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Patients describe what they consider good customer service -

Patients describe what they consider good customer service - | EHR and Health IT Consulting |
Doctors' knowledge and the office experience are more important than price in creating satisfaction, according to a new survey.


When it comes to satisfying patients as customers, practices need well-trained physicians, easy access to patients’ histories and long appointments — or at least the impression of long appointments, according to a Harris Interactive Poll issued Sept. 10.

“As other industries try to build customer loyalty, they are setting certain expectations for service,” said Vaughn Kauffman, principal and leader of the payer advisory practice at the consulting firm PwC. “And consumers are carrying those expectations into health care.”


Harris researchers surveyed 2,311 adults between July 16 and 23. Eighty-four percent had visited a doctor’s office in the past 12 months. Of this group, 83% were satisfied or very satisfied with the encounter. When compared with other service industries, satisfaction scores were higher for restaurants and banks but lower for car dealers and health insurers.


Consultants who work with medical practices say many factors that go into making patients satisfied customers are easier to address than they sound. It’s important to do so, however, because satisfaction is becoming more critical in health care. Keeping patients happy can play a part in earning quality pay and persuading patients to come back and refer the practice to others.


95% of patients say the amount of time spent with a doctor is an important satisfaction factor. 

For instance, 97% rated a doctor’s knowledge, training and expertise as important or very important with regard to creating a positive customer experience, although this factor is not readily changeable.


“That’s a given,” said Meryl D. Luallin, a partner with the SullivanLuallin Group in San Diego, which works with practices to improve the patient experience. “Patients take a doctor’s skills and training for granted. When you board a plane, you don’t stop by the cockpit to ask to see the pilot’s license. Patients typically make the assumption that somebody at the practice has already vetted the doctor.”


Other factors important to patients are easier to tackle. For example, 94% considered a physician being able to access a patient’s medical history as important or very important. Experts on the patient experience said this issue can be improved at practices with paper charts if physicians view them before entering the exam room. For physicians with electronic medical records who are not able to access the information until they are in the exam room, consultants suggest an introduction to the patient and then a brief explanation along the lines of, “I’m going to review your records, and then I’m going to give you my undivided attention.”


“It’s a little more challenging with electronic records because of the way a physician accesses the chart,” Luallin said.


This may help patients feel as if they have had a longer visit. Ninety-five percent in the Harris survey said time spent with the doctor is important or very important in being satisfied with the experience, but this does not necessarily mean lengthening appointments, which may be impractical or financially impossible for a practice. Consultants suggest that physicians sit in front of a patient rather than stand. Physicians who don’t look as if they are about to run out the door may give patients the impression of a longer visit.

“It’s all in the body language,” Luallin said.


Other surveys have suggested that consumers are less price-sensitive about health care than other industries but are more attuned to the service aspects. For example, a report on 6,000 consumers issued in July by PwC found that 69% said price was the No. 1 driver when considering leisure airline travel, but this was true for only 8% considering health care services. Forty-two percent said personal experience was the most important factor when choosing a doctor or hospital, but this was true for only 17% considering an airline ticket purchase.

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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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How payer-provider partnerships support population health |

Accountable care models leverage care coordination with the aim of improving patient outcomes while reducing costs, but their success depends first on agreements between healthcare providers and payers enabling important health data to be shared and made actionable.
“That’s the thing that has really allowed us to start to manage population — when we were able to partner with Aetna and get that data into a system that would quickly allow us to look at populations in different ways,” says Hank Sakowski, II, MD, Medical Director UniNet Healthcare Network. “You can quickly look at a population and identify patients who are predicted to be high spenders in the upcoming years. That has been really powerful.”
The clinically integrated network in Omaha recently announced its plan to expand its collaboration with Aetna’s Coventry Healthcare Care and CHI Health (formerly Alegent Creighton Health) to provide coordinated care to a patient population of Medicare-eligible beneficiaries.
The expansion is the direct result of UniNet’s successful efforts in managing its population of employees using three approaches.
“We have had success in lowering our overall healthcare expenses — that’s where it started — and this was just a natural progression. We saw success; they saw that we were able to manage our employee population well. We wanted to extend that to the general public,” adds Sakowski.
The first approach focused on transition of care, namely the use of transition coaches to guide patients through the discharge process to avoid costly readmissions. Funding from the Centers for Medicare & Medicaid Services (CMS) was instrumental in getting the project of the group, says Sakowski.
The next involved the use of care coordinators to connect with employees lacking in-network primary care physicians as well as those having recently visited an emergency room for a non-medical emergency. And the last hinged on a partnership with Creighton University School of Pharmacy to establish a medication therapy management program.
Being able to identify these potential areas of improvement came as a result of access to various forms of data:
We knew that we wanted to reduce use of high-end care settings — ERs and hospitals — and we have data as a Medicare Shared Savings Program ACO and employee population that show that our ER utilization was pretty high. Also, we have data from Aetna and United. We meet with them and they show us how we’re doing with admissions, ambulatory-sensitive conditions, and just in general. So we have data that show that those were certainly opportunities.
Making this information actionable, however, required a significant amount of coordination between the various healthcare organizations in order for their EHR and health IT systems to interoperate.
“When Allegiant acquired Creighton University Medical Center and the Creighton Medical Associates the faculty plan, they were on two different EHRs — MedVentive and Allscripts — and we’ve subsequently gone on to Epic to try and get on one platform for medical records,” Sankowski.
That was the first step. The next was to establish a registry robust enough to prove useful in population health management:
There is some registry functionality in Epic, but there is not a real complex registry associated with it so that it is what led us to MedVentive which is now a McKesson product with a risk manager and population manager. We were able to stand up the risk manager side with claims data and we’re still working to get the population manager, which is really the registry functionality, hooked up with Allscripts and then we switched to Epic so we’re working to get that up. We should be testing in the next week or so. That will be a big benefit for us.
It stands to reason that before healthcare provides can be held accountable (i.e., assume risk) for a patient population they need sufficient data about those individuals. Getting this health information from disparate systems requires a similar level of coordination, this type between health IT personnel and systems.

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CMS seeks volunteers for end-to-end ICD-10 testing in 2015 |

The Centers for Medicare & Medicaid Services (CMS) is on the lookout for volunteers to participate in ICD-10 end-to-end testing this January.
As a result of the one-year ICD-10 compliance delay which was included as part of the sustainable growth rate (SGR) repeal, CMS had little choice but to cancel testing plans originally slated for this past summer.
Despite CMS’s more proactive approach, not everyone believes that its testing plans or the extra time will lead to success this go-around — namely the American Medical Association (AMA).
“While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time,” Steven J. Stack, MD, AMA President-Elect, said last month. “The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.”
To accommodate the new deadline of Oct. 1, 2015, the federal agency more recently laid out its strategy for ensuring that ICD-10 systems are a go come this time next fall, including end-to-end testing for Medicare fee-for-service (FFS) provider systems at three different times in 2015 — January, April, and July.
Here’s what CMS has in store for the first week of testing:
During the week of January 26 through 30, 2015, a sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The goal of end-to-end testing is to demonstrate that:
• Providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems
• CMS software changes made to support ICD-10 result in appropriately adjudicated claims
• Accurate Remittance Advices are produced
Approximately 850 volunteer submitters will be selected to participate in the January end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers.
To volunteer as a testing submitter:
• Volunteer forms are available on your MAC website
• Completed volunteer forms are due October 3
• CMS will review applications and select the group of testing submitters
• By October 24, the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing
Additional opportunities for end-to-end testing will be available in 2015. Any issues identified during testing will be addressed prior to ICD-10 implementation. Educational materials will be developed for providers and submitters based on the testing results.
With a lack of testing cited by many industry stakeholders as sufficient cause of the latest delay, the testing plan provided by CMS should be a welcomed sight.

