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The four key areas of EHR implementation

The four key areas of EHR implementation | EHR and Health IT Consulting |

Failing to adequately plan for and manage change on the scale of an EHR implementation can send the cost of change soaring.


Effective change management starts at the beginning, with a thorough analysis of existing processes, to provide clarity up front about what works and what doesn’t.


This enables informed choices when considering updates to the hardware infrastructure or changes to record-keeping processes. Wisely investing this time up front will help minimize office downtime and implementation costs later.


Given the scope and complexity of an EHR deployment, you’ll need more than a standard IT project plan to ensure a successful rollout. Your project plan should cover every important activity and major milestone.


Give yourself the time to analyze, implement, train, and practice—and then take it step by step. Think through the entire process, articulate your needs to your vendor and build in a thorough follow-up phase to make sure everything is running smoothly.


The four key areas of change management to help your practice ensure a smoother transition are:


 • Assessment: Careful assessment of existing processes and infrastructure is essential to putting your practice in a strong position to support a new EHR system.


• Resources: Managing resources well ensures you’ll build a capable team with a strong leader and responsive vendor.


• Accountability: Clearly assigned roles and responsibilities provide accountability throughout the project and build commitment at every level.


• Logistics: A well-thought-out plan can minimize the risk of missteps in an inherently complicated, time-intensive process.


EHR implementation has the potential to be an arduous, drawnout and expensive process—but it doesn’t have to be. With careful planning and effective change management, your team can make a streamlined transition that will ultimately benefit both your practice and your patients, from back-office operations to quality of care.


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Organisation Capability's curator insight, January 10, 6:24 AM

Brilliant article that highlights common "watch outs" and common mistakes during change management iniatives.

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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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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Leveraging IT to extend coverage of medical professionals |

Our population of eight billion and growing doesn’t have enough medical personnel (doctors, nurses, physicians) to keep everyone healthy. This is not only valid for underdeveloped countries, but also applies for developed countries, albeit, not as acute. Since biologically cloning medical staff won’t be a viable solution any time soon, the question comes down to whether or not the tech industry can equip healthcare with tools that can heighten the impact and effectiveness medical experts can provide.
The late Steve Jobs famously pointed out that humankind has the unique ability to build “tools” that can amplify our impact.  The bicycle for example, moved humankind to the most efficient living being in terms of moving from point A to point B.
What are then the tools that can create similar amplification effects that can help fill the gap between needed medical experts and the number of available medical experts? Information technology has a big role to play answering that question.
Medical imaging-related technologies, cloud services, and advancements in connectivity (wired and wireless internet) have created a unique opportunity where doctors can virtually be “teleported” from location-to-location to examine patients and their medical data as well as compare notes with fellow experts, all without requiring patients or colleagues to be in the same room.
Today’s internet connection technologies are capable of delivering the necessary data and communications wherever it’s needed. As an example, patients can go to mobile clinics that may not be physically equipped with doctors but have access to technologies that enable doctors in nearby cities to visit bedside.
In other words, a hospital doctor or specialists can virtually interact with and diagnose patients, by making use of video conferencing. They can get access to medical images remotely, tap into other expertise and essentially help the patient who otherwise would not have access to first-rate medical talent.
As in any sector, the demands of the applications and use cases are ahead of the available technologies that support those applications. For example, internet connectivity might be available; however, reliable video conferencing (while simultaneously transferring large medical images) may still not widely be available especially in developing countries.
Put differently, the cloud services, medical imaging services, and real-time communication tools demand better performance and higher reliability than today’s internet connectivity technologies can support. Therefore, we need to pay attention to tools that can potentially bridge that gap.  Technologies such as broadband bonding, WAN virtualization, and WAN optimization are capable of doing just that for communication over internet, medical imaging applications, and any other cloud-based services.
Consider a remote portable clinic that can go to patients in rural areas and remain for an extended period of time. Clearly, such portable clinics can’t all be attended by doctors. However, if medical technicians in those remote clinics are equipped with medical imaging and remote communication technologies, they can virtually bring the patient and all the related medical data to the doctor who may be in a centralized hospital, who could simultaneously work at the remote clinic. Such projects are underway in various parts of the globe and are promising to fill the digital divide and therefore make medical expertise more accessible to patients in remote parts of the world.
Broadband bonding is one such technology that can combine existing wired or wireless internet connections to create a fast and reliable internet connection that can carry the medical imaging data as well as video conferencing-type communication data. Without broadband bonding, access to cloud-based applications, accessing and uploading medical imaging files, or having a high-fidelity video conference between the patient and doctor would not be possible.
Information technology experts are finding ways to leverage newer communication and cloud technologies that can be applied for their specific use cases in the healthcare industry. The tools we are creating today are capable of multiplying the impact of medical experts will have on keeping all of us healthier. Maybe we can’t biologically clone a medical expert yet; however, we can virtually clone his/her presence and therefore bring more doctors to patients.

