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EHR vendor selection checklist for small providers

EHR vendor selection checklist for small providers | EHR and Health IT Consulting |

Selecting a quality EHR vendor is important, but just as crucial is the vendor’s ability to tailor its system to your needs.


There are literally hundreds of EHR systems out there for you to choose from, all with different pros and cons. Selecting a quality EHR vendor is important, but just as crucial is the vendor’s ability to tailor its system to your needs.


Here are some points to consider before making a final selection:


1. How much experience does the vendor have with EHR implementation? What type of stability and track record do they have?


2. Assess your physical environment and document it in a detailed list and rank those in order of importance to your organization.


3. Is the EHR system software designed to fit your organization’s needs?


4. Identify the hardware needs of your office and EHR.


5. Does the vendor offer a Software as a Service (SaaS) solution, sometimes called Application Service Provider (ASP)? Or do they require you to use client-server systems, which require a staff member to manage the entire process of updates, upgrades and backups.


6. How much can the vendor prepare for and help you get selected by CMS for Meaningful Use Stage 1 under the Medicare EHR Incentive Program?


7. Will the system be able to scale up if needed for Stage 2?


8. Will their system be relevant beyond meaningful use?


9. Will there be any trouble converting to IDC-10? Are they compliant in all other areas?


10. Can they help you avoid productivity losses and EHR transition issues?


Remember, you can reach out to Regional Extension Centers (RECs) for guidance and resources.

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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Why dual coding is the best ICD-10 strategy you will hate

Why dual coding is the best ICD-10 strategy you will hate | EHR and Health IT Consulting |

If you're scrambling to meet the Oct. 1 ICD-10 compliance deadline, why would you want to start assigning ICD-10 codes before then?

It's going to cost real money.

For example, billing systems need to be designed for ICD-10 codes and ICD-9 codes at the same time. This could be an expensive option depending on the healthcare vendor contracts.

Even if dual coding capabilities is part of the deal, it will be extra work. Which means a productivity loss. Medical practices will need to assign extra coding resources.

Assume that medical coding productivity drops 50 percent for medical coders not proficient with ICD-10 claims. That's not an unrealistic assumption at this point. Which means in the time that medical coders are assigning ICD-10 codes to four medical claims, they NOT processing eight medical claims for real reimbursement.

It's not unreasonable to expect inadequate clinical documentation for ICD-10 codes. That's going to mean more queries for clinicians. This adds up to time that medical coders and clinicians will not be preparing ICD-9 claims.

This comes at a time when medical practices are being advised to make their business practices more efficient and save cash to get through periods of delayed reimbursements after Oct. 1.

More medical coders can be hired as employees or freelancers to cover the dual coders. That means planning and budgeting for more staffing. But medical practices need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.

In addition to productivity, think about accuracy. How will medical coders know they have assigned the proper ICD-10 codes? They don't have a great deal of experience with the new code set. And they don't have a lot of opportunities for feedback before Oct. 1.

External ICD-10 testing will help gather feedback. But there may be an issue or two arranging it with healthcare payers.

Some healthcare providers create ICD-10 roundtables. Each member codes the same medical records. The roundtable looks for variances and tries to come to consensus on the correct ICD-10 codes needed.

Which can be a great process and training exercise. And expensive. More time would need to be budgeted for the ICD-10 roundtables because coding productivity is going to plummet.

 This all adds up to a real cost. Or investment.

Dual coding means:

  • Medical coders have a chance to practice ICD-10 coding.
  • Clinicians gain feedback to improve documentation.
  • Medical practices will have real case records to test with clearinghouses and healthcare payers.

Don't forget that dual coding also creates ICD-10 data. Medical practices can analyze it to add to internal medical research.

The test data also can be used to predict DRG shifts and reimbursements after Oct. 1.

Chances are that all this time and money will be investments that payoff after Oct. 1. But no one will know that unless they assess the costs of dual coding now.

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Drchrono Announces EHR for Apple Watch to Improve Doctor Visits

Drchrono Announces EHR for Apple Watch to Improve Doctor Visits | EHR and Health IT Consulting |

drchrono, an award­-winning Electronic Health Record (EHR) which includes all of the benefits of billing, practice management and an records in one place, will be the first to offer an integrated EHR on Apple Watch on April 24. The company is a leader in health technology: they were the first to build a native electronic health records (EHR) application for the iPad, offer developers an open healthcare API, a first-and-only EHR integration with Square and data sync with Box.

The drchrono Apple Watch app will revolutionize the physician office experience by providing automated, real-time communication between healthcare providers and patients. Physicians will be able to quickly view a patient’s information on their wrist, respond to patient messages via quick text and view a patient’s prescription refill request, all without having to access the EHR on their phone, iPad or web. As such, the app will be a seamless extension of the drchrono ipad, ipad, web and cloud experience.

“The drchrono Apple Watch app was designed with doctors’ busy lives in mind and is intended to make medical professionals more productive, efficient and organized,”  says Michael Nusimow, co-founder and CEO of drchrono. “Doctors are incredibly busy;  drchrono on Apple Watch gives them insights about their practice and patients just by checking their wrist. Its simply amazing to have a hands free way to gather quick insights about a patient.”

Each Apple Watch “mode” will be utilized to optimize for a physician seeing patients or on-rounds. For instance, “Glance”, which is the watch’s quick view mode will offer doctors a snapshot of their schedule. “Short Look Notifications” or short reminders, will be used to display chats or messages generated from the EHR app; a common use case could be chat messages from colleagues reminding doctors to wrap things up in advance of their next appointment. Finally, the “Long Look Notifications” mode, will offer a doctor a view of the app itself.

The drchrono Apple Watch app will be available from the Apple Watch App Store on April 24.

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Three Ways Front-Office Staff Can Improve Collections

Three Ways Front-Office Staff Can Improve Collections | EHR and Health IT Consulting |

Cash flow at medical practices can be especially slow in the first and second quarters of the year as many patients with consumer-directed health plans (CDHPs) have not yet met their deductibles.

The cash flow problem is worsening as CDHPs become more popular. According to a National Business Group on Health survey, more than half (57 percent) of employers are implementing or expanding CDHPs. This leaves many patients 100 percent responsible for their healthcare costs until they meet that deductible.

If you’re one of the independent practices — especially one with fewer than 10 staff members — dealing with this issue, here are three ways your front-office staff can help you navigate this growing problem:

1. They can focus on detailed eligibility verification. Train your staff to always confirm if a patient has coverage and if he has a copay or deductible. At a minimum, understand if the deductible has been met, but try to obtain a real-time deductible balance. Your staff should also understand benefit details tied to the services you offer and confirm if you are considered in-network for the patient. The more information on hand, the more you can prepare the patient for what his responsibility may be.

 2. They can be prepared to collect at time of service. Your front-office staff is the most important resource in the process of collecting payments up front and collecting on outstanding bills. With benefits and deductible information in hand before a patient walks in the door, your staff is already in a better position for the conversation. And it’s extremely important to establish the systems to manage and collect money because once a patient walks out the door, collection rates drop to 50 percent to 70 percent for small-dollar payments from insured patients, and to only 10 percent from self-pay patients. Make the money conversation part of your practice’s DNA and you will change your business.

3. They can offer a variety of payment options. When McKinsey surveyed consumers to ask why they would opt not to pay a medical bill, respondents cited a lack of options for payment plans, poor timing of bills, and difficulties coping with confusing statements or policies as barriers. The shift to a retail-centric approach in healthcare is here. Smartphones have built-in one-touch payment capabilities and major retail chains are working healthcare into their daily store offerings. Patients want to know what they owe up front and have multiple options to pay, especially when their responsibility is increasing. Make it easy for your patients. Accept credit or debit cards. Allow payments through mobile devices, cards on file, patient portals, monthly billing plans, or payment by check. Think of your front desk as a point of sale terminal and help your staff shift their mindset to work with patients to collect those funds any way a patient will pay.

Bonus Tip: All of these tips can be leveraged without investing in much more than staff time. Your cash flow should go up and your bad debt should decrease to help reduce your revenue cycle.

I encourage you to investigate tools and software solutions that can help your staff be even more efficient and effective with these steps. There are tools that focus on streamlining the eligibility verification process and that can provide additional insurance details in one place.

Check your EHR system for possible add-ons or leverage other Web-based solutions that focus on not only eligibility but also provide additional features for your front desk such as payment or scheduling. Look for a tool that streamlines work flow and gives you a point-of-sale system that meets your patients’ retail expectations. This can greatly reduce the expenditure on staff time and ultimately create a seamless front-desk experience.

With this continued growth in patient responsibility, practices have to adapt their systems and expect that a larger portion of their income is coming directly from the patient.

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The Status of Medical Errors Among Health IT Systems

The Status of Medical Errors Among Health IT Systems | EHR and Health IT Consulting |

While adoption of EHRs and health IT systems has been stressed among federal agencies and the medical industry in order to improve patient care and health outcomes, some issues within the health IT sector may be actually leading to medical errors among healthcare staff.

For instance, a survey from West Health Institute showed that about 50 percent of polled nurses noticed a medical error because a device or EHR system was not integrated adequately within the hospital or practice. Lack of EHR interoperability or integration may make it more difficult for doctors, nurses, and other healthcare professionals to provide effective care and avoid medical errors.