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Calls for Stage 2 changes grow louder | Healthcare IT News

Calls for Stage 2 changes grow louder | Healthcare IT News | EHR and Health IT Consulting |

In a pointed letter sent to HHS Secretary Sylvia Matthews Burwell on Monday, a who's-who of industry stakeholders complained of "immediate concerns" about their members' ability to continue meaningful use participation.

The letter, co-signed by an array of groups – including CHIME, HIMSS, MGMA, AHA, AMA and others – was also sent to CMS Administrator Marilyn Tavenner and National Coordinator for Health IT Karen DeSalvo, MD.

In it, stakeholders reiterate what many of them have been shouting from the rooftops since CMS published its only-mildly-more-flexible Stage 2 final rule, which was announced in late August. The very existence of meaningful use "hinges on addressing the 2015 reporting period requirements," they state.

Rather than requiring 365 days worth of attestation data, HHS should "provide for a shortened, 90-day EHR reporting period in 2015, which would give time for providers to continue their transition without having to drop out of the program," they write.

It's not a new complaint. This past February many of these same industry groups, upon seeing the initial proposed rule, offered HHS feedback that the "pace and scope of change had outstripped our collective capacity to comply" with the program.

"Specifically, we said this dynamic inhibited the ability of our members to manage the transition to 2014 Edition Certified Electronic Health Record Technology  and Stage 2 meaningful use in a safe and orderly manner," the letter reads.

While the groups thought their concerns had been heard and would be acknowledged, they add, "we were surprised to learn that flexibilities meant to mitigate 2014 challenges did not also address program misalignment in 2015 and beyond."

The Aug. 29 final rule, mandating a full-year EHR reporting period in 2015, has left the organizations "incredibly concerned" about the "forward trajectory" of the MU program, they write – pointing out that some 3,800 hospitals would be required to implement 2014 Edition certified technology, configured for Stage 2 measures and objectives, in the next two weeks in order to meet the Oct. 1, 2014 deadline.

More than 237,000 eligible professionals, meanwhile, "will need to be similarly positioned by January 1, 2015."

The numbers speak for themselves, the groups argue: As of now, just 143 hospitals and 3,152 providers have been able to meet Stage 2 with 2014 Edition EHRs.

"This represents less than 4 percent of the hospitals required to be Stage 2-ready within the next 15 days. And while eligible professionals have more time, they are in comparatively worse shape, with only 1.3 percent of their cohort having met the Stage 2 bar thus far."

While the stakeholders reiterated their commitment to meaningful use, they urged Secretary Burwell to "take immediate action by shortening the 2015 EHR reporting period to 90 days" – and also by adding more wiggle room with regard to Stage 2's notoriously troublesome transitions of care and view/download/transmit measures.

"Given that we have less than two weeks left in Fiscal Year 2014, immediate attention to these concerns is needed," they wrote. "This additional time is vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would improve patient safety without compromising momentum towards interoperability and care coordination supported by health IT."

The letter to Burwell, Tavenner and DeSalvo was signed by the following healthcare organizations:

  • American Academy of Family Physicians
  • American College of Physicians
  • American College of Physician Executives
  • America’s Essential Hospitals
  • American Hospital Association
  • American Medical Association
  • Association of American Medical Colleges
  • Association of Medical Directors of Information Systems
  • Catholic Health Association of the U.S.
  • Children’s Hospital Association
  • College of Healthcare Information Management Executives
  • Federation of American Hospitals
  • Healthcare Information and Management Systems Society
  • Medical Group Management Association
  • National Rural Health Association
  • Premier healthcare alliance VHA Inc.
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EHR Success: 4 Change Management Process Tips - InformationWeek

EHR Success: 4 Change Management Process Tips - InformationWeek | EHR and Health IT Consulting |

"When did the software change?" You've no doubt heard that question once or twice.

In healthcare settings, it often comes up when documentation and information on use of electronic health records are not communicated effectively. One reason users pose this question so often is that organizations sometimes overlook the importance of a good change management process as it pertains to EHRs. This, in turn, hinders the success of new EHR configurations.

In the context of an EHR build, change management refers to "a project management process wherein changes to the scope of a project are formally introduced and approved," according to John Fillcetti's Project Management Dictionary.

[Office of the National Coordinator for Health IT adds flexibility to 2014 EHR certification criteria. Read ONC Releases Final EHR Guidelines.]

Early in my career helping various healthcare providers make the transition to EHRs, I learned first-hand the importance of good change process management. I was helping a client's EHR team build and test a number of changes that its end-users had requested. The client had no real formal processes in place to keep track of its builds, so I was to help organize and maintain a shared list.

One of the managers forwarded me all the emails that had been saved regarding each build item. I set out to create a single shared list that would include all the information about each item. That way, I reasoned, all appropriate members of the client team would be able to track updates and new build requests end-users had submitted. Nobody needed to use my spreadsheet. My list had become my personal tracking sheet. As a result, the change process turned into a change crisis.
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With no system for tracking communication about changes, it became one person's responsibility to track and document everything. The unintended consequence was that there could be no assurance that all changes had been monitored. That put the responsible person in the untenable position of having to present updates that could not possibly be accurate or current.

Updates on the actions taken occurred during weekly team meetings. Without a reliable reporting system, next steps depended on people remembering what happened and relying on build analysts to have everything well organized on their own.

Build team members and the person responsible for testing changes sometimes missed meetings -- not because they were indifferent or irresponsible, but because they were not required to attend.

With only one person in charge of documenting developments, details and screenshots that could capture the changes made by the build analyst were sometimes lacking -- and specific test details were sometimes unavailable.

When progress actually did occur and items were set to move into production, there were further delays, because the build had to be scheduled, which could happen only when approved by the entire leadership team. As noted, the leadership received requests for approval by email. Until all team members could respond -- and everyone fully understood the details of the change -- nothing proceeded.

Only after this paralysis became clear to everyone were we able to make the recommendations and changes necessary to succeed. The solutions we provided in this situation are relevant to any healthcare group struggling to enhance its EHR build-keeping.

1. Know the process
The first key to an effective change management structure is to outline and define the process. Knowing how changes will be tracked and communicated will benefit all parties involved, including key leadership personnel who may not be part of the day-to-day build discussions.

Here are some questions to consider:

    How will end-user requests be accepted?
    In what forum will these changes be discussed and solidified?
    What system/software will be used to document and communicate changes?
    Who gives final approval for changes in the live system, and how will they get those approvals?
    If necessary, what is the rollback plan, and how will it be accomplished?

2. Know the resources
The next part of designing an effective change process is to know who will be involved during each stage of the build. Without a method for assigning build items to specific resources, organizations risk delays in getting changes approved through the test/QA, and ultimately intothe live environment. It is also important to involve any users who requested the enhancement to provide additional details when needed and test the changes as well.

Here's who should be involved:

    Build-team managers and at least one analyst
    Support-team managers and at least one end-user support specialist
    End-user requesting the change
    Leadership involved in approving changes

3. Know the details
Another essential aspect of the change process is to understand the details of the change and inform the affected parties when that change will be implemented. Documenting and maintaining a well-organized change management form will help track key elements.

Here are some details to include in a change management document:

    Who is making the request
    What change is being requested
    What specific build or configuration work is required to accomplish the request
    When it is scheduled to be implemented in the test/QA system
    How the change will be validated
    When it is scheduled to be implemented in the live system
    The rollback plan, if applicable.

4. Know what happened
Most importantly, establishing a process to track changes will provide a detailed log of who made what change when and why.

It is beneficial to document the following information in a change process tracking system:
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    When the change was implemented in the test/QA and live systems
    Details from the build analyst, complete with before-and-after screenshots if applicable
    Who completed the testing and when it was completed
    When end-users were notified
    How the change affects the system's users a month or so after the change is implemented

These are just a few of the many factors to consider when implementing a change management process. Every organization is unique, and what works for one may not work for another. Even the most efficient organizations can benefit from ongoing reassessments of how their processes are functioning for their staff and, most importantly, their end-users.