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New Blue Button toolkit to support Stage 2 Meaningful Use |

New Blue Button toolkit to support Stage 2 Meaningful Use | | EHR and Health IT Consulting |
As part of the National Health IT Week festivities, the ONC has announced a new Blue Button patient engagement toolkit intended to provide detailed information on the technical standards necessary to provide online access to personal health data for patients.  The toolkit replaces the previous implementation guide as more and more providers attempt to attest to Stage 2 of Meaningful Use, which requires healthcare organizations to offer patient portal access to their populations.
“Blue Button is for every person, provider, and community interested in improving care and health through information access and use,” write Maya Uppaluru and Erin Siminerio, MPH, on behalf of the ONC in a blog post on HealthITBuzz. “The toolkit is designed for organizations that want to use Blue Button technology to help consumers get access to their digital health information. The Blue Button Toolkit includes the recommended technical standards for sharing data with patients in a structured way, and marketing materials to help organizations communicate the value of online access to health records.  Organizations can follow these guidelines and use these materials to show their support for the Blue Button Initiative.”
Just 28% of patients have online access to their health records, the ONC found in a separate data brief, further highlighting the need for simple, intuitive technologies that allow providers to expand their capabilities and make it easy for patients to engage.  Those patients who do take advantage of the opportunity to view or download their information find the data useful and important for their self-care, and providers may not have as much trouble reaching the 5% patient engagement threshold of Stage 2 meaningful use (MU2) as they used to think.
“MU2 currently requires that more than 50% of unique patients be offered access to their online medical record and that more than 5% of unique patients use view, download, and transmit (VDT) capabilities,” the brief says. “Performance among eligible professionals who are early attesters of MU2 show low levels of performance on this measure compared to some other MU2 measures. However, findings from the survey indicate that among individuals offered access to their online health records, 46% viewed their online record at least once, a rate more than nine times higher than that required by the MU2 threshold.”

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EHR adoption is the first step to an IT-enabled health care system.

EHR adoption is the first step to an IT-enabled health care system. | EHR and Health IT Consulting |
Adopting EHRs is the first step in a long and complex journey to an IT-enabled health care system in which technology is effectively leveraged to address ongoing cost and quality challenges.

This annual report produced by a team of researchers at the Robert Wood Johnson Foundation, Mathematica Policy Research, Harvard School of Public Health, and the University of Michigan tracks the progress of adoption of electronic health records (EHRs). 

In 2013, the percent of hospitals adopting at least a basic EHR quadrupled to 58.9 percent from 2010 when the EHR incentive program was implemented

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Large Illinois hospital merger to test EHR interoperability |

EHR interoperability will be put to the test in the Chicago area with the large-scale merger of Advocate Health Care and NorthShore University Health System.  The partnership will create a network of sixteen hospitals using four different EHR systems from some of the biggest vendors in the business, with more than 2000 employed physicians serving 3 million patients a year at more than 350 locations: a daunting challenge for health information exchange that raises questions about the impact of multiple EHRs in such a massive conglomerate.
The new Advocate NorthShore Health Partners, which still requires approval before the deal closes in early 2015, will shift the business paradigm in Illinois as it produces a $6.8 billion behemoth with more than 45,000 employees.  “This is a huge win for Advocate. It’s an incredible coup to lock up NorthShore. It’s a great market and it’s a great system,” said Jordan Shields, a vice president at hospital merger advisor Juniper Advisory, to the Chicago Tribune.  “[It] is going to shake people. What this does is change the gravity in the metropolitan area.”
The merger will help to secure ongoing revenues in a climate of uncertainty over the role of the inpatient setting and the long-term impact of the Affordable Care Act, which has been restructuring the way patients receive care.  While the potential for employee layoffs to reduce redundancies may have support staff and administrative workers worried, clinicians might be wondering how their EHR systems will be affected by the deal.  NorthShore University is an Epic shop with a single, unified platform across its care sites, but Advocate providers are split between Allscripts for its employed physician group, eClinicalWorks for “physician partners,” and Cerner as its inpatient EHR.
Dr. Wes Fisher, MD, FACC, a NorthShore cardiologist and Clinical Associate Professor of Medicine at the University of Chicago, explains in a blog post discussing the merger that Advocate wanted to allow their physicians to remain more independent by using multiple EHRs.  Providers who leave the Advocate Physician Partners group are allowed to take their patient data with them and set up shop elsewhere without having to worry about losing previous records.
But that admirable flexibility on the part of Advocate may prove a challenge when butting heads with a monolithic Epic partner.  “NorthShore was the metro Chicago’s first EPIC client and while its 4 hospitals are a relative minority compared to Advocate’s more geographically diverse 12-hospital system, its seamless outpatient and inpatient integration of EMR platform may threaten Cerner and Allscripts control of Advocate’s EMR solution,” Fisher writes. “While I suspect change may not come immediately, if a move to consolidate EMR systems occurs, both doctors and patients in one of the systems may see some dramatic changes going forward as a result.”
In the meantime, if the partnership is approved, all four clinical systems must find a way to work together to ensure that patient data flows appropriately across the 350 sites involved in the merger.  Cerner and Allscripts are founding members of the CommonWell Alliance, a pact between EHR vendors to improve interoperability and implement data standards, but standoffish Epic has denounced the effort as a “competitive weapon” and a “distraction” for the healthcare industry.
Will the four major competitors find a way to play nice in the new health system conglomerate, or will Epic’s unified database and proven effectiveness in the hospital setting eventually muscle its way into dominance?   Advocate’s CEO James Skogsbergh notes that the merger is an attempt at ramping up the scale of the health system to be more competitive in a fragmented market, and few EHR vendors are as accomplished at conquering large-scale projects as Epic Systems.  It will be interesting and edifying to see how the new Advocate NorthShore partnership addresses its technology challenges as it moves forward in an evolving healthcare landscape.

