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5 Ways Pinterest Can Be Used for Patient Education in Healthcare | ParkerWhite Brand Interactive

5 Ways Pinterest Can Be Used for Patient Education in Healthcare | ParkerWhite Brand Interactive | EHR and Health IT Consulting |

Pinterest is an image-driven social network that has rocketed in popularity in the last couple of years. Pinterest works as a way to visually organize things on the Internet via “Boards,” which act kind of like folders, to organize thoughts into certain categories or interests. As more and more people use the Internet to search about healthcare, Pinterest is a way to organize the information they find, also allowing for them to share content easily with others. The other potential benefit from Pinterest is to reach people when they’re in various Internet “mindsets.” It can be a way to reach the patient when they’re not necessarily concerned with a particular problem at the moment (i.e. searching for specific health information for an issue they have right now). Pinterest can provide a medium for reaching patients to remind people of the many aspects of their life in which health plays an important role.


Pinterest is a good medium for patient education because many people learn best visually. Images can help convey information that would be much harder to digest in words. It can also serve as a good reference, and is more shareable.


1. How the body works2. How medical procedures work

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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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Clinical Quality Reporting Vital for Improved Patient Care

Clinical Quality Reporting Vital for Improved Patient Care | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) have announced that the 2015 annual updates to last year’s electronic clinical quality measures (eCQMs) have now been released. To view the latest version of the eCQMs and participate in clinical quality reporting, visit the electronic Clinical Quality Improvement (eCQI) Resource Center available through the ONC website.

Currently, there are 64 updated measures for eligible healthcare professionals and 29 updated measures for eligible hospitals. The National Quality Strategy (NQS) along with CMS and the Department of Health and Human Services (HHS) have developed these clinical quality measuresbased around six priorities. These are:

1) Patient and Family Engagement

2) Care Coordination

3) Patient Safety

4) Clinical Processes and Effectiveness

5) Population and Public Health

6) Efficient Utilization of Medical Resources

For eligible hospitals, the updated standards revolve around hearing screening, statin prescription during the discharge process, timeliness of hospital and emergency care, anticoagulation treatment for atrial fibrillation, rehabilitation, and thrombolytic therapy.

Healthcare providers will need to use these updated measures to electronically report data to CMS and its clinical quality reporting programs. These updated eCQMs will be part of the standards for reporting under the Medicare and Medicaid EHR Incentive Programs, Physician Quality Reporting System (PQRS), and the Inpatient Quality Reporting Program (IQR).

The Resource Center offers healthcare providers specification tables, documentation on Measure Logic Guidance, and resources for increasing quality improvements and supporting eCQMs. Via the CMS eCQM Library page, eligible professionals and hospital providers can view previously published specifications for 2014 eCQMs.

The reason eCQMs and clinical quality reporting is so important to healthcare providers is due to the impact it bears on financial reimbursement from either Medicare or Medicaid programs. According to aCMS brief about clinical quality reporting, providers who do not satisfactorily meet data reporting requirements on quality measures for Medicare Physician Fee Schedule (MPFS) will have negative payment adjustments put toward their medical practice.

“The quality programs grew out of two realizations: Health care is unsafe and outcomes are poor,” Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine, told The Wall Street Journal. “But there is no single measure of a doctor’s or hospital’s quality that will fix those problems. Instead, we’re measuring processes. Of the 123 different metrics in the government’s Hospital Compare website, 102 measure processes. That’s important, but it has become too burdensome for the benefit it delivers.”

“Quality should focus on the functional outcomes that mean the most to patients,” Wallace continued. “For a patient who got a knee replacement, can she walk and climb steps? For a man having prostate surgery, can we operate without causing incontinence and impotence?”

Essentially, quality metrics are important toward improving patient care and tracking patient health and functional outcomes across healthcare facilities and hospitals. In order to avoid negative payment adjustments from CMS and ensure quality improvements toward better care at one’s practice, providers are encouraged to follow the most updated eCQMs and participate in quality reporting programs.

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Will Health IT Systems Improve Radiology Reporting?

Will Health IT Systems Improve Radiology Reporting? | EHR and Health IT Consulting |

Within the healthcare industry, there are a wide variety of different professionals who participate in managing patient care including treatment and diagnosis. Health IT systems and EHR technology play a role in every medical providers’ workflow, but do not always assist in streamlining healthcare services. With regard to diagnostics, radiologists have often had difficulty remaining high accuracy rates when determining disease based on test images, particularly with radiology reporting.

However, Nuance Communications has assisted the radiology field by developing the PowerScribe 360® Reporting version 3.0, which offers useful reporting information to radiologists during the clinical documentation process, according to a company press release.

Dr. Lincoln Berland, the Chair of Body Imaging Commission at the American College of Radiology, spoke with EHRIntelligence.comand shared his insights on the radiology field and the technologies including health IT systems that affect it.

When discussing the latest version of the PowerScribe 360 Reporting solution, Berland stated, “I’ve been involved with the development and refinement of this new system and what it’s designed to do is to assist the radiologist at the point of interpretation for making recommendations and describing finding. The way it works is by a radiologist dictating a report and he/she may come upon a finding – for example, an adrenal nodule that they will report. The system will recognize that it’s an adrenal nodule and highlight with a flag in the corner that there is a guidance rule for managing that.”

“A radiologist clicks on that and the algorithm list pops up. Radiologists fill in the blanks of a finding in the dialogue box,” Berland explains. “For example, it could be a two centimeter adrenal nodule that’s less than 10 field units. There may be two to five different features that you fill in. At that point, text appears that indicates how you would say it in the report and how the recommendation would appear in the report. If the radiologist finds it acceptable, he/she clicks accept and it automatically pops into the correct locations in the report.”

“This is revolutionary in the sense that nothing like this has ever been available before,” exclaimed Dr. Berland. “The reason it’s so important is that medicine has become so complex and algorithms for managing different kinds of findings – and particularly incidental findings – have become so confusing that to really make sure the right one is chosen every time, radiologists have to look it up, find an article, read through an algorithm, and follow a chart. This bypasses all of that.”

“In practical reality, the way it worked before this system, is that the radiologist most of the time doesn’t look it up. If they’re a specialist in the area, they’ll remember most of the findings and recommendations, but they won’t do it with complete accuracy. If you’re not a specialist, you may not know where to look it up or that even such a guidance rule exists and you might not get it right,” mentioned the Chair of Body Imaging Commission at the American College of Radiology. “What this provides is efficiency, accuracy, consistency, and the right recommendation every time because it’s appearing right on the screen and all of the potential recommendations have been reviewed before you get to the report.”

When asked what some common challenges in the radiology field are specifically with regard to digital technologies and health IT systems, Berland answered, “One of the main challenges that we deal with is the correlation of information. Radiology requests often have a very rudimentary amount of information that comes with it and the EHR has luminous amounts of information.”

“It’s often in a separate system and radiologists have to open that separate system to review the data, going through reams of pages to find the particular piece of information that’s relevant to the examination that you’re reporting,” he continued. “That is a tremendous challenge. Gathering the right information is one of the most difficult parts about making the correct interpretation, particularly for the increasingly complex radiology procedures that we perform.”

“Another problem is dealing with access to all of the relevant information from patients that are in multiple sites,” he explained. “Nuance now has a system called PowerShare [the Nuance PowerShare Network] so that people can share information and images from other sites very quickly. With something like PowerShare, that information can be shared through the cloud before the patient even arrives at the tertiary care center.”

As a final thought on the challenges within the radiology field, Berland stated, “Accessing the right information at the right time is very difficult. Automating that through a system at the point of interpretation is going to be a game changer in how we manage radiology reporting.”

When asked about some of the benefits and difficulties of implementing the PowerScribe 360 reporting program, Berland answered, “From the standpoint of having worked on the system to try to develop it, the challenges that we’ve had in trying to make sure that all of the answers are correct is that the logic is complex because of the algorithms that follow down multiple different paths and depend on multiple different conditions.”

“One of the advantages of the system is that using the PowerShare method, whenever  an update comes along with a newer algorithm, it can be downloaded through the cloud to all the sites used in the system so that there isn’t a significant delay between the issuance of the new guideline and everyone having access to it,” he explained.

Dr. Berland also discussed the most vital quality check tools that radiologists need to conduct their work.

“The Incidental Findings Committee has devised rules for particular organ systems where incidental findings are discovered. Now we have six papers that cover 11 organ systems. What Nuance and Mass General have done is take five of those rules and one additional guideline from another source and translated them into this computerized system. Specifically, they have a rule for managing renal, liver, adrenal and pulmonary nodules, thyroid, and ovarian cysts incidental findings,” Berland answered.

When asked whether the cloud platform is preferable for storing radiology reports, Berland explained, “I don’t think [the cloud] is a prevalent way of managing information right now. We’re a unified healthcare system with a single computerized system that goes through all of our various physical sites. We manage our data locally with backup.”

“The advantage of the cloud that we see is access to data in other health systems either in our state of Alabama or elsewhere in the region wherever a patient has been seen. The problem is that we don’t currently have standards that are well established enough – patients don’t have a single identifier – so we can’t easily have a unified system over multiple sites. There always has to be some reconciliation locally. I think the cloud will increase in utility because people are now being seen in a broader array of institutions and sites, which is going to require the interconnectivity of data,” Berland concluded.