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Department of Defense Moves Forward with EHR Project | ICD Tagger

Department of Defense Moves Forward with EHR Project | ICD Tagger | EHR and Health IT Consulting |

The Defense Department (DoD) is moving forward with their electronic heath record (EHR) project by issuing a request for proposals. This interesting information came from Dolphin News in their article, “DoD takes next step in modernizing electronic health records.”

The project plan is to modernize its electronic health records and allow the DoD to share health data with the private sector and the Department of Veterans Affairs. The department’s strategy is to engage the larger health information technology marketplace to help identify a solution approach that provides best value and meets operational requirements.

Electronic health records provide a way that healthcare providers can focus on improved accuracy. Making use of an EHR system can avoid dangerous record errors with the assistance of medical indexing programs like ICD Tagger. Any flagged or erroneous files are made easily available for review and corrections as necessary.

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RECs have aided 100,000 providers with EHRs, meaningful use |

The nation’s network of Regional Extension Centers (RECs) have provided more than 100,000 healthcare organizations with the knowledge and tools to implement EHR technology and attest to Stage 1 of meaningful use, the ONC was proud to announce this week in a blog post on HealthITBuzz.   As EHR adoption reaches the saturation point and ONC grants start to run their course, National Coordinator Karen DeSalvo, MD, MPH, MSc, notes that 93% of RECs are expected to reach financial sustainability at the end of the federal funding period by continuing to offer supplementary services and technical aid.
RECs have partnered with more than 150,000 providers and have helped more than 139,000 of those physician organizations adopt EHR technology.  They have been highly successful in reaching a variety of provider types, including 44% of all primary care providers and more than 13,000 specialists.  Fifty-four percent of all rural providers, 80% of critical access hospitals (CAHs), and 83% of all community health centers have been involved with an REC program.
“Through their work, RECs have developed strong relationships with the nation’s providers, establishing themselves as a credible and capable resource,” write DeSalvo and Kimberly Lynch, MPH, Director of the Office of Programs and Engagement. “This trust is all the more important as many small practices are also small businesses, and the livelihood of these providers, their staff and the neighbors they serve are impacted by the tremendous technological investments and operational changes practices make to provide better care.”
Providers are more than twice as likely to successfully attest to Stage 1, studies have found, and the technical assistance that RECs can give has been instrumental in achieving true quality improvements after EHR adoption. “Even relatively long periods of EHR use – up to two years – were not associated with quality improvement for physicians who received no technical assistance or only moderate levels of assistance,” DeSalvo adds.
“Meanwhile, as providers begin to transform care through and beyond meaningful use criteria, RECs will continue to be critical in demonstrating how health IT can be used to measure and improve quality,” the blog post concludes. “We are proud of the hard work of the RECs and the dedication to bring 100,000 primary care providers to achieve meaningful use.  We look forward to the much more being done – and yet to be done – to achieve the vision of better health and better health care.”

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Post-acute care quality bill moves from House to Senate |

A bill that would require post-acute care providers to participate in quality and data reporting is inching closer toward becoming law after recently passing the House the Representatives and making its way to the Senate.
The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 aims to establish a system for collecting “standardized post-acute care assessment data for quality, payment, and discharge planning, and for other purposes.”
On Tuesday, the House agreed by voice vote on a motion to suspend the rules and pass the bill which was introduced by Representative Dave Camp (R-MI) in June 2014.
The bill contains three key provisions:
1. require post-acute care (PAC) providers to report standardized patient assessment data, data on quality measures, and data on resource use and other measures;
2. require the data to be interoperable to allow for its exchange among PAC and other providers to give them access to longitudinal information so as to facilitate coordinated care and improve Medicare beneficiary outcomes;
3. modify PAC assessment instruments applicable to PAC providers for the submission of standardized patient assessment data on such providers and enable assessment data comparison across all such providers.
The American Hospital Association (AHA) is highlighting components of the bill that its advocacy has impacted, namely the lack of a requirement for inpatient prospective payment system hospitals or critical access and cancer hospitals to report patient assessment data.
In a letter to the members of the United States Committees on Finance and Ways and Means, the AHA petitioned lawmakers to amend several components of the proposed bill and emphasized the need to develop a future infrastructure capable of supporting the central aims of the legislation.
In particular, the provider association opposed a provision that could lead to the comparison of post-acute care settings without the consideration of risk adjustment, potentially leading to unfair comparisons of uniquely different care environments:
One of the goals of the data collection mandated by the IMPACT Act is to inform the design of post-acute payments structured around patient conditions, as opposed to specific care settings.n While we share the goal of a more integrative approach to meeting the needs of post-acute patients, comparing data from multiple PAC settings is a difficult undertaking since, among other reasons, each PAC setting treats a different mix of patients and offers distinct services.        
The reporting requirements of the IMPACT Act are slated to be phased in over time and would not begin until Oct. 1, 2016. The bill now sits with the Senate and has an 82-percent chance of being made into law, according to

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Rural Neb. hospital takes on EHR adoption, meaningful use |

Chadron Community Hospital, located in the rural heartland of Nebraska, is celebrating its progress towards becoming fully paperless with an EHR adoption story that holds important lessons for other isolated healthcare organizations.  Profiled in a CHIME case study brief, the 25-bed critical access hospital (CAH) details its journey from paper-bound facility to its second consecutive year on the “Most Wired” hospitals list.
Before going live with their EHR in 2011, the hospital put significant effort into pre-implementation training for staff members, some of whom expressed limited comfort with basic computer literacy skills.  “We went from a complete paper record to completely paperless, and when you do that, the computer becomes one of the training aspects,” explained Anna Turman, CHCIO, CPEHR, CPHIT, Chief Information Officer and Chief Operation Officer for the hospital.
“Even while preliminary planning was under way, the hospital began to offer staff classes in how to use computers and productivity software, and email was used as a tool to get workers used to communicating electronically,” she added.  “Our goal was to have users reach a high comfort level with technology.”
The year-long planning and vendor selection phase included a thorough assessment of workflow processes and the creation of “super-users” from every department to ensure that help was available for providers who might have questions or problems.  After selecting a system, the hospital worked on upgrading its health IT infrastructure across the organization, including automating its pharmacy, emergency department, human resources, and financial department.  “The system helps to take down some of the silos so it’s a more integrated process,” Turman said.
While Chadron Community successfully attested to Stage 1 of meaningful use, Stage 2 is among a constellation of challenges that include ICD-10 and system upgrades.  “[Stage 2] has been a tough haul,” says Turman.  “The slow progress has been disheartening for people.  We had a powerful group to implement this, and we’re so proud of everyone here.  It’s just a steeper path now.  The biggest thing wearing us down is pushing so hard so fast with multiple high priorities.  It is constant rapid cycle change of adjusting one thing to meet a requirement that creates unintended ripple effects, which create other problems that constantly adjust workflow.  Staff experiences this as constant change.  We are making progress, but could use some breathing room to celebrate our successes.”

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Are EMRs profitable or problematic?

Are EMRs profitable or problematic? | EHR and Health IT Consulting |

As Healthcare Dive recently reported, a new study has concluded that at least in the outpatient arena, EMRs can raise revenue while lowering patient volume. The study, which appears to been fairly comprehensive, compared patient volume in reimbursement at 30 ambulatory practices for two years after their EMRs were implemented. The researchers noted that they saw no signs of upcoding or growth in reimbursement rates to account for the growth in revenue per patient.

For EMR fans, this sounds terrific, and suggests that further investment in such technology is likely to yield a return. But alas, nothing is that simple when it comes to the EMR world.

In fact, other studies of late have drawn completely different conclusions  in similar environments.  For example, new research appearing in JAMA Internal Medicine reports that doctors say they waste an average of up to four hours per week when using EMRs. The study, which posed 19 questions to 411 internal medicine attending physicians and trainees who worked in ambulatory practice and used an EMR, found that almost 90% of respondents said at least one data management function was slower, and 64% of respondents said the time taking notes increased. This certainly doesn't sound like a situation in which the EMR is boosting revenues on improving efficiency.

Why can't EMR research get the bottom of this?

