency reported that number of EHs having successfully attested to Stage 2 Meaningful Use as of December 1 doubled from 840 to 1681.

The update comes one day after a group of industry associations voiced their support of a reintroduced bill to modify 2015 meaningful use reporting requirements, the Flexibility in Health IT Reporting (Flex-IT) Act of 2015 that would require a 90-day, quarter-based reporting period rather than a full year of reporting this year.

Support for the bill was bolstered by CMS data indicating that one-third of hospitals expected to demonstrate Stage 2 Meaningful Use in 2014 had to file for a hardship exception or meet Stage 1 requirements again, yet these figures and those provided yesterday by CMS do not add up.

Speaking of bad math, there is CMS data on eligible professionals over the same timeframe that raises questions. As of January 1, a total of 76,730 EPs demonstrated meaningful use in 2014, up from 60,561 EPs as of December 1. As for Stage 2, CMS data from the Health IT Policy Committee meeting incorrectly shows a decrease in successful 2014 Stage 2 Meaningful Use attestations — 16,455 to 16,359. (CMS is currently correcting those figures which will be made available shortly.)

The meaningful use attestation deadline for these eligible providers is set for the end of February. The number of EPs attesting to Stage 2 Meaningful Use has ample time to increase.


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Patient portals and EMRs: Each requires a different skillset

Patient portals and EMRs: Each requires a different skillset | EHR and Health IT Consulting | Scoop.it

Most readers know that an EMR (electronic medical record) is the back-end software that runs a health care organization. EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, and view clinical information.


I’ve written at length about the differences between B2B software and B2C software and how B2B software is generally not very good (particularly from a usability perspective). And it’s not very good simply because it can get away with not being very good. B2B companies often just need a good salesperson that can lock-in long-term contracts to be successful. Once the software is purchased, it’s not easy for users to switch.

B2C companies, on the other hand, need an incredible product to be successful. If your user experience isn’t flawless, you cannot survive in the B2C space. The switching costs for consumers are near zero — the user experience must be incredible. Product is much more important than distribution. B2C user satisfaction scores are significantly higher than B2C scores.

Applying this to health care, if you’re a hospital and your EMR is hard to use, your employees will still use it because they have to — they can’t easily switch to a competitor.

But if your patient portal is bad you will lose patients instantly. It’s too easy for patients to switch to something else.

The Healthcare Information and Management Systems Society (HIMSS) published a good report talking about patient portals.  They noted that despite the difficulty of building a wonderful online consumer experience and the totally different skill set required to execute on it, 80 percent of hospitals surveyed chose their patient portal vendor simply because it was the same vendor that provides their EMR (the top three portals were made by Epic, Cerner and McKesson). All of these vendors have been building B2B enterprise software systems for more than 30 years. They’re all wonderful companies. But they have no idea how to build a patient facing product. Their management, engineering talent, sales force, culture and DNA is all about B2B. They have almost no chance of building a world class consumer product. That’s not a knock on these companies; it’s just reality. You can’t be good at both.

As we transition to a world where the patient is in the driver’s seat, exposing patients to old-fashioned enterprise software code and interfaces is not a good idea. Hospitals shouldn’t let a piece of software touch their customers unless it’s been vetted and tested fully, and it’s clear that patients love it. If you check out the satisfaction scores for most patient portal apps, you’ll find that most patients despise them (one of them I looked at last week had 2,000 reviews in the iOS app store and more than 1,500 of them were only 1 star).

Patients are becoming consumers. They want slick, easy, mobile, beautiful, simple and seamless web experiences. If the software that touches patients doesn’t give them that they’re going to go somewhere that does.

Now, in defense of these hospitals let it be known that there aren’t a lot of great consumer-focused software companies building-out patient portals. So in the short term, they might have no choice. But I’d encourage CIOs that are making patient portal investments to consider the consumer and to cautiously enter into flexible and short term contracts with these patient portal vendors.

You should be careful about buying groceries from the company that fixes your car. And you should be careful about buying consumer-facing software from the company that built your EMR.


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What Happens When An EHR Vendor is Acquired?

What Happens When An EHR Vendor is Acquired? | EHR and Health IT Consulting | Scoop.it

With meaningful use money running out, and as the EHR industry matures, we’re going to see more and more consolidation in the EHR market. Many EHR vendors are going to start running out of money. Other larger EHR vendors are going to want to try and buy up market share. In some ways this has already begun. See Greenway being purchased by Vitera Healthcare Solutions and Cerner acquiring Siemens to name some of the larger ones that have happened recently. Although, anyone that’s been a user of Bond EHR (people still miss that EHR software), Allscripts MyWay, Misys, etc etc etc knows the challenges of when your EHR vendor gets acquired.

While your EHR being acquired by another EHR vendor is almost never a good thing for your EHR software’s future, L Nelms visited this post on EMR and EHR News and offered an even worse story of an EHR being acquired and the fallout the doctors felt. I’ve removed the name of the vendors since the principle could apply to many vendors that get acquired.

After completing Stage one of Meaningful Use, I am now dropping out of the whole damn thing. This decision is based entirely on my continued dissatisfaction with the EMR program I chose. I started using EHR Vendor A in 2012. As many know, EHR Vendor A was subsequently bought by ABC corporation who refused to honor the original contract which promised no additional fees. ABC corporation, knowing that they had customers “right where they wanted them” — knowing that switching programs would incur tremendous costs and disruption to the practices’ work flow, immediately imposed a $250.00 monthly “support fee”, requiring automatic payments from the customers credit card. I do not know what constitutes “support” from this company, as I had problems with the program and attempted to contact them numerous times from Nov 19, 2014 to Dec 9, without a SINGLE reply in any form from them. On Jan 1, 2015, they increased this fee to $300.00.

They continue to inundate us with newsletters telling us how wonderful they are, including an alert urging us to “respond today” to arrange to get the new certified software installed. This was sent on Christmas Eve! They warned us repeatedly that we must be using the new software ON Jan 1,2015, in order to meet MU. What they didn’t mention until the day before the install, was that there is a “one-time installation fee of $99.00″ (charged immediately, of course, to you credit card).

I asked if I could do the install myself and was told “yes, but we’re not really charging for the install, we’re charging for the SQL server update (which actually can be done oneself ). But I was told I had to pay. And now, the new certified software, which is COMPLETELY different from the previous version, is a nightmare. It is agonizingly slow, painstakingly labor intensive, and heaven forbid I should require tech support who, on top of being nowhere to be found, are so disrespectful (the last one one I spoke to actually said — when I expressed my dissatisfaction with not being able to get my data when I terminate my contract — “well we didn’t force you to buy our program”

Which doesn’t explain why I feel so violated…..