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Seven ICD-10 Transition Steps Medical Coders Should Follow

Seven ICD-10 Transition Steps Medical Coders Should Follow | EHR and Health IT Consulting |

With only four months to go until October 1, healthcare providers who are behind in their implementation of the new diagnostic coding set need to follow specific ICD-10 transition steps to ensure success by the compliance deadline. From integrating new systems and upgrading technological processes to training staff on the new codes and testing the systems, providers will need to be ready by October 1 to ensure their healthcare reimbursement and revenue remains stable.

According to the Journal of AHIMA, coders especially have had difficulty moving toward the new ICD-10 codes, as the amount of responsibilities on their shoulders has risen drastically. When it comes to training and learning about the necessary ICD-10 transition steps, the funding for such activities is low and few resources are being put toward it within the healthcare industry at large, the Journal ofAHIMA reports.

“The budget is the paramount issue,” Anita C. Archer, CPC, Director of Regulatory and Compliance at Hayes Management Consulting, told the news source. “Providing funding for [physician practice] coders to attend training is a problem. There is a much better infrastructure on the HIM side.”

MeShawn Foster, another consultant on ICD-10 implementation, stated, “Based on what I’ve heard, some coders have had to use their own money for training and even their own paid time off to attend the training. With hospital coders, the training is available, and they don’t need to pay out of pocket. Justifying the cost of some of these conferences is hard for the physician coder.”

As the ICD-10 transition deadline comes near and providers only have four months to finish their preparation, physician practice coders are experiencing significant challenges in ensuring they can properly utilize ICD-10 codes in time, especially when it comes to their training.

Another complex challenge that physician practice coders will need to overcome is the management of the practice’s superbill, which requires patient demographics to be evaluated. Additionally, EHR templates will need to be updated as part of the key ICD-10 transition steps.

The Journal of AHIMA offered seven practical tips for providers to follow as they adhere to some common ICD-10 transition steps on their path toward the October 1 deadline. These tips are:

1) Become an expert on using the ICD-10 diagnostic codes.

2) Start at the beginning and convert only the top 20 ICD-9 codes to the new ICD-10 codes. This will prevent coders from becoming overwhelmed.

3) Set aside one to two hours for practicing dual-coding per week.

4) Network with other physician practice coders to reduce the costs of ICD-10 training.

5) Find a physician leader in larger medical practices to advocate for ICD-10 training and preparation on the coders’ behalf.

6) Offer ideas and opinions on template design along with template updating.

7) Schedule weekly meetings in order to discuss any and all ICD-10 implementation issues.

By following the seven tips above, physician practice coders will be on their way toward successfully transitioning toward the ICD-10 code set.

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Half of Medical Providers Lack EHR Interoperability Roadmap

Half of Medical Providers Lack EHR Interoperability Roadmap | EHR and Health IT Consulting |

Both medical device and EHR interoperability is emerging as a key concept throughout the healthcare IT field. More providers and vendors than ever before are making connectivity a priority in the coming years. Whether it’s diagnostics, remote monitoring, physician workflows, or wellness and prevention, EHR interoperability holds true value in enabling these processes, reducing medical errors, and improving the quality of healthcare services across the spectrum.

The market research firm Frost & Sullivan recently published a new analysis report calledHealthcare and Medical Device Connectivity and Interoperability that discusses how health IT infrastructure and connectivity is not identical around the globe. The analysts specifically mentioned how the lack of a health IT strategy could be impairing EHR and medical device interoperability in various countries.

The results in the report show that more than 50 percent of medical providers have not developed an effective healthcare IT roadmap.

While many do realize the importance of computerizing patient records, there is still little progress being made worldwide in improving EHR connectivity based on the findings in the Frost & Sullivan analysis.

Additionally, the lack of interoperability developed among EHR and health IT systems among vendors and manufacturers poses a problem for healthcare providers who attempt to improve medical device and EHR connectivity.

In the United States, future regulations like Stage 3 Meaningful Use requirements will necessitate the need for greater health information exchange and EHR interoperability, which is why vendors and manufacturers will need to develop stronger partnerships in pursuit of effective medical data exchange.

Frost & Sullivan Healthcare Senior Research Analyst Shruthi Parakkal spoke and offered more background on the analysis of EHR interoperability. Parakkal discussed some of the most important standards that may aid in improving connectivity throughout the medical sector.

“There has been so much advancement in interoperability standards,” she said. “DICOM [Digital Imaging and Communications in Medicine] standard for imaging and  HL7  are currently the most adopted interoperability standards  to improve connectivity.”

“In the US, standards are being developed through Direct Project under the Department of Health and Human Services (HHS) and the National Coordinator for Health IT,” Parakkal explained. “Certain initiatives are established under Direct Project, which has about 200 members. The group has established a framework for sharing healthcare information that will help providers to qualify for meeting Stage 1 Meaningful Use requirements.”

“The ICD-10 transition is very critical since it is otherwise difficult to classify medical information electronically,” Parakkal mentioned.

When asked what the most interesting finding was discovered in the Frost & Sullivan analysis on EHR interoperability, Parakkal mentioned the lack of a healthcare IT roadmap among about half of medical providers.

“An interesting fact uncovered relates to the need for interoperability standards,” stated Parakkal. “Providers and vendors need to utilize existing standards more and develop a health IT roadmap. Additionally, it is beneficial to get device manufacturers, health IT professionals, nurses, and other medical staff involved in promoting interoperability.”

“One other interesting factor that benefits interoperability is the advances in Wi-Fi, Bluetooth and RFID technology that provides essential connectivity in the medical field,” she included.

When asked how healthcare providers should go about developing a healthcare IT roadmap and working toward greater medical data exchange, Parakkal explained, “Most healthcare providers have a variety of medical devices, but are finding it challenging to integrate new systems with legacy infrastructure and increase connectivity. The high costs and abundance of workflows also pose connectivity challenges to the hospitals.”

To solve these issues, providers need to “look to vendors who offer medical device connectivity solutions. Both partnering with medical device connectivity vendors and interfacing with middle ware/API vendors can help. Also, it is important to train the staff on ways to utilize new systems. Additionally, it is beneficial to have all devices integrated to the EHR,” Parakkal articulated.

Additionally, the Frost & Sullivan analyst answered an inquiry about how vendors and providers can prevent information blocking and support the development of interoperable products.

“There is a lot of change happening in the market and new solutions for integrating devices,” she mentioned. “Many manufacturers have begun sharing medical information as opposed to proprietary gateway solutions. Establishing alliances among health IT vendors is useful. .”

Continua Health Alliance is one such alliance that promotes information sharing. Partnering with vendor-neutral groups, especially in the mHealth field, can prove beneficial to stopping information blocking,” Parakkal concluded.

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The Dawn of The Community EMR

The Dawn of The Community EMR | EHR and Health IT Consulting |

While many healthcare stakeholders would like to see clinical data shared freely, the models we have in place simply can’t get this done.

Take private HIEs, for example. Some of them have been quite successful at fostering data sharing between different parts of a health system, but the higher clinical functions aren’t integrated — just the data.

Another dead end comes when a health system uses a single EMR across its entire line of properties. That may integrate clinical workflow to some degree, but far too often, the different instances of the EMR can’t share data directly.

If healthcare is to transform itself, a new platform will be necessary which can be both the data-sharing and clinical tool needed for every healthcare player in a community. Consider the vision laid out by Forbes contributor Dave Chase:

Just as the previous wars impacted which countries would lead the world in prosperity, the “war” we are in will dictate the communities that get the lion’s share of the jobs (and thus prosperity). Smart economic development directors and mayors will stake their claim to be the place where healthcare gets reinvented.

In Chase’s column, he notes that companies like IBM have begun to base their decisions about where to locate new technology centers partly on how efficiently, effectively and affordably care can be delivered in that community. For example, the tech giant recently decided to locate 4,000 new jobs in Dubuque, Iowa after concluding that the region offered the best value for their healthcare dollar.

To compete with the Dubuques of the world, Chase says, communities will need to pool their existing healthcare spending — ideally $1B or more — and use it to transform how their entire region delivers care.

While Chase doesn’t mention this, one element which will be critical in building smart healthcare communities is an EMR that works as both a workflow and care coordination tool AND a platform for sharing data. I can’t imagine how entire communities can rebuild their care without sharing a single tool like this.

A few years ago I wrote about how the next generation of  EMRs would probably be architected as a platform with a stack of apps built over it that suit individual organizations. The idea doesn’t seem to have gained a lot of traction in the U.S. since 2012, but the approach is very much alive outside the country, with vendors like Australia’s Ocean Informatics selling this type of technology to government entities around the world. And maybe it can bring cities and regions together too.

For the short term, getting a community of providers to go all in on such an architecture doesn’t seem too likely. Instead, they’ll cling to ACO models which offer at least an illusion of independence. But when communities that offer good healthcare value start to steal their patients and corporate customers, they may think again.

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EHR Adoption Challenges Solved through Data Entry Transfer

EHR Adoption Challenges Solved through Data Entry Transfer | EHR and Health IT Consulting |

Once the HITECH Act was passed in 2009, EHR adoption and implementation of health IT systems grew tremendously over the coming years, as more providers began focusing on obtaining financial incentives from the Centers for Medicare & Medicaid Services (CMS) under the EHR Incentive Programs. While patient safety and quality of care has improved with the integration of computerized records, EHR adoption challenges have led to certain burdens among healthcare professionals.