For example, if at the end of a long shift, a professional has to spend an additional two hours entering in data through an EHR or other system, he or she is more likely to make a mistake. In fact, 74 percent of respondents in the survey claimed that it was troublesome to coordinate data stored in a variety of medical devices.

Another poll of 1,224 Massachusetts residents conducted by the Harvard School of Public Health shows that 23 percent of respondents or one of their close acquaintances were involved in circumstances that led to a preventable medical error, according to The National Law Review. About half of these medical errors led to serious health consequences, the poll shows.

The most common problem that was reported is misdiagnosis of a medical condition. Most people polled in the survey did not seek data on patient safety at the medical facility they chose. Additionally, a smaller percentage – 35 percent – of polled Massachusetts residents believe that medical errors are a serious threat in the state.

One medical error that took place at Advocate Lutheran General Hospital led to the death of a baby that was born prematurely, the Chicago Tribune reports. A pharmacy technician entered the wrong data in an existing field on his computer screen when prescribing nutritional fluids to Genesis Burkett, an infant born 16 weeks early.

The error led to automated medical technology preparing an intravenous solution that had 60 times more sodium chloride than was ordered by the physician. When the prescription was given to the baby, his heart was stopped, leaving behind two grieving parents. This shows how a medical error when using health IT systems could have grave results.

“(These) technologies can be enormously helpful, but what is emerging is that when implemented poorly, they can be harmful,” Dr. Ashish Jha, associate professor of health policy at Harvard University’s School of Public Health, told the news source.

Greater EHR interoperability, device integration, and health data sharing could potentially lead to fewer medical errors within the healthcare community. The survey from West Health Institute also found that polled nurses prefer medical devices that are better coordinated and EHR systems capable of interoperability. The seamless sharing of data is being called for by many medical professionals.

“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Ross Koppel, a sociologist at the University of Pennsylvania and health IT expert, told the source.

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Did Meaningful Use Requirements Propel Hospital EHR Adoption?

Did Meaningful Use Requirements Propel Hospital EHR Adoption? | EHR and Health IT Consulting |

Ever since 2009 when the Health Information Technology for Economic and Clinical Health (HITECH) Act became law, the majority of healthcare providers began adopting EHR systems and other health IT tools in order to meet the meaningful use requirements under the Medicare and Medicaid EHR Incentives Programs and avoid the financial penalties set for 2015 and the following years.

The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) supported EHR adoption among hospitals and physician practices through a variety of resources and advisories. Recently, ONC released a data brief that outlines the high EHR adoption rates among hospitals and other providers.

The brief outlines the trends in the adoption of EHR technology between the years 2008 to 2014. ONC also tracked the implementation of certified EHR systems that meet meaningful use requirements as well as general health IT systems.

The results show that 76 percent of hospitals have a basic EHR system. This statistic has increased tremendously over the years, rising by 27 percent from 2013. Out of these reported hospitals, 97 percent have adopted certified EHR technology that meets meaningful use requirements under the EHR Incentive Programs.

Hospital EHR adoption varies significantly across states, ranging from 50 percent to 100 percent. Delaware, South Dakota, and Virginia have the highest rates of basic EHR adoption among hospitals. Kansas, West Virginia, and Hawaii were the three states with the lowest adoption rate of basic EHR systems.

State adoption of EHR systems has also risen significantly from 2008 to 2014, the ONC data brief shows. In 2008, only Connecticut and New Mexico had adoption rates of basic EHR systems above 20 percent.

By 2011, this statistic rose and 32 states had a hospital EHR adoption rate above 20 percent while seven states had a rate above 40 percent. By 2014, hospital EHR adoption rates were above 60 percent in 48 states and above 80 percent in 17 of those states. Clearly, these trends are rising significantly to meet meaningful use requirements and prevent the financial penalties under the EHR Incentive Programs.

The use of advanced functionalities within EHR systems is also increasing. For example, many more hospitals are using EHR technology that includes clinician notes. Additionally, 34.4 percent of hospitals have implemented comprehensive EHR systems in 2014.

Essentially, the adoption of EHR systems among acute care hospitals has quickly increased once the HITECH Act was passed in 2009 and providers began pursuing meaningful use requirements. State EHR adoption rates have also steadily increased among hospitals since the legislation was passed.

“A favorite question of mine, asked during the sessions and included in the report, is the following: ‘The real question is not what data we want to collect, but what problem are we trying to solve?’ I believe the real problem we are trying to solve is how to advance the public’s health wherever people live, work, learn or play, using information and data as a tool,” National Coordinator for Health IT Karen B. DeSalvo stated on the ONC website.

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Three Tips to Remain Engaged with Your EHR Vendor

Three Tips to Remain Engaged with Your EHR Vendor | EHR and Health IT Consulting |

Your physicians are using the EHR. You think you've got your arms around what it will take to manage your system over time and ensure you're achieving meaningful use. What's next? Well, you have a new vendor relationship you need to manage to ensure your EHR continues to contribute to your practice's success.

Here are three tips on managing this key relationship.

Discuss upgrade and maintenance fees

Practices will need to pay approximately 18 percent of the cost of their system each year for maintenance and support; that includes upgrades, so long as the EHR is client-server based, according to Derek Kosiorek, principal consultant with the Medical Group Management Association’s Health Care Consulting Group. If it's a cloud-based EHR, it's all baked into the cost, he said.

"Everything's negotiable until you sign the paper," said Kosiorek. Once a practice has signed a contract with their EHR vendor, they're "on the hook" for those terms.

"The best time to talk about pricing is when you buy the system," he said. "The only arrow you have in your quiver [after that] is if you're considering switching systems. And that's not a card you want to play every time you want to negotiate new terms."

Understand your vendor's upgrade schedule

"Have an understanding of the vendor's plan for future enhancements and upgrades," said Kosiorek. "Inevitably, your practice is going to want something, and the vendor will tell you that's either an enhancement or a feature request. If it's an enhancement, it has to go into the development cycle."

This is especially relevant with the evolving meaningful use regulations, according to Kosiorek, who recommends that practices get educated by their vendor on the product development cycle for the EHR.

Lil Sonntag, health IT consultant and project manager at Aurora-based Colorado Rural Health Center, recommended practices ask early on about the impact of upgrades.

"With cloud-based systems, you don't really have a choice, [the vendor just updates] it," she said. "I know they've gone through a test process, and typically those [upgrades] work really well," she said. Still, Sonntag said that product updates can break things, such as meaningful use reports.

Practices should ask up front about getting on an e-mail list of product updates and what "hot fixes" will be included in those updates, advised Sonntag.

Attend the vendor's user group meeting

Kosiorek advised practice administrators to attend their EHR vendor's user group meetings because these events present a great opportunity to talk to the vendor and fellow users. "In fact, when [practices] are negotiating their contracts [with vendors], I usually recommend that they negotiate in a couple of free tickets to the first user group conference," he said.

Practice administrators should look at the user group meeting program ahead of time and determine their current pain points because, undoubtedly, something at the user group meeting will address those concerns.

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Essential Tools for Building a Direct-Pay Practice

Essential Tools for Building a Direct-Pay Practice | EHR and Health IT Consulting |

I have been operating my direct-pay practice (I accept no insurance; patients pay me a low monthly fee for care) now for over two years. Two years means several things. First, it means that I am out of the "start-up phase" of the business; it is no longer an experiment, or a concept I am trying to prove. I am successfully making a living using an entirely different business model than most doctors in this country.

Two years also means that people see me differently. I have experienced a recent surge in patients joining my practice; many of whom were initially nervous about joining, but now see that my practice is stable.

The last thing that two years means is that I've had a chance to figure out what really works in this type of practice and what is window dressing. Here are the tools I have found most useful in building a successful direct-pay practice.

Essential #1: A good office space

I am not in a typical medical office area, but instead intentionally found a homey-looking space in a commercial office complex. I designed it to feel different from most doctors' offices: comfortable and welcoming. From the outside it looks like a house, not a medical office, and I've filled it with comfortable furniture, pleasing decorations, and coffee for patients on request. Patients will make a point to come in just to chat; and we can because our schedule allows us the extra time to connect with our patients.

This was my biggest start-up expense, but I believe it was absolutely essential in building a new mindset in my patients.

Essential #2: A staff that believes

I now have two nurses (to handle 600 patients), both of whom came from my previous practice. Both of my nurses are zealous in their belief in the direct-care model. Part of their zeal comes from the fact that their lives are so much better in this new office setting, but also, much of it is because they truly like to help patients. My practice model is all about customer service and exceeding expectations. I am really fortunate to have staff to whom that focus comes naturally.

Essential #3: The right communication tools

The one thing my patients value the most in my practice is access to me and my staff. If they have questions, they can call the office or reach me via secure messaging. While it's technically OK to use e-mail for communications (as long as patients sign a HIPAA waiver), I found that most of my patients value security in communication over ease of use. Here are three ways I communicate with my patients:

1. A good phone system. I use Ring Central which is a VOIP Internet phone system, which allows me to cheaply have a complex phone system. Voicemails are e-mailed to me; faxes are also received and turned into e-mails. I can text with patients as well as hold a conference call. It has its flaws, but overall we get a lot for a low price.