I should clarify that my data from EHR Vendor A is “available”: after many cryptic replies from them over several days, I was finally told that I can access the data from the server, but then — and you all know the story– I must take out a second mortgage on my home to have the data converted to some semblance of a usable format. This may not be illegal (only because the the recklessness of the companies has not yet been regulated), but it is certainly of questionable ethicacy

I think this is a fear that many doctors have when selecting and purchasing their EHR software. It’s why many of them still choose to go with the big name EHR vendors. Stories like this one scare doctors away from a small EHR vendor with an uncertain future. Although, I’ve written previously about the uncertain future of large EHR vendors as well.

The EHR industry should do better than this. I hope this story is an aberration, but I’m afraid we’re going to see more and more stories like it as the EHR industry consolidates. There will still be many good EHR actors out there that are appalled by these stories like I am. Hopefully, more and more doctors will find those good actors who are sincere in their efforts to provide a quality product with a quality user experience for the doctor. They’re out there, but bad actors like what’s described above give the good apples a bad name.



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Many Say Meaningful Use Stage 2 Is Disastrous, but the Data Say Otherwise

Many Say Meaningful Use Stage 2 Is Disastrous, but the Data Say Otherwise | EHR and Health IT Consulting | Scoop.it

The industry news is full of disparaging talk about the health of the EHR Incentive Programs (i.e., meaningful use), particularly the low number of Stage 2 attestations. While some statistics show that only 35% of the nation’s hospitals have met Stage 2 meaningful use requirements, further analysis reveals a different story.

Each month since July 2014, CMS and the Office of the National Coordinator for Health IT update the Health IT Policy Committee on the number of successful Stage 2 attestations. The following day, the same headlines appear with multiple industry analyses and strong reactions that take the low attestation volume as a sign of failing long-term meaningful use viability. These critics say that in November 2014, only 17% of the nation’s hospitals successfully demonstrated Stage 2, and most recently that in December 2014 that figure was 35%.

These numbers are being used to demonstrate how difficult it is for the majority of the hospitals to meet Stage 2 requirements and even to make the case that most will not be capable of attesting due to overly stringent requirements. While these numbers are not technically wrong, a closer look reveals a different picture. This is not an attempt to be provocative, but rather we want to provide additional detail to those figures because they do not tell the whole truth about how well hospitals have fared in Stage 2.

Stage 2 Attestation Numbers Send Mixed Messages
First, the numbers cited were correct when the number of Stage 2 attestations were compared with the entire population of U.S. eligible hospitals (EHs). Of course, based on such data, it looks as if only about a third of the hospitals have been able to meet Stage 2 requirements through the end of November 2014. Some have interpreted this number to mean that meaningful use Stage 2 is a disastrous program, but the industry should not use these numbers to judge the success of Stage 2, or in fact, hospitals’ ability to meet the requirements. Why?

The EHs participating in the EHR Incentive Program are required to progress through a set meaningful use timeline. This means every meaningful use participant is scheduled to start at Stage 1 and remain in each stage for two years before moving to the next stage, unless the policy allows otherwise. For example, the early adopters who began in 2011 were in Stage 1 for three years instead of two, as CMS moved the Stage 2 start year to 2014. Therefore, not every EH in the nation is scheduled to attest to Stage 2 in 2014. Even if they wanted to attest to Stage 2, they would not be able to do so.

Instead, the industry should look at how many EHs are scheduled to be in Stage 2 in 2014, rather than looking at all EHs. Per the CMS data:

  • 809 hospitals attested to Stage 1 Year 1 in 2011;
  • 1,754 hospitals attested in 2012;
  • 1,389 attested in 2013; and
  • 83 attested in 2014 by Sept. 30.

Thus, only 2,563 hospitals (i.e., those that started in 2011 or 2012, or 809 + 1754) were scheduled to demonstrate Stage 2 in 2014. Among these hospitals, 65.58% (1,681) of EHs successfully attested to Stage 2 by Dec. 1, 2014. It is this number that tells an accurate story of Stage 2’s viability so far.

Admittedly, CMS only includes Medicare-only or dually-eligible EHs in the database cited above, and CMS did not clearly indicate whether 1,681 include all types of EHs. However, the number of Medicaid-only EHs account for a small proportion here. Based on CMS’ October 2014 report, fewer than 100 Medicaid-only EHs should be in Stage 2 in 2014. Even if we added 100 to the calculation to account for Medicaid-only EHs, the percentage would still be at more than 63%.

Attestations Are on the Rise
In addition, the number of successful Stage 2 attestations has grown exponentially since CMS first announced that 10 hospitals attested to Stage 2 by July 1, 2014. We find many organizations wait until the final 30 days or even closer to the attestation deadline to attest, so it is no surprise to see such growth — especially in the last few months when the number doubled between Nov. 1, 2014, and Dec. 1, 2014.

Additionally, the majority of EHs had to wait until Oct. 1 if they chose the last fiscal quarter, as is likely the case for the majority of attestations. This approach was popular because it gave these organizations the first three quarters of the fiscal year to implement the 2014 Edition CEHRT and to make the required workflow adjustments. So the nearly-66% of successful Stage 2 EHs attestation will only rise from here, especially considering the fact that CMS has extended the hospital attestation deadline to Dec. 31.

Where Hospitals Stand at the End of 2014
The College of Healthcare Information Management Executives recently estimated that about one-third of the hospitals scheduled to attest to Stage 2 in 2014 will use the flexibility rule, which allows them to attest to Stage 1 requirements in 2014 if their certified EHR upgrade was delayed or unable to be implemented at all. If we combine the numbers of those who successfully attested to Stage 2 and those who will rely on the flexibility rule, more than 95% of hospitals are able to attest in 2014. Again, that percentage does not look like a disaster; it shows that the tremendous efforts these hospitals put toward readying themselves for Stage 2 in 2014 paid off for more than half, and CMS’ lifeline worked.

Taking the same approach for eligible professionals (EPs), 57,595 and 139,299 of Medicare EPs attested to Stage 1 Year 1 in 2011 and 2012, respectively. This means 196,894 EPs are supposed to be in Stage 2 in 2014. Per CMS data, 16,455 EPs successfully attested to Stage 2 by Dec. 1, 2014, which accounts for an 8.36% success rate for that group. Of course, the number appears low at this juncture. However, based on the trend for EHs, we expect the numbers to grow tremendously as the majority of the EPs would also rely on the last calendar quarter as their reporting period (Oct. 1, 2014, to Dec. 31, 2014), and EPs can complete their 2014 attestation within the first two months in 2015. In short, it is too early to draw conclusions regarding EP attestations. The real story still remains to unfold for the EP Stage 2 attestation.

Many have touted the misleading data and message that meaningful use is a failure as a reason to push CMS to reduce the reporting period in 2015 from one full year to one three-month quarter or 90 days. We agree with the many benefits that a shortened reporting period in 2015 would provide, and we offer an alternate rationale based on our analysis of the data.