From the potential for medical errors to a conceivably negative impact on the patient-doctor relationship, EHR adoption challenges will need to be addressed as healthcare facilities continue to implement computerized systems in order to qualify for the Medicare and Medicaid EHR Incentive Programs.

Fourteen experts from a wide background of organizations including Kaiser Permanente, Cerner Corporation, and Nextgen Healthcare put together a report to illustrate the future of EHR technology and how to overcome many common EHR adoption challenges. The report was published on behalf of the American Medical Informatics Association EHR 2020 Task Force.

Some of the “unintended clinical consequences” of EHR implementation has been the longer work hours required from the data entry around computerized patient records  and less time for physicians to communicate directly with their patients. Additionally, EHR interoperability has not grown across the medical sector as quickly as previously hoped. Health data exchange is lacking due to information blocking among providers and vendors alike.

The overall goal of the health IT industry is to develop an effective and interoperable health information exchange platform in which patients, providers, healthcare professionals, and public health agencies have ready access to key data. However, EHR adoption challenges have put up roadblocks toward meeting this goal.

The Task Force offers ten suggestions for improving on health IT systems and overcoming some common EHR adoption challenges. First, it is important to decrease the overall burden from a high amount of data entry on the physician. When it comes to diagnosis and treatment, the process of capturing data has fallen on the physician, but moving the data entry toward other members of the healthcare team or even patients themselves could prove beneficial.

“Clinicians remain uncertain regarding who can and cannot enter data into the record, placing a tremendous data entry burden on providers, the most expensive members of the care team,” the Task Force wrote in the report. “Clinician time is better spent diagnosing and treating the patient rather than charting. Regulatory guidance that stipulates that data may be populated by others on the care team including patients would reduce this burden.”

Another suggestion the Task Force offered is to include sound recording during a patient visit instead of manually entering information into the EHR system. When it comes to discussing medical history, conducting a basic physical exam, and giving patients advice, doctors would benefit from a sound recording instead of pure data entry.

By following the suggestions offered in the Task Force’s report, the healthcare sector should move forward in properly addressing some common EHR adoption challenges and paving the road toward a future of effective and interoperable health IT products.

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Switching EHRs - leaving the frying pan for the fire?

Switching EHRs - leaving the frying pan for the fire? | EHR and Health IT Consulting |

Thinking about switching EHRs? This is a really big decision. Much bigger than choosing between the red patent pumps and snakeskin peep-toes, or your salsa selection at Chipotle. So before you rush into making a move, consider the following:

  1. Why am I even considering switching in the first place?
    Is the vendor sunsetting your product or not keeping up with ONC (Office of National Coordinator) certification?
    Or does your staff report that it is no good (probably using much stronger language), that there are too many clicks, or can’t get desired reports?
  2. Analyze your needs
    Map your workflow. Carefully consider WHY each step occurs – is there a clinical or regulatory reason? If not, get rid of it. Taking bad processes into a new system will not make you any happier with the new technology than the old. Sometimes an outside set of eyes can help shed light on these waste points. There is a pretty forest out there if you stop looking at the beetle-infested trees. You may not even need the following steps if you can improve how you use your current system.
  3. Assess your infrastructure and security
    Along with mapping processes, you should also have an inventory and map of hardware and networks. Assuming you are maintaining an up-to-date security risk assessment, this may be a good place to start.
  4. Do your research
    I know, many of us do not want to re-live college research projects without the reward of more letters after our name, but you will not regret this. Resources include the ONC,, and KLAS. You may also consider a consultant who is familiar with many EHRs and regulations.
  5. Make a comprehensive list of your needs and shop
    A key step that is often not given enough attention is to delineate your requirements in complete detail. These requirements can then be used to create a Request for Information (RFI) or Request for Proposal (RFP) to any potential software vendor. There are hundreds of products out there and they all may dazzle you with a demo. Get under the hood and test drive when possible. Seek out as many organizations that you can who use the product for a balanced opinion.
  6. The price tag is not always straightforward
    Sure, the monthly subscription, setup fees, yearly fees, may be clearly spelled out in the contract, but what about internal costs or future upgrades? Ask the vendor about their upgrades and additional modules processes, as these items will be inevitable with changes in technology and regulation. Are these generally associated with additional fees? Will your current hardware be sufficient or do you need to purchase new? Costs of servers, tablets, and wireless networks should be factored in to your overall cost. What about training for staff or additional IT resources to manage the application? And, as with everything, cheaper is not always the way to go. It may save you a few dollars now but the long range price may be high.
  7. Due diligence complete. I am ready to switch
    Read your contract carefully. Make sure you know your level of support as to the hours, turnaround time, and go-live. Make sure they were clear with an implementation schedule and assumptions.
    Server, web, yearly/monthly fees
  8. They can just move all my current patient information into the new system, right?
    Um, not so much. Data mapping and migration is difficult, time consuming and costly.
    There is no 1 to 1 map from any system to each other. If you choose to migrate data, consider only active patients with a critical subset of their information, such as medications, problems, diagnoses, etc. Another alternative is a data archiving service where you can have access to view your data at any time.
  9. Many perfectly good EHRs have failed due to bad implementations
    The vendor will have a project manager and an implementation plan. However, you need to have both of your own as they will not account for every aspect of your workflow and organizational needs. If you have not implemented a technology solution before, it is highly suggested you get help from an experienced implementation specialist or project manager. Planning and detailed checklists should be a critical part of your implementation. During the design and build process try to customize as little as possible. It will take several months to know what the system can do and is best optimized at a later date. You can also not have too much training or at-the-elbow support for weeks after go-live. These are often the highest complaints heard.

Now, given all that, is it still feeling hot in the kitchen or are you using your frying pan for the best meal you have ever had?

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Flash storage poised to benefit healthcare IT

Flash storage poised to benefit healthcare IT | EHR and Health IT Consulting |

The economics of flash storage are changing, and the healthcare industry is in a perfect position to take advantage of these changes to solve multiple challenges.

Healthcare has an exploding data storage problem. Increased use of electronic health records (EHRs) and digital images (among other issues) has healthcare CIOs struggling for cost-effective storage solutions, including the cloud and aggressive data-tiering.

The issue with these solutions is that the Health Insurance Portability and Accountability Act (HIPAA) is very specific and rigorous about putting data in the cloud. Choosing the wrong partner could expose you to risk and fines. And, surprisingly, with the exception of “cold” data — which is usually held on tape and other cheap storage solutions — flash storage is starting to be more economically viable for tier 1 storage, and possibly for lower tiers as well.

It isn’t just that flash storage is getting cheaper (though it is). It’s also that flash storage lets you save money on the surrounding infrastructure. On a pure GB/dollar point of view, spinning disks are still cheaper than flash storage, but that’s not the right way to look at it anymore.

Flash storage lowers your storage footprint by 84 percent, saving you money both in terms of physical space and environmental costs. Because of its 90 percent lower latency, flash allows you to run more virtual machines and fewer physical servers, further reducing costs. Flash storage also allows better storage utilization and better scalability.

And perhaps the most overlooked part of all of this is that, because of all the savings above, you often lower licensing costs because you are running less hardware. Add it all up, and the case for flash improves significantly.

Benefits of using flash storage in healthcare

The obvious first benefit of using flash storage in healthcare is that it gives you the opportunity to make more data readily available with low latency and at lower costs than other solutions. This is not merely a matter of convenience, it is an actual necessity in healthcare.

Reforms around the Affordable Care Act put more emphasis than ever on preventive care. The emphasis for health professionals is on follow-up care to prevent patient re-hospitalizations and on intervening with chronic diseases before they become acute. In other words, more data will be “hot” and an increasing number of departments within a healthcare organization will be accessing that hot data. Flash is a good way to respond to these changing methods of accessing your data.

Another major benefit to bringing more flash into healthcare is its advantages to virtual desktop infrastructure (VDI). Virtual desktops are an attractive solution in a healthcare environment, and flash’s low latency is ideal for it. VDI allows use of EHRs in a much more secure environment. Terminals throughout the hospital (sometimes left unattended by necessity) are no longer physical points of access to privileged data and sensitive networks. Administrators can manage access and permissions better with VDI, and more easily update terminals. This is especially valuable for remote clinics, where IT professionals are not always available to easily secure and update remote terminals. A secure virtual desktop makes HIPAA violations far less likely.

Another reason flash storage is beneficial for healthcare environments is because it scales fast. Mass casualty and trauma events can tax systems and quickly use up system resources. Flash, with its low latency and ease of use with virtual machines, allows hospitals to spin up storage quickly in response to emergencies.

Future potential for flash storage in healthcare

In the near future, you will also see flash storage used in medical research, as well as in the growing field of personalized medicine. Particularly resource-intensive functions, such as genome mapping, will become more common in both research and personalized medicine. These advances will mean that medicine will be prescribed, in part, based on a patient’s genetic makeup. For instance, some medication has been known to work on some people and blocked in other people with certain inhibiting genes. Previously, this medication would fail to be approved by governing bodies.

However, personalized medicine and big data might soon be giving a new lease on life to these drugs. The data storage needs to accommodate these advances will increase exponentially, and Flash will serve as a major component in meeting the challenge. Now is the time to build your internal capabilities and infrastructure in preparation for the future data storage needs of healthcare.

How much you use flash depends partially on your type of environment. Some healthcare enterprises will be able to use cheaper options for some or all of their storage needs. But the economics of flash are changing. Less hardware, less physical space, less latency, combined with more scalability and power means flash, and even all-flash storage arrays, may be the right solution for a healthcare CIOs needs.