2. Messaging system. I use Twistle, which is a HIPAA-compliant "chat" system. This might be the tool my patients value the most. It works like a secure chat, with apps available for Apple and Android phones. It also notifies me via e-mail when patients have tried to contact me, and my nurses can be copied on the messages as well. I can securely send lab reports (as PDF files) or handouts regarding conditions as attachments, and patients can send images (rashes, wounds, etc.) to me from their mobile app.

3. E-mail system. While I don't encourage e-mail communication, some patients prefer it. We use our own domain hosted on Google's Gmail website. It's very easy to use and extremely affordable.

Essential #4: Billing systems

I experimented with several billing systems. I initially used Intuit Quickbooks and their integrated billing features. For a while I used ADP's automatic billing system, which worked fairly well, but didn't integrate well. Most recently, a new start-up, Hint Health has built a very elegant and easy-to-use billing system specifically designed for direct-care practices. They are very easy to work with, and solve issues quickly and easily. They also integrate with several EHR systems, and are always open to further integrations.

Essential #5: Facebook

Hands-down, the best marketing tool I have is my Facebook page. Not only does it provide an easy communication tool for patients and those interested in my practice, but I can promote posts to the exact demographic I am interested in. I promote any specials I am running for new patients, but I also promote posts or articles that highlight how my practice is different. The money I've invested here has paid itself over manyfold.

There are other tools I use regularly, but these are what I consider essential, and without which I could not have created a successful direct-pay practice.

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3 Privacy, Security Takeaways

3 Privacy, Security Takeaways | EHR and Health IT Consulting |

This year's Healthcare Information and Management Systems Society Conference was bigger than ever, attracting more than 43,000 attendees. And the hot topics of privacy and security came up frequently at many sessions, interviews and informal chats during the event.

Three key themes that emerged are EHR interoperability challenges, emerging cyberthreats from hackers and potential new breach targets.

EHR Interoperability

 If we could just start eliminating some of the easy ways that attackers can get in, that more than anything will have the biggest impact. 

Secure, nationwide health data exchange is a top goal of the Department of Health and Human Services' Office of the National Coordinator for Health IT. Certainly, the mass adoption of electronic health records by medical professionals and hospitals participating in the HITECH Act "meaningful use" incentive program, which launched in 2009, has brought the industry to a tipping point for the use of digitized records, as ONC's leader Karen DeSalvo pointed out several times during HIMSS 2015.

Securely sharing that data locally, regionally and nationally can potentially improve care coordination, and hopefully improve patient outcomes and reduce costs. But the path to true EHR interoperability, which paves the way for data sharing, is riddled with many small potholes and several large obstacles. That includes technology standardization and application programming interface issues that need to be sorted out by health IT vendors.

And for healthcare providers, it also means having more clarity about trust issues, including a better understanding of HIPAA - such as what data can and cannot be shared with other healthcare providers, with or without patient consent.

There's also a need to harmonize, or, at the very least, better understand, the patchwork of state privacy laws that complicate health information sharing.

Data segmentation and electronic patient consent technology - if implemented properly - hold promise for protecting the privacy of patients' most sensitive health information, including records of mental health, substance abuse and reproductive health treatment.

Another major hurdle for achieving interoperability: intentional and unreasonable information blocking among healthcare providers and vendors who use a variety of tactics that prevent the sharing of patient data. Unfortunately, those tactics include some healthcare providers inappropriately using HIPAA as an excuse to not share patient records.

Lucia Savage, ONC's privacy officer, noted in discussions at HIMSS that the agency is working with the Department of Health and Human Services' Office for Civil Rights to assess those situations where healthcare providers inaccurately blame HIPAA for why they won't exchange or release patient information.

Evolving Threats

It's no surprise that the recent hacker attacks against Anthem Inc. and Premera Blue Cross were hot topics at this year's HIMSS. Unfortunately, security experts at the show made it clear during educational sessions and one-on-one discussions that those attacks are just the tip of the iceberg of sophisticated external threats that the healthcare industry is facing.

Plenty of other healthcare organizations also have had significant breaches, committed by bad guys externally and internally or triggered by mistakes by insiders and business associates. But unfortunately, far too many have yet to detect these breaches.

The bottom line is that healthcare organizations need to ramp up their risk management programs to improve breach detection as well as prevention, moving well beyond a narrow focus on HIPAA compliance. "If we could just start eliminating some of the easy ways that attackers can get in, that more than anything will have the biggest impact," security expert Mac McMillan, CEO of CynergisTek, told me during an interview at HIMSS.

The Next Targets

But who will hackers be targeting next? In interviews at HIMSS, those singled out as potential targets were business associates - especially cloud vendors - self-insured firms, health information exchanges, and systems containing health data from consumer wearable devices.

"Hackers are bad guys, but they're good economists," Dan Berger, CEO of risk assessment consulting firm Redspin, told my colleague Howard Anderson during an interview at HIMSS15. "By that what I mean is it's all about a rate of return." As a result, hackers will target "large data stores of PHI" to maximize their ability to grab information that they can sell, he says.

Berger argues that larger business associates, which have access to huge amounts of patient information, as well as major self-insured companies that store health data on their employees, could be the next targets for hackers.

Meanwhile, McMillan predicts that health information exchange organizations also could be targeted because of the large amount of data they handle. And when it comes to consumer-generated health data that patients increasingly want to share with their providers, "we're moving fast in these technology areas, and we don't have all the privacy and security answers yet," McMillan told me.

Setting Priorities

So, now that we've reached the tipping point in digitizing health information for millions of patients across the country, sharing that data securely - and keeping it safe while it's at rest - will need to be a perpetual mission for healthcare organizations and their business associates. I just hope they're prepared to handle that mighty challenge, and that many more entities will make significant progress in protecting patient data before the next annual HIMSS conference rolls around.

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Epic latest to drop fees for data exchange

Epic latest to drop fees for data exchange | EHR and Health IT Consulting |

It seems that all anyone had to do was ask. Just a few days after the Office of the National Coordinator reprimanded EHR vendors such as Verona, Wis.-based health IT giant Epic – and many others – for charging fees for exchanging patient data, Epic CEO Judy Faulkner reportedly announced at HIMSS15 in Chicago last week Epic would drop fees until at least 2020, the Milwaukee Business Journal reports.

"Most complaints of information blocking are directed at health IT developers," wrote ONC in a report to Congress earlier this month. "Many of these complaints allege that developers charge fees that make it cost-prohibitive for most customers to send, receive or export electronic health information stored in EHRs, or to establish interfaces that enable such information to be exchanged with other providers, persons, or entities."

While not naming names, the report holds that "some EHR developers allegedly charge a substantial per-transaction fee each time a user sends, receives, or searches for (or 'queries') a patient’s electronic health information. EHR developers may also charge comparatively high prices to establish certain common types of interfaces – such as connections to local labs and hospitals."

In addition to Epic, other health IT companies – athenahealth and Cerner among them – had declared earlier they would absorb the fees, taking the burden off their clients.

It's a practice that had been going on for years. Perhaps sometimes all it takes is a good scolding.

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HITECH Helped Promote EHR Use, but Usability Issues Remain

HITECH Helped Promote EHR Use, but Usability Issues Remain | EHR and Health IT Consulting |

While the recent push to adopt health IT systems has helped to improve care and reduce costs, issues with usability and interoperability require further federal attention, according to a study published in the Journal of the American Medical Informatics Association, FierceHealthIT reports.

Study Details

For the study, University of Edinburgh researchers interviewed 47 U.S.-based health IT stakeholders. The researchers sought to determine whether health IT has helped to achieve the Institute for Healthcare Improvement's "triple aim," for health care. The triple aim includes:

  • Enhancing population health;
  • Improving patient care; and
  • Reducing health care costs.

The stakeholders interviewed included:

  • Government employees;
  • Health IT experts;
  • Health policy experts;
  • Patient advocates;
  • Payers;
  • Providers; and
  • Vendors.
Study Findings

The researchers found "a widely shared belief" that the HITECH Act spurred the adoption of a digital infrastructure that is being used to improve the quality of care while reducing costs.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

However, there was concern among physicians regarding the usability of:

  • Electronic health records; and
  • Computerized decision-support systems.

Physicians said the systems were immature technologies that had been written based on old code designed for hospital billing. In addition, physicians said they considered currently used EHR technology to be inadequate in:

  • Supporting multidisciplinary teamwork; and
  • Incorporating quality measurement into care delivery.

Both physicians and vendors said meaningful use requirements present a distraction from more development and clinical priorities.

In addition, many respondents reported that it is important to move toward value-based care driven by data and high levels of care, and away from fee-for service payment models.

Policy Recommendations

During the interviews, many respondents suggested that CMS and the Office of the National Coordinator for Health IT require vendors to open their application program interfaces and encourage collaboration with:

  • Small vendors; and
  • The medical informatics community.

The two areas that were considered the biggest policy issues were:

  • Further financial reform; and
  • Interoperability.