First, so far, about two-thirds of EHs that are scheduled to be in Stage 2 in 2014 have successfully met the requirements. Based on research conducted among our members, we found that the shortened reporting period in 2014 played a critical role in their success. They would not have been able to attest or found it to be significantly challenging if any longer than a three-month quarter reporting period were imposed in 2014. This is because they would not have sufficient time to completely implement and stabilize the 2014 Edition CEHRT and to adjust existing or implement new workflows. In addition, the longer reporting period would equate a higher denominator, making it more difficult or nearly impossible for the providers to achieve the required threshold.

Stage 2 also introduced more complex objectives such as View, Download and Transmit, and Transitions of Care. These two objectives alone required many hospitals to deploy their IT capabilities in new territories of patient engagement and information exchange. As we’ve previously discussed, these two objectives are arguably the most challenging in Stage 2, and the majority of providers who attested showed marginal performance around the required thresholds. These two objectives are significant first steps toward something greater in health care, and it will take time to improve performance in these areas. CMS recognized these challenges and enacted the flexibility rule in 2014. It certainly would not hurt the forward momentum of the meaningful use programs to allow such an option in 2015.

Second, the meaningful use program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the meaningful use program is to promote better care and better health for consumers/patients, including ourselves.

Per a recent report, patients value providers’ use of EHRs, appreciate the ability to access their data in a timely manner and seek even more robust functionalities in EHRs. So far, one of the great accomplishments of the meaningful use program is the significant growth of EHR adoption among providers. This leads to higher recognition of its values among consumers. The meaningful use program should continue, but at a more measured pace, so we all can achieve the goal with little to no compromises.

We hope that these numbers and rationales provide a meaningful perspective as CMS and ONC continue to make data-driven decisions in setting the policy in 2015 and Stage 3. We think that when one asks for leniency, showing great results so far and good faith based on accurate data would trump defensive arguments.

Nevertheless, while there is no further change in the existing policy, providers should continue to keep up their efforts and push to achieve the higher goal of better care and better health.


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Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com

Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10.  More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together.  But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process.  Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.

“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions.  The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.

Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them.  Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues.  They will address issues as they occur and learn as they go after implementation.  They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.

“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”

“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.”  Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.

“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.

“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.

Will EHR vendors and billing partners pick up the slack?  Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education.  The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists.  One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.

The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are.  CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing.  ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed.  Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so.  “Articles on ICD-10 are fear-based,” said a participant.  “I try not to go there.”

So where will they go?  To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions.  It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs.  ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.

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Distressed docs turn up heat on ONC

Distressed docs turn up heat on ONC | EHR and Health IT Consulting | Scoop.it

A coalition of 35 physician organizations led by the American Medical Association says docs are fed up their electronic health records and the multitude of requirements that come from the federal meaningful use program. They have a seven-point plan for relief.

"Among physicians there are documented challenges and growing frustration with the way EHRs are performing," the coalition writes in its Jan. 21 letter to National Coordinator Karen DeSalvo, MD. "Many physicians find these systems cumbersome, do not meet their workflow needs, decrease efficiency, and have  limited, if any, interoperability."

Moreover, they add, ONC-certified EHRs raise safety concerns: "We believe there is an urgent need to change the current certification program to better align to testing to focus on EHR usability, operability snd safety."

The medical societies urge ONC to adopt their seven-point plan for improving EHR certification.

  1. Decouple EHR certification from the meaningful use program.
  2. Reconsider alternative software testing methods.
  3. Establish greater transparency and uniformity on user-centered design testing and process results.
  4. Incorporate exception handling into EHR certification.
  5. Develop CCDA guidance and teststo support exchange.
  6. Seek further stakeholder feedback.
  7. Increase education on EHR implementation.

The coalition elaborated on its concerns for patient safety.

"Unfortunately, we believe the meaningful use certification requirements are contributing to EHR system problems and we are worried about the downstream effects on patient safety," the physicians wrote, adding that medical informaticists and vendors had told members of the coalition that meaningful use certification had become a priority in health IT design at the expense of physician and patient needs.

The coalition memebers said they'd also become concerned over the lack of ONC oversight regarding EHR certification.

The physician groups also raised concerns about information security and lagging interoperability. They especially emphasized the need to separate the meaningful use program from EHR certification.

"We are concerned  that if the administration were to maintain the program, as currently structured, EHR innovation will languish and improvements in performance, quality, safety, interoperability and efficiency will continue to be out of reach."

In a Jan. 15 letter responding to ONC's call for comment on its federal strategic plan, the American Academy of Family Physicians, part of the coalition, also took ONC to task.


"We are concerned that work has not been done to determine why these goals have not been achieved during the past 10 or more years and how the tactics and activities of the next 10 years will be different," AAFP Board Chair Reid Blackwelder, MD, wrote in the response, referring to interoperability.

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Managing Your Practice's Revenue Cycle in 2015

Managing Your Practice's Revenue Cycle in 2015 | EHR and Health IT Consulting | Scoop.it

It's 2009 and you are looking at your key performance indicators (KPIs) from 2008. It was a difficult year due to the recession, but your practice made it through OK. Your payment mix was positive — the percentage of major insurance carriers was consistent with the previous year.

It's now 2015: You are again looking at your KPIs and realize the payment environment has changed radically. Patients are now responsible for a much larger portion of their medical bill, and there has been a significant increase in the size of outstanding patient balances. This is in spite of the increase in insurance coverage due to the healthcare exchanges.

Several questions come to your mind: What is happening when patients check in at the front desk? Are staff letting patients know what their outstanding balance is? What is happening on the back end with patient collection efforts after the visit is concluded?

So you look and ask:

1. Does your practice's financial policy (that statement given to patients and posted on the website) state that payments are due prior to seeing the provider?

2. What does your daily collections report show? This simply states, based on today's schedule of patients, how much was collected in terms of dollars, how many patients were collected from, and if there was no collection posted, why that occurred.

3. Does the front desk get accurate information on the copay, deductible, and past due balances for all patients? Are there inaccuracies, preventing them from asking for or collecting the amount due? Is that information provided in a timely manner?

4. Do automated/staff generated appointment-reminder phone calls suggest that there will be a payment required prior to seeing the provider?

5. Do you have adequate guidelines for staff concerning patients who don't pay prior to seeing the provider? Does your staff have the authority to reschedule a patient if payment is not made? When is this clinically acceptable?

6. Does your malpractice carrier provide guidance in terms of not seeing a scheduled patient due to lack of payment?

7. Is there adequate training for front-desk staff in how to ask for payment at the time of visit?

8. Have staff members have been assigned to identify and collect outstanding patient balances?

9. Are there options through the patient portal to collect outstanding patient balances?

10. What is the practice position on collecting from a new patient with a high deductible plan? Do you make sure you see the patient after the visit to ensure that the level of services and all services provided are documented and can be collected at check out? Is there an estimate of cost provided to the new patient at intake — on the initial call, as well as at check in?