You'd figure, with the government spending some $20 billion in incentive payments to encourage EMR use, that the industry would have the details as to just what benefits they offer, how to use them in the most effective way, how to leverage them to improve provider workflow and revenue and how to configure them to make them easy to use. And you'd assume that there would be some research consensus as to how to get these things done.

The sad truth is, however, that nobody seems to have the slightest idea how to standardize these approaches, and research seems to produce conflicting results that only makes things worse. The reasons are varied, but major factors include the following:

Standardizing EMRs is near-impossible

In theory, EMRs have the same job to do everywhere they go. In reality, though, even vendors certified for Meaningful Use are in no way in lockstep. And when EMRs are implemented, they must be adjusted to the unique workflow patterns of individual hospitals and medical practices. One has to wonder what the medical practices were doing in the Drexel University study that found growth in revenue per patient. In the context of the industry as a whole, it seems likely that this result is an anomaly at best.

There's too many EMRs out there

When the government is handing out money hand over fist to providers who buy EMRs, there's going to be a ton of vendors out there eager to meet your needs. The problem with that, however, is it discourages the industry from coming together in setting standards that simplify the way their core products work. I've stopped counting at this point, but there's got to be hundreds of EMR vendors on the market, and they simply don't cooperate much. And with providers using so many different types of EMRs, researchers are likely to come up with different conclusions as to their effectiveness, logically enough.

Different EMRs aren't compatible

Part of what sucks the value out of EMRs is the reality that providers can't share data with one another. Free, compatible data flow from doctors to hospitals to other health facilities is still at a primitive stage. That's the case despite demands from policymakers that EMRs become "interoperable," a nice way of asking that vendors drop the walls forcing providers to use their product and their product only. Researchers are forced to homogenize data coming from multiple vendors, which is likely to result in widely varied conclusions as to where it EMRs ought to head.

Frustrated by all of these complexities, doctors and even hospitals with gigantic investments are increasingly considering another a new EMR, though unfortunately, they may find that the workflow problems, vendor support, lack of data flow and other crippling problems just pop back up again with their new vendor. While the reality is that providers probably need to invest (and reinvest) in EMRs to survive these days, we're far from the day where it's an easy or well-understood process.

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Taking the physician perspective on EHR-HIT optimization |

With all of the current government initiatives and mandates, physicians have been left in the dust to try to figure out how to meet the requirements set out by the government, their practices, or their health systems — and still have quality time with their patients. The days of physicians simply treating the patients are in the past. Now their focus is on ensuring that everything is well documented in their electronic health record all the while making sure they meet certain criteria.
With that said, we can all agree that EHRs have done incredible things for us. The ability to instantly put your hands on the patient’s record versus searching for the paper chart for hours and sometimes days is amazing. Being able to easily have flowcharts and reconcilable medication and problem lists has made the intake process so much more efficient. But when was the last time we focused on what the physician needs in order to be efficient in this new electronic world?
Many articles have been written about EHR and health IT optimization assessments and how they can assist in finding streamlined ways to make the patient visit more efficient. These are not to be disregarded, as the process of conducting an optimization assessment and making changes to the system or workflows is vital. However, I challenge organizations to look beyond optimization of the application. Are there other significant changes that can be made surrounding physician-patient interactions to increase the quality of the visit?
Network and hardware assessments can provide valuable data on increasing the response speed when a physician is working within the application. As the end-user base increases, as the volume of data increases, and as expansion of coverage for your network increase, understanding how these changes have impacted response time is often forgotten.
Many organizations have a hardware refresh period whereby physicians have their devices well beyond the realistic life of the hardware in an effort to get their money’s worth. The problem this poses is how it ultimately affects the physician. An evaluation of this process as well as other technical assessments is equally as important as a utilization and optimization assessment of the application.
Rarely have organizations reconfigured their examination rooms upon the implementation of their EHR technology. Unfortunately how the examination room is set up and where physicians access their electronic devices in relation to their patients can affect the quality of their visit. The inability to have that connection with patients can ultimately result in non-compliance as well as cause a bottleneck in the physician’s documentation of the visit.
Among all the other countless initiatives that health systems face, taking a step back with a physician focus to determine pain points for the physicians should be at the top of the list. Remembering that with the advances in EHR and health IT come tremendous changes in how physicians now see their patients.

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Designing medical apps for pleasure and happiness to improve patient outcomes - iMedicalApps

Designing medical apps for pleasure and happiness to improve patient outcomes - iMedicalApps | EHR and Health IT Consulting |

Does pleasure and happiness matter for health? And why aren’t more of our patients motivated to care for their own health?

At the most recent hxrefactored conference by Health 2.0 and Mad*Pow, David Sobel MD MPH (@KPHealthyFun), primary care physician and Director of Patient Education and Health Promotion for The Permanente Medical Group and Kaiser Permanente Northern California, spoke on designing apps and web experiences for health and happiness. The conference — which focused on healthcare experience design particularly in the context of web, wearable, and mobile technologies — attracted over 500 designers, developers, and leaders in health.

“Where do you focus on in the situation?” Sobel said. “The most recalcitrant, difficult to change [patients and users] — absorbing all your energy? Target the ready & willing: help people do what they already want to do.”

During his talk, Sobel noted that healthcare providers can become frustrated and cynical about prescribing things that fail. Much of medical care is focused on preventive screenings, exercise, and healthy diets. Providers can instead target issues that preoccupy patients’ minds — real life issues including stress, sex, and sleep — and use the principles of pleasure as part of one’s motivational toolbox.

His talk further incorporated medical evidence that pleasure and happiness improves patient outcomes. For instance:

  • People with higher happiness and life satisfaction reported 50% better health and less long-term limiting health conditions 2 years later
  • Factors such as life satisfaction, absence of negative emotions, and optimism cause better health and longevity
  • Touch therapy can benefit patients with PTSD, eating disorders, and other psychiatric patients
  • Altruism reduces mortality risk in seniors giving social support versus receiving support.
  • Having a view of nature led to postsurgical patients requiring less pain medication and being discharged one day sooner than a view of a brick wall
  • Watching a humorous video for 30 minutes per day resulted in post-myocardial infarction survivors having fewer arrhythmias, lower blood pressure, and lowered stress hormones.

When designing mobile applications and devices, these principles can influence user adoption and outcomes. Sobel states that behavior change within patients tend to occur in small, incremental planned changes. Applications could implement behavior change with different methods:

  • providing small steps, with feedback and performance data
  • using major life events triggering an epiphany or a breakthrough
  • making changes in a patient’s environment
  • making the patient feel good

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HIMSS Analytics Honors Naples Community Hospital (NCH) Healthcare System With Stage 7 Award

HIMSS Analytics Honors Naples Community Hospital (NCH) Healthcare System With Stage 7 Award | EHR and Health IT Consulting |

HIMSS Analytics recognized the two hospitals the Naples Community Hospital (NCH) Healthcare System, in Naples, Fla., (my home town) with its Stage 7 Award. The award represents attainment of the highest level on the Electronic Medical Records Adoption Model  (EMRAM), which tracks EMR progress at hospitals and health systems.

HIMSS Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics™ Database. There are eight stages (0-7) that measure a hospital’s implementation and utilization of information technology applications. The final stage, Stage 7, represents an advanced patient record environment. The validation process to confirm a hospital has reached Stage 7 includes a site visit by an executive from HIMSS Analytics and former or current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.
“The NCH Healthcare System is honored to be designated as a HIMSS Stage 7 health system,” said Phil Dutcher, COO, NCH Healthcare System.  “We recognize that this achievement places us in the company of other leading healthcare systems that have also demonstrated that the effective use of advanced information technology materially improves the delivery of care for patients.”
During the second quarter of 2014, 3.2 percent, of the more than 5,400 U.S. hospitals in the HIMSS Analytics® Database, received the HIMSS Analytics Stage 7 Award.