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Important Features For Your Practice Computers

Important Features For Your Practice Computers | EHR and Health IT Consulting |

Medical computers are an essential element of the modern health care system. They help increase efficiency in every setting from the front office to exam rooms, surgery, and radiology departments. Choosing computers for your practice is an important task, so here are some features to look for:

Sanitation Promoting Features

A clean environment is indisputable in health care facilities, and a critical component of a medical grade computer is their ability to support one. Hygiene-promoting features on your practice computers should include the following:

  • Sealed enclosure resistant to liquid and can be cleaned with disinfectant.
  • Antimicrobial coating on keyboards and monitors or all-in-one computers.
  • Fanless design to reduce dirt accumulation in the system and dust from circulating.
  • Minimal crevices that are potential homes for bacteria.

Mobility and Accessibility

When medical computers are mobile and accessible, health care organizations can save time, money and improve patient care. Nurses and doctors can bring computers with them on patient rounds or during check-in. This accessibility in medical computers lets doctors and nurses focus on patients, not hardware, during appointments. Look for computers that fit into a variety of settings, whether they can be placed on wall mounts, medical carts or nursing stations. VESA mountable computers are the preferred industry standard. The medical computer supplier you choose should offer assistance in installing your computers where you need them. Also, check for an internal lithium battery that allows for mobility without interrupting data management.

Touchscreens are another significant option that lets caregivers focus on patients. When they are easy to use, caregivers can easily enter data and interact with the computer, while still giving attention to patients. Medical Computer touchscreens are also more hygienic since they can come with an antibacterial coating.

Administrative Tools

A high performing and efficient hospital or clinic has central coordination, and medical grade computers reinforce this. With medical grade computers, administrative staff can enter and edit a patient’s medical, insurance and billing information in a patient environment. Each computer on the network should have access to this information, with a setup that allows for HIPAA compliance. Elimination of redundant inputs, reduction of errors and the switch to electronic rather than paper billings all save costs.

Low-Cost Installation

While changing to a medical computer system or getting an overhaul of your current system will undoubtedly involve some expense, you can minimize it in a few ways. One is by choosing a system compatible with as much of your existing systems as possible. For example, inquire about the extent of inputs and outputs that would be necessary with a new system; you may be able to make use of parts of your current system and thus save trouble and money from redundant equipment purchases.

Another way to reduce the initial investment cost is to consider the time and resources required to get doctors and other employees able to operate the system. First, software should be easy to use. Look for medical grade computers that support your preferred software programs or that come with new software that is simple to learn. Insist on getting a free trial before committing to a purchase.

Second, be sure to train employees before your upgrade is complete. Extra time from tutorials is expensive to a hospital or clinic, so find out how long it typically takes for users to master the system. If possible, purchase your medical computers from a company that provides follow-up support..

Cloud-Based Systems

Your practice computers need to be compatible with the cloud. As recently explained on this site, 96 percent of health care organizations are using or considering the cloud. Those who do can hope for average cost savings of 20 percent each year.

Using the cloud has additional advantages over cost savings. It allows for unlimited storage and frequent backups. Also, storage on a remote server rather than a large server on site prevents the risk of losing data in case of a flood, fire, etc. Check for a computer with EN/UL 60601 medical certification with which protects against power surges, failures and improves on-site safety.

A quality medical grade computer has a number of important characteristics that allow for reduced costs and upgraded patient care. Keep a list of necessary features in mind when you shop for your new computer or system, and your health care organization may soon see benefits.

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EHR Certification Standards Allow Health IT Design to Evolve

EHR Certification Standards Allow Health IT Design to Evolve | EHR and Health IT Consulting |

Health IT design and the development of EHR certification standards are dependent upon federal regulations, which need to address today’s physician needs as well as future demands in the healthcare industry. This is why the Stage 3 Meaningful Use proposed rule offers more flexibility for doctors and EHR developers who can now focus on meeting their medical establishment’s unique requirements. interviewed Amit Trivedi, ICSA Labs Program Manager of Healthcare, to hear more about the EHR certification process and the importance of developing EHR certification standards that are useful in future years throughout the healthcare industry.

“There is always that push and pull between what are people doing today, what works today, what can I use today and then what is going to be the best thing for me down the line — whether it’s two years, four years, five years, or later,” Trivedi stated.

The ICSA Labs Program Manager of Healthcare also mentioned an important element when it comes to the first steps of designing EHR technology.

“When you get down to standards and how certification influences standards, one of the things that is most important is laying a baseline or foundation for folks to know where to start when they’re developing product,” he said.

Trivedi outlined how the beginning of the EHR certification standards development and the design of health IT systems truly had few regulations to follow. Developers were deciding what actions to take without much guidance. That changed quickly, however, when the Centers for Medicare & Medicaid Services (CMS) unveiled the EHR Incentive Programs and analogous meaningful use requirements.

“Early on when I was working with one of the only testing/certification bodies out there, there wasn’t really that big federal push laying down which standards were required. It really was the Wild West,” Trivedi explained. “Everyone was using their own version or flavor of HL7 or their favorite document for sharing clinical summaries. But we have been slowly narrowing things down to get closer to a shared vision, starting with some of the meaningful use and 2011 Edition criteria. There you saw the beginning of coalescing into single standards.”

Trivedi went on to discuss how many current EHR certification standards are established in ways that allow health IT design and certification to evolve over time. The latest 2015 edition of EHR certification standards, for instance, lay a foundation that allows system design to expand in multiple ways.

“Right now where we’re at the 2014 Edition and the newly proposed 2015 Edition rules lay out some very solid standards in terms of baselines or a floor that the industry can look to adopt and evolve on,” Trivedi said. “There are other standards like FHIR that may not be quite production-ready yet, but those are things people want to keep an eye on and it is a hot topic, no pun intended. There are a lot of folks with their eyes on that standard, including the ONC through their standards advisory work.”

The EHR certification expert also discussed how meaningful use requirements play a role in moving the objectives of health IT implementation forward. Currently, the exchange of healthcare data is an imperative aspect of Stage 2 Meaningful Use regulations. For the next step after Stage 2, physicians will need to demonstrate direct improvements in patient care.

“With the 2011 Edition and Stage 1 Meaningful Use, it is really about getting technology into the provider space. Let’s shift the conversation from moving from paper to electronic and let’s get everyone on an electronic platform,” Amit Trivedi said. “Stage 2 (and then the 2014 Edition) is the first time providers and EHRs are being asked to exchange that information. So we’re actually just at the beginning of that. We’re in to 2015 but we’re still in the middle of Stage 2 right now.”

“Now finally you’re seeing people being required to and asked to exchange that data,” Trivedi continued. “And then with the later stages, Stage 3, the idea is now that you can exchange data, what can you do to demonstrate that care is improving. How can you use that data to improve care, to collect metrics, and to demonstrate that these changes are happening.”

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Modifications to Meaningful Use for 2015 through 2017

Modifications to Meaningful Use for 2015 through 2017 | EHR and Health IT Consulting |

On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

Better Care, Smarter Spending and Healthier People
The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.

Vision for the Future

The proposed rule issued today is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”). This will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.

Simplifying and Streamlining

The proposed rule would streamline reporting requirements. To accomplish these goals, the NPRM proposes:

  • Reducing the overall number of objectives to focus on advanced use of EHRs;
  • Removing measures that have become redundant, duplicative or have reached wide-spread adoption;
  • Realigning the reporting period beginning in 2015, so hospitals would participate on the calendar year instead of the fiscal year; and
  • Allowing a 90 day reporting period in 2015 to accommodate the implementation of these proposed changes in 2015.

Supporting Interoperability and the Adoption of Electronic Health Records

The EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers and patients to exchange and access health information electronically and support interoperability broadly. The program supports interoperability by requiring the capture of data in structured formats as well as the exchange of data in standardized form as well as the sharing of this data electronically with other providers and with patients.

The proposed rule would reduce required reporting, allowing providers to focus on objectives which support advanced use of EHR technology and quality improvement, including health information exchange.

Improving Outcomes for Patients

The rule would support improved outcomes and measurement of those outcomes. By proposing to simplify the reporting requirements, the proposed rule would allow providers to focus on objectives that support advanced use of EHR technology, including quality measurement and quality improvement. The rule supports providers leveraging their resources and health IT to coordinate care for patients, to provide patients with access to their health information, and to support data collection in a format that can be shared across multiple health care organizations.

Program Registration and Participation Milestones

As of March 1, 2015, more than 525,000 providers have registered to participate in the Medicare and Medicaid EHR Incentive Programs. In addition, more than 438, 000 eligible professionals, eligible hospitals, and CAHs have received an EHR incentive payment. As of the end of 2014, 95% of eligible hospitals and CAHs, and more than 62% of eligible professionals have successfully demonstrated meaningful use of certified EHR technology.

Sujaya's curator insight, April 21, 3:40 AM

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FDA to use EHR data for drug monitoring

FDA to use EHR data for drug monitoring | EHR and Health IT Consulting |

The FDA is offering a grant of up to $1 million to turn large amounts of EHR data into numbers the agency can use to gauge the effectiveness of FDA-approved drugs.

The intent is for the FDA to continually assess the drugs after they go to market, as mandated by law.