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My Conversation with Chair of AMIA EHR 2020 Task Force

My Conversation with Chair of AMIA EHR 2020 Task Force | EHR and Health IT Consulting |

On May 29 the EHR-2020 Task Force of the American Medical Informatics Association issued a report with recommendations on the status and future directions of EHRs. Thomas Payne, M.D., medical director of IT services at University of Washington Medicine and chair of the task force, called me from AMIA’s iHealth 2015 Clinical Informatics Conference in Boston to discuss the recommendations.

I mentioned to him that several of the recommendations, including the very first one, target cutting down on the amount and complexity of documentation clinicians have to do.  I asked Dr. Payne why the task force put such a strong emphasis there?

“The reason we focused on that area is because it is causing a great deal of problems in practices,” Payne said. “Providers are very vocal in describing the burden this poses to them. And people who go to see those providers are also noticing that they don’t get the attention and focus that they used to. They see their doctor and nurse staring at a computer screen. It is lengthening the days of providers, interfering with the interaction that people have with providers and taking providers away from what they do best. That is why it is in the first set of recommendations.”

He added that practitioners do not mind documenting if it impacts the person they are caring for. They understand how important it is. “They question when documentation requirements don’t directly benefit the person sitting across from them,” he said. “It is occupying a fair amount of time in the patient encounter. Patients notice this too.”

Although the group did not offer specific recommendations about Stage 3 of meaningful use, it did make some more general observations about CMS calling for more functionality as opposed to focusing on improving outcomes. “Our group feels that we have adequate functionality to accomplish a great deal of good as things stand today,” Payne said. “We are hopeful we will give providers and vendors time to fully capitalize on the functionality in place. We are not discussing the specifics of Stage 3 in this report. But in general we believe it is a good time to consider solidifying the functionality there today and carefully consider any additional requirement that extends the time at the point of care. That is having an impact that we all didn’t anticipate.”

Other recommendations call for more transparency both in the certification and EHR safety realms. Payne said that although in some cases there are legitimate concerns about intellectual property and a competitive marketplace, the task force felt that more openness would lead to a better match between EHR vendor and provider, and that better match will lead to more satisfactory use of that product.

“We also feel that transparency is important when things don’t go as planned,” he said. “When safety risks are identified, those should also be transparently available to others, and the workarounds to mitigate those risks should also be available to others. We think it would be helpful if we have some means of aggregating these discoveries that would permit everyone to reduce the risks. The specifics of how that would happen, is a topic AMIA will take up at its policy conference this fall, Payne added, “because it is important we get that right.”

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The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs

The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs | EHR and Health IT Consulting |

Electronic health record (EHR) advocates argue that EHRs lead to reduced errors and reduced costs. Many reports suggest otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums. As interest in patient-centeredness, shared decision making, teaming, group visits, open access, and accountability grows, the EHR is better viewed as an insufficient yet necessary ingredient. Absent other fundamental interventions that alter medical practice, it is unlikely that the U.S. health care bill will decline as a result of the EHR alone.

Much of the literature on EHRs fails to support the primary rationales for using them.

AFTER EXTOLLING THE virtues of the electronic health record (EHR) in his 2004 State of the Union Address, President George W. Bush established the Office of the National Health Information Technology Coordinator (ONCHIT) and charged it with developing a “health information technology infrastructure” that “reduces health care costs resulting from inefficiency, medical errors, inappropriate care and incomplete information.” This charge includes the adoption of EHR systems that can “reduce health-care costs by up to 20% per year.” Retail sales, financial services, 0and telecommunications are examples of industries using information technology (IT) to achieve quality and savings. Accordingly, the same lesson can be applied to U.S. health care.

Or can it? A considerable body of evidence suggests that widespread adoption of the EHR increases health care costs. Although the focus of this paper is on the limitations of the EHR in ambulatory care, ample research shows that this might likewise apply to inpatient settings.

EHR definition and uptake.

The Healthcare Information and Management Systems Society (HIMSS) defines the EHR as a “longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.” It does more than store information: It “supports other care-related activities directly or indirectly, including evidence-based decision support, quality management and outcomes

reporting.” According to the National Health Care Survey, EHRs were in use in 17 percent of physicians’ offices, 31 percent of emergency rooms, and 29 percent of hospital outpatient departments in 2003. In office settings, the 17 percent figure has not changed since 2001.

Cost savings.

Given the inflationary $1.9 trillion cost of U.S. health care, 20 percent savings is significant. A RAND analysis estimated that national adoption of the EHR could lead to “more than $81 billion” in annual savings, while Jan Walker and colleagues estimated that information exchange across providers, hospitals, public health, and payers could save $77.8 billion per year.

The Case For The EHR

As noted, the EHR’s potential is based on its ability to introduce new efficiencies to health care delivery. Each is examined below.

Worker productivity gains.

One analysis showed that the EHR increased documentation time among physicians by approximately 17 percent, while computerized provider order entry (CPOE) increased it by 98 percent.8 In a separate study, EHR implementation at Kaiser Permanente resulted in a 5–9 percent decrease in office visits replaced by telephone contacts.9 Even if future “smart texts” or automated physician orders correct these inefficiencies, it is unclear whether the EHR enables gains in provider-to-patient ratios. Rather, these studies suggest that a possible outcome is that the same providers would serve the same patients, with fewer office visits, more remote communication, and more documentation.

However, the EHR can enable clerical staff reductions amounting to $13,000 per physician per year.10 For these savings to be realized, staff employment would need to be completely terminated. Although this is likely in outpatient settings, anecdotes of health care systems (where EHRs are prevalent) offering displaced workers other employment opportunities (including in IT departments) are commonplace enough to dilute these savings.

Ultimately, if the EHR consistently reduced labor costs, lower staffing ratios should enable insurers—representing the “front line” in managing health care costs—to reduce their fee schedules among EHR-enabled providers. The same should be true for participants in consumer-directed health plans. There is little evidence that this is occurring among the 17 percent of practices possessing an EHR.

Billing optimization.

Not only are the EHR’s labor savings questionable, but increased billings are another likely outcome. Thanks to underlying decision logic previously only available to large institutions, the EHR can “auto-populate” or scour the record to justify a greater intensity of service. Accordingly, “increased coding levels” account for the return on investment.11 Alternatively, better “capture of charges” and fewer “billing errors” can lead to a five-year $86,400 “benefit” per provider.12

Although additional detail may warrant increased payment, the “content” might be unchanged from the point of view of the patient (the end user). Physicians are prone to under-documentation, but these EHR enhancements, appropriate or not, arguably increase health care costs without any corresponding increase in quality.

Medical mistake avoidance.

EHR advocates point to “decision support” that reduces errors of omission and commission at the point of care as a critical safety advantage.13 The Agency for Healthcare Research and Quality (AHRQ) has endorsed several IT interventions that promote patient safety (such as error tracking and alerts about the timing of tests); however, mention of the EHR is conspicuously absent. In fact, AHRQ’s “20 tips to help prevent medical errors” also fail to mention the EHR, versus interventions such as hand washing or relying on large-volume hospitals for complicated surgeries. The EHR’s failure to pass muster with AHRQ’s evidence-based approach to translating research into practice might explain the necessity of funding a large number of projects to better evaluate the EHR’s role in patient safety.

Indeed, the available evidence is decidedly mixed. Examples of omission-type error reductions include alerts about vaccination status among children cared for in the emergency department; inpatient vaccination and anticoagulation reminders; diabetes, hypertension, vitamin B12 deficiency, thyroid and anemia screening in the elderly; health maintenance and counseling in a pediatric practice; and hypertension identification and control.

 However, EHR decision support has no effect on adherence to primary care guidelines for asthma or angina management; it leads to “variable” and “limited” adherence to diabetes and coronary artery disease reminders; it has no effect on evidence-based interventions for heart disease and heart failure; it causes no change in the care of patients with depression; it leads to “unwieldy” tracking and monitoring of preventive health and chronic illness; and it has no impact on diabetic glucose control.

Why such inconsistency? Physicians might resent the loss of professional autonomy or have limited tolerance for on-screen prompts. In one survey, 75 percent of physician respondents admitted ignoring reminder icons, and more than half seldom or never acted on the information. The EHR also impedes addressing other immediate patient needs in a time-limited office visit.

EHR advocates also point to errors of commission. For example, important information might be missing from paper records, including radiology or laboratory tests. Accordingly, if inaccessible records are responsible for costly retesting, reductions should be readily achievable. This was not the case at Kaiser Permanente, where “use of clinical laboratory and radiology services did not change conclusively” over a two-year transition to the EHR.

Excessive testing could be more a function of defensive medicine, ease, or fear of uncertainty. EHR decision support tools—including peer management, guideline promotion, and alerts about cost or redundancy—might reduce this. However, an EHR-based decision support system that is cost-saving, generalizable, and sustainable remains elusive. Finally, ancillary testing is an important source of revenue. “Profit center” laboratory or radiology departments will not necessarily welcome EHR-based interventions that lead to fewer tests and less revenue.

Storage of other encounter data.

Medical records are notoriously vulnerable to damage or disappearance. Hurricane Katrina’s destruction of Gulf Coast physician office practices has been cited as an example of the need for electronic medical information storage. Yet Hurricane Katrina’s cost was not factored into any of the previous savings estimates; in fact, the president’s endorsement of the EHR predated this disaster by more than a year. Furthermore, the history remains a time-honored and reimbursable feature of every physician-patient encounter. Aside from the few situations in which patients are too ill to communicate, patients’ recall of past medical facts is accurate across a wide range of conditions.27 It is also far cheaper than remote storage.