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Blog: Healthcare Apps and Wearables – A Gateway to Patient Engagement?

Blog: Healthcare Apps and Wearables – A Gateway to Patient Engagement? | EHR and Health IT Consulting |

Like most men my age, I could stand to lose a few pounds. It came as no surprise when my wife purchased a JawBone Up – a sophisticated pedometer and calorie tracker – for my birthday in March. I am a gadget nerd, but this device sat on my dresser for over a month before I opened it. Once I set up the device and downloaded the corresponding app, I entered the new world of data empowerment. As exciting as this may sound, the question that I keep coming back to is this: how will this data help me get healthier and shouldn’t my physician be counseling me on my self-imposed methods for self-improvement and more importantly, the results?

For hundreds of years, people have been monitoring their vital signs using stethoscopes and thermometers. It was not until the 1980s, when diabetic patients started to take digital glucose readings at home, that we saw the ability for physicians to gather solid data via patient tracking. However, the question still remains: how are we importing and maximizing use of this data?

Patient engagement is at the crux of a new paradigm within the shared-risk, Patient- Centered- Medical-Home, Meaningful-Use-Healthcare world. Further, in the self-directed Obamacare era, consumers are tasked with taking charge of their own wellness by managing their own data & health. Although EMR utilization has increased dramatically in the past decade, these silos of information largely do not tap into the devices that patients have been using for decades. With the limitations of interoperability between these silos of EMR systems, very little data is streaming from one database to the next. Patient engagement becomes limited to an individual patient portal that in most cases is clunky, hard to use, and does not give a complete picture of patient health.

A non-scientific study of 20 to early 40 year olds within my peer group showed that not one had a primary care physician they visited on an annual basis. The respondents noted that the Urgent Care setting was their only place for access to a primary care physician. This further highlights the disadvantages of patient health information being stored in multiple arenas and databases.

There is a light at the end of this gloomy tunnel. In the past couple of years, Healthcare IT Accelerators like Blueprint Health and Health 2.0 have assisted a new breed of startup. Beyond these accelerator companies, a new generation of healthcare startup is adopting a business to consumer model that can lead to business-to-business financial success. By combining premium services with convenience and social interconnection, these startups are beginning to see real market penetration.

In order for all of this to work, it must be possible for patients to be engaged passively, not actively. The information must flow without the patient having to facilitate it. Physicians must be part of the process of evaluating the engagement. With the world of wearables only in its infancy, interoperability of the network needs to define and drive how these independent silos will interact. When this networked transformation happens, the power of the system will far exceed that of the isolated patient or physician operating independently. Over time, this data will be combined with a complete health record to provide truly personalized medical updates and a comprehensive view of your health and habits, thus filling in all the gaps between medical checkups and doctor visits.

At the end of the day, when you strip away all of the technology, you are left with a patient looking to stay healthy and a physician looking to keep patients healthy. In this new exceedingly connected world, the importance of a highly-trained and technologically-adept primary care physician quarterbacking the care and interpreting data (including information from personal devices) will become more important than any time in history.

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Why final rule comes as last straw | Healthcare IT News

Why final rule comes as last straw | Healthcare IT News | EHR and Health IT Consulting |

CMS and ONC disappointed many CIOs and IT teams around the country on Aug. 29 when it issued a final rule for Stage 2 meaningful use that lacked the flexibility on reporting that so many had counted on – and perhaps expected, because what they had proposed seemed like a reasonable compromise to them.

CHIME, which represents 1,400 CIOs, fired off a statement the same day.

Russell Branzell“CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015,” Russell Branzell wrote in his response to the rule. “This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.”

[See also: MU Stage 2 offers 2014 flexibility.]

CHIME and other industry organizations had proposed reporting on Stage 2 requirements for any three-month quarter. In their view, it was a practical approach, one that made it more likely they would succeed and one that showed their continued support for the Meaningful Use Program.

Branzell further notes that nearly every stakeholder group echoed CHIME's recommendations to give providers the option of reporting any three-month quarter EHR reporting period in 2015. The recommendations he argued would "help hundreds of thousands of providers meet Stage 2 requirements in an effective and safe manner. Further, it would serve as positive incentive for those who must seek alternative paths to MU in 2014 to continue their work in 2015. Such a change would also have benefits for cross program alignment in areas of clinical quality measurement.

"This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off the cliff," he added in his statement;  "and it would have ensured the long-term vitality of the program itself. Now, the very future of Meaningful Use is in question."

As of August 25, 143 eligible hospitals and 3,152 eligible providers had attested to Stage 2. So far, the program had paid nearly $25 million in incentives.

[See also: MU Stage 2 offers 2014 flexibility.]

Marc Probst"The numbers are very low for particularly Stage 2 attestation. I mean, they’re like, what 4 percent of what should be, you know, currently going for Stage 2," Marc Probst, CIO of Intermountain Healthcare, and a member of the Health IT Policy Committee, remarked at a meeting of the federal advisory panel on September 3.

Probst was responding to CMS' Elizabeth Myers, who pointed out there was indeed flexibility in the final rule, but added there had been a lot of misunderstanding concerning reporting periods.