To that end, the FDA launched its Sentinel Initiative, a long-term program designed to build and implement an electronic system for monitoring the safety of medical products in the post market setting.

The agency has created infrastructure on which to run the program through its Mini Sentinel pilot, a distributed database with access to more than 150 million patient records has been created (the Sentinel Distributed Database).

In order to optimally leverage the data, however, new analytic methodologies will be required.

According to the notice posted in the Federal Register, eligibility is limited to the Reagan-Udall Foundation, which has established the IMEDS-Methods program, which is uniquely positioned to develop the new methodologies required for FDA to conduct effective active post-market safety surveillance of medical products using large electronic healthcare data.

The IMEDS organization has developed a network of statisticians, epidemiologists, data scientists and clinicians who have experience operating in both the IMEDS research laboratory and also familiarity with the Sentinel Distributed Database. In addition, through the Reagan-Udall Foundation public-private partnership, the IMEDS-Methods program has a unique ability to convene FDA, patients, academics, government and industry so that the findings and tools developed through its research agenda will be promulgated and adopted.

Applications deadline is June 15. The one-year grant period begins a month later.

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First Apple Watch health IT apps bring important messages to the wrist

First Apple Watch health IT apps bring important messages to the wrist | EHR and Health IT Consulting |

Many of the first Apple Watch health IT apps will give doctors faster access to critical information and ease communication between health care providers, while other apps will attempt to get patients more engaged with their health.

Don’t expect doctors to glance at their wrists to view X-rays or a patient’s chart, though. Given the Apple Watch’s screen size, functions that involve text messages work best on the device.

 “Doctors get that the watch is a tool to help them deal with information overload,” said Michael Nusimow, CEO of drchrono, which makes EHR (electronic health record) software.

Like many other companies in the health space, drchrono announced its app this week at a large health IT conference put on by the Healthcare Information and Management Systems Society, a nonprofit that looks to use IT to improve medical care. About a dozen companies in the health care industry announced their Apple Watch apps this week.

EHRs can overwhelm a physician with troves of data on a patient, Nusimow said.

With drchrono’s Apple Watch app, doctors can receive relevant and important information, such as when a patient arrives at the office. The app can also provide them with the patient’s vital statistics and pictures.

The watch is better suited for tasks like getting text notifications, while the iPad and iPhone, which drchrono also has apps for, can handle functions that require bigger screens, like reviewing charts, Nusimow said.

Watches are more socially acceptable than smartphones, making them ideal to handle messages and notifications, said Vik Kheterpal, principal at CareEvolution, which develops the technology behind health information exchanges.

CareEvolution worked with health insurance provider Anthem to develop its Apple Watch app, which was announced this week. The app, called cFHR, is designed to provide Anthem customers with timely health information. The app, for example, will remind patients to check their blood pressure or alert them about possible medication interactions.

While the iPhone can complete the same tasks as the Apple Watch, there’s a nuanced difference between the devices, Kheterpal said.

People depend on smartphones to instantly convey information. But as the devices have become larger, people may find them a bit cumbersome to constantly remove from their bag or pocket. Plus, some aspects of smartphones, like the devices inopportunely ringing, are social taboos, he said.

The Apple Watch, by comparison, is an extension of the phone, always on a person’s wrist and reliably delivers notifications, Kheterpal said.

The Apple Watch won’t replace the iPhone, said Nate Gross, co-founder of Doximity, a startup that operates a social network for U.S. physicians.

With its app, Doximity was looking to offload some functions to the watch, but save a majority of the tasks for the iPhone.

“We focused on messaging because in the clinical setting, there are a number of times when you just don’t want to take out your phone to start texting,” said Gross.

In some situations, doctors may find that speaking is a better option that typing, he said. For instance, they may prefer to dictate patient notes instead of type them into an iPhone.

While an iPhone app can receive messages, doctors may not hear the phone or feel it vibrate if they place the device in their pocket or lab coat, said Gross.

Doximity’s app, which was announced last week, allows physicians to view messages sent to them from other doctors who use the company’s social network and also to receive alerts when a fax arrives.

In health care, “time is tissue” and delivering alerts to a person’s wrist may help a doctor view an urgent message more quickly, he said.

Some physicians who work long hours may need to extend the Apple Watch’s 18-hour battery life to the get the most from their health IT apps, Gross added. Emergency room doctors and medical residents can work 24-hour shifts.

Some may purchase third-party watch bands equipped with batteries while others will charge the device during their shifts, he said.

“We will see friction occur on battery life for very specific doctors rather than doctors as a whole,” said Gross. Physicians aren’t accustomed to owning watches that require nightly charging, he added.

Mareq's curator insight, April 25, 12:05 PM

Great idea!!

Defamation Suits Against Patients: Three Big Risks

Defamation Suits Against Patients: Three Big Risks | EHR and Health IT Consulting |

There are rare times when an online review is so damaging that a doctor must file a defamation lawsuit, such as when the review accuses the doctor of criminal behavior or serious malpractice. The reputational harm of that type of review is simply too great to ignore.

For most other negative reviews, however, your best bet is to take a deep breath and ignore it. The risks of filing a lawsuit are too high. Here are three of the biggest risks of filing a defamation lawsuit against a patient.

The Penalty Imposed by Anti-SLAPP Laws

About half of the states have passed laws prohibiting "Strategic Lawsuits Against Public Participation," or "SLAPPs." SLAPPs are lawsuits intended to silence critics by burdening them with the costs of defending a lawsuit until they stop the criticism.

Anti-SLAPP laws try to reduce the lawsuits that are filed to restrict free speech and have been successfully used to defend against defamation cases filed by doctors.

These laws vary by state. For example, in California, the anti-SLAPP statute allows a defendant to file a special motion to strike the complaint when the defendant's supposed bad conduct arose from his "right of petition or free speech under the U.S. Constitution or the California Constitution in connection with a public issue." Posting an online review almost certainly fits this requirement.

After the defendant files this special motion, the court will dismiss the complaint "unless the court determines that the plaintiff has established that there is a probability that the plaintiff will prevail on the claim." This is not a high standard, but losing this motion can mean paying a penalty: not only will the court dismiss the lawsuit, but it will also order the plaintiff to pay the defendant's attorney's fees.

Here's a real-life example: In 2009, a California dentist filed a defamation lawsuit against a patient based on a Yelp review that said, in part, "don't go here, most painful dentist ever." The patient filed a motion to strike under the anti-SLAPP statute and won. The complaint was dismissed and the patient was awarded $43,000 in legal fees. The doctor filed a second complaint, and the case was dismissed again; this time the patient was awarded $26,000 in legal fees. In 2013, the California Supreme Court refused to allow the doctor to revive his lawsuit.

Not only did the dentist pay his own legal fees in this case, but he also paid an additional $69,000 for the patient's legal fees. Anti-SLAPP laws are a serious deterrent against filing defamation lawsuits.

Appearance of Bullying and Greater Exposure of Negative Reviews

Another risk of filing a lawsuit is the appearance that you are bullying a patient and the related risk that your complaint will bring more attention to the negative review than simply leaving it alone.

This is sometimes known as the "Streisand effect." In 2003, Barbara Streisand sued a photographer for $50 million for taking aerial pictures of her home in California. She claimed the photographs violated her privacy. Her lawsuit, however, drew massive media attention and, according to some reports, over 400,000 people ultimately viewed the pictures of her home online.

The public may view a lawsuit by a doctor as an effort to bully a patient into removing a bad review. Public criticism may be harsh, even if the review contains demonstrable untruths. For example, in the McKee v. Laurion case discussed earlier, the story of physician McKee's lawsuit was picked up by a local newspaper and then was posted on the popular website Reddit. According to McKee, he received dozens of negative reviews on RateMDs, including one that called him the "d*ckface doctor of Duluth." Plus there was extensive media coverage of the case — much of which was sympathetic to the patient.

Defending (or Losing) the Lawsuit

Lawsuits are public events. The filings are generally available to anyone who wants to read them, and the media often finds defamation lawsuits irresistible, particularly if the allegations are salacious.

Winning a defamation lawsuit may be an uncomfortable experience. Defendants will often claim that the review is true and therefore not defamatory. Part of litigation will include answering questions about whether the statements are true.

Let's take a hypothetical example. A review by a former patient on RateMDs says that you had a sexual relationship with her when she was a minor. You sue the patient for defamation. During your deposition, your personal relationships with any patient (adult or minor, current or former) will be the topic of questioning. Even if you have nothing to hide, having your personal life under a microscope is an unsettling process.

The bigger risk, though, may be losing the lawsuit altogether. Losing a defamation lawsuit will forever leave the impression that the review is accurate. This is an unfortunate result since you can lose a lawsuit for any number of reasons.

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As CMS Becomes Lenient, Providers Tackle Patient Engagement

As CMS Becomes Lenient, Providers Tackle Patient Engagement | EHR and Health IT Consulting |

While patient engagement remains a top priority for many medical organizations across the country, the Centers for Medicare & Medicaid Services (CMS) released a proposed ruling modifying meaningful use requirements and specifically relenting on a major patient engagement objective.