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What Happens When Billing Is Optimized?

What Happens When Billing Is Optimized? | EHR and Health IT Consulting |

In my recent EHR workshop in Dubai I talked with them about the many changing EHR business models that I’ve seen over the last 10 years. I was really trying to highlight how these new business models have generally been good for healthcare since it’s caused EHR prices to drop to a much more reasonable price point.

Take for example the Free EHR model. Whether you love it or hate it, one thing is certain: Free EHR has caused all the other EHR vendors to lower their price. I’ve seen this over and over again with EHR vendors. It’s hard to compete with an overpriced product against free. So, they had to lower their price so that the price of their EHR didn’t look as bad against free.

One model that I mentioned to those who attended my workshop was that some EHR vendors charge a percentage of billing in order to use their EHR software. athenahealth is the most famous for this approach. Their business model has worked pretty well for them because they’re able to say that not only will the practice get the EHR software for free, but athenahealth also can make the case that by having them assist with the practices billing, then they can help to better optimize the practices billing as well. So, the practice is getting more effective billing and a free EHR. This is why athenahealth could charge such a high percentage of an organization’s billing.

Turns out that there are a lot of billing companies that make a similar business case. Pay me 4-6% of your billing and we’ll optimize your billing which will actually make you more money than you’re paying us. Most of the billing management companies work off of this approach. Of course, this approach works best when you’re talking about practices that aren’t doing a good job managing their billing. This actually seems to apply to most practices.

What I’ve started to wonder is what’s going to happen once all of these practices’ billing is basically optimized? Now the percentage of billing starts to feel really expensive. Practices won’t be good at realizing the optimization that’s occurred and I’m sure that many will choose to take on the billing again. As they take on the billing, they’ll head back to a less than optimized state and then they’ll be ripe pickings for a billing company again.

I can see this cycle happening over and over again. Plus, if you’re a billing company or a company like athenahealth that makes your money off of a percentage of billing, then there’s always new practices that are at every stage of the cycle. So, there’s new business all over the place. The key for these organizations is to find the practices that are at the right place in the cycle.

Will anything happen to stop this cycle?

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Health Information Blocking Continues to Plague Data Exchange

Health Information Blocking Continues to Plague Data Exchange | EHR and Health IT Consulting |

Ever since the HITECH Act was passed and the Medicare and Medicaid EHR Incentive Programs were established, more than $29 billion was put toward expanding EHR implementation and health information exchange. Eligible physicians and hospitals were encouraged to adopt EHR systems and health IT platforms by offering financial incentives to those that do. Additionally, under the EHR Incentive Programs, reimbursement penalties would be given to those that have not met meaningful use requirements by a certain period. Despite the clear pathway toward medical data exchange, various stakeholders have participated in health information blocking, which impedes the goals of the healthcare IT industry for improved access to key data.

The New York Times reported that administration officials have found hospitals and laboratories along with EHR vendors participating in health information blocking in order to keep their consumer base from jumping toward a competing healthcare provider.

The federal government is currently attempting to create an environment across the healthcare industry in which medical information will flow freely from one facility to the next. The Obama Administration continues to make it a priority for hospitals and clinics to adopt EHRs and computerize patient records.

President Obama signed a stimulus bill upon taking office that gives hospitals and doctors incentives for implementing certified EHR technology. While large numbers of healthcare providers have adopted electronic records systems, the problem at hand is that few are able to share patient data across platforms designed by different vendors. Essentially, health information blocking delays the progress of EHR interoperability.

“We have electronic records at our clinic, but the hospital, which I can see from my window, has a separate system from a different vendor,” Dr. Reid B. Blackwelder, chairman of the American Academy of Family Physicians, told the news source. “The two don’t communicate. When I admit patients to the hospital, I have to print out my notes and send a copy to the hospital so they can be incorporated into the hospital’s electronic records.”

Another pediatrician from Massachusetts also lamented that he has tried and failed to connect medical records with a hospital’s EHR system in order to better coordinate care with his patients. Not long ago, the Office of the National Coordinator for Health IT (ONC) sent a report to Congress expressing the need to put an end to health information blocking.

Additionally, the costs of sharing data among medical practices are creating barriers and essentially showing that various providers decline to share key data that is needed to treat a patient regardless of their condition.

Certain companiesare also making it more difficult for hospitals to connect to multiple laboratories and technology services while others have customers sign strict contracts that prohibit them from easily choosing a different EHR platform.

Recently, a House Committee passed a bill that states health information blocking is a federal offense. It is also against the law for doctors and hospitals to deliberately take part in health information blocking if they are receiving federal incentives from the Centers for Medicare & Medicaid Services (CMS) for adopting certified EHR technology, according to a bill passed in Congress last month.

Through federal regulations, it is possible that health information blocking could become a problem of the past.

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The Tower of EMR Babel

The Tower of EMR Babel | EHR and Health IT Consulting |

It’s the sad state of interoperability. This week when I was teaching an EHR workshop I asked for those attending to define what an Electronic Health Record was in their own words. I’d say 90% of them said something about making the healthcare data available to be shared or some variation on that idea. This wasn’t surprising for me since I’ve heard hundreds and possibly thousands of doctors say the same thing. EHR is suppose to make it so we can share data.

While people pay lip service to this idea and just assume that somehow EHR would make data sharing possible, that’s far from the reality today. This is true even in some organizations where they own both the hospital and the ambulatory provider. How sad is this? Extremely sad in my book.

I’ve often wondered what would change the tide. I’ve been long hopeful that ACOs and value based care would help to push the data sharing forward, but that’s going to be a long process. The private HIEs are working the best of any HIEs I’ve seen, so maybe the trend of hospitals acquiring small practices and hospital systems acquiring hospital systems will get us to EHR data sharing nirvana. Although, I don’t think it’s going to make it there in most communities. Instead it’s just going to have a number of large organizations not wanting to share data as opposed to some large and some small ones.

Do people really have much hope for true EHR data sharing? Does FHIR give you this hope? I’m personally not all that optimistic. We all know it’s the right thing to do, but there are some powerful forces fighting against us.

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ICD-10 End-to-End Testing Week Shows Few Coding Errors

ICD-10 End-to-End Testing Week Shows Few Coding Errors | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) has released the results of its second effective Medicare FFS ICD-10 end-to-end testing week, which took place at the end of April.

Starting on April 27 and ending on May 1, clearinghouses, payers, billing agencies, and Medicare Fee-For-Service healthcare providers participated in CMS’ second successful ICD-10 end-to-end testing week.  Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor assisted the individual entities during this end-to-end testing.

CMS was able to work with a wide range of providers, submitters, and claim types, as it served the majority of volunteers. The second ICD-10 end-to-end testing week shows that the federal agency will be able to successfully accept claims when the ICD-10 implementation deadline rolls around.

With 875 participants in the ICD-10 end-to-end testing period, more than 23,000 test claims were submitted at the end of April. To see the results, click here. For the most part, participants were able to send their ICD-10 claims effectively and these were processed by Medicare billing systems without any major issues, CMS reports.

In fact, the results show that the acceptance rate was higher in April than the prior ICD-10 end-to-end testing rate from January. There were less errors related to diagnosis codes on the latest batch of end-to-end testing claims.

Out of any errors that did occur, the majority were unrelated to ICD-9 or ICD-10 diagnosis codes, CMS states. Providers who are still looking to participate in ICD-10 testing with the federal agency are encouraged to take part in acknowledgement testing, which can be performed at any time until the October 1 deadline.

The last ICD-10 end-to-end testing week with CMS will take place on July 20 to July 24, 2015. The ability to volunteer for this testing week has already ended. However, any participants from January or April are welcome to participate in the July ICD-10 end-to-end testing session again and are automatically eligible to test their systems an additional time.

It is vital to continue preparing for the ICD-10 transition over the coming months. Starting on October 1, any Medicare claims that do not use an ICD-10 diagnosis code will be invalid. The Medicare claims processing systems will be unable to accept ICD-9 codes after the deadline. The last day providers can submit ICD-9 codes to CMS is September 30, 2015. Dual coding will also not be accepted after this deadline.

While there is only four months left to prepare for the ICD-10 transition, providers can still take advantage of the many resources offered by the federal agency. The Road to 10 website, for instance, is a very useful tool in preparing for the ICD-10 implementation. CMS offers a variety of solutions for providers that are struggling to meet the ICD-10 transition deadline.

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Does Certified EHR Technology Need Simplified Standards?

Does Certified EHR Technology Need Simplified Standards? | EHR and Health IT Consulting |

Healthcare providers seeking to successfully attest to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs will need to implement certified EHR technology in their medical practice. The Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) have established several important certification standards for EHR systems and update the certification criteria annually.

With regard to the 2015 Edition Health IT Certification Criteria proposed rule, the Healthcare Information and Management Systems Society (HIMSS) sent forward public comments to National Coordinator for Health IT Dr. Karen B. DeSalvo. The organization asked ONC to reduce the number of criterion along with the standards and functionalities of the latest proposed rule regarding certified EHR technology. HIMSS asks for the overly complex certification criteria to be simplified in order to assist developers and providers in designing flexible and customizable certified EHR technology platforms.