"I’m just wondering if we have a goal," Probst said. "I mean is it 10 percent by making these changes we should now get, 10 percent? 50 percent? I mean, there’s no way we’re going to get 50 percent, but, you know, I’m kind of going to why this set of rules, this very complex set of rules when there were some pretty obvious ones that we decided – ONC and CMS decided – not to pursue that could have had a much bigger impact."

It's a good question.

Part of the problem is that U.S. healthcare organizations everywhere have been barraged with a slew of government requirements, most of them complex and with a dizzying number of timelines. It's as if they are being told, "Do this; do that, and when you're done, make sure you dot the "i's and cross the "t's," and don't forget this other project, and the next one after that." If you don't get it all done right, there will be penalties to pay.

As if to prove our point, the day this issue was set to go to press, ONC issued yet another “final rule,” dropping its controversial 2015 edition certification criteria and instead opting for a more flexible version of the 2014 edition. The new rule is meant to “respond to stakeholder feedback,” wrote National Coordinator Karen DeSalvo, MD – but many CIOs might be forgiven for not being exactly thrilled about another 187-page document to digest.

The constant rulemaking – and revising – starts to get daunting and dizzying, even for the most detail-oriented.

Barring a change of rule, which does not seem likely – it is, after all, called a "final" rule – providers, hospitals and IT staffs are stuck with the mandate. And as trite as it may sound, the only choice is doing the best they can do, which calls for planning, maybe hiring more help and dotting one "i" and crossing one "t" at a time, or else absorbing penalties.

As for the government directives, couldn't the government at least align mandates so that deadlines do not compete with one another? Create rules that intelligent, savvy people, like Probst and his CIO colleagues can readily understand?

Sure, it's complicated. But, perhaps CMS and ONC could consider adding a large dose of simplification.

The Meaningful Use Program has garnered broad support as a way to truly transform our ailing healthcare system. It would be a shame to lose all that steam at Stage 2.

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DeSalvo praises Vermont for HIE infrastructure efforts |

National Coordinator for Health IT Dr. Karen DeSalvo applauded Vermont’s efforts to continue building a health information exchange (HIE) infrastructure that includes broadband access in rural areas of the state while speaking at the annual Vermont Information Technology Leadership (WITL) summit this week.  With very high EHR adoption rates among hospitals and physician providers and a long-term effort to bring HIE capabilities to the state’s healthcare organizations, DeSalvo held up Vermont as an example to the nation during her keynote address.
“People are willing to share their data if it will improve their care and will help others, as long as it doesn’t lead to discrimination against them,” said DeSalvo while discussing the state’s 90% patient consent rate to be involved in the VITL Access health information portal, which began rolling out to providers in August.   Ninety-three percent of the state’s hospitals and 64 percent of primary care organizations have adopted the HIE technology, the Burlington Free Press reports.
VITL also provides Direct messaging services and is working to bring admission, discharge, and transfer (ADT) notifications to providers later in the year. “This fall is really going to see nine years of work come to fruition, and the hopes and dreams of a statewide information system actually being available,” said Paul Harrington, executive director of the Vermont Medical Society.
At the end of 2013, VITL completed a successful pilot with Fletcher Allen Health Care that tested the exchange of radiology reports. “Hospitals generate volumes of clinical data that can be critically relevant for treating patients in order to enhance care, so it is invaluable for providers to have immediate access to patient health information, especially at the point of care,” said John K. Evans, CEO of VITL at the time. “What we learned through the pilot is that the development time of these interfaces can be dramatically improved by expediting decisions related to specifications and testing.”
Vermont has been at the forefront of EHR adoption and has achieved nearly universal implementation rates, with all 14 of the state’s hospitals and 97% of primary care practices now live on an EHR.  VITL also functions as the state’s regional extension center (REC) and has helped numerous providers to implement technology and achieve meaningful use.

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ONC opts against proposed voluntary 2015 EHR certification |

In light of public comments, the Office of the National Coordinator for Health Information Technology (ONC) has given up on its proposal for “Voluntary 2015 Edition” EHR certification criteria.
Instead, the federal agency revealed plans incorporate components of a revised 2014 Edition EHR certification criteria to be known as either “2014 Edition Release 2″ or “2014 Edition Release 2 EHR certification criteria” as part of a recent final rule published in the Federal Register.
“This final rule reflects ONC’s commitment to continually improve the certification program and respond to stakeholder feedback. It provides more choices for health IT developers and their customers, including new interoperable ways to securely exchange health information,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said yesterday. “It also serves as a model for ONC to update its rules as technology and standards evolve to support innovation.”
The decision is motivated by the belief that a more direct naming convention will provide greater consistency and predictability across governmental programs. “Stakeholders that seek to leverage the ONC HIT Certification Program would then be able to choose which edition of certification criteria (or subset of criteria within an edition) is most relevant and appropriate for their program needs,” states the final rule.
Along with the Centers for Medicare & Medicaid Services (CMS), ONC will be hosting a webinar to discuss recent changes to meaningful use in 2014 — one for reporting flexibility for eligible providers depending on their version of certified EHR technology (CEHRT) and this most recent one changing voluntary EHR certification criteria.
The final rule for 2014 Edition Release 2 certification criteria comprises ten optional and two revised certification criteria which are included with the 2014 Edition. Additionally, the rule brings an end to one major concept — the Complete EHR.
“We have finalized our proposal to discontinue the Complete EHR definition and Complete EHR certification,” the authors of the final rule write. “To be clear, the discontinuation of the Complete EHR definition and Complete EHR certification will have no impact on current 2014 Edition Complete EHR certifications or in using a 2014 Edition Complete EHR to meet the current CEHRT definition.”
The elimination of the Complete EHR definition addresses concerns from commenters about being able to verify to which certification criteria an EHR technology was certified and avoid ambiguity that does not occur for EHR modules that must specify such details.
“Last, while we do not believe the use of the terms ‘Complete’ or ‘Comprehensive’ are appropriate for ‘labeling’ EHR technology going forward, we will consider for our next rulemaking whether any other ‘labeling’ for certified technologies could continue to make the scope of certification clearer,” the ONC concludes.
Based on the decisions of the ONC and CMS, the two agencies are listening to stakeholders. But the question remains: Are their decisions only adding to the confusion?