Previously, Stage 2 Meaningful Use requirements called for 5 percent of a provider’s patient base to access, download, and/or transmit their electronic health information, but now this objective has been changed for the years 2015 to 2017 in the proposed ruling. If the proposed rule becomes initiated as part of the meaningful use requirements for the next several years, eligible hospitals and physicians will need to ensure that just one patient views, downloads, or transmits their electronic medical data.

Even though CMS may be changing some patient engagement requirements, healthcare providers are still geared toward improving patient satisfaction as well as medication adherence. At the 2015 HIMSS Annual Conference and Exhibition in Chicago, the company TowerView Health was announced the winner of the 9th annual Venture+ Forum pitch competition meant for startups, according to the company’s press release.

Last week, 15 startup companies were chosen to take part in pitching live presentations to a panel of investors and healthcare experts. TowerView Health pitched to the investors a solution that assists patients with chronic diseases manage their complicated medication schedules.

TowerView’s pillbox allows patients to receive a pre-filled medication tray directly from their pharmacist. This pillbox is capable of sending reminders to patients if they miss a dose or don’t take a prescribed drug on time. The company works with health plans and at-risk providers to offer this particular service to patients for free.

“HIMSS and the mHealth Summit are focused on creating opportunities, providing business-building content, fostering partnerships and supporting entrepreneurs and early-stage companies developing innovative new health technologies.  The Venture+ Forum is an excellent resource for companies to network and connect with healthcare providers, payers, channels, institutions and strategic dealmakers,” Richard Scarfo, Vice President of Personal Connected Health Alliance at HIMSS, said in the press release.

TowerView Health isn’t the only organization looking to increase patient engagement. For example, HealthPrize Technologies, LLC and MeadWestvaco are collaborating on a new patient engagement and medication adherence platform, according to a news release.

Another organization called IntegraMed Fertility has adopted web-based patient engagement applications that are likely to revolutionize care and patient satisfaction through this network. The Patient PLUS portal from Anthelio Healthcare Solutions provides a much-desired self-service aspect that’s missing from much of the medical industry. These self-service capabilities include automating appointment scheduling and pre-registration. It also allows for viewing and accessing medical histories, electronic records, laboratory results, and radiology reports while at home or in a healthcare setting. Secure messaging tools for strengthening the patient-physician relationship are also available through this portal.

“Patient PULSE is a perfect fit for these patient-centered clinics, as it provides a multitude of ways to personalize the patient portal experience, providing additional support and communication opportunities for patients while empowering them to take a more active role in their care,” Asif Ahmad, CEO of Anthelio Healthcare Solutions, said in a public statement.

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EHRs Could Help Patients Maintain Health Insurance 'Stability'

EHRs Could Help Patients Maintain Health Insurance 'Stability' | EHR and Health IT Consulting |

Electronic health records could be used to help patients track and maintain their health insurance coverage, according to a study published in the Journal of the American Medical Informatics Association, FierceEMR reports.

Study Details

For the study, researchers examined 69,189 pediatric patients':

EHR coverage data;
Medicaid coverage data; and
Reimbursement data.

Participants were selected from 96 safety-net clinics in the Oregon Community Health Information Network.

The researchers sought to determine whether EHRs could:

Help primary care clinics validate coverage in real time; and
Help patients maintain care continuity by providing insurance enrollment and retention support.

Study Findings

Overall, the study found EHR data had a high agreement level with Medicaid and reimbursement datasets. In some cases, the EHR data were more accurate.

Therefore, the study concluded that EHRs could be used to validate patients' coverage.

The researchers wrote that the findings "presen[t] validation for using the EHR as a source of health insurance information and sugges[t] that confidence in this information is possible." In addition, they wrote that the results also could "support development of EHR-based tools that inform clinic staff about patients' health insurance status, and engage staff and patients in ensuring insurance stability".

The study recommended further research on the topic.

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Work-Life Integration for Physicians

Work-Life Integration for Physicians | EHR and Health IT Consulting |

While I was preparing a talk on work-life balance, I stumbled across a 2014 article in Harvard Business Review by Stewart Friedman. It is worth reading for all those in search of work-life balance, although he argues that the whole idea of balance is the wrong way to approach the issue. Mr. Friedman articulates the concept of work-life integration: instead of viewing yourself being pulled in different directions (work, family, self), you consider how the various parts of your life overlap and integrate.

In the article, he describes several different exercises that can help you consider your own ability to integrate the personal and professional arenas, as well as identifying the skills you will need to achieve improved integration. What I like about his method is that there is not a "one size fits all" approach in which it is verboten to check e-mail at the dinner table or zone out on your morning commute. Instead, he challenges his readers to experiment, test, and explore what works best for each individual.

So, over the past week, I've been considering my own work-life integration. Truthfully, it still feels like a balancing act rather than a friendly merger. However, by using some of his exercises, I can report a recent success. In January, I changed from a primarily clinical to a primarily administrative/leadership role in my organization. One thing I failed to consider as carefully as I should have was the time demands for "after-hours" meetings and events. With young children at home, I am fiercely protective of the dinner time to bed time window. As a physician, I am used to being at work late or being called back to the hospital, but these demands somehow feel better than skipping dinner just to attend a meeting. Patient care can occur at all hours, meetings shouldn't.

My promise to my family and myself was to limit my late evenings to once a week. However, I started the month of April with seven or eight requests already and became concerned about my ability to be professionally and personally successful. I started with a heart-to-heart with myself. Truthfully, my amazing stay-at-home husband could handle it if I was away from home more often than just once per week. While I was concerned about childcare/homework/bedtime items, I knew that it was more than that. The fact is, I love my family and enjoy spending time with them. Even if it is just being silly around the dinner table or watching DVDs of old 80s sitcoms that my kids love now as much as I did then, that time can be the best part of my day. I am not willing to give it up, even for career advancement.

I concluded that my first resolution was the right approach — a maximum of four evenings per month. Next, I reviewed the invitations and requests on my time and determined that I needed to both prioritize and strategize, first on my own, and then with my boss. I am happy to say I was successful on both fronts, and now feel that I am achieving a balance between professional and family demands.

Desire to succeed at work can easily eclipse family obligations. But this physician found a way to integrate both goals into her life.
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Tech Tools to Boost Patient Collections

Tech Tools to Boost Patient Collections | EHR and Health IT Consulting |

With the proliferation of high-deductible health plans under the Affordable Care Act, patient payments have become a bigger chunk of many practices' revenue. As a result, experts say physicians should be developing more sophisticated collection strategies that take advantage of technology to help get money in the door.

Used effectively, technology can help smaller practices stay on top of patients' coverage and financial responsibilities under the new high-deductible plans, as they may be new to both practice and patient. Many newly insured patients are unaware of the service-level details of their policies. So it's important to give your staff readily available information about coverage, balances, and answers to frequently asked questions.

Technology can help you streamline processes at the front desk to facilitate collection at time of service, provided that you invest in staff training, said Colleen Fusetti, a director at FluidEdge Consulting in Malvern, Pa.

"You need to put a lot of emphasis on training staff to use the technology and understand patient balances and payment options so that they, in turn, can educate the patient," she said. "The ability to collect drops considerably after the patient walks away from the front desk."

Fusetti and other revenue cycle management experts also offered these tips for getting the most out of your technology tools to improve patient collections:

• Set up a patient portal. The portal allows patients to check their eligibility and claims data and view or pay their balances online.

• Integrate an insurance eligibility service into your practice management and EHR systems. Some services allow you to run a verification check on every patient scheduled for a visit over the next few days so that you can reach out to patients in advance to get new insurance information, if needed.

• Use an automated appointment reminder service. The services not only remind patients about upcoming appointments but also link patients to the portal where they can see any pending balances, make payments, and review their coverage before arriving.

• Consider online credit card processing. You can accept credit or debit card payments from any Internet-enabled device linked to a mobile card swiper.

• Set up automatic payments. Many merchant service companies offer an option to keep patients' credit card information on file securely. After discussing financial responsibility for a future procedure or service, patients can decide whether to authorize a one-time payment pending final calculation of their bill or set up a payment plan with recurring payments.

• Take advantage of online resources. The AMA offers a Point-of-Care Pricing Toolkit free to its members. The resource provides tools to help practices collect what patients owe at the time of service.

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Interoperability, Usability, and Meaningful Use Stage 3

Interoperability, Usability, and Meaningful Use Stage 3 | EHR and Health IT Consulting |

Satisfaction and usability ratings for certified electronic health records (EHRs) have decreased since 2010 among clinicians across a range of indicators.” This announcement was made two years ago the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition by Michael S. Barr, MD, MBA, FACP. His presentation highlighted “ the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability.

The Electronic Health Record Association (EHR Association), a non-profit association of more than 40 EHR companies, created an electronic health record (EHR) Developer Code of Conduct, which aims to encourage transparency and collaboration among EHR developers, as well as developers, providers, and industry stakeholders.

On the first page of the EHRA code of conduct, the very first item (after a general statement) is Patient Safety. The code says:

Recognizing that patient safety is a shared responsibility among all stakeholders in an increasingly health IT-enabled, learning healthcare system: We are committed to product design, development, and deployment in support of patient safety. We will utilize such approaches as quality management systems (QMS) and user-centered design methodologies, and use recognized standards and guidelines.