On the other hand, HIMSS did acknowledge that ONC and CMS have attempted to decrease any complexities in the latest health IT certification criteria requirements as well as the objectives under the Stage 3 Meaningful Use proposed rule. However, due to a wide variety of new requirements under the 2015 Edition Health IT Certification Criteria proposed rule, it behooves the federal agencies to develop a more simplified approach and reduce the number of options available with regard to certified EHR technology.

HIMSS also commented and showed support of ONC’s innovative solutions for certification and incentivizing providers to adopt health IT systems and certified EHR technology. However, HIMSS strives for the certification criteria to improve interoperability and include more specific, goal-oriented standards.

“There are several instances in the draft regulation where it is unclear what is truly optional for the 2015 edition certification criteria. This includes requirements for Meaningful Use, 2015 Edition Base EHR Definition, as well as conditional criteria that apply to certification for particular functionalities. HIMSS strongly encourages ONC to clearly delineate what the essential 2015 requirements are to meet Meaningful Use, 2015 certification, and the Base EHR definition,” HIMSS commented in a letterto DeSalvo. “For new federal program-related health IT certification programs, HIMSS suggests that ONC or another agency establish the programmatic goals before commencing with any certification program associated with the effort. It is important that certification criteria be closely evaluated and aligned with the functionalities necessary to meet the goals of the program in question as we move beyond EHR-specific certification.”

Essentially, HIMSS urges the two federal agencies to use effective goals for the certification and meaningful use programs and integrate these goals into the standards and objectives of the proposed rulemaking. The certification criteria specifically needs to be closely in line with the goals of IT adoption, EHR interoperability, and health information exchange.

As ONC and CMS consider the multitude of comments submitted, the latest rulings on the 2015 Edition Health IT Certification Criteria along with the Medicare and Medicaid EHR Incentive Programs will become more coordinated and aligned with the many suggestions. In the near future, providers may be able to adopt tailored, interoperable certified EHR technology that meets the needs of their medical practice.

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Increasing Productivity with Your EHR: 5 Strategies

Increasing Productivity with Your EHR: 5 Strategies | EHR and Health IT Consulting |

With the passage of the HITECH Act in 2009, the federal government began requiring physicians to adopt EHR technology. The act mandates "meaningful use" of EHRs by providing incentivized Medicare and Medicaid payments to physicians who use the technology and imposing Medicare penalties on non-adopters. Since then, physicians have voiced concern about decreased productivity and revenue with EHR implementation.

Study results have been mixed, with some studies showing decreased productivity and others showing stable or increased productivity after implementation. Given these inconsistent results, it's reasonable to conclude that success varies among practices with respect to EHR adoption.

So how do you implement an EHR and maintain or improve your productivity? Here are five strategies to consider.

1. Provide Quality Training

Some people in your practice may be technical whizzes. Most are probably not and will require in-depth training to begin feeling comfortable and efficient using an EHR. Successful training requires an initial assessment of physician and staff computer skills, several days of individualized in-house training, as well as ongoing feedback sessions and tutorials. One training technique that has been shown to be effective is to create peer "super users" within the practice who can help others get up to speed with the new system.

2. Delegate Tasks to Your Staff

The work flow of your practice will change as you adapt to using an EHR. One way to improve the new work flow and increase efficiency is to delegate certain data entry tasks to support staff. You can enable medical assistants and nurses to enter vital signs, social and family histories, problem lists, and medical reconciliation into the electronic chart. You can even grant certain staff the ability to enter orders that are later electronically co-signed by you. Each task you delegate is less time that you spend at the computer and more time available for your patients.

3. Customize Your EHR

Do you like your notes and charts formatted a certain way? Do you order certain tests frequently? Almost all EHRs allow for customizable templates as well as ways to create lists of "favorite" or frequently used orders and order sets. Customizing your EHR can significantly decrease the number of "clicks" you need to make for each patient encounter.

4. Decrease Your Typing

For years, physicians used paper charts and transcription services, so it's not surprising many of them feel that typing slows them down. Consider working with a medical scribe who not only is a speedy typist but who is also trained in medical terminology as well as effective and thorough charting. If hiring a scribe seems like it would be too much of an expense, consider purchasing voice recognition software to decrease your burden of typing and boost your productivity.

5. Implement a Patient Portal

Patient portals are convenient for your patients because they allow people access to their health information online. But patient portals can also be convenient for your practice and can even improve your office's efficiency. Ask your patients to fill out new health information, issues, and concerns from home a day to two before coming in to see you, thus allowing you to have access to patient questions in advance and to save time during appointments. Encourage patients to use the portal to request and "pick up" prescription refills, referrals, and lab test orders, as well as to schedule office visits — all of which will free up your support staff to attend to other duties.

Since the passage of the HITECH Act, medical practices have been mandated to adopt EHRs. While the transition to new EHR technology can be challenging, various strategies can be used to enable a practice to quickly increase productivity and revenue.

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Errors after ICD-10 Compliance Deadline Affect Reimbursement

Errors after ICD-10 Compliance Deadline Affect Reimbursement | EHR and Health IT Consulting |

The ICD-10 compliance deadline is right around the corner and providers will need to be ready to transition to the new coding set by October in order to receive sufficient reimbursements for medical care services from the Centers for Medicare & Medicaid Services (CMS). In preparation for the ICD-10 transition deadline, providers are still struggling with a variety of challenges in moving from ICD-9 coding to the extensive list of diagnostic codes.

paper published in The American Journal of Emergency Medicine evaluates ICD-9 codes in an Illinois emergency department’s Medicaid database to see whether mapping tools could better prepare emergency room doctors to transition toward ICD-10 codes.

Out of 1,830 codes encountered in the study, 27 percent or 574 codes represented complicated multidirectional mappings. The results show that these particular mappings are convoluted. In a secondary analysis, 23 percent of 622 diagnostic codes were found to be clinically inaccurate.

Out of these mappings, 8 percent represented clinically incorrect visit encounters. Inaccuracy of these mappings could potentially affect physician reimbursement when providers switch to the new codes after the ICD-10 compliance deadline takes hold.

The paper goes on to explain that the ICD-10 transition will affect workflow processes, coding procedures, and health IT support. Due to the greater detail and expansion of the coding set, there will be a wide range of operations to prepare in time for the ICD-10 compliance deadline.

When it comes to physician reimbursement, clinical documentation, and public health reporting, the accuracy of diagnostic codes among the emergency care sector is vital. Essentially, one of the biggest challenges is that, due to the high spike in the number of codes under ICD-10, the chance for mistakes and selection of the wrong code rises dramatically.

“The Center for Medicare and Medicaid Services and the Centers for Disease Control and Prevention created the General Equivalence Mappings (GEMs) in order to ensure data consistency at the national level during ICD-9-CM to ICD-10-CM transition,” researchers from the University of Illinois wrote in the published paper. “Although ICD-10-CM/Procedure Coding System transition is forecasted to be costly and represent logistical and business challenges in the healthcare field, its benefits are significant and include improved quality of care, cost savings from increased accuracy of payments and reduction of unpaid bills, and improved tracking of health care data as related to public health. These benefits are balanced by such challenges as planning and implementation, price of entry, shortage of qualified/trained coders, need and expense for further training of the workforce, and loss of productivity leading to escalated cost during transition.”

The results of this study illustrate the potential impact of transitioning to the new codes upon the ICD-10 compliance deadline. Along with modifying clinical workflow, the financial reimbursements among hospitals and clinics may be affected negatively upon the ICD-10 conversion.

Over the coming months, medical care providers including emergency room physicians will need to ensure their staff and facilities are ready for the ICD-10 compliance deadline. From training to upgrading systems and end-to-end testing, hospitals and clinics will need to be prepared to avoid reduced reimbursements starting in October.

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Finalization of Stage 3 Meaningful Use May Need Postponement

Finalization of Stage 3 Meaningful Use May Need Postponement | EHR and Health IT Consulting |

With more providers, vendors, and stakeholders sending their comments to the Centers for Medicare & Medicaid Services (CMS) with regard to the proposed Stage 3 Meaningful Use rule, it becomes more apparent that the deadline for the last stage under the Medicare and Medicaid EHR Incentive Programs may need to be delayed in order for hospitals and healthcare professionals to be completely prepared.

The American Hospital Association (AHA) recently sent CMS their comments on the Stage 3 Meaningful Use proposed rule and explained that the federal agency may need to postpone the deadline set forth in order to better develop the “standards and infrastructure” necessary for advancinghealth information exchange. Essentially, AHA proposes that CMS wait until it has more experience with the challenges and achievements under Stage 2 Meaningful Use requirements before moving forward with finalizing the mandates for Stage 3 Meaningful Use.

The AHA Executive Vice President Rick Pollack does support that the Stage 3 Meaningful Use proposed rule expands on health information exchange and patient engagement, but reminds CMS that this year is the first time many providers across the country have implemented Stage 2 Meaningful Use requirements and preparing for a deadline in 2018 will prove difficult.

Currently, there are extensive challenges in attesting to Stage 2 Meaningful Use requirements, Pollack explains in the letter to CMS. Some of the issues to overcome include “lack of vendor readiness, mandates to use untested standards, insufficient infrastructure to meet requirements to share information and compressed timelines.”

Additionally, healthcare providers have found that EHR implementation and upgrades toward improvedinteroperability as well as ICD-10 coding proves to be extraordinarily expensive. AHA discovered that, between 2010 and 2013, US hospitals as a whole spent $47 billion annually to adopt health IT platforms. AHA also mentioned how helpful it is that CMS changed the EHR reporting period between 2015 to 2017 to better address some of these challenges.