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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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Survey: 81% of physicians feel over-extended by patient load |

EHRs, meaningful use, and ICD-10 aren’t the only things stressing out physicians who are increasingly struggling to make ends meet while rising to the challenges of federal initiatives and changing patient demographics.  A survey of 20,000 providers conducted by The Physicians Foundation reveals that more than eight in ten physicians feels like they are over-extended or operating at full capacity when it comes to the number of patients they must see each day in order to keep revenue flowing.  More than forty percent are even considering taking drastic steps to decrease their workload, including turning patients away, reducing their hours, or even fleeing clinical work all together.
Physicians responding to the survey work an average of 53 hours a week and see 20 patients per day, but spend 20% of their time on non-clinical paperwork.  The vast majority, eight-five percent, have implemented EHR technology, but few physicians are satisfied with the outcome.  Only 24% think EHRs have improved their efficiency, while just 32% believe the technology has had a positive impact on patient care.  Forty-seven percent added that EHRs detract from positive interactions with patients, which has been highlighted in other studies as one of the key reasons physicians keep doing their jobs.
As the stressors continue to pile up, so do reasons to opt out of the practice of medicine.  Thirty-nine percent of providers plan to accelerate their retirement due to unsatisfactory changes in the healthcare system.  Half of physicians believe that ICD-10 will cause a severe disruption to their practice, and even more admit to having somewhat to very low levels of morale.  Older physicians and those who own their own practices were more likely to express sour attitudes towards the impact of healthcare reforms, while the growing number of employed physicians were slightly more sanguine about the future.
“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. “As such, the growing diversity of the physician workforce will reflect different perspectives and sentiments surrounding the state of medicine. 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.”
But physicians are becoming much choosier about the patients they take on board.  Despite 25% of providers believing the ACA is a positive development, thirty-eight percent of physicians refuse to see Medicaid patients or limit the number of Medicaid beneficiaries they take on board.  A quarter of providers feel the same way about Medicare patients.  Twenty-six percent of providers participate in an accountable care organization (ACO), yet just 13% believe that the pay-for-performance reimbursement structure will have a positive effect on quality and costs.
“These trends carry significant implications for patient access to care,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “With more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the US healthcare system to properly care for millions of new patients.”

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Advocates call for immediate 2015 meaningful use changes |

Dissatisfied with a provision in a recently finalized rule impacting meaningful use, a group of provider associations led by the College of Healthcare Information Management Executives (CHIME) is calling on the Department of Health & Human Services (HHS) to take immediate action to ensure that eligible professionals and hospitals have reporting flexibility in 2015 as well as 2014.
“Unfortunately, the final rule, published in the September 4 Federal Register, maintained a provision requiring providers perform a full-year EHR reporting period in 2015,” the letter to HHS Secretary Sylvia Mathews Burwell states. “Our organizations remain incredibly concerned that a full-year reporting period will diminish the benefits of the rule HHS proposed in May and complicate the forward trajectory of Meaningful Use.”
Instead of offering the flexibility promised by government officials, these organizations contend that the proposed and final rules fail to do so by focusing exclusively on 2014 alone despite assurances to the contrary.
“The proposed rule meant to address our concerns, published in May, received widespread support from our organizations; we understood this to be an honest acknowledgement of our concerns and we knew that regulators had to act quickly to have a positive impact on the program in 2014,” note the authors of the letter. “However, we were surprised to learn that flexibilities meant to mitigate 2014 challenges did not also address program misalignment in 2015 and beyond.”
In place of a full year of reporting, the group is requesting a 90-day EHR reporting period in 2015 based on feedback from their constituents, many of which are hospitals whose reporting period coincide with the federal fiscal year beginning October 1:
For roughly 3,800 hospitals, the final rule requires implementation of 2014 Edition CEHRT configured for Stage 2 measures and objectives by October 1, 2014. More than 237,000 eligible professionals (EPs) will need to be similarly positioned by January 1, 2015. This is in addition to the 1,200 hospitals and 290,000 EPs who also must have 2014 Edition CEHRT implemented before the beginning of their reporting year at Stage 1.
To date, only 143 hospitals and 3,152 EPs have demonstrated an ability to meet Stage 2 requirements using 2014 Edition CEHRT. 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.
For CHIME and others, the EHR Incentive Programs are in jeopardy of halting the momentum already built by a successful Stage 1 Meaningful Use and preventing many providers from coming close to realizing the aspirations of Stage 3 Meaningful Use.
Little time remains for HHS to make the changes recommended in the letter as the new fiscal year commences in just two weeks.
“With just two weeks to go before the start of Fiscal Year 2015, immediate attention to this requirement is essential,” CHIME President and CEO Russell P. Branzell, FCHIME, CHCIO, said in a public statement. “There are thousands of hospitals right now desperately trying to determine how to appropriately install and configure software for Stage 2, and how to start collecting data by the end of this month.”

