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Half of docs nationwide e-prescribe via EHRs | EMR Industry

Half of docs nationwide e-prescribe via EHRs | EMR Industry | EHR and Health IT Consulting |

Just about one half of physicians nationwide are now performing electronic prescribing using an electronic health record on the Surescripts network, with all states producing double-digit increases.


The percent of physicians e-prescribing using EHRs swelled from 7 percent in December 2008 to 48 percent in June 2012, according to a report released Nov. 27 from the Office of the National Coordinator for Health IT.

Surescripts is a leading e-prescribing network, which is used by 95 percent of pharmacies for routing prescriptions, excluding closed systems such as Kaiser Permanente.


Twenty-three states had more than half of their physicians e-prescribing using an EHR, with New Hampshire, Minnesota, Iowa, North Dakota, and Wisconsin experiencing the largest increases since December 2008, according to the report.

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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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Survey Shows Many Unprepared for ICD-10 Implementation

Survey Shows Many Unprepared for ICD-10 Implementation | EHR and Health IT Consulting |

Is your physician practice ready for ICD-10 implementation? The latest survey commissioned by Navicure and conducted by Porter Research found that ICD-10 preparedness varies tremendously among US healthcare providers. The survey takers included practice administrators, billing managers, practice executives, coders, and billers.

With the prior delays of the ICD-10 implementation date, it would stand to reason that there may be another postponement. However, 67 percent of respondents trust that the ICD-10 transition will take place on its newly scheduled date of October 1, 2015.

A major challenge of the ICD-10 transition that 41 percent of respondents cited is lack of payer readiness. One of the issues associated with the prior ICD-10 delays is that many providers paused the preparations for the transition until the date was closer. Only 23 percent continued with their efforts after the delay took place.

Some of the top concerns survey respondents commented on include the impact on staff productivity, lack of staff training, and the possibility of the ICD-10 transition deadline being pushed back yet again. However, only 5 percent feel that their technology won’t be ready in time for the implementation.

When it comes to being prepared for ICD-10 integration, only 21 percent of survey takers claimed they were “on track for implementation.” A total of 15 percent have not started preparing for the implementation at all while 11 percent developed a plan.

Those who have not started preparing for the ICD-10 transition cite five major reasons:

(1) Waiting on EHR vendor to provide ICD-10 software updates

(2) Waiting to implement a few months before the October 1 deadline

(3) Lack of staff, time, and training resources

(4) Belief that the ICD-10 transition date will be further delayed

(5) Lack of knowledge on where to begin

Despite some of these issues, out of all polled, 81 percent are at least somewhat confident that they will be ready to implement ICD-10 coding by the October 1, 2015 deadline. While these numbers are high, they have actually dropped from the 87 percent vote of confidence from a survey taken in the fall of 2013. Clearly, with only 21 percent of respondents feeling they are on track, providers may not be completely prepared for the ICD-10 transition as of yet.

“Since 2013, Navicure has been conducting ICD-10 readiness surveys, which have allowed us to gain broad perspective on how we can best help healthcare organizations prepare for the transition,” Jim Denny, founder and CEO of Navicure, said in a public statement.

The majority of respondents expect staff productivity loss of one to 40 percent. Providers may need assistance with improving productivity and efficiency when the ICD-10 integration takes place. Additionally, 49 percent of survey takers are either planning to conduct end-to-end testing or are already in the midst of this process. Unfortunately, this is a decline of 7 percent when compared to the fall 2013 survey.

The report goes on to explain the importance of beginning ICD-10 preparations such as staff training and clinical documentation practices even if waiting on new software updates. End-to-end testing is also vital to incorporate in order to address any risks with payer collaboration before the October 1 deadline.

Additionally, providers should prepare for a dip in staff productivity for the first three to six months after ICD-10 integration. It is important to develop a plan to manage these potential issues. Transitioning to ICD-10 will not be an easy road, but with thoughtful strategies in mind, it will be more manageable over the long-term.

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EHR Vendors Will Lower Data Exchange Prices or Close

EHR Vendors Will Lower Data Exchange Prices or Close | EHR and Health IT Consulting |

In an opinion piece for the Brookings Institution's "TechTank" blog, Niam Yaraghi, a fellow at the Brookings Institution's Center for Technology Innovation, writes that the best way for the federal government to address "outlandish" health data exchange fees charged by vendors is to focus on new pay-for-performance efforts.

According to Yaraghi, the federal government has spent billions of dollars "to incent medical providers to adopt electronic health record systems so that they can electronically share medical records."

However, Yaraghi writes that EHR vendors "have taken patient data hostage and are not willing to release it unless they receive a big ransom." He notes, "They typically claim that technical problems limit the interoperability of their products" and charge significant fees to allow providers to exchange data.

To address the issue, Yaraghi argues that the federal government has three choices:

  1. Pay EHR vendors' prices to release data and allow sharing between medical providers;
  2. Regulate the industry and make EHR vendors allow such data sharing; or
  3. Take no action.

He writes that the "government appears to be following the first plan" noting, "The [EHR] incentives, which were initially planned to encourage physicians, will end up with EHR vendors and help drive future profits."

In regard to the second plan, Yaraghi writes, "The benefits of regulating the EHR industry, if any, will take a very long time to become tangible."

Therefore, he argues that the "best solution for the government is to do nothing." According to Yaraghi, "The new pay-for-performance payment methods in which the medical providers are being paid a fixed amount for treating patients would drive them to become more efficient and increase their profit margin by seeking solutions such as health information exchange to cut costs."

Further, he notes that because of market saturation, EHR vendors' only source of revenue is data exchange charges and that currently they can charge "outlandish" prices "because they know the incentives from the federal government allow doctors to cover their costs." However, Yaraghi writes that "if the free money from the government were to stop, then EHR vendors would have to persuade the physicians to pay for the exchange fees." He concludes, "EHR vendors will end up lowering their fees to a reasonable level or will eventually go out of business".

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Vendor Fees Harm EHR Interoperability, Other Goals

Vendor Fees Harm EHR Interoperability, Other Goals | EHR and Health IT Consulting |

Stakeholders say that fees charged by electronic health record vendors to transmit and receive data between different EHR systems are hindering the progress of the meaningful use program and harming efforts to achieve interoperability, Politico reports.

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

Details of EHR Vendor Fees

Lawmakers did not anticipate the EHR vendor fees when creating the meaningful use program, Politico reports.

According to more than a dozen sources interviewed by Politico, providers generally pay between $5,000 and $50,000 to transmit information between their organizations and other entities, such as:

  • Blood and pathology laboratories;
  • Health information exchanges; and
  • Government agencies.

In addition, EHR vendors sometimes levy additional fees every time a physician receives or sends data.

Stakeholder Reaction

Former National Coordinator for Health IT Farzad Mostashari said that the vendor fees to share data are "not because of technical standards, but because of business practices," adding, "The vendors don't have the same incentives as the providers do."

According to Politico, EHR vendors have become increasingly reliant on such fees as sales of new software decline. For example, NextGen Healthcare and its parent company had sales revenue decline from $149 million in 2012 to $87 million in 2014. Meanwhile, revenues from interchange fees increased from $49 million in 2012 to $67 million last year.

Some stakeholders contend that such fees are making health data sharing prohibitively costly.

Lance Donkerbrook, COO of Commonwealth Primary Care accountable care organization, said, "The No. 1 factor hindering the exchange of information between health care stakeholders is the exorbitant fees that most EHRs are charging for integration, connectivity and reporting." He said that many of the 250 independent physicians in the ACO are not able to share data with one another because they have a total of 30 EHRs among the doctors, with vendor fees ranging from $7,500 to $40,000.

According to Politico, the problems associated with EHR vendor fees have become particularly acute in the past year as providers have attempted to attest to Stage 2 of the meaningful use program, which requires providers to share data.

Meanwhile, Sarah Corley -- vice chair of the Electronic Health Records Association, which represents the majority of EHR vendors, and CMO of NextGen -- said, "As with other areas of health care, variability increases costs, and all stakeholders in health care need to work together to reduce this variability and the factors that drive it."

Potential for Legislative, ONC Action

National Coordinator for Health IT Karen DeSalvo at a meeting earlier this month described concerns about of EHR vendor fees as a "common refrain" that "Congress has asked us to do something about."

The Office of the National Coordinator for Health IT's certification program requires EHR vendors to demonstrate that their EHR software will allow providers to demonstrate meaningful use of EHRs, including data sharing. However, ONC does not have the power to regulate vendor fees, according to Politico.