11. Is there guidance for staff on the occasional patient who is private pay and requests a discount — e.g., offer a 25 percent discount (or even 50 percent if you have a fee schedule strategy of 200 percent of Medicare, which means that the patient payment would be equal to that of Medicare)?

There is no time like the present to review your patient payment strategy.

One more thing — there was a slight adjustment in the Medicare conversion factor from $35.80 to $35.75 as of Jan. 1 (which was a technical change and not an SGR revision); but remember too, that Medicare allowances will change as of April 1, 2015. There could be a significant hit, but more likely there will be a small change in the allowable amount at that time. Just be aware of it.


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Exploring the Role of Clinical Documentation

Exploring the Role of Clinical Documentation | EHR and Health IT Consulting | Scoop.it

We need more clinicians weighing in on the design of the tools they use, so I was gratified to see a policy paper from the American College of Physicians about EHRs this week. In a sporadic and tentative manner, the paper recognizes that our digital tools for clinical documentation are part of a universal health care system that requires attention to workflow, care coordination, outcomes, and research needs.

The strong points of this paper include:

  • A critique of interfaces that hobble the natural thought processes of the clinician trying to record an encounter

  • A powerful call to direct record-keeping away from billing and regulatory requirements, toward better patient care

  • An endorsement of patient access to records (recommendation 6 under Clinical Documentation) and even more impressively, the incorporation of patient-generated data into clinical practice (recommendation 5 under EHR System Design)

  • A nod toward provenance (recommendation 3 under EHR System Design), which tells viewers who entered data and when, thus allowing them to judge its accuracy

Although the authors share my interests in data sharing and making data available for research, their overarching vision is of an electronic record that supports critical thinking. An EHR should permit the doctor to record ideas about a patient’s condition as naturally as they emerge from his or her head. And it should support other care-takers in making treatment decisions.

That’s a fine goal in itself, but I wish the authors also laid out a clearer vision of records within a learning health care system. Currently a popular buzzword, a learning health care system collects data from clinicians, patients, and the general population to look for evidence and correlations that can improve the delivery of health care. The learning system can determine the prevalence of health disorders in an area, pick out which people are most at risk, find out how well treatments work, etc. It is often called a “closed loop system” because it can draw on information generated from within the system to change course quickly.

So at the start of the policy paper I was disappointed to read, “The primary goal of EHR-generated documentation should be concise, history-rich notes that reflect the information gathered and are used to develop an impression, a diagnostic and/or treatment plan, and recommended follow-up.” What about supporting workflows? Facilitating continuous, integrated care such as in a patient-centered medical home? Mining data for new treatments and interventions? Interfacing with personal health and fitness devices?

Fortunately, the authors massage their initial claim by the time they reach their first policy recommendation under Clinical Documentation: “The primary purpose of clinical documentation should be to support patient care and improve clinical outcomes through enhanced communication.” The primary purpose gets even better later on: “As value-based care and accountable care models grow, the primary purpose of the EHR should remain the facilitation of seamless patient care to improve outcomes while contributing to data collection that supports necessary analyses.”

One benefit of reading this paper is its perspective on how medical records evolved to their current state. It notes a swelling over the decades in the length of notes and the time spent on them, “the increased documentation arguably not improving patient care.” Furthermore, it details how the demands of billing drove modern documentation, blaming this foremost on CMS’s “issuance of the evaluation and management (E&M) guidelines in 1995 and 1997.” I suspect that private insurers are just as culpable. In any case, the distortion of diagnosis in the pursuit of payments hasn’t worked well for either goal: 40% of diagnoses are wrongly coded.

The pressures of defensive medicine also reveal the excessively narrow view of the EHR currently as an archive rather than a resource.

The article calls for each discipline to set standards for its own documentation. I think this could help doctors use fields consistently in structured documentation. But although the authors endorse the use of macros, templates, and (with care) copy/forward, they are distinctly unfriendly toward structured data. Their distemper stems from the tendency of structured interfaces to disrupt the doctor’s thinking–the presevervation of which, remember, is their main concern–and to make him jump around from field to field in an unnatural way.

Yet the authors recognize that structured data is needed “for measurement of quality, public health reporting, research, and regulatory compliance” and state in their conclusion: “Vendors need to improve the ability of systems to capture and manage structured data.” We need structured data for our learning health care system, and we can’t wait for natural language processing to evolve to the point where it can reliably extract the necessary elements of a document. But a more generous vision could resolve the dilemma.

Certainly, current systems don’t handle structured data well. For instance, the article restates the well-known problem of redundant data entry, particularly to meet regulatory requirements, a problem that could be solved with minimally intelligent EHR processing engines. The interactive features available on modern mobile devices and web interfaces could also let the clinician enter data in any manner suited to her thinking, imposing structure as she goes, instead of forcing her into a rigid order of data entry chosen by the programmer.

Already, Modernizing Medicine claims to make structured data as easy to enter as writing in a paper chart. As I cover in another article, they are not yet a general solution, but work only with a few fields that deal with a distinct set of health conditions. The tool is a model for what we can do in the future, though.

The common problem of physicians copying observations from a previous encounter and pasting them into the current encounter is a trivial technical failure. On the web, when I want to cite material from a previous article, I don’t copy it and paste it in. I insert a hyperlink, I did in the previous paragraph. EHRs could similarly make reporting simple and accurate by linking to previous encounters where relevant.

The ACP recommendations are sensible and well-informed. If implemented by practitioners and EHR developers who keep the larger goals of health care in mind, they can help jump over the chasm between where EHRs and documentation are today, and where we need them to be.


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4 Things Your Patient Portal Should Include

4 Things Your Patient Portal Should Include | EHR and Health IT Consulting | Scoop.it

Karen Gallagher Grant has a great blog post up on the MRA Health Information Services blog that talks about the ideal patient portal. She breaks it down into 4 things that a patient portal should provide:

  1. Information that is meaningful
  2. Easy access for patient review for data integrity
  3. Dashboard information about prescriptions that combine pharmacy information and clinical information
  4. Appointment scheduling

And 5 things she’d ideally like to see in a patient portal:

  1. Details about my next appointment
  2. Wellness tips
  3. Access to home health through telemedicine solutions
  4. Customized decision support via nationwide clinical data repositories
  5. Patient exchange of information

I found these lists really interesting, but I asked myself “Is this what we really want in a patient portal?

I think the number thing people want in a patient portal is access to a provider. Sure, it’s great to be able to access your paper records, your prescription history, your appointment list, and even some health information. Although the health information is never going to be as good as what Dr. Google can provide.