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The Important Triad Of Needs For EMR Systems

If you do business in the Healthcare industry (unless you've been absent for a few years), you undoubtedly know about the Federal Government's scheme to pay for EMR systems across the United States. It's all part of the stimulus package, of course, which means a lot of free government money will be handed out this year and next. This has resulted in a huge change in the EMR software industry, as these systems make their way into medical practices still using paper medical records.

Selecting from the wide variety of EMR software products available today on the market is no simple job. With Federal subsidies flowing fast to support the industry, every software programmer with a cell phone wants a bit of the action. Cutting down the list of electronic medical records software shops to a manageable level is the first thing you should consider in order to make choosing the right EMR system vendor. Here are some considerations when planning your purchase of an EMR software system:

1. CCHIT Certification Means Quality - In response to the huge interest in the development of electronic medical records systems, the industry created a commission known as CCHIT (or the Certification Commission for Health Information Technology) in order to create standards for EMR software. Acquiring CCHIT-certification isn't cheap or simple, which is why it's as close to a guarantee that you're dealing with a superior product and company as the industry has. Avoid all non-CCHIT certified developers from the start, and your shortlist will be far more manageable.

2. Meaningful Use, And Its Great Importance - Of all factors, having a shop with high-quality knowledge of the Government's idea of meaningful use is important when searching for your EMR vendor. As part of the Government stimulus offer, doctors must demonstrate meaningful use of electronic medical records software, which isn't as simple as it looks. As with anything Government-built, there is an ocean of small print to work through to guarantee you can qualify for the immense Medicare subsidies. Ensure you ask your potential developers for their approach to meaningful use, and ask that they provide recent references of doctors whose meaningful use claim went through easily.

3. Keep It Simple - Outside of meaningful use and CCHIT-certification, no aspect is morecrucial for your practice than your EMR system's ease of use. Keeping it simple, in this case, will save you more time and expense than you ever thought possible. The savings are all there: an easy to use EMR product is embraced quicker by your staff, learned faster, and has less potential for confusing moments once the installation has taken place and the application is operating. This can cut the cost of training your staff with the software markedly, and can save your practice countless support call dollars in the long run. Put simply, people like easy to use systems, and embrace them faster. When you look at ease of use, you don't have to be an expert: just use your gut. Once you've developed your 4-5 EMR developer shortlist, obtain all of their product demos. Install them on your computer (if there's no Windows version, you may want to move on!), get the feel for them for about an hour each, and see how you feel. Make your shortlist shorter by cutting away the more complex products.

Purchasing an electronic medical record system is not an simple task, but with the stimulus funds soon to expire, it is a timely one. Make sure your developer knows its stuff, and selecting a best of breed from the broad selection of EMR systems should be easy.

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Does EHR design limit the critical thinking of physicians? |

This week will include a fair share of praise for health information technology and its benefits for supporting efficient and effective care, but it comes on the heels of some harsh criticism by one California pediatrician who is arguing that EHR technology hinders the critical thinking of physicians.
“As a physician, I do not want my thinking to be limited in any possible way by a template that I need to fill out in order to create a note,” writes Charles McCormick, MD, FAAP. “Every patient is different, and not a single one of us fits into the same box. We are, unfortunately, dumbing down medical care providers just like we dumbed down our teachers.”
In his harangue of EHR use, the Stockton-area physician identifies two deficiencies in the current technology preventing healthcare organizations and providers from realizing the promised benefits of adopting these systems and services — a lack of interoperability and template design.
“Different record systems currently do not communicate with one another, although records can be copied and sent to another physician,” McCormick contends. “Hospital systems are substantially different from systems used in private offices and the systems used in our local hospitals are often strikingly counterintuitive and Byzantine.”
For the pediatrician and Associate Medical Director for Health Plan of San Joaquin, the EHR presents constraints for physicians looking to engage actively with their patients during encounters.
In my practice, I have been using a federally approved EMR for the past year, and I find that a significant portion of my thinking is directed toward how to record a patient visit rather than what actually happened in the visit. Previously, I had used a record-keeping system in which I recorded information in my own handwriting, and I would note those things that were important to me so that I could reference them later as I cared for my patient.
Today, I have to figure out how to get the important information into a box somewhere in the medical record. This usually means about an extra hour every day to make my notes meaningful. Mixed in with the important information is a large quantity of trivial or insignificant information that obscures what is really crucial. There is nothing concise about the modern EMR!
The not-so-subtle dig at meaningful use and certified EHR technology (CEHRT) is full of complaints about the effects of a physician adjusting his thinking to suit the electronic record rather than applying his critical thinking to providing a patient with the treatment best suited to the latter’s condition.
Apparently, the problem with current EHR templates is a lack of space for physicians to document those bits of information that do not conform nicely with check boxes and drop-down fields.
“We spend more and more time struggling to use a technology that actually limits the creative process and less time facing our patient and thinking about their problems. Applying an old cliché, we need to resume thinking out-of-the-box,” McCormick concludes.
As National Health IT Week begins, the pediatrician’s criticism is a reminder that EHR technology is not perfect and that its shortcomings need to be addressed and resolved.