Meanwhile, some Republican lawmakers are considering potential legislative solutions. Rep. Michael Burgess (R-Texas), chair of the House Energy and Commerce Trade subcommittee, is drafting a bill to enforce data sharing among providers, Politico reports. He said, "Interoperability is what makes an EHR useful. It's unfair that practitioners have to spend money on connections they thought were part of the EHR when they bought it." Although he acknowledged that vendor fees are an issue that "should be resolved in the marketplace," he noted that "you can't just drop your EHR like a used car and get another one." He said that lawmakers are "very closely" examining what legislation would "look like" if the market does not fix the problem on its own.

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Behavioral Health EHR Adoption Shows Promise in Survey

Behavioral Health EHR Adoption Shows Promise in Survey | EHR and Health IT Consulting |

In today’s healthcare sector, implementing EHR systems has become a way of life. It is nearly impossible for a medical office to avoid EHR adoption, said Jennifer D’Angelo, Chair of the new HIMSS Long Term Care and Behavioral Health Task Force and Vice President of Information Services for Christian Health Care Center.

“From an interoperability standpoint, and from a reimbursement standpoint, it’s being required,” D’Angelo told Behavioral Healthcare. “All levels of care will need to have an EHR for care coordination among all providers.”

A survey of Behavioral Healthcare readers shows that most of the respondents find their EHR systems satisfactory and are using them extensively. Only a small percentage (9.1%) are “very unsatisfied” with their current EHR technology. In fact, 72.5 percent feel neutral or satisfied with their EHR system.

The survey points toward the majority of behavioral health specialists viewing EHRs as technology that enhances patient care. While most have adopted EHR systems, some have yet to make the transfer often due to low funding for this particular expenditure. Some of the common reasons for not adopting an EHR are: financial (41.3%), no need for it (32.5%), haven’t found the right one (13.8%), and staff resistance (5.0%).

Others may continue to shop for better health IT technology, especially if their current systems do not line up with meaningful use requirements. Physicians are more likely to adopt EHR technology with features that achieve meaningful use in order to receive financial incentives from the Centers for Medicare & Medicaid Services (CMS). For example, some vendor’s health IT systems may be capable of meeting Stage 1 Meaningful Use requirements but not Stage 2.

Other potential disadvantages of EHRs that the survey highlighted are:

(1)   time consuming

(2)  causes confusing

(3)  difficulty getting data reports

(4)  costly

D’Angelo recommends that hospitals and clinics have support onsite during the first couple of weeks during EHR implementation in order to resolve any potential end-user issues quickly and efficiently. Despite the potential problems associated with EHR technology, there are significant benefits that physicians are seeing. Survey respondents reported a number of benefits including:

(1) improving patient care

(2) reducing paper-based records

(3) boosting staff efficiency

(4) helping guarantee reimbursement

The best EHRs offer a more streamlined workflow process for a variety of tasks including pulling up patient files, recording new visitor data, and finding key information quickly.

EHR consultant Eileen Casella Rider explains that EHR technology that is developed with the input of healthcare staff members tends to work better in a care setting than those built solely from a technical standpoint. Rider goes on to say that some clinicians may not have superior computer skills, which may lead to confusion and emphasizes the need for extensive training on EHR systems.

A final aspect of the survey finds that, out of all respondents who knew their EHR server choice, 34 percent use the software-as-a-service (SaaS) option. Experts claim that SaaS is the server of the future and will only increase in popularity. This type of feature allows clinicians to run their EHR system through the cloud.

These survey results display the tangible benefits of EHR technology in the medical care setting.

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EHR Integration Assists Lean Production Design

EHR Integration Assists Lean Production Design | EHR and Health IT Consulting |

The healthcare industry has emphasized “Lean Production” – a term coined by MIT researchers meaning the elimination of waste – in recent years, as it continues EHR integration initiatives and the adoption of electronic prescribing along with other health IT technology.

According to a report from the Agency for Healthcare Research and Quality (AHRQ), lean production refers to subtracting waste that eats up resources (funds, staff, time, or room) without increasing value or quality.

The report covers six case studies in which healthcare organizations incorporated lean initiatives such as improving the recording of outpatient data, bed flow, and outpatient EHRs. Lakeview Healthcare adopted these programs among others and interviews were conducted with physicians, nurses, and both clinical and nonclinical staff.

Many of the interviewees reported that Lakeview Healthcare experienced enhanced efficiency, employee satisfaction, and a more organized environment. Additionally, top executives stated the focus on lean production led to a $29 million return on investment over the last 14 years.

The organization also focused on quality improvements and increasing patient satisfaction. EHRs were introduced through group training in outpatient medical offices. Some physicians learned how to effectively use EHR technology in one-on-one training sessions.

EHR systems assisted greatly in improving patient flow in the ambulatory care setting. In order to reduce potential issues during EHR implementation, senior leadership incorporated process improvement work before adopting the health IT systems.

Initially, EHR implementation led to a dip in productivity due to the learning curve of adopting new technology. However, this trend reversed and a management engineer reported that chart filing time decreased by 70 minutes once the implementation was finished. This reduced wait times for patients as well, thereby improving patient satisfaction. The incorporation of technology also ensured patient safety.

“The use of technology meant integrated and improved patient safety processes,” the report stated. “The management engineer reported that, as part of the larger value stream of projects that included the Surgeons’ Preference Cards, patient safety improved as a result of checklists that were built into the computer system that could be used as a communication and debriefing tool.”

The results show enhanced routinization and organizational culture. In fact, the interviewees indicated a rise in teamwork and encouragement to gain better outcomes for patients. The focus on “Lean Production” has led to higher reported employee satisfaction and a low nursing vacancy rate.

Another case study came from Central Hospital where both improvement of emergency cardiac care and management of surgical procedure cards were incorporated into the lean strategy. The top leadership at this organization has used lean initiatives to enhance care and efficiency as well as transform the work culture.

A third case study from the academic medical facility Grand Hospital Center incorporated cardiology follow-up appointment scheduling as part of its lean program. Both EHR and scheduling systems were used to collect the necessary data to track progress of the lean initiatives.

The team at the Grand Hospital Center also aimed to decrease the costs of supplies, implants, and other resources. Some of the benefits the program achieved are the reduction of discharge time by three and a half hours and assigned rehabilitation therapists to specific floors to cut down on travel time.

Essentially, EHR integration could play a significant role in medical facilities’ aims to reduce waste and adopt the “Lean Production” style.

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ICD-10 Acknowledgement Testing Checklist for Providers

ICD-10 Acknowledgement Testing Checklist for Providers | EHR and Health IT Consulting |

While ICD-10 acknowledgment testing is available any day of the year up until October 1, 2015, CMS is taking the first week in March to host another dedicated opportunity for providers.  The testing weeks serve as way to gather data about the way providers send their sample ICD-10 claims to Medicare and allow providers to ensure that their claims can be accepted by the adjudication system without any technical glitches.

Those organizations that have not participated in previous testing weeks are encouraged to join in during the next chance on March 2 through 6, or the final scheduled occasion at the beginning of June.

In order to successfully submit claims for ICD-10 acknowledgement testing, direct-submit healthcare organizations, including providers and clearinghouses, will need to keep the following questions, tips and, requirements in mind.

What is ICD-10 acknowledgement testing?

Acknowledgement testing is the most basic form of assurance that a claim can be accepted by a Medicare Administrative Contractor (MAC) for later adjudication.  It should not be confused with end-to-end testing, in which a claim is processed through all Medicare system edits in order to produce electronic remittance advice (ERA).  Acknowledgement testing simply provides a yes or no answer to the question of whether or not the sample claim can be accepted.

Providers are encouraged to use ICD-10 acknowledgement testing as a basic way to ensure that they are on the right track with their ICD-10 preparation.

How do I participate?

Information about acknowledgement testing will be provided on your local MAC website or by your clearinghouse.  Any provider that submits electronic Medicare fee-for-service claims is eligible for participation.  There is no registration required.  For more information on eligibility, click here.

ICD-10 acknowledgement testing does not test initial connectivity to the MAC system, nor does it ensure that your internal systems are capable of producing, accepting, storing, or transmitting codes.  Internal preparations for the generation and transmission of ICD-10 codes should already be completed before MAC testing.

How do I prepare my sample claims for submission?

Ensure that you have enough claims coded in ICD-10 to represent your typical submissions spectrum.  CMS reminds providers that claims must have the “T” in the ISA15 field to indicate the file is a test file.  Use a valid submitter ID, national provider identifier (NPI), and Provider Transaction Access Numbers (PTAN) combinations.  Claims that contain invalid identifiers will be rejected.

Be sure that the claims do not include future dates of service.  All claims must be dated before March 1, 2015 in order to be processed. Claims must also have an ICD-10 companion qualifier code or they will be rejected.

Providers may engage in “negative testing” by submitting purposely erroneous claims in order to confirm that the MACs will catch defects or incorrect information.

What information will I receive from my MAC?