I was surprised that almost nothing (except the Telemedicine solution) talks about the patient portal being used to connect with the doctor. This is the most compelling reason for a patient to use the portal. They want to connect with someone. Notice the emphasis on the one, that means with an actual person. Yes, in many cases this can be the front desk, the biller, or the nurse, but patient portals see the most value when the portal is a way for a patient to connect to a person. Then, the rest of the resources become more valuable and used as well.

The problem is that most of the patient portals out there don’t do a good job connecting people. Although, maybe I’m just biased because of the Physia Connect messaging product we’ve developed and the docBeat messaging company I advise. However, seeing these two products helps me realize how beneficial it can be to make healthcare communication simple. Once we do that, it opens up whole new windows of opportunities.

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Employment Manuals as Asset Protection for Doctors

Employment Manuals as Asset Protection for Doctors | EHR and Health IT Consulting | Scoop.it

Medical professionals and their practices face many types of risk outside the strict scope of medical malpractice liability. One major recurring risk to doctors is employment-related lawsuits that can be mitigated by following some simple steps.

As I discussed last week, a good asset protection plan has many layers, including management of all reasonably anticipatable risks. The stakes here are high on two fronts; first, the awards themselves can be financially devastating, with sexual harassment verdicts, as one example, regularly reaching hundreds of thousands of dollars. Second, the costs of legal defense alone can drive a medical practice out of business, easily reaching six figures in short time — without including the potential dollar value of any award that may be obtained against the physician.

The risk is growing

According to a recent EEOC press release the agency collected nearly $400 million in fines in 2013 alone — the largest collections year in the history of the EEOC — and receives close to 100,000 complaints a year. The most common causes of these complaints, in order, are; retaliation under all the statutes (about 40 percent); followed by race discrimination (about 33 percent); sex discrimination, including sexual harassment and pregnancy discrimination (roughly 27 percent); and discrimination based on disability (about 25 percent). Both race and disability discrimination claims increased as a percentage of all charges.

Step one: Have a professionally drafted employment manual

We consistently find that medical practices have one of the three following bad scenarios at play with their employment policies and manuals, which should be formal, written, distributed to all employees and enforced:

1. We have NO formal manuals.

2. We have generic manuals of speculative value that are not specific to our business and how it operates (i.e., we got it free off the Internet or from a doctor buddy in another state.)

3. We have a custom manual but have NOT implemented it, distributed it to our staff in a formal way, or consistently enforced it.

So what? Why do I even need an employment manual and policy guide?

Any of the scenarios above is a danger to your practice. Your employment manual is your compliance bible for both management and employees, and prescribes the rules and procedures for the vast majority of employment-related issues at your practice. According to Paul Edwards, CEO of CEDR Solutions, an employment law resource that specializes in medical practices:

"Your employee handbook is also your first defensive tool in deterring and fighting employment lawsuits. Policies that are well-written and in compliance with all state and federal laws can prevent 90 percent of legal exposures because an employee or manager was not aware of or did not understand a rule or regulation. A strong handbook will also often deter aggressive contingency fee attorneys who know it is much more difficult to fight and win when a medical practice has implemented written, legally compliant policies."

Why does it have to be "custom"?

Edwards outlined some key legal areas that required custom drafting in an employment manual:

1. It should be specific to the laws of your state. Employment laws vary from state to state and some, like New York and California are more onerous for employers than others. Not citing the right laws can make your practice non-compliant or subject you to rules that are more onerous than they should be. If it's in your manual you are required to follow it.

2. It should be specific to the number of employees you have. Your compliance burdens change with staff size, so the difference between 49 employees vs. 50 employees or even 14 employees vs. 15 employees can be significant.

3. It should be specific to your industry. You have many additional, unique compliance burdens as a medical employer and significantly extended liability on issues like HIPPA compliance, credentialing, etc., — these should be specifically addressed.

4. It should be specific to the "culture" of your practice. Every practice and its needs and expectations are different, your manual and polices should match how your practice actually runs and mirror your expectations.

In my next installment on this issue I will cover the next step or layer required to protect your personal and business assets against the risk of employment-related lawsuits. Until then, think about your own practice and which of the areas above needs additional attention.



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Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says

Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says | EHR and Health IT Consulting | Scoop.it

Clinging on to the current outdated ICD-9 code system until ICD-11 is ready for use at some unspecified point in the future is akin to the endless idle loitering of Vladimir and Estragon in Samuel Beckett’s classic play Waiting for Godot, says the Coalition for ICD-10 in a new opinion piece.  After waiting more than twenty years for the implementation of ICD-10, the healthcare industry simply cannot afford another two or three decades for the newest code set to be finalized and ready for use.

“Based on the World Health Organization’s (WHO) current timeline, ICD-11 is expected to be finalized and released in 2017,” the commentary explains. “For the US, however, that date is the beginning, not the end.  As with every WHO version of the ICD codes, ICD-11 would need to be adapted to meet the detailed payment policy, quality assessment and other regulatory requirements of US stakeholders.”  The country could be waiting until 2041 for the entire pre-implementation process to be completed, the Coalition adds.

Meanwhile, the healthcare industry will be forced to continue to use a significantly outdated code set that cannot account for many emerging health threats or new advances in technologies, diagnoses, and procedures.  That’s just fine with representatives from the American Medical Association (AMA), whose House of Delegates voted to reject an internal report noting that implementing the changes inherent in ICD-10 would provide an important foundation for the eventual adoption of ICD-11.  The report concluded that skipping ICD-10 all together was “not recommended” as a viable course of action, yet the AMA continues its resistance to the ICD-10 codes – and the Coalition continues to fight back against their reticence.

“The US simply cannot wait decades to replace ICD-9, a code set that was developed nearly 40 years ago,” the Coalition states. “US healthcare data is deteriorating while at the same time demand is increasing for high-quality data to support healthcare initiatives such as the Meaningful Use EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and patient safety and decreasing costs.”

The AMA argues that the expense of ICD-10 implementation is overwhelming for smaller physicians struggling keep their doors open, pinning the costs at anywhere from $50,000 to $225,000 for a small provider.  Despite contradictions from AHIMA, the cost of the switch has been a major selling point for opponents.

However, after two one-year delays, the tide seems to be turning in support of ICD-10.  Not only is the Coalition growing, but Congress has stepped in to enforce the idea of a 2015 due date.  Will the wait for Godot be over in October?  The Coalition would certainly like to see an end to the “unending barrage of excuses” and continual delays.

“Waiting for ICD-11 is simply not a viable option,” the blog post concludes. “The absurdity of the endless waiting in Waiting for Godot culminates in frustration: “Let us not waste our time in idle discourse! Let us do something, while we have the chance!” Yes, the wait needs to be over. It’s time to stop wasting time. It’s time to get ICD-10 implemented.”

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Reigniting ICD-10 Momentum in Your Organization

Reigniting ICD-10 Momentum in Your Organization | EHR and Health IT Consulting | Scoop.it

Now that Congress has rejected requests to delay ICD-10, it’s time to get on the bandwagon or risk significant financial implications. ICD-10 touches virtually every aspect of your organization’s processes and systems, and failure to prepare and comply with the mandate will have a significant impact on your reimbursements.