Nonetheless, the proposed modifications to Stage 2 Meaningful Use requirements in the middle of its lifecycle only illustrate how various issues need to be addressed before a ruling is finalized and an approaching deadline passes only to find providers unprepared.

“Hospitals strongly support the long-term goal of the EHR incentive programs, and they have been working diligently to implement new health information technology to improve the quality and coordination of care for patients,” Pollack wrote in the letter to CMS. “While the Stage 3 proposals offer promising ideas that could further health information exchange and support greater patient engagement, we do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate. In addition, the standards and information exchange structures needed to support many of the Stage 3 requirements are not yet mature enough to be included in regulation. Furthermore, Stage 3 proposals such as relying on third-party applications to access sensitive patient data in EHRs may be a successful mechanism for the exchange of patient data information, but they raise important questions about patient privacy and information security that must be carefully considered.”

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AMIA Issues Report on Electronic Health Records

AMIA Issues Report on Electronic Health Records | EHR and Health IT Consulting |

Today AMIA released the results of a task force report on Electronic Health Records (EHR).  The Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs was released in the Journal of the American Medical Informatics Association (JAMIA)  and represents an evolutionary approach in the management of patient medical data.  EHRs allow health-care providers and clinicians to record patient information electronically instead of using paper records.

The EHR-2020 Task Force is comprised of a distinguished group of 15 experts. The findings are being presented publicly today at the AMIA iHealth 2015 Clinical Informatics Conference in Boston, Massachusetts. The report recommends changes that will support patient engagement, improve provider workflow, support innovation, and set the stage for future improvements that will improve patient’s health and healthcare.

AMIA is at the forefront of using EHRs and information technology to enhance medical care and advance the functionality of EHRs.  The EHR-2020 Task Force report represents practical solutions to the concerns members have about the challenges of EHR adoption. AMIA worked with many groups, government agencies and professional organizations to determine methods to solve EHR challenges that providers encounter, and to further create a sustainable framework for innovation in EHRs.

“Health information technology is a key part of enhancing health and health care, and empowering patients to be first-order participants in their care.  As part of this report, we listened to our members who work closely with EHRs to understand the current challenges. We think these recommendations will improve the value that EHRs will provide to patients, and set the stage for more significant benefit in the future“, said Douglas B. Fridsma, MD, President and Chief Executive Officer, AMIA.

Security and confidentiality are at the heart of EHR planning since its inception and AMIA is acutely aware of the concerns of the general public as well as the medical community.  As the professional home of health informatics professionals, AMIA’s members —multidisciplinary and interprofessional—address many of the EHR problems from a wide range of perspectives:  as informaticians, clinicians, scientists, vendors, innovation and implementation scientists, change agents, and people who cross all these boundaries.

“While we recognize that there are challenges with implementing and using EHR technology, this report is aimed at practical solutions that we believe will improve health and health care for patients and their caregivers. We are hopeful that it will generate the thoughtful conversations and innovations that will make what is possible, real for all patients,” said Thomas Payne, MD, Chair, AMIA EHR 2020 Task Force. Dr. Payne is the Medical Director, IT Services, University of Washington (UW) Medicine and Associate Director, UW Medicine Center for Scholarship in Patient Care Quality and Safety.

There is an urgency to act on behalf of patients and the individuals who care for them. AMIA will continue to work with policy makers on their critical role in moving our nation toward better use of EHRs to better serve medical providers and the general public.

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Concerns on Proposed Meaningful Use Requirements Abound

Concerns on Proposed Meaningful Use Requirements Abound | EHR and Health IT Consulting |

With the deadline for public comments regarding the proposed Stage 3 Meaningful Use requirements at an end, various healthcare groups and medical providers submitted their opinions on the regulations in the nick of time. The American Hospital Association (AHA) urges the Centers for Medicare & Medicaid Services (CMS) to delay the finalization of Stage 3 Meaningful Use until providers are more prepared to meet its demands.

In a letter to the Secretary of the Department of Health and Human Services (HHS) Sylvia Burwell, the AHA along with other healthcare organizations stated their preference of delaying the finalization ofStage 3 Meaningful Use requirements. Essentially, a handful of medical organizations, from the AHA to America’s Essential Hospitals and the Children’s Hospital Association, are concerned about the capability of current health IT infrastructure to support the objectives under the last stage of the Medicare and Medicaid EHR Incentive Programs by 2018.

Additionally, the letter asks for HHS to work toward speeding up the process of health information exchange and developing an effective health IT infrastructure that would be able to meet the requirements under the Stage 3 Meaningful Use rule.

“We have learned from early experience in Stage 2 that it is unwise to finalize requirements based on untested standards, such as the Direct protocol for sending summary of care documents. We need testing and refinement of standards, as well as time to work through implementation issues, before a standard becomes a regulatory requirement. Indeed, we still have many lessons to learn from Stage 2, given that 2015 is the first year that most providers will be meeting the Stage 2 requirements,” the letter stated. “We believe that Stage 3 requirements, including the higher thresholds and more robust requirements for technology should be built on evaluation of experience in Stage 2 by all providers, and not just those that are among the first adopters.”

With regard to the proposed modifications to Stage 2 Meaningful Use requirements, it seems that the majority of stakeholders approve of the objective to reduce the reporting period to 90 consecutive days. Dr. Reid Blackwelder, Board Chair of the American Academy of Family Physicians (AAFP), was one proponent of the decrease in the reporting period.

This particular change would allow more medical practices to successfully attest to Stage 2 Meaningful Use requirements in 2015.  Additionally, the AAFP is pleased with the removal of the 5 percent threshold requiring patients to view, download, and transmit their healthcare data in place of having just one patient who accomplishes this.

One issue that Blackwelder did find is that essentially the proposed modified rule eliminates Stage 1 Meaningful Use and fuses it into a combination with Stage 2 Meaningful Use requirements. This is certain to “cause significant confusion,” Blackwelder said.

Additionally, the AAFP encourages CMS to address the problems of meaningful use audits, which are putting “undue hardship” on physicians across the nation. As the comment period for these proposed rulings has come to a close, CMS will work toward addressing the many concerns among the healthcare industry.

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Servers in the Attic

Servers in the Attic | EHR and Health IT Consulting |

It all started when I had to go up to my attic to get something for my wife. Once I was up there it was like a trip down memory lane. There was stuff up there that I had not seen in years and some things that I didn’t even realize that we had. So after I came back down we started having a discussion about our attic inventory. I have course wanted to purge most of the things up there, but the requirement always came back to the value it had either tangible or sentimental. Other issues came up and soon the attic discussion was low on the priority list.

A few weeks ago I was talking to a CIO about their EPIC migration and what they were going to do about all the remaining legacy systems. He mentioned the challenges with defining what to keep, and figuring out what all the stakeholders wanted to do with their niche’ systems. It was a moment of Déjà vu’ as I realized that this was similar to my attic discussion. His data center had become his server attic.

Software often becomes a product that users get attached to. Some users navigate through software screens while drinking coffee and talking to coworkers…it becomes second nature. They become personally invested with the product. So when organizations migrate to a new product, Information Technology departments are often left with racks of servers in the back of the data center. Some applications continue to be used because some functionality does not work the same in the new system, or there is still some data in the old legacy system.

Deciding what to get rid of and what to archive from your old systems can be a daunting task. You first have to figure out what systems actually contain data and which ones can be retired. This due diligence sets the foundation for any Legacy Data Retirement project.

Determine what applications have been or will be replaced by your new system.

What interfaces are currently active that will be repurposed or deactivated as part of the new system.

What are the use cases for the applications that contain data? What information will users need to access and how will it be used; Reports, static view, exporting as a csv file?

Take the time to talk to the users and understand the value of the data to them from a clinical and workflow perspective.
What applications are tied to the accounts receivables rundown? What utilities will remain active to expedite billing?

Finally, what are the dollar savings around the license and support fees of the retired applications? This should be enough to make the case for archiving the data and engaging a legacy archive software vendor. There are many vendors that will work through the process of extracting, transferring the data and, loading it to a relational database. They provide an application layer that sets on top of the database which allows users to perform most if not all the required access to the data.

One piece that should be understood is that Digital Imaging and Communications in Medicine (DICOM) files. These are your PACS type files. They normally are handled differently than standard data extracts since you have to have a link to the images which enables users to view the necessary patient images. Some legacy archiving software companies contract separately to provide this service, or organizations can contract with a preferred vendor to store and archive images. Either way, it has to be considered as part of the legacy archiving project.

Like the discussion I had about the content in my attic, be prepared to get some push back from some users about retiring their applications. Healthcare data has value in some way, shape or form. Often there is research value and sometimes it allows for patient trending. There are also regulatory policies around retention that you should review and discuss with your legal department. Again, this can be a difficult task especially if you are preparing to go-live on a new system. But going through the process will yield substantial savings, improve access to valuable data and make you feel better next time you visit your server attic.

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EHR & Artificial Intelligence Can Reduce Medical Errors

EHR & Artificial Intelligence Can Reduce Medical Errors | EHR and Health IT Consulting |

While I had heard that almost 400,000 Americans die each year because of medical mistakes, in a recent article Forbes contributor Dan Munro underscored that volume when he asked readers to imagine the largest commercial aircraft -- an Airbus A-380 -- crashing every day for a year: The number of passengers who would perish aboard those imaginary crashes compares to the number of patients really dying annually in our hospitals due to blunders.