Test claims will be assigned a 277CA or 999 acknowledgement as confirmation that the claim was accepted or rejected by the system.  The test will not confirm that the claim would be paid under ICD-10, nor will testers receive any remittance advice.  The MACs and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) will have extra staff available to take calls from providers who have questions about the process or their results.

Providers will need to engage in full end-to-end testing with their payers if they wish to receive information about their coding accuracy or payment rates.  While CMS has scheduled end-to-end testing for April 2015, participating providers have already been selected.  Providers are still encouraged to engage in end-to-end testing with their private payers as soon as possible.

What do I do next?

During prior acknowledgement testing, CMS has released basic data on acceptance rates several weeks after the dedicated testing period.  But providers participating in the opportunity do not need to wait until then to take action based on their own results.  With a mere seven months until October 1, 2015, organizations that experienced unexpected denials from acknowledgement testing should work with their ICD-10 preparation teams or consultants to resolve internal or coding errors quickly.

Healthcare organizations should also make sure that they are coordinating with their major payers to conduct additional, more robust testing of ICD-10 claims.  Providers should continue to utilize clinical documentation improvement programs, revenue cycle contingency planning, and coder training and education during the last few months of preparation in order to combat potential negative impacts from the new codes.

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EHR Switchers Ranks Amazing Charts #2 for Happiness

EHR Switchers Ranks Amazing Charts #2 for Happiness | EHR and Health IT Consulting |

A new survey of physicians that switched Electronic Health Record systems ranks Amazing Charts #2 for customer satisfaction. Published by the American Academy of Family Physicians this month, the EHR Switch Survey: Responses from 305 Family Physicians is one of the first major studies examining the relationship between changing EHR systems and greater practice satisfaction. AAFP lists Amazing Charts as having gained net new switching customers during the survey period.

In response to the statement, “I am happy with our new EHR system,” practices that switched to Amazing Charts responded with the second-highest positive score. The article explains: “On this last point, it seems worthwhile to note that two systems, Praxis and Amazing Charts, had zero negative responses to the statement, ‘I am happy with our new EHR system.'”

Fifty-nine percent of those surveyed agreed or strongly agreed that the new EHRs have useful new functionality; and fifty-seven percent agreed or strongly agreed that their new systems allow them to achieve meaning­ful use.

“The number of practices switching EHRs is growing as more and more physicians and their administrative teams realize their current system was the wrong choice and does not meet their needs,” said John Squire, president and COO of Amazing Charts. “Created by a family physician, Amazing Charts combines a high level of usability in clinical documentation and office workflow with overall affordability, which makes it ideal for physician-owned practices, especially in family medicine.”

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Orion Health, a population health management and healthcare integration company, today announced that Greenway Health has selected Orion Health’s Rhapsody Integration Engine®to unify Greenway’s financial transaction processing solutions on a single, scalable technology platform. Rhapsody will help accommodate Greenway’s tremendous growth in transaction services, and the organization will use Orion Health’s professional services to design and build the core transaction-processing engine. Rhapsody will process eligibility, claims and remittances for millions of daily transactions across Greenway’s growing national customer base.

“Greenway Health is dedicated to using standards-based interoperability to streamline secure data flow and improve our customers’ connectivity, processes and outcomes,” said Shantanu Paul, Executive Vice President of Product Development at Greenway Health. “Likewise, we’re always seeking to do the same within Greenway. The flexible and adaptable Rhapsody Integration Engine and the relationship with Orion Health will help us achieve that as we continue to grow our transaction services capabilities.”

Rhapsody enables the secure electronic sharing of claims data, achieving real-time connectivity from any system to any system, streamlining processes and reducing operational costs for improved financial performance. The integration engine enables health information technology companies and partners to quickly and easily connect complex financial and clinical systems between healthcare trading partners, regardless of technology or standards.

“This new partnership is strategic to both organizations as we continue to enable our customers to automate critical business processes including financial clearinghouses. Orion Health worked closely with Greenway Health to ensure we fully understood their business and technical environment to jointly design and scope the final solution,” said Harish Panchal, Global Vice President of Sales, Intelligent Integration, at Orion Health. “We have long-standing relationships with our clients, and everyone at Orion Health is very excited about working with Greenway Health, a great company and leader in the healthcare industry.”

Rhapsody is used by thousands of organizations in the United States and around the world, including hospitals, IDNs, software companies, public health agencies, health information exchanges (HIE), health plans and now financial clearinghouses. The integration engine provides comprehensive support for an extensive range of communication protocols and message formats, and helps interface analysts and hospital IT administrators reduce their workload while meeting complex technical challenges.

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Study: ICD-10 Costs for Small Practices Less Than Previously Estimated

Study: ICD-10 Costs for Small Practices Less Than Previously Estimated | EHR and Health IT Consulting |

ICD-10 expenditures for small physician practices will not be as high as previously estimated, according to research from the Professional Association of Health Care Office Management, published recently in the Journal of the American Health Information Management Association.

Researchers polled 276 physician practices with fewer than six providers, with results finding that the practices spent an average of $8,167 on ICD-10 implementation, while individual providers spent an average of $3,430. According to the researchers in this study, there are now three studies documenting that ICD-10 implementation costs in small physician practices are dramatically lower than originally reported in the widely publicized American Medical Association (AMA)-funded study, which estimated the cost for a small practice to implement ICD-10 was in the range of $22,560-$105,506.

Survey respondents were asked to specify the number of providers in the practice where a provider was defined as a direct caregiver, such as physicians, physician assistants, and nurse practitioners. Respondents were asked to specify the total expenditures in the practice for all ICD-10-related activities, including costs already incurred and costs remaining to be expended. The instructions associated with the question on expenditures specifically noted that the costs of obtaining ICD-10 manuals and documentation, ICD-10 training costs, the cost of superbill conversion to ICD-10, and software system upgrades and testing should all be included as ICD-10-related expenditures.

As expected, the expenditures associated with ICD-10 increase as the size of the practice increases, but the per-provider expenditures decrease as the size of the practice increases. The per-provider ICD-10 average expenditures ranged from $4,372 for a practice with a single provider to $1,838 for practice with six providers, the study found. What’s more, on average, the combined amount of ICD-10-related hours expended across all personnel types in practices with six or fewer providers was 45.5 hours per provider in the practice. “Based on this survey and the two other recent studies, the financial barriers to ICD-10 are significantly less than originally projected,” the researchers concluded.

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Electronic health records and data abuse: it's about more than medical info

Electronic health records and data abuse: it's about more than medical info | EHR and Health IT Consulting |

On the heels of the recent announcement that medical insurance firm Anthem was breached, we look at the nuance and impact of a medical record breach versus a medical data breach. They are certainly related, but digging through troves of data containing primarily identity information is significantly different to an attack that focuses on specific treatment of a specific patient.

If an attacker can harvest name, social security number, phone, address, email and the like, that haul has a much wider potential audience than, say, whether or not a patient underwent a specific medical procedure. A stolen medical record containing a lot of detail may sell for a lot of money, but that market is more specialized than the broader market for general identity data.

To help folks visualize the different levels of data that thieves might want to swipe from a medical facility, and then abuse, my colleague, Stephen Cobb, created this diagram of a generic electronic health record.

Level one is pretty basic info, things that are fairly easily knowable about you without any hacking, normally sourced through Open Source Intelligence (OSINT) gathering. However, grabbing a big fat collection of such data might still earn a bad guy some black market bucks, say if a spammer needed fresh targets.

The illegal earnings potential goes up a notch if you can grab Level 2 data. Scammers can use that to carry out several kinds of identity theft, creating fake IDs, opening credit card accounts, committing tax fraud (filing fake returns to get a refund) or even use it to answer challenge questions to online accounts, thereby pivoting the attack to new digital beachheads. Even Level 2 data is enough to commit some types of medical ID theft, though the bad guys have no clue how healthy or sick you really are (here’s a pretty scary case of what can be done with just a stolen driver’s license).

Level 3 data just makes all of the above that much easier; plus, it enables new forms of badness. Some crooks prefer taking over an established account to opening a (fake) new one. the number of electronic records or EHRs that actually contain financial or payment data is not clear, but obviously a lot of healthcare entities do handle it at some point, making them a target for digital thieves who turn around and sell it on carder forums.

When you get to Level 4 data, the badness takes on a new dimension. If an attacker has a patient’s full (or partial) history, it’s easy to imagine matching up a willing bidder who has a need for a similar medical procedure with a donor record to (roughly) match, in an attempt to get pinpointed specific services they would otherwise have difficulty receiving.

But the options for selling medical history-style Level 4 records may be much narrower in scope than, say, bulk repackaging and resale on the underworld markets of lower levels, appealing to any buyer who wants to assume an identity, spread a wider net and attack other properties, or engage in fraudulent activity which is then blamed on you (if it’s your record that was compromised).