If your organization has lost momentum or has not started the ICD-10 journey, hiring internal resources or working with external experts will be necessary to meet the deadline. Below is a cheat sheet – based on best practices and industry guidelines – of essential questions to ask leadership and next steps:

  • Is ICD-10 a priority for your leadership team?
    Evaluate organizational awareness of ICD-10 and confirm leadership is in place to drive the transition. Successful ICD-10 planning involves defining project leadership, executive sponsorship, and reporting structures. Given the far-reaching organizational impacts of ICD-10, without defined roles and responsibilities, a critical remediation area may be missed. Identify stakeholder accountability for ICD-10 compliance and designate project managers to lead revenue cycle, coding and clinical documentation improvement (CDI), and IT system initiatives. Develop a project communication plan that sets expectations about what should be communicated to whom, the reason for the communication, frequency, and method.
  • Are your systems ready and have you evaluated the impact of ICD-10 to all system workflows?
    Assess operational readiness by taking an enterprise-wide systems and process inventory to identify where codes are used. Utilize assigned project managers to uncover all systems and processes where ICD-9 codes are sent, received, or stored. Conduct workflow analyses to ensure understanding of how systems and processes are impacted. This exercise can provide immediate benefit to an organization as workflows operating inefficiently are identified. Develop a prioritized project plan and remediation timeline for each impacted area. For example, technology and workflows need to be optimized within patient access to assure compliant orders for dates of service on or after October 1, 2015. Conduct regular reporting on initiatives and ensure stakeholders are being held accountable for designated tasks.
  • Does your staff have appropriate organizational awareness and knowledge of ICD-10?
    Understand what roles individuals play within your organization with respect to ICD-9 code usage, and employ a role-based training initiative. While coders, CDI specialists, and providers will need the majority of training, areas, such as patient access, ancillary departments, business offices, and IT should not be overlooked. Also, keep in mind the impact on your quality team. Patient populations monitored by core measures, as well as other quality metrics are determined by ICD-9 codes. When selecting a training vendor, confirm the vendor offers courses tailored by job function and provides the necessary courses for coders and specialty-specific training for providers. Track and communicate training progress and ensure training compliance is an organizational priority. As part of your strategy, attempt to incorporate training with other planned education to reduce workflow disruption.
  • Are you establishing ongoing experience with the new code set?
    Act fast to incorporate dual coding initiatives. Based on experiences with ICD-10 in other countries, research suggests that allowing coders to simultaneously code in ICD-9 and ICD-10 allows them to achieve proficiency and decrease productivity loss. Dual coding has been shown to significantly reduce the anticipated 40 to 60 percent inpatient and estimated 20 percent outpatient productivity loss. The first step is to create a project plan that identifies coders, checks systems, and determines expected coding system upgrades. Next, create a strategy for managing dual coded data to be analyzed. A coding roundtable of key stakeholders from an organization’s coding team should be developed to create accountability and drive documentation improvements during the dual coding process. As part of the learning process, coder education should initially emphasize documentation requirements for coding the most common conditions within the organization and those with the highest allowed amounts. A minimum of six months of practice is recommended.
  • Are you conducting internal and external testing of systems for ICD-10 compliance?
    Define testing goals and document a plan to test each impacted system internally and conduct external testing to the greatest extent possible. Appropriately testing impacted applications is a complex and time-consuming process and should not be seen as a last step. Many variables — including competing organizational priorities and resource availability — as well as clearinghouse, payer, and third-party tester schedules, can influence the testing timeline. Designate a well-defined team to undertake, define, and monitor the testing readiness plan for your impacted systems and software. Each impacted system should be reviewed for the type of testing that is needed. Billing systems are the most complex and must be ready to send ICD-10 coded bills to payers or payment will be denied. Testing of billing systems should include all of the workflows where codes live, (e.g., claim edits that currently contain ICD-9 codes). Use your high volume and high value codes for testing, and determine the ICD-10 workflow for each impacted application. Then, complete individual testing of applications by running the applications through the identified workflows. Once that process is complete, begin integrated testing through following the process for codes to flow to downstream applications and out to the payer. If you haven’t been selected for payer testing, then work with your clearinghouse to test claims externally through them.
  • Is your CDI program optimized and ready for ICD-10?
    Emphasize clinical documentation process improvements to realize bottom-line gains now while preparing for ICD-10. While most healthcare systems have a CDI program, many are not achieving the desired results in appropriately coding conditions to the highest level of specificity. For example, if the organization is not able to code the specific type of congestive heart failure in ICD-9, the problem will only worsen in ICD-10 with requirements for greater specificity to attain complications and co-morbidities (CCs) and major complications and co-morbidities (MCCs) for many DRGs. While revamping a CDI program is a separate goal, perfecting ICD-9 queries and introducing ICD-10 queries early will help prepare an organization for ensuring compliance with the increased specificity ICD-10 demands.
  • Have you planned for predicted delays in cash flow?
    Create a contingency plan to mitigate potential productivity and revenue losses. Hope for the best, but prepare for the worst. Based on Canada’s ICD-10 experience, coding productivity may drop by 50 percent immediately following implementation. Performance improvements may take at least 90 days to be realized. If claims are suspended, rejected, or delayed following ICD-10 implementation, have a plan available in advance to quickly respond to different scenarios. Alternatively, some providers and payers have drafted stopgap provisions in their contracts to maintain a consistent cash flow and “true up” every three months.

While changing processes, systems, technologies, and staff resources to accommodate the shift from ICD-9’s 17,000 to ICD-10’s 140,000 codes may seem overwhelming, there is still time to meet the requirements by taking a prioritized and focused approach.  Having the right mix of expertise and staffing is necessary to meet the upcoming deadline.  Contingency plans will also help mitigate losses following ICD-10 implementation. Beyond getting paid, ICD-10 also promises to improve clinical outcomes by increasing the specificity and accuracy of clinical documentation to guide patient care decision-making. It’s an investment that is worth the effort.


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Amazing Charts Releases 2015 Predictions for Medicine and Technology

Amazing Charts Releases 2015 Predictions for Medicine and Technology | EHR and Health IT Consulting | Scoop.it

Amazing Charts, a leading developer of Electronic Health Record (EHR) systems for physician practices, today issued its healthcare predictions for 2015.

1.      Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end Concierge Medicine, and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.

2.      Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.

3.      EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.

4.      Wearable Health Devices Empower Patients: Led by FitBit, the market for mobile health monitoring devices saw explosive growth in 2014. Now Apple is entering the scene, and 2015 promises to see even more apps and devices introduced to consumers. How the government regulates these devices may depend on how they are marketed. For example, a glucometer could be unregulated if the intent is for a user to monitor blood sugar levels for better nutrition. If the same glucometer is marketed for monitoring diabetics, however, it may be more strictly regulated as a medical device.