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How Does a Practice Deal with All These High Deductible Plans?

How Does a Practice Deal with All These High Deductible Plans? | EHR and Health IT Consulting |

One of the biggest trends we’re seeing in healthcare today is a shift towards high deductible plans. This shift first started as more and more employers stopped offering insurance or cut the type of health insurance they offered. This started the trend towards individuals purchasing high deductible insurance plans.

While the shift to high deductible insurance plans started well before the Affordable Care Act (ACA), the government mandated health insurance and associated health insurance exchanges (HIX) have thrown gas on the already flaming fire. What most patients didn’t realize when they signed up for insurance on the government’s HIX is that a large majority of the plans were high deductible insurance plans. This has led to a huge influx in high deductible plans entering medical offices.

What does this increase in high deductible plans mean?
This change is one of the most significant changes in healthcare reimbursement we’ve seen. High deductible plans mean a major shift in who will be paying the bill. Instead of collecting most of your money from insurance companies, your clinic will need to become expert at collecting money from patients as well. Yes, that’s right. You’re still going to have to collect from the insurance companies like before, but you’re going to have to build additional expertise around collecting payments from patients too.

While it’s true that clinics have been collecting payments from patients forever, that doesn’t mean that clinics have been doing a good job of actually collecting the money. In fact, I find practice after practice who hasn’t stayed on top of their patient collections. In the end, they often send their patient collections to a collections agency which frustrates the patients and tarnishes their name or they just write off the patient pay portion completely.

Suggestions to Improve Patient Collections
The first step to improving patient collections is to really understand the details of your patient’s insurance plan. This starts with doing an insurance eligibility check and verifying your patient’s plan details. We wrote about ways to streamline your insurance eligibility checks previously. Doing it right takes time, but with the right workflow automation solutions you can make sure that those working in your practice have the right insurance information. Once they have the right payment information, you’re much more likely to collect the payment from the patient while they’re standing in front of you at the office.

While collecting the patient payment from the patient while their in your office is ideal, there are dozens of reasons why this won’t happen. Some don’t have the money on them. Some walk out before you can collect. Etc etc etc. How then do you engage the patient in the payment process once they’ve left your office? In the past, the best solution was to send out bill after bill through the US postal service or possibly call the patient directly. This is an extremely time consuming and costly process that can take 60 to 90 days to obtain results.Plus, it costs several hours of man power and postage.

In the electronic world we live in, the first thing you can do to improve your patient collection process is to implement an online patient payment portal. This online payment process increases patient collections dramatically. The next generation patient is so unfamiliar with writing checks and sending snail mail, that those payments often get delayed. However, by offering the online patient payment option, you remove this barrier to payment.

The other way to improve patient collections is to use an automated messaging and collection process. This approach uses a collection of text, secure text, email, secure email and even smart phone notifications and automated calls in order to ensure the patient knows about their bill and has the opportunity to pay the bill. Plus, these customized decision rules provide a much more seamless and consistent approach to patient collections.

This movement to the empowered patient with a high deductible insurance plan is not likely to go away. Employers are happily getting out of the health insurance business and many want patients to have more responsibility over the healthcare they receive. Being sure that you have a well thought out patient collection workflow is going to be critical to the ongoing success of any medical practice

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68% of patients would be interested in telehealth consults |

More than two-thirds of patients would be willing to give a telehealth conference a try, according to a new study in Telemedicine and E-Health, although a number of patients who tried conducting a physician visit through videoconferencing were not satisfied enough with the experience to continue online consults.  While most patients had access to broadband internet and a home computer or smartphone device, just 14% of patients believe that a telehealth consults brings them more value than meeting face-to-face with their provider.
The team of researchers from the Mayo Clinic conducted a telephone survey with 263 patients with an average age of nearly 58 years.  Eighty-four percent of patients had access to a computer or smart device, and 75% had access to broadband internet.  Just 38% felt comfortable setting up a video call on their own, but 57% believe their home technology is capable of doing so.  Perhaps unsurprisingly, the study found that patients who reported a higher level of comfort with video call technology were also more likely to accept a telehealth invitation from their providers.
Thirty-eight percent of the participants responded that they were “very likely” to engage in an online visit with their providers, while a further 28% were “somewhat likely.”  The remaining 38% indicated that they were “not at all likely” to engage.  Patients who had not participated in a video call before were much more skeptical about its benefits than those who had tried the novel method, with 86% preferring a face-to-face encounter and just 34% believing that a telehealth consult could provide the same level of care as an office visit.  However, 64% of patients who had experienced a video consult still preferred to speak to a provider in person about their health issues, indicating a questionable level of satisfaction from online meetings.
“The gap between high willingness to engage with a provider over video and the relatively little experience with the medium suggests that patients see video appointments as a feasible and desirable way to interact with their providers,” the study says. “They may be dependent, however, upon their provider to offer the service; they may not voluntarily ask for it because of a lack in fluency with related use cases.”
The researchers found three major drivers that led to higher levels of acceptance for telehealth use, including the patient’s comfort level with video technology, their age, and the distance they would have to travel to meet with a physician.  Patients who were most likely to accept a telehealth consult also reported high levels of technical ability, while those who lived a longer driving distance from their provider were more likely to try an online visit instead of making the trip.
“Those with a willingness to accept a video appointment had a mean age of 55.4 years, and the mean age was 64.1 years for those not at all likely to accept,” the team adds.  “Age also had a larger effect among those who were comfortable: increasing age was actually associated with a higher likelihood to accept an invite.”
“It is evident that patient demand for video appointments from their homes is nascent, but that there is, nevertheless, a core of patients whose interest could be leveraged to help nurture mainstream usage,” the study concludes.  “Interest in the service, once offered, is highly dependent on the patient’s willingness and confidence to co-create the experience by obtaining and setting up the components required for a video appointment on his or her end.  If the obstacles to creating and offering a reliable video appointment service can be overcome, for patients who have the interest, aptitude, and confidence, there exists an opportunity to co-create the broader experience and availability of video appointments.”