Of course, the threatscape may well change as the EHR becomes more universal. With the proliferation and sprawl of third party providers who are somehow tapped into a cohesive health ecosystem, there will always be various specialized smaller providers whose business is targeted to a specific subset. That’s not bad, it’s just how the health segment does business; in many cases it leverages strengths of one organization to help another. But it does imply a larger potential attack surface, which has implications for security if the data sprawl is not carefully managed. For example, if an attacker can gain a beachhead in one of the providers in the ecosystem, will they then have an elevated trust relationship with other systems within this ecosystem?

And here’s the rub: having instant digital access to all of a patient’s medical data (or other sensitive information) wherever a doctor happens to physically be is a wonderful tool, but now we have many more endpoints in question with security environments to understand and corral. This implies an ongoing need, not just for really smart endpoint protection, but also strong encryption, and authentication, as well as sane network segmentation, vigilant network monitoring and reliable disaster recovery.

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EHR Patient Outcomes Just Got Real

EHR Patient Outcomes Just Got Real | EHR and Health IT Consulting |

Aligning incentive and quality programs with existing Accountable Care Organization (ACO) agreements is essential to improving patient outcomes and confidently negotiating private payer risk-based contracts. I started installing EHRs in 1999 with expected benefits of prescription legibility and reduced chart pulls. Today’s EHR has a similar impact to medicine as that of the electrocardiogram (EKG) in 1903. Electric pulses display patterns to determine heart health and EHRs capture electric data patterns for a population to assess and manage the health of our communities.  Population Health is dependent on EHR data and evidence-based interventions to ensure the population is stratified accurately. Nobody argues the benefit of being able to track results for improvements as this is a benchmark in all industries. The strategy providers and hospitals execute will determine who is providing services five years from now. The five steps below are critical to establishing this strategy.

1. Crosswalk Program Measures Utilizing the National Quality Forum (NQF) Number

a. Building a crosswalk is an exercise that defines like measures across ACO contracts, incentive and quality programs. Pick a baseline program to draw measure correlations to the other programs. We recommend utilizing the NQF number as the common thread among these programs; however, not every measure within each program has a NQF number. In addition, not every program uses the same measure subset nor are all measures applicable to each medical specialty or to your business.

b. The objective of the crosswalk is to determine the measure pool for which supports the achievement of all programs by providers as a byproduct of providing good quality care.

2. EHR Capability and Reporting

a. With the measure pool proposed, it is time to confirm that the EHR will support the measures selected. This includes software versions, application configuration and data submission capability for each program targeted.

b. Capturing quality measures from claims data is a short term and short-sited strategy. Only evidence-based content collected in the EHR has the ability to improve the patient’s outcome at the point of the encounter.

c. The EHR content captured is the foundation that population health software will use for risk stratification. The measure pool should be aligned to the risk factors defined in the community assessment. This ensures that measures and community health management are in aligned to have the largest impact in patient outcomes in the community.

3. EHR Workflow, Training and Dashboards

a. Once the measure pool is finalized, workflow and training material need to be updated to include steps to capture the necessary documentation. Documentation that is not captured consistently on the patient population will result in ineffective risk stratification and quality measure degradation.

b. Physician dashboards or reports must be available to track performance and remediation plans. Since quality data has been reported from claims historically, the right tools and feedback loops to the healthcare team has been lacking.

4. Provider Alignment

a. The patient determines the hospital or physician they will use for health services based on quantified quality data available on hospital and physician compare CMS websites. This information is publicly available to software developers through APIs so shopping for healthcare services based on reviews will become as common as reviewing products on Amazon.

b. Patient volume, and therefore revenue, will be driven by patients armed with subjective patient reviews and quantitative quality outcomes based on the services they are seeking.

c. On January 26, 2015, the U.S. Department of Health & Human Services aligned patient outcomes to Medicare payments stating “HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACO) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018”. (HHS Press Office, 2015)

d. Provider operating contracts need to include incentives now for quality outcomes to shape behavior in preparation for the fee for value transition in 2016 for Medicare, which will be quickly followed by the private insurance industry.

5. Governance Change Control

a. A robust governance structure with change control process is necessary more than ever before. The effort put forth to improve outcomes can be lost when introducing new applications, workflows and existing application change requests. Detailed change control process for checking baseline measures and workflows are required.

b. A test environment reflecting production with reporting capability ensures that impacts to outcomes are mitigated through testing before we affect the care of our patients.

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Brief History of EHR Incentive Payments, Payment Adjustments

Brief History of EHR Incentive Payments, Payment Adjustments | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) oversee the Medicare and Medicaid EHR Incentive Programs, meaningful use payments, and payment adjustments for eligible professionals and hospitals including critical access hospitals (CAHs).

Under the Medicare EHR Incentive Program, healthcare facilities may receive a maximum incentive payments of $44,000 over the course of five sequential years. The payments first started in 2011 and will continue until the end of 2016. Meanwhile, the Medicaid EHR Incentive Program confers a maximum of $63,750 over six years. In order to receive these incentives, eligible professionals and hospitals must prove they are meaningfully using certified EHR technology (CEHRT) in their practices. After first-year entities participated in the program, they could obtain as much as $18,000. In subsequent years, incentive payments were lower, ending with $2,000 by the fifth year for Medicare eligible professionals.

In 2009, Congress passed a ruling within the American Recovery and Reinvestment Act that assigned payment adjustments or penalties to eligible medical professionals and hospitals that did not meet meaningful use requirements of CEHRT under the Medicare EHR incentive program. Eligible providers who do not meet meaningful use will receive one-percent payment reduction in the first year, which will rise in every subsequent year to a maximum of five percent.

Healthcare providers who are eligible only for the Medicaid program will not have the burden of these payment adjustments. For those who serve both Medicare and Medicaid patients, they will be subject to payment adjustments if they fail to meet meaningful use requirements.

The first penalties began on October 1, 2014 for Medicare hospitals. Eligible professionals who did not meet meaningful use requirements received their first payment adjustment after January 1, 2015. Recently, CMS announced that approximately 78,000 eligible professionals are subject to meaningful use penalties of more than $2,000.

“The penalties physicians are facing as a result of the Meaningful Use program undermine the program’s goals and take valuable resources away from physician practices that could be spent investing in better and additional technologies and moving to alternative models of care,” Steven J. Stack, MD, President of the American Medical Association, said in a statement. “The AMA continues to work with the Administration to improve the Meaningful Use program and looks forward to seeing how CMS’ anticipated new rules address these issues this spring.”

Despite the burden of the penalties, CMS does offer exceptions to those truly having difficulty implementing CEHRT and meeting the requirements of meaningful use. Those who are eligible but unable to meet meaningful use requirements due to a significant hardship are allowed to file for a meaningful use hardship exemption by completing an application. Upon approval of the hardship, it is valid for one year only and a subsequent application must be presented the following year. A hardship exemption may not be granted for any longer than five years.

There are also a handful of cases in which entities will not need to submit hardship exemption applications but will automatically be given an exception. These include new providers in their first year of service and professionals of specific PECOS specialties among others.

For those who wish to avoid a payment penalty in subsequent years, the National Library of Medicine offers tools that help providers meet EHR certification conditions and reach meaningful use stipulations.

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Epic Systems Squeaks to Top of Physician EHR Adoption List

Epic Systems Squeaks to Top of Physician EHR Adoption List | EHR and Health IT Consulting |

Epic Systems is the number one vendor when it comes to physician EHR adoption, but it only barely beats out some of its close competitors for the top spot, according to a report from SK&A.  While the mega-vendor is a frequent choice for large hospitals and health systems, taking best-in-show honors from KLAS Research for nine out of the past ten years, Epic has not yet secured total dominance on the physician side.  The highly fragmented market has left a number of other vendors nipping at Epic’s heels, including eClinicalworks, Allscripts, and Practice Fusion, which have secured similar shares of the top 35% of physician customers.

In contrast to last year’s report, where the top ten vendors made up 53% of the physician EHR adoption market, this year’s research shows that just eight vendors have now scooped up the same proportion of providers.  Epic, now at 11.6 percent of the overall market, has grown by more than 1 percent over last year’s numbers, while eClinicalworks has stayed steady at 10.2 percent, and Allscripts follows at 8.7 percent.

The next few vendors, including Practice Fusion, NextGen, GE, and Cerner, drop off from 6.7 percent to 3.5 percent, while other companies, including athenahealth, McKesson, Greenway, and MEDITECH, hover between one and two percent of market share.  Overall adoption has increased from 61 percent to 62.8 percent of all responding providers, the report shows.