The terms User-centered design (UCD), Usability, and User eXperience (UX) have been used over the years to describe the work of the software professionals that specialize in the human-computer interaction. “Software Human Factors” is the field of study that applies the methodologies of Human performance and ergonomics to software. Instead of trying to design objects that work with the physical attributes of the human body, experts in Usability and User-centered design virtual interactions that work with the mental capabilities of human minds.

They were great for mathematicians, but the general public was really confused about how they worked. They were confused because in order to perform even the most basic mathematical functions people had to think differently. They had to think like the mathematicians.

Adding up a series of numbers was simple. All one had to do is key in a number, press , key in the next number, press , and then press the plus key to calculate the sum of all the numbers entered. As Easy as π!

The problem with these calculators was that the design of the user interface focused exclusively on expert users and these experts were a very limited sample size. The answer to fixing the calculators was User-Centered design. UCD is a design philosophy that creates a culture of understanding and enabling end users to perform their tasks using an information architecture and taxonomy that matches their mental model.

After changing the user experience to match a more common understanding of arithmetic, e.g. key in a number, press plus, key in another number, then press equal, the market for desktop calculators exploded.


The Health Information Technology for Economic and Clinical Health Act (HITECH Act ) is part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA contains incentives related to health care information technology and contains specific incentives designed to accelerate the adoption of electronic health record (EHR) systems among providers. The Office of the National Coordinator for Health Information Technology (ONC) released a set of Safety-enhanced Design §170.314(g)(3) certification and meaningful use requirements for Electronic Health Records (EHRs). In stage 2 of these certification requirements EHR vendors must include evidence of user-centered design and summative usability test results in their submission.

Summative usability testing for safety-enhanced design involves recruiting targeted users as test participants (Doctors, Nurses, and other medical practitioners) and asking these users to complete a set of pre-defined tasks. An expert test facilitator conducts the testing via an established test protocol while the test sessions are recorded and later analyzed.

The summative usability tests for ONC Meaningful Use Stage 2 certified EHRs are all made public on the CHPL site.

A big problem is that many of the EHR vendors didn’t work with medical professionals in their designs. They created what we call Engineering-centric designs, not User-centered Designs. They made HP Calculators. They created systems that are easy to use for engineers and not medical professionals. Complicating matters, a number of EHR vendors took serious end-runs around the regulations and did not conduct nor report on a proper usability test to become certified. It was fairly obvious that some of the Authorized Testing and Certification bodies seem to be rubber-stamping the summative usability reports perhaps without even looking at them.

Think about this: If an EHR vendor took side-steps in preparation of their usability evaluation, what other short-cuts did they take with development of their system? I’m frightened that someone may suffer serious injury because some EHR vendor ignored usability testing so that their clients can get ONC funding.

The U.S. Food and Drug Administration has acknowledged getting hundreds of reports of problems involving health information technology including numerous patient injuries and deaths.

Some examples seen at hospitals across the country:

  • At Marin General Hospital in Northern California, RNs called on the Marin Healthcare District board to delay implementation of their EHR system. “Orders are being inadvertently passed to the wrong patients. People have gotten meds when they’ve been allergic to them. This is dangerous,” Marin RN Barbara Ryan said in comments reported by the Marin Independent Journal.
  • In Chicago, the Chicago Tribune in 2011 reported on a patient death at Advocate Lutheran General hospital after an automated machine prepared an intravenous solution containing a massive overdose of sodium chloride — more than 60 times the amount ordered by a physician.
  • At Affinity Medical Center RNs in Massillon, Oh. RNs in June raised multiple objections to the hurried introduction of an EHR system. Subsequently, they have cited medication errors, delays in care, problems with documentation, computers crashing, and other concerns.

For another example of why usability in healthcare is so important, see “How Bad UX Killed Jenny”.

The office of Rep. Michael C. Burgess, MD (R-Texas) released a draft bill that is designed to fix some of the issues associated with the HITECH Act. The draft bill completely ignores the problems with usability in healthcare IT and continues the policy of excluding caregivers, patient safety and patient rights organizations, and other healthcare organizations, from playing an active role in ONC.

Proposed rules for stage 3

On Friday March 20, 2015 the HHS released their proposed rules for Stage 3 of the meaningful use program. Contained within these new rules was very significant, but under reported, changes in the meaningful use program: An expansion of the Safety-enhanced Design (aka usability) testing portion.

For the complete text of the changes to the Safety-enhanced Design program see pages 191 to 196 of the proposed 2015 ONC certification document.

A Quick summary of the enhancements includes:

  • ONC will requires 17 instead of 7 functional areas to test
  • ONC recommends 15 participants, instead of providing no recommendation (we have seen many certified EHRs that only tested on two people!
  • ONC clarifies the User-centered Design reporting requirements.
  • ONC provides guidance on when an EHR needs to be retested due to changes in the UI

We welcome these changes to the usability testing portion of the Stage 3 criteria as many of these changes are a direct result of suggestions given as public comment on the 2014 certification program by those, including us, in the usability community.

What exactly is usability and user-centered design?

According to the ISO 9241-11 standard usability is defined as “The effectiveness, efficiency, and satisfaction with which specified users achieve specified goals in particular environments (ISO 9241-11).”

Effectiveness – The accuracy and completeness with which specified users can achieve specified goals in particular environments.

Efficiency – The resources expended in relation to the accuracy and completeness of goals achieved.

Satisfaction – The comfort and acceptability of the work system to its users and other people affected by its use.

Usability in healthcare can be difficult to achieve, but it is important to remember that it is not only based upon the aesthetics of the user interface. Good Usability is also not determined by the number of clicks (see The Myth of Too Many Clicks).

A useable healthcare system must be designed to match the mental models and workflow of its users. A usable EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying). The big business interests of the Healthcare industry may cry wolf (and lobby hard) against enhancements to the usability program because they don’t want to spend the extra time and money to provide a healthcare system that truly follows a safety-enhanced design philosophy. They are no better than the automobile industry that fought hard against seatbelts in the late 1960 and against The United States Intermodal Surface Transportation Efficiency Act of 1991 that required airbags in cars.

With Congress working on legislation to fix major healthcare problems caused by the HITECH act, we hope that they will finally address the issue of lack of EHR usability.

John Vollenbroek's curator insight, April 23, 2:39 AM

Design of the user interface focused exclusively on expert users and these experts were a very limited sample size.!

Does Healthcare Fraud Impact Meaningful Use Audits?

Does Healthcare Fraud Impact Meaningful Use Audits? | EHR and Health IT Consulting |

While the majority of medical providers are preparing for the ICD-10 transition deadline and are utilizing diagnostic coding accurately, there are certainly outliers who have attempted to defraud the healthcare system and the Centers for Medicare & Medicaid Services (CMS). These outliers may even affect the CMS’ stance on meaningful use audits. Former Central Texas Hospital owner Tariq Mahmood is one such individual that has been sentenced to 135 months in federal prison last Monday for submitting false and fraudulent claims to healthcare payers including CMS.

The Cameron Herald reported that Mahmood was ordered to pay $599,128.02 to CMS and Blue Cross Blue Shield of Texas due to the violations of identity theft and fraudulent medical care claims. Mahmood had owned and operated a handful of hospitals across the state of Texas including Lake Whitney Medical Center, Central Texas Hospital in Cameron, Renaissance Terrell Hospital, Cozby Germany Hospital in Grand Saline, and Community General Hospital in Dilley.Meaningful Use Audits

Prosecutors Assistant U.S. Attorneys Nathaniel C. Kummerfeld, Frank Coan and Special Assistant U.S. Attorney Ken McGurk claimed during the trial that Mahmood and other individuals defrauded Medicare and Medicaid from January 2010 to April 2013 by submitting false identities and inexistent diagnoses and treatments.

Currently, ICD-9 diagnostic codes are being utilized by healthcare providers while the ICD-10 coding set will be required to use by October 1, 2015, which is the ICD-10 transition deadline. Mahmood, however, modified and incorrectly sequenced diagnostic codes to reflect the wrong medical conditions and diagnoses of his patients without checking their healthcare records. The names of Medicare beneficiaries and their associated numbers were also incorrectly and fraudulently used.

“Americans enjoy the best health care in the world and the cost for this care is expensive,” U.S. Attorney John M. Bales said in a statement.“What we do not need is providers like Tariq Mahmood who masquerade as physicians who pretend to care about American health care but actually are determined to loot the Medicare Trust Fund. He is now being held to account, and I congratulate the prosecution team for a job very well done.”

Former chief financial officer of the Cameron hospital and the Shelby Regional Medical Center Joe White will also be sentenced for defrauding the government and healthcare payers on Monday, April 27.

White had made a false statement regarding the meaningful use achievements of the Shelby Regional Medical Center and claimed the hospital met relevant meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. This false statement led to the hospital being awarded $785,655 from Medicare.

Healthcare professionals that defraud the medical payer system along with federal agencies lead to difficulties among honest providers who have successfully met meaningful use requirements and are preparing to accurately and authentically send ICD-10 coding claims to CMS by the ICD-10 transition deadline. For example, current meaningful use audits are burdening a variety of healthcare professionals who have received financial incentives from CMS for meeting relevant meaningful use requirements.