People who want nothing to change usually dispute the number of deaths. For the sake of argument, let us assume the actual number could be represented, then, by one crash every four days. Even then, surely it is worthwhile trying to figure out how to prevent these errors.

Certainly, procedural failures or pure accident causes some errors but incomplete or incorrect information about the patient is at the heart of a large percentage of these mistakes.

As Munro points out, a major problem is that the current healthcare industry is incentivized by revenue and profits -- not safety and quality. Therefore, as newly re-elected Florida Governor (and former healthcare CEO) Rick Scottsaid at a recent meeting to discuss cutting costs in healthcare, the industry has been unwilling to voluntarily reduce profits. Since safety and quality using current methods would be expensive and slash profits, perhaps electronic health records (EHRs) and health information technology (HIT) could  accomplish the  goals of all stakeholders.

EHRs can maintain patients' complete medical histories, along with all known allergies and medications. The record should travel with patients, no matter where they go for treatment. Doctors do not have to rely on the patient's fallible memory at every encounter. The record speaks for patients, even if patients are incapacitated for any reason.

We must recognize that doctors often face points of no return -- and patients get no second chances. Choosing the right medicine or treatment is frequently a game of probabilities. Choose the right medicine and the patient will live. Choose the wrong one and the patient will die. This is why even the most qualified doctors often seek second or third opinions before embarking on a risky treatment plan. Doctors have told me countless stories about their ability to save patients because a complete EHR was available. In these cases multiple doctors were able to view the same information at the same time, often while residing thousands of miles apart. They collaboratively agreed on the best option -- and saved the patient's life.

EHRs also facilitate artificial intelligence. A patient's medical history often is full of reams of data; manually winnowing through that information is a daunting task. Today, teams of top doctors help develop artificial intelligence systems that can quickly determine if a proposed medicine, food, or medical procedure will likely cause the patient greater harm than good. This will reduce a large number of medical mistakes.

There is no cause for concern. Decisions suggested by artificial intelligence systems developed by top-notch doctors likely are more accurate than decisions made solely by humans. Watch Vinod Khosla discuss this fascinating issue. All doctors are not created equal. As Khosla pointed out, studies show that if you give the same data on a patient to a random group of 10 doctors and ask them if surgery is recommended, half will choose surgery while the other half will choose not to perform surgery.

If artificial intelligence systems are built using the medical minds of the doctors that choose the right answers, these technological solutions sift through an incredible amount of data and provide more medically reliable recommendations. Of course, a human doctor still makes the ultimate decision. However, the doctor has the benefit of a large amount of data analysis and is much more likely to make a decision based on complete information, not incomplete data.

Perhaps EHRs plus AI will save many more

lives and dramatically reduce medical errors without increasing costs too much.

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EHR vs EMR - What's the Difference?

EHR vs EMR - What's the Difference? | EHR and Health IT Consulting |

Should you implement an EMR or an EHR? Do you know the difference? Is there a difference?

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded provider’s understanding of the two software definitions.

Recently, National Alliance for Health Information Technology (NAHIT) established definitions for electronic medical records (EMR), electronic health records (EHR) and personal health records (PHR).

NAHIT Has Defined EMR and EHR

The NAHIT has produced the following definitions for EMR and EHR:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems). More on this later…

Who Needs Which?

Marc Anderson, CEO of the AC Group, says it comes down to the words “medical” and “health.”

An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements. It will help providers report and measure quality indicators for pay-for-performance incentives.

Meanwhile, an EMR is a more silo’d record of a single diagnosis or treatment, most likely used by a specialist. If your responsibility is taking care of one unique problem – perhaps an orthopedist setting a bone – then a stand-alone EMR may well be sufficient. Certain specialists may not need information about patient history as much as they need specialty-specific workflows and templates.

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EHR Interoperability Solutions Progress in Healthcare Sector

EHR Interoperability Solutions Progress in Healthcare Sector | EHR and Health IT Consulting |

EHR interoperability is the name of the game, as healthcare providers and health IT vendors begin to realize the importance of connecting systems and medical devices to better communicate and share data throughout a medical organization.

National Coordinator for Health IT Karen B. DeSalvo has mentioned time and time again the need for EHR interoperability throughout the healthcare sector in order to ensure all physicians and healthcare professionals are able to access key data when making vital clinical decisions. Additionally, payers, patients, and hospitals will need the ability to view necessary health information to create a healthier population around the nation.

The Brookings Institution released a policy brief several months ago calling for fixing some of the issues and challenges within the health IT industry including the need for greater EHR interoperability and data exchange. Redundant testing and duplicative data entry would be solved with an increase in medical data sharing.

The Office of the National Coordinator for Health IT (ONC) has gone forward with addressing the challenges and needs of the healthcare community with regard to improving EHR interoperability. From the ONC Nationwide Interoperability Roadmap to the report to Congressaddressing information blocking, this federal agency has put great efforts toward advancing EHR interoperability throughout the country.

Despite ONC’s efforts, according to Chief Informatics Officer Dr. John D. Halamka, there is an access of policy and political barriers to true health information exchange. Halamka states that the Massachusetts State Health Information Exchange (HIE) creates thousands of connections between hospitals and professionals throughout the nation with the help of Health Information Service Providers (HISPs).

The CIO goes on to say the EHR interoperability has a “positive trajectory” and that there is currently sincere progress taking place in boosting health data exchange. More importantly, Halamka states the importance of continuing efforts, identifying gaps in EHR interoperability, and solving these issues. Moving forward is the only real option.

Analysis from the research market firm Frost & Sullivan shows that interoperability and connecting healthcare tools is not uniform around the globe. In order to fix this issue, stakeholders will need to address connectivity standards and create a “digital healthcare strategy” that can connect vital medical devices in efforts to improve care coordination.

“More than 50 percent of healthcare providers do not have a healthcare IT roadmap, although they acknowledge the role of digital health in enhancing healthcare efficiency,” Frost & Sullivan Healthcare Research Analyst Shruthi Parakkal said in a public statement. “Consequently, even the existing interoperability standards such as HL7, DICOM and Direct Project are not being utilized optimally by many providers.”

Instead of requiring upgrading individual systems and investing funds in updating workflows, it would benefit hospitals and clinics if vendors developed products with guaranteed connectivity even when devices are developed by multiple manufacturers.

Parakkal also mentioned the importance of EHR interoperability in healthcare providers’ quest for successfully attesting to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs and qualifying for financial incentives for adopting certified EHR technology. As CIO Dr. John D. Halamka mentioned, we must move forward in order to improve EHR interoperability on a national level.

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Stage 3 Meaningful Use ‘Too Ambitious’ on Patient Action Goals

Stage 3 Meaningful Use ‘Too Ambitious’ on Patient Action Goals | EHR and Health IT Consulting |

Various stakeholders have begun taking part in sending their public comments to the Centers for Medicare & Medicaid Services (CMS) with regard to the Stage 3 Meaningful Use proposed rule and the proposed modifications to Stage 2 Meaningful Use requirements for the next few years.

The College of Healthcare Information Management Executives (CHIME) released their comments to CMS about the proposed rulings on May 27. CHIME representatives found that Stage 3 Meaningful Use requirements under the proposed rule are “too ambitious” and need some significant revisions, according to a company press release.

Additionally, the organization showed complete support of CMS in reducing the EHR reporting period in 2015 from a full year to a continuous 90-day period. CMS did reduce the number of objectives under the Stage 3 Meaningful Use proposed rule and improved the reporting periods, but the high number of total proposals for the Stage 3 portion was thought “unworkable” by CHIME representatives.

“Were all requirements finalized as proposed, we doubt many providers could participate in 2018 successfully,” CHIME stated in its public comments. “And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures.”

There are specific steps CHIME offered that may

improve attestation to Stage 3 Meaningful Use requirements if CMS integrates the suggestions in the final ruling. These steps are:

1) Requiring a 90-day reporting period under Stage 3 Meaningful Use regulations for the first year of attestation

2) Retain the same 90-day period for any eligible healthcare provider participating in the Medicare or Medicaid EHR Incentive Program for the first time

3) Discontinue patient action thresholds under the patient portal objectives

4) Reduce the number of measures in certain encompassing objectives like health information exchange and care coordination

5) In limited circumstances, give providers the opportunity to meet objectives via paper-based means

6) Give providers a 90-day remission in any calendar year for program upgrades, bug fixes, or EHR optimization

CHIME was especially concerned with “unrealistic” health information exchange measures and the ongoing uncertainties around patient action objectives. CMS proposed that modified Stage 2 Meaningful Use requirements would mandate that only one patient among a provider’s consumer base would need to view, download, and transmit their health data. However, under the Stage 3 Meaningful Use proposed rule, this requirement goes up to 25 percent of the patient population among eligible hospitals and professionals. CHIME was also concerned that attesting to Stage 3 by 2018 was too soon and providers would not be ready.

“While we acknowledge policymakers’ intention to make each Stage more difficult than the last, we are concerned with the strategy that envisions Stage 3 serving as both the apex of MU requirements and as a starting point for those providers with no experience at Stage 1 or Stage 2 of the EHR Incentive program,” CHIME said. “We worry some of the objectives pose too great a stretch for seasoned meaningful users, let alone those who have never participated in the program.”

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