Quite notably, the top twenty vendors make up less than three-quarters of the physician EHR market.  Twenty-seven percent of providers are using close to 500 different products that may be proprietary, specialty-specific, or small newcomers in the industry.  Providers with one to three physicians were significantly more likely to be using one of these unknowns than larger organizations, with close to 30% of these small organizations adopting a product outside of the mainstream.

The fragmentation of the EHR landscape is a boon for startup developers and smaller companies looking to cash in on the few remaining paperbound providers, or those seeking to become an unhappy organization’s choice for a replacement EHR.  But it is also bad news for health IT interoperability, as small vendors who may or may not be certified by the ONC for meaningful use attestation, are built upon a wide array of proprietary technologies that do not foster data exchange.

While a 2013 survey found that small EHR vendors were more likely than larger ones to produce happy customers, likely due to better customer support and more individualized attention for training and technical glitches, these vendors may also be more likely to fold suddenly under financial pressures, leaving physician organizations in the lurch.

But financial disasters are not the provenance of small vendors alone.  Epic has made more headlines than most other vendors for its role in several spectacular EHR implementation failures, though it is most frequently cited for its success in larger hospitals, and continues to expand its footprint into major health systems.  The Mayo Clinic recently announced that the vendor would be replacing Mayo’s trio of EHR systems with a single, integrated platform, while Epic remains in contention for the $11 billion Department of Defense EHR modernization contract.  The company’s suite of offerings, including business intelligence software, ambulatory practice management, health information exchange, and patient portals provides physician practices with an attractive toolkit to fuel expansion into the physician EHR world.

Other companies are seeking a similar crossover between the ambulatory and hospital markets as adoption reaches its saturation point.  athenahealth, ranked eighth in physician EHR market share by SK&A, is moving into the hospital sphere by offering its cloud-based services to the rural and critical access hospital (CAH) market.

“Rural and CAH organizations may not receive the same attention as academic medical centers and large, clinically-integrated health systems, but they make up approximately 1/3 of the hospital market,” explained Jeremy Delinsky, Chief Technology Officer at athenahealth.  “They’re also innovative, important pillars of their communities, providing tremendous value and quality at generally lower costs. These providers have been unable to afford the steep price tags of legacy software installations. Our revenue model is closely tied to that of our customers; we don’t make money unless they succeed.  We think this message will gain a lot of traction in the CAH market.  From there, we will have room to climb upmarket.”

EHR vendors looking to achieve a foothold in both worlds will need to tailor their offerings appropriately for customers no longer satisfied with basic data entry interfaces.  While some companies tout the standardization of their user experiences as a selling point, products that will continue to gain traction in either segment of the marketplace will need to meet the specific needs of choosy providers looking to make the most of their costly EHR investments.

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Is your medical practice ready for dual coding?

Is your medical practice ready for dual coding? | EHR and Health IT Consulting |

Although medical practices cannot submit medical claims with ICD-10 codes until Oct. 1, there are a few good reasons to start using them sooner.

Those reasons support dual coding — when healthcare organizations assign ICD-10 and ICD-9 codes simultaneously to medical records.

The advantages include:

  • Medical coders can practice their ICD-10 knowledge
  • Clinical documentation deficiencies are exposed
  • Extensive internal and external testing can be done

This won't be cheap. Systems need to be designed for dual coding. And no matter what your vendor promises, dual coding is extra work. That means there will be a productivity loss. Maybe computer assisted coding (CAC) will help. Costs would be associated with:

  • Added time
  • Maintaining data collection
  • Analyzing data

Medical practices likely will need to assign extra coding resources. Extra medical coders can be hired to cover the dual coders. Healthcare providers need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.

To get dual coding started, the Centers for Medicare and Medicaid Services (CMS) recommends answering the following questions:

  • Can the practice management system (PMS) or electronic health record (EHR) can capture ICD-9 codes and ICD-10 codes in the same patient encounter?
  • How much dual coding will be done?
    • How often?
    • How many encounters will be processed?
    • Are all diagnoses or just the top X percent of diagnoses are represented?
  • Will the ICD-10 codes be captured in the PMS or EHR system or on paper?

Before dual coding can start, a medical practice should:

  • Upgrade systems so they are ICD-10 compliant.
  • Make sure clinical documentation can support ICD-10 coding.
  • Start ICD-10 training and education.
  • Test with healthcare vendors or payers.

Then start practicing ICD-10 coding on real cases in the medical practice. Chances are that all this time and money will be investments that payoff after Oct. 1.

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EHR Usability Challenges for Clinical Decision Support

EHR Usability Challenges for Clinical Decision Support | EHR and Health IT Consulting |

To live up to its potential, clinical decision support tools should be able to assist clinician EHR users to make the most appropriate evidence-based decisions when treating their patients. Current EHR technology, however, still exhibits signs of growing pains in terms of how clinicians receive these support services.

“That companion, support tool is absolutely appropriate, but there are certain instances where it needs to be a little more forceful,” says Harvard Vanguard urgent physician Erin Jospe, MD, who also serves as Associate Chief Medical Officer at PatientKeeper.

“That is why there should be a range of different types of alerts that a physician gets,” she explains. “There are certain things where it is fine for them to be in line; there are other things where you need a hard stop.”

The fine line is between prescriptive medicine and physician autonomy. EHR developers need to be mindful of the various and varying needs of clinicians when determining how clinical decision support tools and services impact their EHR workflows.

“Understanding the different applications of clinical decision support will allow them to shine,” Jospe maintains. “It’s not going to be a one-size-fits-all approach. In certain areas, just offering evidence links is sufficient — not everybody needs to see it and will go with the recommendation being presented. Other times you think your patient might be the exception.”

According to Jospe, that latter notion is more often than not a common one among clinicians and likely a source of their frustration when clinical decision support becomes implemented into their care delivery.

“We all think that our patients are special and we want to value and respect the individual human person in front of us, she continues. “When we then try to plug that into a rules-based engine, there is a dissonance between those two imperatives — there is a rule and my patient is exceptional. Trying to understand that and allowing for both as appropriate is what EHRs should be striving to do.”

Connecting filtering with EHR usability

A patient’s EHR comprises numerous fields of data, notes, and other bits of information, but in order for a clinician EHR user to be most effective in her care delivery she must be able to identify the most relevant pieces of clinical data.

“The ability to dive into the specific area of information you’re looking for is crucial,” says Jospe. ” You have to be able to find just what you’re looking for either based on what you’re seeing with the patient or idea that you had. Being able to navigate quickly and efficiently to the information you think you need but still be to trace your way back to broader pools of information is the key or at least one of the primary tenets of a good EHR.”

Historically, this kind of EHR functionality has not featured in EHR design. As a former primary care physician, Jospe claims it created struggles for her earlier in her career and still does for others today.

“That was one of my struggles with primary care and the EHR system that I had to be in,” she reveals. “I was responsible for all of the information that I was seeing but understood the context for maybe five percent of it. I wasn’t the ordering provider — there were specialists, things done in the past, etc. — so how to make sense of that is a real burden and it keeps a lot of docs up.”

Echoing EHR usability sentiments recently expressed by Micky Tripathi, PhD, MPP, of the Massachusetts eHealth Collaborative (MAeHC), Jospe foresees future EHR design that enables EHR end-users to filter clinical data based on their needs.

“You have to be able to find just what you’re looking for either based on what you’re seeing with the patient or idea that you had,” she maintains. “Being able to navigate quickly and efficiently to the information you think you need but still be to trace your way back to broader pools of information is the key or at least one of the primary tenets of a good EHR.”

In the context of a physician, that’s the ability to parse the notes of particular colleagues separately or together. “That ability to give control over finding and communicating information — that’s the secret sauce,” adds Jospe.

It’s so exciting that there is data that can be used to predict the direction and trajectory of your patient’s health. Having that brought to your attention as things are changing is really important and that deserves to be moved and flowed up to the top instead of presented as an option to go in that direction.

Returning to clinical decision support, the road ahead for EHR developers is to ensure this technology is a useful touchstone for clinicians of varying types. “It’s a hard balance. There is a fine line between forcing a particular thought pattern and offering some guidance,” says Jospe.

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Why Are So Many Big Health IT Companies from Small Cities?

Why Are So Many Big Health IT Companies from Small Cities? | EHR and Health IT Consulting |

I was reading over something on HIStalk the other day that talked about how many major healthcare IT and EHR companies have come out of small cities. In fact, when you think about the EHR world, there are only a handful of EHR companies that have come out of the tech hub of the world, Silicon Valley, and they’ve all been started within the past 10 years.

In the article HIStalk mentioned the town Malvern, Pennsylvania. I hadn’t even heard of the town, but a look at Wikipedia has Siemens Healthcare, Ricoh Americas, and Cerner as among the companies based in Malvern. I think the Cerner mention in the list must be because Cerner just purchases Siemens Healthcare, so they are now claiming them. However, Cerner is definitely a Kansas City based company. Either way though, Kansas City is not a HUGE city either and certainly hasn’t been the hub of technology (although, I know they have some cool tech things happening now, like most cities).