5.      EHR Interoperability Still Around the Corner: While all EHRs will not be able to seamlessly communicate in 2015, the core infrastructure for increased data liquidity will largely be in place. The data standards of the CCDA and its predecessor, the CCD, are increasingly used by EHR vendors. In addition, Meaningful Use Stage 2 mandates that patients can receive a digital summary of their own records on demand. These positive steps forward will combine in 2015 to get us closer to the promise of data interoperability.

6.      EHR Switching Accelerates: Many practices selected an EHR system lured by the promise of Meaningful Use incentives and now find themselves dissatisfied with their decision, primarily because the solution is not user friendly and slows them down. Despite barriers to switching systems, we will witness a mass conversion of solutions toward EHRs that better meet providers’ expectations and requirements.

7.      The Doctor Will NOT Be In: In 2015 and beyond we will see reimbursements drive the “virtual” appointment, whereby health plans will reimburse clinicians for online patient visits. Patients and their providers will connect over virtual platforms for scheduling, reviewing test results, writing prescriptions, etc. As they do, more and more insurers will follow suit as technology advances and claims its place in the doctor’s office.


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4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch

4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch | EHR and Health IT Consulting | Scoop.it

One of the biggest misnomers about an EHR implementation is that it will replace many of the human elements of your practice. While the EHR can replace some of the tasks and processes that were done by humans, the reality is that EHR software is most powerful when paired with human touch. This concept is infused into our Ideal Medical Practice Workflowwhitepaper and should be infused into every clinical practice.

As we enter 2015, here’s a look at 4 more ways your practice can benefit from a mix of technology and human touch:

1. Rescheduling Patients
One of the biggest forms of lost revenue for a practice comes in not rescheduling patients who missed their appointment. While some of these missed appointments represent low quality patients, many missed appointments happen for a good reason and are an opportunity for more revenue for your practice. Unfortunately, most practices don’t consistently reach out to patients and reschedule their appointment. Along with providing additional revenue for your practice, this extra patient outreach is a great form of customer service that will be appreciated by many of your patients and shared with their friends. While some of the rescheduling can be done using technology like emails and text messages, nothing shows a patient you care about them more than a telephone call about a missed appointment.

2. Complete Eligibility Verification
I’ve written previously about the importance of complete eligibility verification and a quality eligibility verification team. While having the correct eligibility information is always important, I can’t stress how much more important eligibility verification is at the start of a new year. At the start of a new year, patients once again are working to meet their deductible and therefore have a higher patient pay amount. Plus, the new ACA insurance plans means many patients will start the new year off with a new insurance plan. If you don’t have a 100% consistent process for verifying a patient’s eligibility, then you’re office is likely working off of old information which will hamper your ability to collect the correct payment from the patient.

3. Referral Tracking
Not appropriately tracking referrals is a big issue in many practices that can easily be handled with a mix of technology and human follow up. Not tracking these referrals is a big clinical compliance issue for your practice that has the potential to lead to a lawsuit. Along with the potential legal liability, I believe having a dedicated team following up on these orders will become extremely important in the new world of value based reimbursement and ACOs. In this next generation of reimbursement, your payment will depend on your ability to ensure patient compliance with outside referrals.

4. Annual Well Visit Reminders
Annual Well visit reminders are another great way to increase high quality visits to your practice. Many practices convert a regular visit into an Annual Well visit. While this may seem convenient for the patient, it usually means you’re cutting the patient short in the care you could provide them. You just don’t have the time in a sick visit to do a thorough well visit exam as well. Even more important is reaching out to those patients you haven’t seen for a while. It’s incredibly valuable to have a dedicated person or team who identifies all of these patients and sends them a reminder or calls them about their annual well visit. Plus, these annual well visits are a great way to add to your bottom line.

As you look at each of these 4 ways to improve your practice, they all require the right mix of technology and human touch to be done properly. In a busy practice, that can often mean hiring more staff or outsourcing some of these processes to an outside company. Either way, the value created for your practice by implementing these small but important changes will easily offset any additional costs. Plus, you’ll have happier and healthier patients in the process.


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Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)?

Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)? | EHR and Health IT Consulting | Scoop.it

I’m not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old.  There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation.  Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need.  Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform,  I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed.  Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer.  These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient.  For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program.  Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google.  Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees.  As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive.  And that extends to things that keep us healthy.  To interact with your health means you are imperfect, you are mortality.


Rather than a PHR, I would like to propose a different tool, a managed PHR (mPHR).  This would be owned by the patient, but managed by a surrogate, a care coordinator (CC).  This person would be responsible to keep the person on track, taking their medications, keeping their appointments, explaining their illness (or at least research) their problem.  This may seem far fetched, by I believe CC will be a new job in 3-5 years.  And when this army of providers spreads across the land, they’ll look for a tool to do their work.  And it won’t be an EMR.  It will be a mPHR.

What would the perfect mPHR do?

Here is a list I’ve compiled


  • Upload data from disparate hospitals and clinics
  • It would store and view previous radiology exams
  • It would do med reconciliation and education
  • It would send reminders
  • It would manage exercise programs
  • It would allow differing levels of permissions and access…for the patient, the advocate and family
  • It would message those defined in the persons ecosystem if the PHR identifies a down trend.
  • It would report on utilization and changes in utilization
  • It would collect biometrics including wt, BP but also depression and pain indices with reporting and messaging
  • It would link/suggest support groups based on the problem list
  • It would leverage secure texting and email for messaging
  • It would be platform agnostic & cloud based

The critical thing here is actually not the functional requirements…these have already been fairly well defined…it is the ability to easily work with surrogates and family while maintaining some level of choice and control by the patient.

This is not an idle ask.  I am now working with a developer building senior communities with integrated care and care coordination.  I can buy an EMR, but not an effective PHR for these communities.  With any luck at all, we will be managing thousands of lives in these communities in the next few years.

To all you bright entrepreneurs out there, help me out.  Build the perfect mPHR.  If I am right, and there is a lot of evidence I am, you’ll transform how we care for one another, and make a lot of money doing it.  I won’t be your only customer.


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Accountable Care, Patient Portals Lag behind Expectations

Accountable Care, Patient Portals Lag behind Expectations | EHR and Health IT Consulting | Scoop.it

The slow uptake of accountable care reimbursement structures and the low implementation rates of advanced patient portals are among some of the top issues in healthcare over the past year, according to HIMSS Analytics, and present both challenges and opportunities for the industry as it moves forward into reforms that encourage patient engagement, individualized care, and higher quality outcomes.   While mobile technologies and telemedicine are enjoying widespread interest and use among healthcare providers, opportunities to increase adoption of health IT, improve patient engagement, and provide better patient care abound in the year to come.