The NCH Healthcare System is a not-for-profit, multi-facility healthcare system.  It includes two hospitals (referred to as the NCH Downtown Naples Hospital, and NCH North Naples Hospital) with a total of 716 beds.  The NCH Healthcare System is an alliance of 636 physicians and medical facilities in dozens of locations throughout Collier County and southwest Florida.
“NCH Healthcare System is a top tier example of healthcare technology at work for the entire patient experience,” said John P. Hoyt, FACHE, FHIMSS, executive vice president, HIMSS Analytics. “From a comprehensive electronic medical record that  has assisted in improving quality, safety and efficiency, to a complete ’smart room’ concept that has helped improve patient and employee satisfaction, NCH is an example of where inpatient care is heading in the future.”
NCH Healthcare System will be recognized at the 2015 Annual HIMSS Conference & Exhibition onApril 12-16, 2015, in Chicago, Ill. Visit the HIMSS Analytics web site for more information on the Stage 7 award.

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Using meaningful use, ICD-10 to build a successful practice |

A provider’s EHR system has a critical role to play in the short-term pursuit of meaningful use and the long-term achievement of compliance with ICD-10. For North Carolina Pediatric Associates, the recent transition to new certified EHR technology (CEHRT) has even more far-reaching benefit as a means of connecting a growing physician practice.
“For me and my practice, I started out with one location and as the practice grew and we added locations it became advantageous to have electronic medical records,” the organization’s owner and President Cornelius Cathcart, MD, tells
“The story about how it increases speed and make things better for the physicians to see more patients is probably not 100 percent true,” he continues. “But it does allow you when you have multiple locations to have your providers available to your patients regardless of where they are. They are able to pull up records from one location from another. We all know people tend to fall in love with a provider or two.”
More recently, Cathcart has had to consider how the EHR will enable his growing organization to remain successful in an environment of significant change in healthcare. The process of selecting the right EHR technology, one that ended with the choice of a CEHRT from NextGen, was informed by Cathcart’s decade’s worth of experience using EHR systems — not all of it good.
“We have been on the forefront of many of these upcoming technologies in medicine,” the pediatrician explains. “We started with a system that was just beginning, worked with it for about a year, never got it up and running well enough to satisfy us, and went back to paper records for a period of time. Then we started in another system that we actually had up until now.”
An impetus for choosing an EHR replacement was the need to prepare for the road ahead which contains two roadblocks — Stage 2 Meaningful Use and ICD-10. “We wanted to get into a system that would be compatible with all of our medical records, patient portals, and ICD-10 ready; therefore, we were looking to transition,” adds Cathcart.
Unlike ICD-10 which has little to do with improving care quality, the EHR Incentive Programs has served the pediatric practice a stepping stone to continued patient safety and improved care coordination, and access to health information and ultimately sustained success for practice as a whole.
“The whole purpose of the electronic medical record was patient safety,” Cathcart maintains. “Meaningful use just takes that one step further. It not only allows you to see everything going on with a patient, but it also allows patients to view their own records, which is a big plus.”
And although increased clinical efficiency is still a ways off, early returns are already being experienced by pediatricians as far as electronic prescriptions are concerned.
“The timesaver comes when you’re prescribing medications,” says Cathcart. “You might want to prescribe drug X and the patient is on drug A, B, and C. You have to take the time to assess whether A, B, or C will conflict or be compatible with drug X, so you have to stop and look that information up. With a good electronic medical record system, it automatically alerts you to those types of things.”
Much work still remains for North Carolina Pediatric Associates to achieve meaningful use and be prepared for ICD-10 in 2015, but right now its health IT infrastructure is enabling the organization to expand its network of care.

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Why is a custom EHR platform important for urgent care? |

Typically, an urgent care center doesn’t have beds and their patients don’t make appointments. The centers provide walk-in, extended-hour access for acute illness and injury care that is either beyond the scope or availability of the typical primary care practice or retail clinic.
It is for these reasons that many urgent care centers have resisted adopting EHR systems, but as the multi-location business model for urgent care is becoming more commonplace, these facilities will find it necessary to adopt the technology. Yet because of the uniqueness of urgent care, only a custom specialty-specific compliant platform designed to treat acute conditions will make sense for a practice to find the right EHR to achieve ROI.
Urgent care physicians work in a fast-paced, highly dynamic environment with speed in patient check-in which can only be achieved through an integrated smooth workflow system. EHR software made for urgent care clinics and emergency medical facilities are designed to expedite patient check-in and integrate smoothly into the practice workflow — similar to the practice of urgent and emergency care, which requires physicians to draw from multiple specialties to diagnose and properly treat the wide variety of patient symptoms encountered.
Likewise, urgent care EHR software draws its functionality from EHR systems created from other specialties. And like software systems for primary care practices, the EHR software platform should be capable of charting multiple conditions at the same time. It should also be able to integrate with X-ray, EKGs, Holter monitors and other devices, all while being capable of receiving and analyzing any lab data generated for each patient.
An EHR designed specifically for urgent care will have a variety of specific content as well as workflow included in the product. More importantly, it must be adapted to the workflow and method of practicing in an urgent care environment. With so many products in the market and so many variables in deliverables, here are four items to consider when evaluating EHR offerings for urgent care operations:
1. Evaluate product needs based on practice size: How many people work for you? What is a typical number of patients you see per day? Week? Month? All of this matters when choosing the right EHR or health IT system because they are designed for anticipated numbers of users and conditions. The current practice size as well as anticipated growth needs to be factored in for potential scalability of the software for a meaningful selection and implementation.
2. Systems architecture:EHR software can be utilized two different ways based on each practice need. If installed directly on office computers, it is called “client-server” and the data can only be retrieved if users activate those systems. When the software is “cloud-based” or SaaS (software as a service), that means the data can be accessed from any computer with an internet connection. If the practice capital expenditure budget is small but the operational budget has more flexibility, usually a SaaS model is the best fit. For larger clinical set-ups, the client/server model may be a better option because the initial cost of purchasing EHR software plus the training, applicable hardware and the ongoing system support involves such a large investment.
3. Certifications to consider:To obtain the maximum possible payments from the Center for Medicare & Medicaid Services (CMS) through the EHR Incentive Program for Medicaid, an urgent care provider must acquire, implement, or upgrade a certified EHR system and demonstrate meaningful use of that certified EHR technology (CEHRT). The certification program overseen by the Office of the National Coordinator for Health Information Technology (ONC) provides a defined process to ensure that EHR technologies meet the adopted standards and certification criteria to help providers and hospitals achieve meaningful use.
4. Specifics to urgent care: Make sure your selection includes the following five components to insure complete customization for your facility:
• bubblesheet intake forms,
• medical equipment interface (e.g., Holter Monitors, EKGs)
• referral letters,
• workers’ compensation forms,
• alert systems for emergency notifications
While selecting an urgent care EHR may seem like a daunting task, once you have the right platform in place it will not only improve the efficiency of operations but also patient communications. Take the time to get it right because it matters.
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Docs still unconvinced of EHRs' worth | Healthcare IT News

Fewer than 25 percent of physicians say electronic health records have made them more efficient, and not even 33 percent of them say EHRs have improved care quality, according to a new survey.

The poll of 20,000 physicians was commissioned by The Physicians Foundation. It found that, while 85 percent of docs had implemented EMRs, nearly half of respondents (47 percent) complained that the systems detract from patient interaction.

Meanwhile, the report paints a picture of a medical practice industry in flux, with doctors stretched thin – and many planning to close-up shop thanks to the regulatory and technology changes unfolding all around them.

More than 80 percent of physicians say they're over-extended or at full capacity, while only 19 percent indicate they have time to see more patients, according to the poll. Forty-four percent plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs.