The healthcare IT behemoth, Epic was founded in Madison, Wisconsin and now has headquarters in Verona, Wisconsin. If you aren’t in healthcare IT, my guess is that you’ve probably never even heard of Verona.

Those are just a few examples and I’m sure there are many more. Why is it that so many of the large healthcare IT companies have come from small cities? Will that trend continue or will large cities like San Francisco, Boston, New York, and LA start to dominate?

I’m a bit of a young buck in this regard. So, I don’t have the answer. Hopefully some of my readers do. I look forward to hearing your thoughts. Is there an advantage to being from a small town when going into healthcare? It’s exciting to me that healthcare innovation can come from anywhere. I hope that trend continues.

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Free iOS App from ADP AdvancedMD Allows Any Physician Practice to Assess ICD-10 Preparedness

Free iOS App from ADP AdvancedMD Allows Any Physician Practice to Assess ICD-10 Preparedness | EHR and Health IT Consulting |

South Jordan, Utah – February 24, 2015– ADP® AdvancedMD, a leader in all-in-one, cloud electronic health record (EHR), practice management, medical scheduling, medical billing services as well as a pioneer of big data reporting and business intelligence for smaller medical practices, today announced the release and availability of AdvancedMD ICD-10 Toolkit, a free app that gives private practices a suite of ICD-10 preparation tools. Now anyone with an iPhone or iPad running iOS8 can easily test their readiness and train staff for the October 1deadline, free of charge. Customers of AdvancedMD practice management software can also leverage the app to add ICD-10 codes to their charge slip templates.

“ADP AdvancedMD has been a leader in the ICD-10 transition process and a champion of independent physicians and small practices, with such tools as, a website aimed at helping medical practices prepare for the ICD-10 transition, featuring a timeline and a wealth of tools, training and tips to help practices prepare for the change,” said Raul Villar, president, ADP AdvancedMD. “With less than half of all practices ready for the change, we saw a need for a tool that would aid the entire community of independent physicians in their progress.”

The app was created as part of the ADP AdvancedMD iCommit program, which offers incentives to engineers for independently pursuing innovations in addition to their regular jobs.

“We decided that there should be a tool to help everyone prepare for the change to ICD-10 and give our community the ability to gauge their readiness,” said Barlow Tucker, software engineer, ADP AdvancedMD. “A free app was the clear choice because it’s easy to access and use, plus it allows people to get an ICD-10 ‘checkup’ at any time.”

The AdvancedMD ICD-10 Toolkit allows users to:

– Track preparedness for ICD-10
– Compare ICD-9 codes with the ICD-10 equivalents, including risk of increased specificity
– View potential high-risk areas
– Search for ICD-10 codes and sub codes
– View articles and action plans to guide a specific transition

Download the new AdvancedMD ICD-10 Toolkit app for iPad®, iPhone®, and iPod Touch® available for free on the Apple app store.

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EHRs are not a business strategy

EHRs are not a business strategy | EHR and Health IT Consulting |

Somehow health systems have adopted the notion that electronic health records are central to their competitive strategies – viewing the technology’s capabilities beyond their original design and intent.

EHRs were created to collect information and help practitioners from within the four walls of the health system make better informed decisions; they weren’t built to connect hospitals with their trading partners, nor were they built to solve critical business issues such as dwindling reimbursements and the transition away from fee-for-service to value-based care.

In fact, once all health systems inevitably implement EHRs, they become another toolset within the hospital; they become expected assets of the institutions, not unlike thermometers, stethoscopes or examining rooms. What they don’t do is provide a market advantage. A successful provider network will look to cost-effective cloud-based solutions to complement EHRs, broaden and connect the care community, grow revenue, create workflow efficiencies and, ultimately, provide a truly competitive advantage.

The problem with EHRs

Since their inception, EHRs have been a touchy subject. Operating executives have acknowledged the importance of upgrading outdated analog tools and implementing effective instruments for retrieving patient data, entering orders, receiving results and documenting visits. But they have also admitted their disappointment in the resources – both financial and operational. Physicians have also been vocal in their dislike of EHRs, pointing to the technology’s disruptive nature and time-consuming requirements.

Hospital executives that expected to see returns on their EHR investments have been disillusioned, knowing now that new revenue opportunities originate outside of those walls. Inpatient admissions and surgical procedures are no longer contributing needed revenue growth, as volumes are being reclassified and transitioned to outpatient settings.

As Moody’s Investors Service has reported, nonprofit hospitals’ income declined for the second straight year in 2013. Hospitals must turn their attention to technologies that can connect the broader community of independent providers, uncovering the value in new referral sources and effective care coordination. EHRs were not designed to meet this need.

The cloud-based solution

Regardless of EHRs’ deficiencies, the initial decision to digitize was not wrong – it was necessary to improve efficiency. But that action was a one-time occurrence and should not be viewed as a competitive strategy.

Though arguably useful in the long term, investments into EHR technologies do not improve outpatient revenue and associated contribution margins. And with the shift to value-based care, it is more important than ever that health systems prioritize care coordination across organizational boundaries. EHRs’ limitations in this area can be detrimental to a health system’s business strategy.

Network providers must turn to additional tools that can help fill the holes left by EHRs. Inexpensive cloud-based software can help supply what EHRs lack – the ability to quickly grow outpatient volume, curtail network leakage and lift contribution margins. These tools act as referral management platforms and assist in scheduling and analytics. They are designed to interoperate with EHRs, adding new value to the tool and potentially helping create the investment returns that were originally expected.

Health system executives who want to create a competitive advantage will think beyond EHRs, unlocking value unknown to those who simply implement the same cookie-cutter tools as their competitors. 

David Greene's curator insight, February 24, 8:28 PM

Good article.  Most EHRs are still missing the key concept of creating engagement with patients because that was not in their initial design.  Now systems need to look to other solutions for improving quality and cost containment by better engagement throughout the continuum.  Healthcare should look to other industries to replicate how they create successful interactions with customers, and then devise strategies that will truly engage those who will determine the future pay for performance revenues...

Bharat Employment's curator insight, February 25, 1:58 AM!

Acute Care EMR Purchasing Plans 2015

Acute Care EMR Purchasing Plans 2015 | EHR and Health IT Consulting |

Stiffer competition between key vendors is causing a growing number of providers to be undecided about which EMR to purchase when looking to make a buying decision. In the KLAS acute care EMR purchasing plans report released today, researchers found that even though providers have fewer choices due to market contraction, they are less likely to have made up their minds about which system to buy when evaluating future purchases.

Energy in the market is being driven largely by legacy customers looking to make a purchasing decision. This report shines a light on which companies are under consideration by providers looking to make a decision and what is fueling that consideration.
“The competition between Epic and Cerner is closer than it has been in years past as customers determine their future purchasing plans. This has left twice as many facilities “up for grabs” as there were last year,” said report author Coray Tate. “The lion’s share of the remaining customer mindshare is split between MEDITECH and McKesson, pretty consistently along partisan lines.”

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How EHR Data Exchange Drives Healthcare Reform, Improvement

How EHR Data Exchange Drives Healthcare Reform, Improvement | EHR and Health IT Consulting |

Increased EHR data exchange is beginning to play an important role in reforming the healthcare industry and enhancing the quality of care. Essentially, EHR data exchange is being used to transform the efficiency of care, engage patients, support population health management, and boost healthcare quality.

The Office of the National Coordinator for Health Information Technology (ONC) explains that the benefits of exchanging EHR information include reducing test redundancy and improving efficiency by ensuring all healthcare professionals handling a patient’s care have access to the same data. Additionally, EHR systems provide a more streamlined approach to administrative tasks and in doing so the costs associated with these aspects of care are reduced.

Through patient portals and the curtailing of redundant paperwork due to the growth of health information exchange (HIE), patient engagement is also increased. In fact, the Centers for Medicare & Medicaid Services (CMS) has elevated the importance of patient engagement by incorporating patient-centered conditions into Stage 2 Meaningful Use requirements.

For example, the EHR Incentive Programs calls for patients to be able to access their health information and communicate with their healthcare professionals electronically. Many patients have already received follow-up or preventive care reminders and used a patient portal to access their medical data such lab test results and current medication lists. Privacy and security of these messaging services are also of the utmost importance to the healthcare field, as it is a major part of Stage 2 Meaningful Use requirements.

As part of its Health IT Success Stories series, ONC discussed the patient engagement initiatives at Helping Hands Pediatrics, Inc., a small clinic located in Sharon, Penn. Using this practice’s assessment tools, patients with asthma are able to contemplate how the condition influences their day-to-day life.