“Patient engagement is more than just today’s hot topic – it is foundational to the future of healthcare,” said HIMSS Analytics Research Director Brendan FitzGerald.  Yet few providers who have patient portals have selected software that allows patients to truly engage with them, the organization found.  Sixty-two percent of hospitals are live on a portal, but just 23% can allow patient users to view their personal health record or lab results.  Without functionalities that encourage patients to visit the portal site on a regular basis or offer features that patients have expressed preference for, healthcare providers may find themselves struggling with Stage 2 meaningful use throughout 2015.

Despite the slow adoption of feature-rich portals, telehealth seems high on the agenda of many organizations.  Nearly half of organizations have adopted up to four different telehealth technologies, including two-way video conferencing, which is viewed as the best entry-level investment for providers looking to dive into the telehealth sphere.

“Organizations continue to strive toward a value-based rather than volume-based care model, and many telemedicine technologies can aid in that transition,” FitzGerald said in August. “However, the study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market.  Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

But adoption of those value-based principles continues to be slow for the majority of the industry.  Only a quarter of providers have a clear and defines strategy that centers on accountable care.  While the number of accountable care organizations is growing by the day, organizations may be more focused on attempting to successfully attest to Stage 2 meaningful use instead of shouldering more financial risk under a value-based reimbursement structure.

Instead, they may turn to mobile technologies as a simpler way to coordinate care, improve communication, boost efficiency, and cut waste.  “It’s one thing to state that mobile technology is cool; it’s another to determine what value it brings to the healthcare equation,” said David Collins, Senior Director, Health Information Systems for HIMSS North America.


Providers certainly see that value as increasing demands on their time make on-the-go access to EHRs, clinical decision support, and other information a necessity.  More than half of hospitals already use mobile devices such as smartphones and tablets, with 69% of providers using the technologies to access clinically-related apps.  Thirty-six percent of clinicians believe that mobile devices such as tablets and smartphones will be instrumental for reducing redundancies and improving efficiencies, which may indicate a bright future for pocket-sized computing in healthcare.

“The study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market,” FitzGerald concludes.  “Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”


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EMRs can hurt physicians during lawsuits. Here's how.

EMRs can hurt physicians during lawsuits. Here's how. | EHR and Health IT Consulting | Scoop.it

While the electronic medical record (EMR) has advantages, it also has introduced liability risks. EMRs can lead to lawsuits or result in a weak defense by casting the physician in an unfavorable light.

For example, examine these exchanges in a recent malpractice trial:

  • Plaintiff attorney: Doctor, if the emergency renal consult was called in at 11:30, why did you wait until 6 p.m. to see the patient, during which time his kidneys became severely damaged?
  • Doctor: I did see the patient within 30 minutes.
  • Plaintiff attorney: Where does it show that in the chart?
  • Doctor: Uh … it doesn’t, I guess. I saw the patient but wrote the note later.
  • Plaintiff attorney: So you claim you saw this critically ill patient in 30 minutes, spent one hour evaluating him, but did not document your findings for another six hours?

And later in the trial:

  • Defense attorney: But the lab record shows that the kidney function was declining …
  • Judge: [interrupting] The physician notes state each day that kidney function was normal. How do you explain that in the face of deteriorating kidney function? Why would a physician write that, unless he hadn’t looked at the lab testing or the patient?


EMRs can increase malpractice risk in documentation of clinical findings; copying and pasting previously entered information can perpetuate any mistakes that may have been made earlier. Incorrect information is the most common user-related contributing factor in malpractice cases involving EMRs, according to a study by The Doctors Company of EMR-related closed claims from 2007 to 2013.

In the study, 15 percent of cases involved pre-populating/copy-and-paste as a contributing factor. Copy-and-paste is a necessary evil to save time during documentation of daily notes, but whatever is pasted must also be edited to reflect the current situation. Too often, the note makes reference to something that happened “yesterday.” For example, the sentence “Patient presented to ED with chest pain yesterday…” is pasted over the next two weeks in the daily progress note. An even more telling example is a sentence like “Patient’s admitting lab is normal…” being perpetuated while the actual creatinine levels rise every day.

In one case, the judge commented about copy-and-paste issues: “I cannot trust any of the physician notes in which this occurred and the only conclusion I can reach is that there was no examination of the patient … it means to me that no true thought was given to the content that was going into ‘the note.’”

Checkboxes, particularly those that pre-populate, can be a physician’s nemesis. It’s easy to click on checkboxes, and often they are pre-checked in templates. EMRs have been presented in court that show, through checkboxes, daily breast exams on comatose patients in the ICU, detailed daily neurological exams done by cardiologists, and a complete review of systems done by multiple treating physicians on comatose patients. Questioning in court as to how long it takes to do a review of systems and a physical examination, the patient load of the physician for that day, and how many hours the physician was at work cast doubt on the truthfulness of the testifying physician. A time analysis showed that there was no way the physician could have accomplished all that was charted that day.

In one case that typifies how to impeach a doctor, it was clear that the doctor spent eight hours at work and, accounting for lunch, spent a little over seven hours seeing patients. But the total time it was documented that he spent on each patient would have required his time at work to be 15 hours.

As one judge stated in court: “This medical record is simply not believable. I don’t know whether to fault the hospital, the company that wrote the software, or the physician, but the only one on trial here is the physician. In medical malpractice, the record must speak for itself, but this record is worse than silent. It is egregious.”

Notes can also be problematic. One issue that frequently comes up is the actual time the patient was seen. It is the accepted practice, especially on teaching rounds, to see all patients and then write notes at the end of the day. The EMR will automatically date and time-stamp the physician’s note as the time the note was created. This gives a misleading impression of when the patient was actually seen, and in a rapidly changing clinical situation, the note may not accurately reflect the patient’s clinical condition at the time the physician actually saw him. Therefore, it’s important to state in the note the specific date and time that the patient was seen and examined.

Reading an EMR is like taking a drink out of a fire hydrant — it is bloated with repetitive data, and critical findings can easily be missed. Copying information such as entire x-ray reports and lab data into notes only adds to this problem. Because the details of the chest x-ray can easily be looked up, the x-ray should only be summarized in the note, such as, “chest x-ray normal except for right upper lobe infiltrate consistent with a viral pneumonia.”

The fundamental mantra when writing a note in an EMR is to show that you put thought into the record. Discrete data, though strongly favored by IT professionals and insurance companies, does not accomplish this. Free-text entry of three or four sentences can convey far more information than several pages of template-driven notes and will reflect that you saw the patient and put thought into the note.

All these common EMR issues — incorrect information, copy-and-paste, and poor note-taking — cast doubt on the integrity of the doctor and the medical record. While the doctor may not have committed a clear-cut act of malpractice, these types of issues in the medical record cast the doctor in an unfavorable light in front of a judge or jury.


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