Other findings from the survey:

  • Thirty-nine percent of physicians say they'll accelerate their retirement plans due to changes in the healthcare system
  • Twenty-six percent of physicians now participate in an accountable care organization, though just 13 percent believe ACOs will enhance quality and decrease costs
  • Fifty percent of docs say the ICD-10 switchover will cause "severe administrative problems" for their practices
  • Physicians spend 20 percent of their time on non-clinical paperwork
  • Physicians surveyed said they work an average of 53 hours per week and see approximately 20 patients per day

In the 2012 poll, many docs said high levels of government regulation, malpractice liability pressures, inadequate and inconsistent reimbursement and eroding clinical autonomy were adversely affecting their outlook on care delivery. In 2014, survey questions focused more on clinical autonomy, given the significant patient implications. When asked about levels of clinical autonomy and the ability to make the best decisions for patients, 69 percent of physicians indicate that their decisions are often compromised – demonstrating a strong potential bearing on quality of patient care.

Fifty-six  percent of physicians still describe their morale as "somewhat to very negative." Nonetheless, optimism levels increased between 2014 and 2012: This year, 44 percent of physicians characterize themselves as somewhat or very positive about the current state of the medical profession, compared to 32 percent in 2012.

"The state of the physician workforce, and medicine in general, is experiencing a period of massive transition,” said Lou Goodman, PhD, president of the Physicians Foundation and CEO of the Texas Medical Association, in a press statement.

"While I am troubled that a majority of physicians are pessimistic about the state of medicine, I am heartened by the fact that 71 percent of physicians would still choose to be a physician if they had to do it over, while nearly 80 percent describe patient relationships as the most satisfying factor about practicing medicine."

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How to use an EHR? Depends whom you ask | Healthcare IT News

How to use an EHR? Depends whom you ask | Healthcare IT News | EHR and Health IT Consulting |

The data in electronic health records may be structured, but the usage patterns of the doctors who interact with them is anything but, according to research from Weill Cornell Medical College.

[See also: When EHR design is a 'what not to do']

After getting acclimated to EHRs, physicians tend to fall into their own personalized usage patterns, according to the research – leading to a huge variability to how the systems are put to work.

The Weill Cornell study – performed in collaboration with the Institute for Family Health, a network of 18 New York City health centers – aims to better understand these unique dynamics between docs and health IT, offering perspective on which aspects of EHRs work well, and which need to be improved to standardize and optimize care.

[See also: Usability 101 workshoppers conduct research methods for improving EHRs]

"The variability really reinforces that the EHR is not a black box where you plug in this software and it's going to change everything for the better," said Jessica Ancker, a professor of healthcare policy at Weill Cornell, who led the research, in a press statement. "The patients and the doctors and the software are all interacting in a pretty complex and nuanced way."

First published in the Journal of the American Medical Informatics Association, the study analyzed 430,803 encounters of EHR use across 99,649 patients. The data showed how physicians varied widely in their approaches to different aspects of the EHR, such the frequency with which they responded to alerts and how often they updated patients' problem lists.

Working to reduce alert fatigue – and perhaps even scrapping some of the more burdensome but less efficacious elements of EHR design in favor of those that offer more value could help improve patient care, the research suggests.

Ancker has also published recent research examining consumer-facing personal health records, which have seen an increase in uptake from 11 percent in 2012 to 17 percent in 2013. As with clinical health records, patients' usage patterns will necessarily vary, but Ancker says any use of PHRs is better than none.

"The hope is that PHR breaks down a little bit of the barrier between specialized medical knowledge and the patient," she said in a statement. "EHR and PHR both have the potential to improve the way we deliver healthcare in this country, giving higher quality care and getting patients more engaged in their own healthcare, leading to downstream healthier people."

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Using the EHR to dive into data mining, clinical analytics |

Using the EHR to dive into data mining, clinical analytics | | EHR and Health IT Consulting |
In the first post of this series, we introduced the power of electronic health record (EHR) data and how it can completely transform a health system’s view on operations and quality. Moving forward, we’ll dive into how to make this happen through deep-dive data integration to power the next-generation of healthcare analytics.
Most healthcare analytics platforms rely heavily on claims data, which is highly structured but lacks the context afforded by EHR clinical data. When such analytics systems rely on clinical data, they usually depend on vendor-supplied integration messages, such as the Continuity of Care Document, or CCD. While specifications like CCD offer a compact and convenient way to exchange information between for explicit purposes, they also impose limitations through both design and implementation that make them insufficient for population health and performance analytics.
Arcadia recently had the opportunity to explore the nature of these limitations in collaboration with Beth Israel Deaconess Care Organization. The results of that project, published in the Spring 2014 edition of the Journal of Health Information Management, identified a number of points at which the CCD definition, itself can be a primary inhibitor of information exchange, rather than facilitator. A related survey of structured EHR documents (C-CDA) documents supplied by 21 different EHR platforms found over 615 errors between them. While C-CDA and other documents based on the HL7 standard formats solve some point-to-point interoperability problems, they are not yet able to consistently catalog the long history of health interactions typically documented in EHR systems that widely differ in architecture and capability.
Rather than relying on vendor-supplied CCDs, mining data directly from EHR tables allows for improved processes that best support the business intelligence and performance management necessary for health systems.  Robust EHR integration captures the full set of vitals, lab orders, notes, observations, diagnoses and other attributes that need to be analyzed to support initiatives like meaningful use, Patient Centered-Medical Home, accountable care and other initiatives that require requiring advanced reporting.
Inside the EHR
When it comes to EHRs, it is all about the little differences. Every EHR system, especially in the ambulatory space, recreates numerous common workflows that a care team performs during a visit. These workflows may include logging the patient’s appointment, to recording the provider’s observation and notes, to tracking the procedures and charges that, in addition to the consultation, will be billed to the patient or payer.
But it’s the little differences that count. Which fields are free text? Which are checklists? Which are picklists? What’s customized? What’s a favorite? These questions all lead to vast differences in the suitability of data for performance measurement. A CCD may only be mapped to a single template, leaving out other critical areas where information may be stored. By mapping to all known variations with in the EHR, performance measurement is more accurate and users gain more trust in their data.
To illustrate the challenge of EHR integration, we dug into one seemingly simple process: the assessment of a patient’s smoking status and the associated documentation of smoking cessation. In other words, in how many different ways does this EHR system document someone as a smoker? Using this as an example, you can best understand the complexities involved with data extraction.
We are not using Natural Language Processing or scanning through long note fields. These are selections made using drop-downs, checkboxes, or pick-lists in the EHR. In other words, they are all structured fields.
This is what we found:
This process reveals how to best approach the challenge of integration. Some variations of smoking status documentation were mundane: “Current Heavy Tobacco User”, “Current Heavy Cigarette Smoker,” “Former Heavy Cigarette Smoker,” or simply “Heavy Cigarette Smoker.”
Others seemed to create more questions than answers: “Not Smoking a Pipe,” “Not a Current Light Tobacco Smoker,” or “Having Recently Stopped Smoking.” Again, these were not creative free-text notations: all of these variations are available for selection or attachment to the record from an EHR prompt.
Given the extensive variations in patient data, it is critical to develop a reference library of mappings, code-sets, and translations that identify structured and unstructured elements for every connected system. The reference library can use standardized code sets, such as LOINC, CPT, RxNorm/NDC that constitute the most structured form of documentation.  But as shown, these code sets alone cannot fill the wide range of mappings and vendor references necessary. The reference library should be augmented to include custom user interface components and order sets that support a health system’s analytic requirements.
Ensuring that all practicable areas of documentation are sourced should be the driving force for the architecture behind your healthcare organizations’ EHR abstraction and integration.
Under the Hood
Health systems that are expanding and acquiring new practices rapidly need an integration platform that drives scalability across a range of technical maturity. A model that is adaptable to integrate with a $10 million data center or a server secured in the closet of a two provider primary care clinic. The capabilities and volume of data present complex challenges but any integration model should emphasize the following features.
Security:  Look for a platform that incorporates the latest in encryption and data protection. Data should be encrypted both at rest and in transit. Furthermore, a system that allows integration without needing clients to open special firewall or tunnels in their networks is critical.
Scale: Cloud hosted configuration allows for updated mappings for specific clients or across entire integration libraries covering over 20 EHRs across multiple versions for each.
Trust: Monitoring and surveillance to know that the integration can be a trusted source beyond the implementation.
The amount of visibility into this process is critical, and considerable. The following graph depicts the insertion of reported labs during a data warehouse implementation:
The rise in activity is due to the phased rollout of the integration. Proper surveillance allows for the identification of problems in integration in near real time.  The large drop that occurred from December 24 to January 4 can be explained by holiday closures, but it could also indicate a new version of the EHR deployed over New Year downtime. Tools like this help maintain the integrity of the integrated system moving forward.
As you can see, visibility and reliability are as crucial to meaningful analytic insights into your organization, as they are essential to a powerful, configurable, and effective integration platform. Understanding the wealth of data in an EHR system, properly mapping the information and concepts, and managing the technical complexity of the ETL process are essential to successful integration of your data assets.