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Are Limited Networks Necessary to Reduce Health Care Costs?

Are Limited Networks Necessary to Reduce Health Care Costs? | EHR and Health IT Consulting |

Among the dirty words most hated by health care consumers–such as “capitation” and “insufficient medical necessity”–a special anxiety infuses the term “out-of-network.” Everybody harbors the fear that the world-famous specialist who can provide a miracle cure for a rare disease he or she may unexpectedly suffer from will be unavailable due to insurance limitations. So it’s worth asking whether limited networks save money, and whether they improve or degrade health care.

As I understand it, four reasons are seen for limiting the doctors covered by an insurance plan.

Increased utilization of approved facilities

This is a pure business concern, not a quality concern. If you can channel patients back into a few hospitals and clinics, you can keep your beds filled and save the money wasted when bored staff sit around posting travel photos to Instagram.

Excluding expensive facilities

Another business concern. Studies have shown no correlation between the prices charged by health care providers–including world-famous facilities and prestigious academic settings–and the quality of outcomes. So just by artificially lopping off the institutions that charge a lot, insurers can save money while still serving their recipients well.

Better coordination of care

Now we move beyond the bean-counters and enter into real issues of quality. Supposedly, institutions that know each other through frequent referrals can work more closely together, making sure that post-discharge plans are followed and patients are kept on track for improvement. There is no guarantee that such coordination will happen, but it’s a goal of health reform and underlies the Accountable Care Organization (ACO) model.

More intensive use of primary care providers

Ideally, every professional in health care would develop a holistic understanding of the patient and think long-term. In practice, the PCP is most likely to do so. (With the intensified use they’ve seen over the past several years, and consequent shortening of time spent with each patient, this valuable perspective may be less common.) If a limited network can encourage the patient to rely more on his PCP, it may keep him healthier.

I was stimulated to write this article by a recent paper by the National Bureau of Economic Research (NBER) examining the costs of health care in my state, Massachusetts. The statistical models used in this article are hard for non-specialists like me to get their heads around, but the study looks well-grounded (as one would expect from the NBER, one of the country’s leading research institutions) and the conclusions are reassuring.

People who choose limited networks pay much less, mostly because the premiums for such networks rise much more slowly than for broad networks (p. 12). The Commonwealth of Massachusetts also benefited from cost savings. Although the data provide very little on which to judge the quality of outcomes, the few statistics available on such measures as inpatient spending and emergency room visits (p. 25) indicate that quality of care for limited networks is at least as good as for broad ones.

As one might expect, the narrow plans deliberately excluded expensive health care providers (pp. 5-6).

The one variable I’m not sure the authors could control for is the possibility that healthier people were more likely to choose limited plans (p. 27), and that costs might naturally be lower for such individuals. I will have to trust that the authors took this possibility into account.

The challenge I’d like to toss into the ring is this: couldn’t a rational health care system achieve all the benefits of limited plans while allowing patients to see anyone they want? Let’s consider again the four benefits I mentioned earlier:

Increased utilization of approved facilities

A rational health care system would pay for outcome instead of utilization, encouraging hospitals and clinics to put their spending where it was needed and hold back from expensive purchases that require excess use to pay off.

Excluding expensive facilities

A rational system would collect and publicize quality measures, and place some of the financial burden on patients to encourage them to do some price-shopping. Both of these innovations are starting to be seen. Idealists among us can even hope for a standard set of fees to replace the current chaotic negotiations between provider and payers.

Better coordination of care

If patient data was stored in a standardized format–preferably by the patient herself–all providers would have access, and a fee-for-value reimbursement model would encourage them to work together for better outcomes.

More intensive use of primary care providers

A holistic approach to health–which would reach outside the individual doctor’s office to the whole community in which the patient lives–would make the PCP the natural starting point for all health issues and give PCPs the tools to maintain patient health year-round.

So even though I acknowledge the value of ACOs and other forms of limited networks so long as our current health care system is limping along, the need for that kind of trade-off could end if we lift our eyes a little higher, look farther toward the future, and make strides toward better goals.

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