“Through the integration of assessment tools, the children in our practice really get a chance to think about their disease and how it affects their daily life. This sense of ownership in their disease management was well worth the effort,” Office Manager Angie Chlpka told ONC representatives.

Along with increasing patient engagement, EHR data exchange improves population health management by allowing physicians to coordinate with public health officials and improve community health initiatives.

EHR systems can improve public health reporting by offering an efficient data collection process with the ability to share information across various healthcare facilities. For example, immunization registries and electronic laboratory reporting provide a streamlined system in which physicians can send population health data to public health officials.

This type of information exchange could play a large role in studying, preventing, and managing disease. For instance, clinicians should be able to receive alerts on major public health concerns in the near future. EHR technology also offers a way to improve communication and collaboration between public health officials and physicians.

One of the most important roles EHR systems play in healthcare reform is in quality improvements. EHR technology is poised to reduce medical errors and drug prescription mistakes. On the whole, this should lead to better patient health outcomes and improved safety.

Accurate and error-free EHR data is tied directly to quality improvements in the healthcare industry. Poor or insufficient data, on the other hand, will reduce patient safety and undermine the effectiveness of HIE, according to the American Health Information Management Association (AHIMA).

Enhanced decision-making and quality care delivery is directly linked to complete and accurate EHR data. In order to ensure data quality is first-rate, AHIMA advises medical organizations to focus on data capture and improving clinical documentation practices. Also, incorporating uniform data models will better establish the reliability of the information stored in EHR systems.

Whether it’s patient engagement and greater healthcare efficiency or better population health management capabilities and quality improvements, the collection and sharing of EHR data plays a large role in the ongoing healthcare reform across the nation.

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CDC Sees Increase in Emergency Care, Ambulatory EHR Adoption

CDC Sees Increase in Emergency Care, Ambulatory EHR Adoption | EHR and Health IT Consulting |

The Centers for Disease Control and Prevention (CDC) recently released a survey that shows an increase in emergency and ambulatory EHR adoption between 2006 to 2011. It was found that, by 2011, 84 percent of hospital emergency departments (EDs) and 76 percent of outpatient departments used an EHR system.

In fact, EHR adoption rose from 19 percent in 2007 to 54 percent in 2011 among EDs. Additionally, more outpatient facilities began focusing on Stage 1 Meaningful Use requirements. The trends show a steady rise in the implementation of any EHR system among emergency care facilities across the five-year timeframe.

The HITECH Act of 2009 is one of the reasons that EHR technology has seen greater implementation as it gave eligible hospitals and professionals monetary incentives to adopt health IT systems.

As such, the number of emergency departments with EHR technology that meets meaningful use guidelines rose significantly from 2007. Since payments for meeting Stage 1 Meaningful Use began in 2011, this increase comes as no surprise. For example, electronic prescribing (e-prescribing or eRx) increased from 38.6 percent in 2007 to 62.6 percent by 2011.

Along with the widespread use of ordering prescriptions electronically, health IT systems increasingly began recording patient history, patient problem lists, and providing warnings of negative drug interactions or allergic reactions. However, less than 20 percent of emergency and outpatient departments reached thresholds for nine Stage 1 Meaningful Use requirements. To receive meaningful use incentive payments, hospitals will need to demonstrate the achievement of 14 core set objectives and 5 of 10 menu set objectives.

As part of its Health IT Success Stories series, the Office of the National Coordinator for Health Information Technology (ONC) shared the experience of one emergency department at a hospital-based clinic in Cincinnati, Ohio. In 2011, the University of Cincinnati (UC) Internal Medicine and Pediatrics practice implemented an EHR system in order to share patient data through the hospital’s Health Information Exchange (HIE).

One major aspect of the HIE included incorporating the Emergency Department/Admission Alert System, which warns the facility when a clinic patient has entered emergency room care or hospital admission. With the help of the alert system, the physicians at the clinic were able to develop care plans for patients to prevent future emergency room visits.

“After our patients are discharged from the hospital or ED, our clinic is able to proactively reach out to them to make sure they understand their discharge plan and set up follow-up appointments as needed,” Dr. Jonathan Tolentino, an internal medicine and pediatrics physician at the clinic, told the ONC.

Along with the follow-up care, the clinic incorporates EHR-based risk stratification to determine which patients need the greatest amount of assistance after emergency department care.

“The risk stratification system, combined with the ED alerts, not only helps us deal more aggressively with high-risk patients, but also helps us increase care coordination,” Dr. Tolentino went on to explain.

Greater adoption of alert systems and EHR technology among emergency departments will likely improve patient safety and health outcomes over the coming years.

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Laying the foundation for an image-enabled EHR / EMR

Laying the foundation for an image-enabled EHR / EMR | EHR and Health IT Consulting |

As more and more types of patient data and images are being created across hospital departments and externally across the continuum of care, healthcare organizations’ data management needs are rapidly evolving. And as industry pressures for improving quality of care and controlling costs continue to mount, it has become paramount that hospitals have the ability to access, share and optimize patient information from the EHR / EMR—all data, regardless of source, location or format—in a fully integrated, patient-centric manner.

Imaging data is no different. It requires long-term enterprise archiving solutions that go beyond simply storing digital imaging data to ones that manage data based on industry standards, ensure its protection, and enable easy search and retrieval of all unstructured content, while laying the foundation for EHR / EMR integration.

But the healthcare industry is at a critical impasse as it moves from an age of time-honored traditional care to an age of redefined ability where we’ll empower more patient-centric care to keep our communities healthier. Despite the investments we’ve made in electronic health records (EHRs), much of the patient information clinicians need access to—mostly unstructured—resides outside the EHR / EMR with little facility for accessing or the ability to share it.

To achieve long-term enterprise data management strategies, meaningful-use initiatives and create longitudinal patient views of the patient record, imaging data and other unstructured content must be integrated into the enterprise in order to achieve EHR / EMR goals. And it will be crucial that we redefine how diagnostic images and related content are managed and accessed to create a single patient-centric view, enterprise-wide as we look to improve patient outcomes while lowering the cost of care.

Building an Enterprise-Centric Solution for Today’s Image & Content Challenges
IDC has defined the patient-centric evolution of the vendor-neutral archive (VNA) as an application-independent clinical archive, or AICA. Many in the industry have contended that this is, in effect, the second generation of the VNA—a ‘super VNA’ of sorts. But, as IDC outlines, the concept of an AICA is differentiated from the VNA. An application-independent clinical archive would move the industry more towards patient centricity by shifting focus to enhancing clinical relevance as opposed storage rationalization.

I’ve been a big supporter of this movement, and IDC is certainly on the forefront of changing how the healthcare industry will achieve long-term enterprise data management strategies and meaningful-use initiatives. And if the recent RSNA conference is any indication, so is the industry itself. But to create longitudinal patient views of the patient record, imaging data and other unstructured content must be integrated into the enterprise in order to achieve EHR / EMR goals.

To this end, I see the next evolution of diagnostic image management as a slightly different acronym—ICM (image and content management). Similar to the concept of an application-independent clinical archive, ICM would include all the functionality of a VNA for diagnostic image storage, but additionally include enhanced capabilities of enterprise content management for comprehensive clinical content management, integration and sharing. As a scalable data management and archiving solution, ICM would be optimized to manage all unstructured content—irrespective of type. And through integration with the EHR / EMR, it would make available to multiple clinicians at the point of care, a longitudinal, patient-centric view of a patient’s medical record.

The ICM concept would allow healthcare organizations to redefine their clinical content management strategy and image-enable their EHR / EMR with a single, integrated system for managing and viewing all types of unstructured data—not just diagnostic images. And it would allow hospital Chief Information Officers (CIOs) and PACS administrators to simplify infrastructure and expand capacity, undisrupted, through both routine maintenance and PACS migrations.

Redefining Image and Content Management
While VNAs are typically implemented as a department-centric solution, the concept of an ICM would be implemented as an enterprise-centric solution. It would afford healthcare organizations the ability to eliminate departmental imaging silos and consolidate medical image resources to create an integrated management and viewing experience of all clinical content from any EHR / EMR. And it would enable a strategic approach to enterprise data management while increasing productivity and simplifying, at a reduced cost, the achievement of Meaningful Use Stage 2 and HIMSS Stage 7, as well as compliance with federal and state regulations.