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EHR giant Epic explains how it will bring Apple HealthKit data to doctors

EHR giant Epic explains how it will bring Apple HealthKit data to doctors | EHR and Health IT Consulting |

Epic Systems, the dominant EHR provider in hospitals and large medical groups, has been working with Apple on its HealthKit consumer health data initiative. But until now, the famously media-shy Epic and the famously secretive Apple have said very little about how the HealthKit ecosystem will work to the benefit of clinicians. But Epic has begun to talk.

Apple launched its new iOS 8 mobile operating system today, and a significant feature in that release is the Health app, which stores various types of our health data. You can think of HealthKit as a consumer health-information cloud data repository that connects to, and receives information from, a variety of consumer devices (connected scales, fitness trackers, smartwatches, etc.) and apps (food diaries, calorie counters, workout journals, and so on).

People in the health care industry hoped for more from Apple’s HealthKit platform than just amassing and sharing wearables data among app and device makers. They wanted HealthKit to make a difference. They wanted it to make people healthier.

A large platform collecting billions of data points about hundreds of aspects of our health on a daily basis might create a powerful information resource for health care providers and researchers. But in order for that to happen, the data will have to find a way into clinical systems, like the electronic health record (EHR).

“Apple’s HealthKit has tremendous potential to help close the gap between consumer collected data and data collected in traditional healthcare settings,” said Epic president Carl Dvorak in an email to VentureBeat. “The Epic customer community, which provides care to over 170 million patients a year, will be able to use HealthKit through Epic’s MyChart application—the most used patient portal in the U.S.”

The “customer community” Dvorak refers to is the hundreds of clinics and hospitals that use the Epic EHR. Patients use the Epic MyChart app to access elements of their own patient record from the Epic EHR. But note that the EHR accesses HealthKit data from the MyChart app, not via a direct integration with the HealthKit platform.

“While Apple will never mirror your Health data to iCloud (or allow another app to do that), once you provision access to another app, they may transport it elsewhere (e.g., to your provider’s EHR), but only if that particular endpoint allows access,” said Malay Gandhi of the accelerator Rock Health.

This may have been by design to avoid regulatory or privacy issues that might have arisen from Apple storing personal health data on its servers and then transmitting it past a health provider’s firewall and into clinical systems within. Here’s how Epic spokesman Brian Spranger describes the movement of data starting at the consumer device and ending at the Epic EHR.

“A consumer health app, like the Withings Scale, will notify HealthKit that it has a new weight and ask HealthKit to store that weight in the database on the iPhone,” he said.

Notice that the weight data that the scale collects doesn’t sit in the HealthKit cloud; it’s on the user’s phone.

“If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit “wakes up” the MyChart app and tells it there’s new data,” Spranger said.

So in this regard, HealthKit acts more like a traffic cop, connecting to devices and directing them to send or store data, all guided by privacy rules.

“The MyChart app on the phone then transmits that weight back to the EpicCare EHR system where it can be used appropriately as part of the patient’s medical care,” Spranger said.

Gandhi says that for the consumer, the Health app in iOS 8 is really the epicenter of Apple’s health ecosystem.

“Health is fundamentally a data aggregation and provisioning app disguised under very thin visualization,” he writes in a note to VentureBeat. “The consumer controls what data goes in, and what goes out, at a reasonably deep level (it would be like if when an app asked for access to your contacts, you specified access at the individual contact level).”

A year from now there may be many developers working with hospitals and their EHR vendors on HealthKit apps that present all kinds of consumer-generated information to physicians. The challenge, for now, is to boil down the mountains of information that will be gathered into the clinically meaningful and actionable bits.

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7 out of 10 providers around the world say clinical usability is the number one factor when choosing an EMR

7 out of 10 providers around the world say clinical usability is the number one factor when choosing an EMR | EHR and Health IT Consulting |

Nearly 75 percent of interviewed providers around the world reported that clinical usability outweighed every other criteria when choosing an EMR. This, as well as which other factors are driving provider decisions and which vendors hold the most mindshare, is included in the latest KLAS report on global EMR market share.

“The surprise in the feedback is the uphill battle that perceived lower cost vendors are facing as providers weight their selections heavily toward usability and technology, and just how much that battle is benefiting higher cost solutions,” said report author Chris Brown.
For this report, entitled “Global EMR Perception 2014: Usability and Integration Driving Mindshare,” KLAS spoke to provider organizations around the world to determine which vendors are being selected and why, what criteria are most important, and what scares providers most about implementing such technology.
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Meaningful use audit leaves Arkansas hospital owing $900,000 |

CMS is asking Drew Memorial Hospital (DMH) in Monticello, Arkansas to pay back $900,000 in Stage 1 meaningful use incentive dollars after a post-attestation audit revealed that the hospital failed to meet one of the measures involved in the program.  According to CEO Scott Barrilleaux, the audit for fiscal year 2011 – 2012 revealed that the organization did not perform a risk assessment
“What that audit did is look at what we said we invested in the 19 measures. When the hospital first agreed to receive the money, we vowed to become meaningful users of the electronic health-record system and do so under the stipulation of those 19 measures in the agreement,” Barrilleaux explained at a Drew County Quorum Court meeting, according to the Advance-Monticellonian. “We were one of the first wave of hospitals to take advantage of the program and these types of audit simply are not that common.”
“When you’re the youngest and you don’t get to learn from other’s mistakes, these things happen,” he added. “We did a risk assessment in 2005 and then another one last year. What we didn’t do was perform a risk assessment during the years outlined in the audit. So, at the moment we are scheduled to lose our year two payment of the agreement in the amount of $904,000.”
CMS keeps the results of meaningful use audits close to the vest, partly so that hospitals on the list for further scrutiny don’t have a chance to examine exactly what the auditors are looking for. “Some of it is going to be private for a reason,” Rob Anthony, Deputy Director of the CMS Office of eHealth Standards and Services told EHRintelligence last year. “Obviously, we have certain audit protocols and risk profiles that we wouldn’t want to make public because we want to have a robust program oversight.” Individual hospitals that have endured the process sometimes reveal tidbits of information about the ordeal, but public failures have been rare so far.
Drew Memorial plans to appeal the decision, but does have the cash on hand to return the incentive money if the application is denied. “We started filling out the appeals paperwork today,” Barrilleaux said. “Still, I want to go ahead and book the loss to avoid any interest that might accrue during that appeals process. Trust me I didn’t want to have to come here tonight and tell you this. I’ve talked to a couple of other hospitals and while they have yet to be audited, this apparently is likely to happen to others as well.”

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CureMD Healthcare: Why does my practice need a medical billing company?

CureMD Healthcare: Why does my practice need a medical billing company? | EHR and Health IT Consulting |
In our country, a medical billing service is the intermediary between a doctor and his payments. However, while the Health IT sector is flourishing, many providers are missing out on even greater revenues in the form of quicker claim processing and reimbursements. Can a medical billing company be that intermediary; a question on the lips of all providers.