The American Academy of Family Physicians has asked CMS to offer a report that outlines the reasons why some providers have failed the meaningful use audits. Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue pursuing claims under the EHR Incentive Programs and filing additional meaningful use audits.Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue filing additional meaningful use audits.

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How the Cloud Targets Meaningful Use Requirements

How the Cloud Targets Meaningful Use Requirements | EHR and Health IT Consulting |

The medical sector is geared toward adopting EHR systems and enhancing data exchange among hospitals and physician practices in order to improve care, lower costs, and increase positive population health outcomes. One health information exchange system called Healthcare Access San Antonio (HASA) has recently adopted a cloud platform to better engage patients and more effectively meet meaningful use requirements.

One common concern with HIE organizations is the potential for data breaches and violation of patient privacy and security measures. Chief Executive Officer of Healthcare Access San Antonio Gijs van Oort spoke with and mentioned the typical protocols the HIE follows to ensure data security standards are met.Cloud Platform and Meaningful Use Requirements

“We’re following protocols and standards federally as well as state-wide. We have a whole series of those in place that we’re checking on a regular basis,” Van Oort said. “We capture security not only in our processes and the way we operate but also in contractual agreements with the customers. That’s probably where we see most of the likelihood [of data breaches] if a physician is using the HIE and does not necessarily use the appropriate protocols or security levels. That’s where we see most of the risk with us. In general, we are working very cautiously and carefully with our customers and, so far, things have gone well.”

HASA CEO Gijs van Oort also spoke about the patient engagement measures the recently implemented ManaCloud platform from Mana Health has helped the organization achieve. The HIE was able to meet the patient portal objectives under Stage 2 Meaningful Use requirements.

“We’ve been able to meet many of the patient portal requirements for Stage 2. With Stage 3 just coming out, we’re starting a dialogue with ManaHealth as well as our analytics portal, which is the trigger for the population of the patient portal to evaluate which particular measures we can meet,” he said. “So far, we are getting positive feedback from CMS.”

“The patient portal needs to be patient-oriented. It doesn’t necessarily need to be a medical application. When we found ManaHealth, we were very excited about their capabilities and their history in social media. We’ve learned over the years, that if you put a medical application in front of a patient with the hope that the patient will adopt it, we won’t be very successful.”

Health Information Exchange“Currently, our patient portal is able to view, download, and transmit medical information, which is one of the requirements. It also adds the education component which is very intuitive. It adds proxy access so parents, with the approval of a child, can get access to a child’s medical record. It has direct messaging and we’re working on building out these kind of services so that the portal will indeed become meaningful for the patient and not only to meet meaningful use criteria.”

Gijs van Oort continued by explaining the stages and objectives under the EHR Incentive Programs that the ManaCloud platform enabled the HIE to achieve.

“So we’re still trying to finalize Stage 2 Meaningful Use measures. Stage 3 measures are not final yet. We are looking collectively how we can best meet them and which ones we can meet,” Van Oort stated. The HASA CEO also mentioned how HIEs may be able to help providers meet Objective 5 under the Stage 3 Meaningful Use requirements.

“One of the things that we’re interested in is to find out if you look at Objective 5 in Meaningful Use Stage 3, there is no mention of HIE being able to meet some of these criteria,” Van Oort stated. “The HIE would be the perfect place for that in the fact that it aggregates patient data and it would be a patient-friendly way to provide the patient copies of their medical record. We’ve made some preliminary inquiries with CMS to ascertain whether an HIE would be a qualifying source for meeting those particular objectives. So far, it seems to be positive.”

“Objectives five and six, which have to do with patients having access to their record and the engagement of the patient” are met with the help of this cloud platform.

“HIE capabilities are under objective seven, which we’re doing through our other application. From an HIE perspective, I feel that we can provide plenty of support to these providers,” Van Oort said.

Cloud PlatformWhen asked what benefits the cloud-based system has offered their organization, Van Oort stated, “We are looking at reducing duplicate testing and identifying unnecessary emergency department visits. We’re working closely with a local Medicaid HMO who has been receiving daily updates about ED visits. It allows them to more quickly develop innovations and case management [decisions].”

When asked how implemented health IT systems at HASA improve care coordination, Van Oort stated, “In order to provide value, we need to put multiple functionalities in place so that our community gets optimal benefit from it. We started with a provider portal, which is a typical HIE functionality where data is brought in from different sources and aggregated and homogenized.”

“We then coupled that with an analytics portal that provides real-time and clinical data back to the community. That has benefits for public health. Thirdly, the ManaHealth portal is linked to our analytics portal to pull data for the patient, so that patients get a copy of their medical history. With these three platforms tied together and data flowing in near real-time, we now can support clinicians in the community, the hospitals, public health, and patients.”

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Meaningful Use Aligns with Health Information Exchange

Meaningful Use Aligns with Health Information Exchange | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) announced today that the public is welcome to submit comments to the recently released notices of proposed rulemaking. Comments regarding the Stage 3 Meaningful Use proposed rule and/or the 2015 Edition EHR Technology Certification proposed rules must be submitted by May 29 at the latest.

Eligible hospitals, eligible professionals, and critical access hospitals will all be affected by the final Stage 3 Meaningful Use ruling under the Medicare and Medicaid EHR Incentive Programs.

CMS also released notices of proposed rulemaking that modify meaningful use requirements from 2015 to 2017. Healthcare providers, health IT vendors, and other stakeholders have until June 15 to submit comments regarding these proposed modifications. This proposed ruling will also be applicable to critical access hospitals, eligible professionals, and eligible hospitals.

The modifications to the meaningful use requirements includes changing the Medicare and Medicaid EHR Incentive Programs reporting period to a 90-day timeline in 2015 and 2016 that aligns with the calendar year. Additionally, reporting requirements that are redundant, duplicative, or unnecessary due to EHR advancements are removed in the proposed ruling. And finally, patient engagement objectives under the Stage 2 Meaningful Use requirements are also revised.

The public is welcome to submit comments by electronic submission, direct mail, or courier. For electronic comment, access this site and follow the “Submit a Comment” instructions.

A key aspect of the Stage 3 Meaningful Use proposed rule is to expand EHR interoperability and develop effective health information exchange systems. The Office of the National Coordinator for Health IT (ONC) is especially focused on developing better health data exchange entities, which is evident through its Nationwide Interoperability Roadmap published earlier this year.

ONC reports that advancing interoperable exchange of medical data will enable providers to spend money more wisely, improve patient care, and ensure a healthier population. The results in a data brief from the American Hospital Association show that health information exchange is skyrocketing compared to previous years. For example, as many as 75 percent of hospitals reported last year to electronically exchange health data with other hospitals and ambulatory care providers.

This statistic has increased by a total of 23 percent since 2013 and rose an impressive 85 percent from 2008. In 2014, 64 percent of hospitals exchanged clinical care summaries with outside ambulatory care providers or hospitals. The exchange of patient medication history also grew to 58 percent. Another research finding from the data brief shows that the majority of hospitals in 42 states were exchanging care summaries.

The move away from fee-for-service payments toward value-based care will also impact the greater need for effective electronic exchange of healthcare information. When healthcare professionals are able to access patient data whenever they need it, coordinated care efforts are improved and patient outcomes should be positive, ONC explains. It seems that hospital and provider competition is falling by the wayside while more care coordination and teamwork are bringing together medical professionals.

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75% of Hospitals Had a Basic EHR System in 2014, ONC Data Show

75% of Hospitals Had a Basic EHR System in 2014, ONC Data Show | EHR and Health IT Consulting |

The percentage of hospitals with electronic health record systems increased eightfold between 2008 and 2014, according a data brief from the Office of the National Coordinator for Health IT, FierceHealthIT reports.

The report was based on an American Hospital Association survey of non-federal acute-care hospitals.


Overall, the data show 97% of hospitals in 2014 had certified EHR technology, an increase of 35% since 2011


Meanwhile, 75.5% of hospitals in 2014 had a basic EHR system, up from 59.4% in 2013 and 9.4% in 2008.

The report showed that in every state at least half of hospitals had adopted a basic EHR in 2014.

The states with the highest adoption rates of basic EHR systems included:

  • Delaware, with 100% of hospitals;
  • South Dakota, with 95.1% of hospitals; and
  • Virginia, with 93.2% of hospitals.

Those with the lowest adoption rates included:

  • West Virginia, with 49.6% of hospitals;
  • Hawaii, with 54.8% of hospitals; and
  • Kansas, with 60% of hospitals.

Meanwhile, 34.4% of hospitals in 2014 had adopted comprehensive EHR systems.

In a blog post, Matthew Swain -- a program analyst in ONC's Office of Planning, Evaluation and Analysis -- and ONC Interoperability and Exchange Portfolio Manager Erica Galvez wrote that that about 60% of hospitals in 2014 exchanged data electronically, marking a 55% increase from 2013.

However, Swain and Galvez said, "While these survey results are promising, there is plenty of room for progress." They added, "These results capture exchange activity among hospitals; however, these results do not assess exchange volume, whether the exchange is interoperable, and if information is available to providers at the point of care".

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