In a more simplistic view, an ICM would allow healthcare organizations to consolidate medical image storage resources to create an integrated image and content management platform that affords the ability to:

  • Facilitate Sharing: through the use of open standards, enable the sharing of all diagnostic images and unstructured content throughout the enterprise and across the continuum of care while maintaining patient privacy and security.
  • Aggregate Data and Index Metadata: aggregate any data type and index the associated metadata to ensure that all clinical images are stored in a central location, organized by patient, for easy access.
  • Image-Enable the EHR/EMR: from a single data repository to provide a fully integrated, patient-centric view of the complete patient record—further facilitating enterprise-wide consistency and collaboration, and supporting Meaningful Use Stage 2 and accountable care organization (ACO) efforts.
  • Improve Data Availability and Protection: by consolidating growing volumes of imaging data across multiple departmental solutions, and providing instant access to both new images and evaluation of relevant prior diagnostic studies. And ensure regulatory compliance by making data secure, immutable—unable to be deleted or altered—and auditable.
  • Apply Workflow Processes: allow for workflow processes to be applied against the data to enable further improvements to patient care.
  • Improve Interoperability and Virtualize Data: improve the interoperability of information and virtualize data within and between systems to enhance clinical efficiencies, reduce healthcare delivery costs and improve patient-care decisions.
  • Avoid Vendor Lock-In: to more quickly adopt or incorporate new imaging technology, or replace clinical applications, by using standard, non-proprietary data file formats—allowing for the avoidance of compatibility issues, costly integration and data migrations, and potential workflow disruptions.

By leveraging a single repository beyond the imaging department and across multiple departments to manage image and non-image data based on industry standards, healthcare organizations will be better suited to realize their data management strategies under the concept of ICM—and move more readily from imaging silos to content-centric synergies in delivering better patient care across the continuum.

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Top 10 EHR vendors in physician offices

Top 10 EHR vendors in physician offices | EHR and Health IT Consulting |

There's little question that Cerner and Epic are the giants in the EHR field. Epic is dominant not only in the scope of its market share but also in the depth of its client base. Mayo Clinic announced last month that it would be abandoning its three current EHR systems in favor of a new contract with Epic, which will now be the healthcare icon's sole EHR provider and strategic partner. Jilted in the deal were GE and Cerner, who were the providers of Mayo's current systemsalthough if you tallied the figures when Cerner acquired Siemens' EHR unit for $1.3 billion, it still had the largest US market share of any vendor, with 1,132 acute care hospitals. 

But a more granular look at market share amongst physician offices shows a slightly different market picture.

Epic is still on top, but only by a percentage point (eClinicalworks is close on its heels). And as you might expect, Epic's client base skews heavily towards larger practices, dominating the 41+ practice market at 54%. On the lower end of the scale (1 - 3), Epic, eClinicalworks, Allscripts and Practice Fusion are all within a percentage point or two of one another. 

Cerner, notably, is way down the list across the board in the physician practice world, taking just 3.5% of the overall market. So is athenahealth, at 3.3% overall and just 0.4% and 0.8% in the 26 to 40 and 41 and up segments. This tallies with the cloud-based vendor's ongoing investments in the inpatient market, however: In January, the cloud-based provider purchased start-up RazorInsights to move into the 50-bed and under sector, a niche that accounts for one-third of all hospitals in the US; and last week the company announced that it has purchased WebOMR, Beth Israel Deaconess' cloud-based, stage 2-certified EHR, for commercial development in the hospital setting.

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What Does Epic’s App Store Mean for EHR Interoperability?

What Does Epic’s App Store Mean for EHR Interoperability? | EHR and Health IT Consulting |

Epic Systems may be leaping to the top of yet another health IT category with a new app exchange, which would allow external developers to create products that would interface with Epic’s popular electronic health record system.  The Epic App Exchange would be the health IT version of Apple or Google’s app stores, and may first try to secure entries developed by Epic customers that would enhance the openness and interoperability of the famously tight-lipped infrastructure.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” said Nordic Consulting co-founder Mark Bakken in an interview with the Wisconsin State Journal.  “Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge.”

The app store mirrors a 2013 effort by athenahealth to connect innovative services to enhance interoperability, health information exchange, and data governance for users of their products.  The athenahealth Marketplace intends to bring “the best HIT solutions to the forefront,” athenahealth CEO and Chairman Jonathan Bush said at the time. “Similar to what is for consumers, our platform, with the immense support of our Marketplace partners, will serve as a one-stop ‘shop’ for high-value HIT solutions.”

A spokesperson from Epic confirmed the project, which Bakken says may launch within the next few weeks.  The Verona, Wisconsin company has faced criticisms in the past about its closed systems as the healthcare industry embraces the notion of EHR interoperability, data standards, and widespread health information exchange.

While it has made a few nods towards industry integration, Epic has secured such dominance in the hospital market that it has been able to largely ignore the complaints, but it has several big projects on its agenda that may make it more difficult to continue down its previous path.

In addition to bidding for an $11 billion contract from the Department of Defense that will likely value interoperability and open architecture above Epic’s monolithic culture, moving into the ambulatory market will require more flexibility than it has shown in the hospital sphere.

Primary care providers interested in population health management or joining the accountable care movement need EHR infrastructures that can easily speak to products from different vendors.  With the ambulatory EHR market so fragmented and the priorities of physician offices changing, Epic may need to expand its interoperability strategies if it wishes to continue its slow but steady gain in market share.

The app store might be a smart way to do this.  By encouraging third parties to develop connections between Epic products and other offerings, Epic gets to take credit for promoting EHR interoperability without having to do too much of the work itself.  The company will be providing interested developers with a “roadmap” about how to work with the company, Bakken says.  More details will no doubt be forthcoming, but until then, the healthcare industry will have to do what it always does: wait at Epic’s gates until it decides to open up.

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Epic Systems to open its own app exchange

Epic Systems to open its own app exchange | EHR and Health IT Consulting |

Epic Systems Corp. is about to launch its own app store — much like Apple’s App Store — opening the door for outside companies to create applications that will work with Epic’s widely used electronic health records systems.

Mark Bakken, co-founder and former chief executive of Nordic Consulting, the largest consultant firm working with customers of Verona-based Epic, stirred up excitement about the plan Tuesday at a luncheon meeting of the Wisconsin Innovation Network.

Bakken said the app store will launch in a few weeks and it will “open the floodgates” for all sorts of companies to develop and market their apps, especially those in the Madison area populated by former Epic employees.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” Bakken said later in an interview.

Epic spokesman Shawn Kiesau confirmed the plans but could not provide immediate details. It will be called the App Exchange, he said.

Bakken said Epic’s App Exchange will work similarly to Apple’s App Store.

“Let’s say you want to create an app for the iPhone. Apple has automated that online. As long as you play by all the rules, they’ll publish it,” said Bakken. Epic will be “publishing a road map about how to work with Epic,” he said.

Bakken said there are all sorts of potential uses for the Epic App Exchange, both for health care organizations and for consumers. He said he expects the first apps to come from Epic’s customers, so that one health care organization can offer other hospitals and clinics the specialized programs it has developed to work along with Epic’s software.

“Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge,” Bakken said.

Politically, he said, the App Exchange should squelch some of the criticism Epic has drawn from those who say its system is too closed, and that it is too hard to share medical records between health care groups that use Epic’s systems and those that don’t.

That may be particularly important as the U.S. Defense Department considers which team should receive a contract worth up to $11 billion over five years to install an electronic health records system for the U.S. military. Epic and IBM have submitted a joint application for that contract, which is expected to be awarded later this year.

Bakken’s comments about Epic’s App Exchange came as the Madison tech entrepreneur spelled out plans for HealthX Ventures, a fund Bakken is forming to invest in very early-stage health information technology companies, many of which are being created in the Madison area by former Epic employees.

Currently at $5 million, Bakken hopes to raise $10 million to $20 million for the fund. He said Nordic’s clients include some of Epic’s most prestigious customers, such as Kaiser Permanente, Johns Hopkins and the M.D. Anderson Cancer Center at the University of Texas, and he plans to introduce some of the local start-ups to them.

A goal of HealthX Ventures is “helping startups get to the next level,” said Bakken. If they can snag $1 million in revenue within a year, other venture firms will want to invest, he said.

“And hopefully, we have five more Epics,” Bakken said.

Epic has about 8,000 employees and its preliminary 2014 revenues were $1.8 billion, spokesman Kiesau said.

About 135 people attended the luncheon at the Sheraton Madison Hotel held by Wisconsin Innovation Network, a tech-oriented group that’s part of the Wisconsin Technology Council. Among them was Niko Skievaski, co-founder of Redox, a new business aimed at helping health care applications connect with electronic health records companies such as Epic.

Redox grew out of 100health, initially meant to incubate health IT startups. “We were missing the capital and therefore couldn’t get them going fast enough. That’s why we focused on Redox,” Skievaski said.

He said Bakken was Redox’s lead investor in a $350,000 funding round in December. “He sat other investors down and said, ‘Guys, this is a good deal,’” Skievaski said. He said Bakken’s HealthX fund is “exactly what Madison needs right now.”

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