Managing your practice is not a walk in the park with doctors having to manage their patients and in addition to working towards achieving Meaningful Use incentives and avoiding penalties, the ICD-9 coding process and the fear of the fast approaching ICD-10 diagnostic codes among other things.
How can an in-house biller or professional billing company change the doctor’s revenue cycle? The answer is simple; through the internet, the intermediary transmits insurance claims directly to the insurance. Yes there is a clearinghouse involved, but that’s for the biller to worry about. As a provider, you have one less aspect to manage.
In addition, Medicare prioritizes electronically submitted claims. Claims transmitted online take 10 to 14 days for payment, in contrast to paper-based claims, which can take approximately 27 days. With so many days saved, even more money is earned by the doctor.
Now comes the next question, in-house or outsourcing medical billing? There’s a pretty straightforward self-evaluation statement for this. With both avenues providing the same service; would you prefer dedicated billing staff, to which you’d have to allocate a separate room and computers? Or would you prefer a company with numerous billing professionals, who’d do everything to maximize your reimbursements, and who’d charge an extremely low percentage of your annual revenues for their services? 
The more practical choice would be to outsource your billing to a company who’d do all this for you, all without taking a large amount of space and money to carry out your services for you. Additionally, most EHR vendors offer to execute this service for you, which means that you don’t even have to worry about system compatibility issues.
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Data protection authority investigates eHealth and wellness/fitness apps | JD Supra

eHealth and fitness/wellness applications are being investigated and potentially sanctioned by the Italian data protection authority that found half of them not compliant with applicable privacy laws.

We have already discussed in this post about the potential data protection issues affecting eHealth applications.  However, this is the first time that the Italian data protection authority takes a strong move against their lack of compliance with privacy regulations.  Indeed, as part of the initiative named Privacy Sweep 2014 undertaken by the Global Privacy Enforcement Network (GPEN), the international network aimed at enhancing the cooperation between data protection authorities, 1,200 applications have been reviewed and 59% of them were found to operate in breach of data protection laws.

Issues identified in eHealth/wellness apps

The lack of compliance was identified in the fact that through such eHealth applications:

  1. An adequate privacy information notice compliant with applicable data protection laws is not provided at the time of the installation or very generic information are provided which are not in line with the requirements imposed by data protection laws;
  2. The volume of personal data requested from users is excessive if compared to the services provided and 3/4 of the applications reviewed require consents to the processing of:
    • localization data,
    • device ID data,
    • other accounts data
    • video recording functionalities and
    • contact lists.
  3. The size of the privacy information notice is not adapted to the reduced size of the screen which makes it almost unreadable or the privacy information notice is placed in the section of the app dedicated to technical specifications.
Actions that might be taken against eHealth/wellness apps

The Italian data protection authority is considering the next steps to be taken against such eHealth and wellness applications with the view of adopting potential sanctions against them.  This practice is also part of the monitoring activity that will be run through the consultation on mobile health launched by the European Commission.

Additionally, it should be considered that if the above mentioned eHealth and wellness applications process health related personal data the data protection compliance applications and potential sanctions will further increase.  And this is not an issue relevant only for European companies since also US or Asian companies offering their applications to European users shall comply with the above mentioned obligations.

Finally, as mentioned in this post, with the growth of wearable technologies the data protection and regulatory obligations might become more stringent.  And don’t forget to join us at the webinar on legal issues of the Internet of Things, wearable technologies and eHealth were some of these issues will be covered.

Hopefully a more flexible approach will be adopted in the future by data protection authorities.

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CMS reminds 1st-year Medicare EPs of 2014 reporting deadline |

The Centers for Medicare & Medicaid Services (CMS) is looking to get the word out to first-year Medicare eligible professionals in the EHR Incentive Programs that an important deadline is fast approaching.
October 3 is the last day for Medicare EPs new to meaningful use to begin their 2014 reporting period and avoid payment adjustments in 2015.
These eligible providers must complete a 90-day reporting period to qualify for a Medicare EHR incentive payment. Unless these physicians have applied for a 2015 hardship exception back in July 2014, they are in line to experience a payment adjustment as a result of non-compliance with the federally-mandated Medicare EHR Incentive Program.
Here is the complete message from CMS:
CMS wants to make sure you don’t miss an opportunity to receive incentive payments for the Medicare EHR Incentive Program.
The last day to begin a 2014 reporting period for first-year Medicare eligible professionals is October 3rd.
Here are a few key points eligible professionals who have not yet started participation in the Medicare EHR Incentive Program should know.
Earning Incentives
• October 3rd is the last day to start the 90-day reporting period in 2014 for the Medicare EHR Incentive Program.
• If you start participation by October 3, you will have the opportunity to receive an incentive for 2014, and if you continue to achieve meaningful use, can earn incentive payments for 2015 and 2016 participation.
• If you wait and start participation in 2015, you will not be eligible to receive incentive payments, but can avoid payment adjustments.
Avoiding Adjustments
• You will not avoid the payment adjustment in 2015, as you will not be able to attest to 90 days of data by October 1, 2014.
• If you applied for a 2015 hardship exception by July 1, 2014, you may avoid the payment adjustment.
• If you attest to 2014 data by February 28, 2015, you will avoid the 2016 payment adjustment.
Medicare eligible professionals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

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AMA urges EHR design overhauls, releases usability framework |

After a RAND report labeled EHRs as a primary source of stress for physicians, the American Medical Association (AMA) is repeating its calls for the healthcare industry to take a long, hard look at the way EHRs are designed, urging vendors to pay more attention to the usability of health IT systems to support physicians instead of frustrate them.  The AMA has released a new framework outlining the top eight priorities for creating more intuitive EHRs that encourage efficiency, including building products that are interoperable and designed to promote team-based practice and care coordination.
“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said AMA President-elect Steven J. Stack, MD. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.
“Now is the time to recognize that requiring electronic health records to be all things to all people – regulators, payers, auditors and lawyers – diminishes the ability of the technology to perform the most critical function – helping physicians care for their patients,” Stack added. “Physicians believe it is a national imperative to reframe policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus.”
According to the AMA, the most important priorities to consider when designing an EHR product are the following:
• The EHR must enhance physicians’ ability to provide high quality care by becoming a useful tool instead of a distraction.
• The design and configuration must support team-based care and allow providers to work to the top of their skill sets.
• Software should include features that promote care coordination, including the ability to automatically track referrals and provide tools that track patients along the continuum of care.
• Health IT must be modular and easily configurable, allowing APIs to enhance and expand technical capabilities.
• EHRs should support clinical decision making by presenting pertinent information in an easily digestible format with the help of real-time data analytics.
• Interoperable data standards should be the foundation of EHR technology so that providers can share critical information across care sites and venues.
• EHRs should facilitate patient engagement and welcome mobile technologies that contribute to the patient record.
• Vendors and developers should pay close attention to end-user feedback and be nimble enough to make changes that will enhance the user experience.
“Effective use of EHRs is a key element in achieving the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of health care,” the report says.  The AMA plans to continue its education efforts and its outreach to vendors, developers, and policymakers to help encourage stakeholders to meet the industry’s needs.  “Through these efforts, we hope to advance the delivery of high quality and affordable health care. The AMA stands ready to partner with others across the health sector to bring this vision to life.”

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Experience is not a good predictor of performance for Epic consulting firms

Experience is not a good predictor of performance for Epic consulting firms | EHR and Health IT Consulting |
The number of engagements completed by a firm is not an accurate predictor of provider satisfaction when it comes to Epic consulting. Despite the standout performance of a few experienced firms like Nordic and Sagacious Consultants, there is little correlation between overall satisfaction and experience, according to the latest KLAS report on Epic consulting firms.
“It is great for providers that this market is so competitive,” said report author Erik Westerlind. “There are a lot of really solid performing firms in this space, and when you look at the top performers, they all have that burning desire to truly help providers. And that more than experience is the reason for their success.”
For this report, KLAS spoke to 149 provider organizations, who shared their experiences with 33 different Epic consulting firms. With so many options available, providers face the challenge of understanding how these consulting firms stack up and which is the best fit for their Epic-consulting needs. The goal of this report is to help providers differentiate between the various options.

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