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The Social Business of Fighting Disease

The Social Business of Fighting Disease | EHR and Health IT Consulting | Scoop.it

Whilst social media tools have primarily been used for commercial ends, there is a growing stream of evidence showing that it has scientific and social benefits as well. Nowhere is this more so than in the tracking and prevention of diseases.

 

For instance Google Flu Trends tracks search queries and applies its trending algorithm to gain an understanding of where flu outbreaks are occuring. A 21 month study by John Hopkins University found that the app was exceptionally good at predicting when hospitals would start to see people coming in with flu symptoms.

 

Primary investigator of the study, Dr. Richard Rothman, said that the results were promising for “eventually developing a standard regional or national early warning system for frontline health care workers.”

 

Social media context

 

It could be argued however that social media is a better method of tracking the spread of infection because it provides you with better context. Back in January the American Journal of Tropical Medicine and Hygiene reported that tweets and other public ‘status updates’ were a better way of determining the spread of cholera in post-earthquake Haiti than official channels. The research was conducted by scientists at Children’s Hospital Boston and Harvard Medical School and with over 6,000 people having died from the disease in Haiti, it has serious implications in terms of disaster prevention.

 

“When we analyzed news and Twitter feeds from the early days of the epidemic in 2010, we found they could be mined for valuable information on the cholera outbreak that was available up to two weeks ahead of surveillance reports issued by the government health ministry,” said Rumi Chunara, PhD, of the Informatics Program at Children’s Hospital Boston, Research Fellow at Harvard Medical School, and the lead author of the study. “The techniques we employed eventually could be used around the world as an affordable and efficient way to quickly detect the onset of an epidemic and then intervene with such things as vaccines and antibiotics.”


Via nrip
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Luca M. Sergio's curator insight, December 20, 2012 10:26 AM
so much potential from the social space to identify disease trends and act at an early stage ....
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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Mental health providers want patient tracking, all-in-one EHRs | EHRintelligence.com

Mental health providers want patient tracking, all-in-one EHRs | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
For the 33% of mental and behavioral health providers who are still entirely paper-based, integrated practice management and EHR software is at the top of the wish list, according to a new report from Software Advice.  Eighty-three percent of prospective buyers are seeking one comprehensive application to cover everything from patient scheduling to revenue cycle management to patient documentation, signaling a significant shift away from the piecemeal adoption of health IT that has led to so many interoperability problems within organizations and among business partners.
Primary care EHRs may tout their patient documentation features, which are important for episodic care that addresses single problems like a sinus infection or skin rash, but mental health providers must develop and track an ongoing care plan that may not have such clear-cut goals.  These care plans are complicated by the fact that up to 50% of patients don’t show up for scheduled appointments, making patient tracking and scheduling features critical to revenue cycle management and billing.
Eighty-three percent of providers surveyed in the report indicated that patient management features were of the utmost concern when choosing an EHR or PM suite, compared to just a quarter of other providers who said they plan to focus investment on patient scheduling applications in another recent poll.  Thirty-one percent specifically requested the ability to efficiently track patient assessments and treatment plans.  Other highly requested features include mobile integration, e-prescribing, appointment reminders, customizable templates, and eligibility inquiries.
Like other specialists who have lower rates of EHR adoption than primary care providers, relatively few mental health clinicians are fully electronic.  A third of providers are still entirely reliant on paper, while 20% are currently using a hybrid paper-EHR workflow.  Thirty-one percent are fully electronic, and 16% of providers who participated in the poll are starting a new practice.  Reducing the amount of paperwork is the top reason mental health providers are choosing to implement EHRs, while 21% also indicated that they plan to comply with regulations such as meaningful use.
Just as among their peers in primary care, cloud-based software is in very high demand.  Ninety-two percent would prefer web-based software over on premise systems, which is no surprise considering half of the sample size is made up of solo physicians who may not have the technical resources and knowledge to install and maintain their own servers.



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EHRs play role in medication reconciliation, but challenges remain

EHRs play role in medication reconciliation, but challenges remain | EHR and Health IT Consulting | Scoop.it

EHRs can help hospitals standardize medication reconciliation, but data quality, and technical and workflow issues continue to present challenges, according to a study by the National Institute for Health Care Reform.


For the study, researchers at the former Center for Studying Health System Change examined how 19 U.S. hospitals utilized EHR for medication reconciliation. More than one-third used a hybrid paper-electronic reconciliation process, often because the hospitals found early versions of the EHR vendor tools to be inadequate to get the job done.

However, hospitals that had implemented more advanced EHR-based medication reconciliation functionality integrated medication reconciliation with electronic admission and discharge ordering to improve legibility, reduce data re-entry and support more patient-friendly discharge instructions, according to the study.


But a number of challenges remain before EHR-based medication reconciliation can offer safety and efficiency benefits. These include:

  • Access to reliable medication histories
  • Refining EHR usability
  • Engaging physicians more fully and routinely sharing patient information with the next providers of care
  • Enhancing ways for stakeholders to share the best EHR designs and implementation strategies

The transition to EHR-based medication reconciliation is still a work in process, with hospital implementation and use of EHR modules evolving along with EHR vendors’ product development,” wrote the authors. “The inclusion of medication reconciliation as a Stage 2 Meaningful Use requirement is likely to push more EHR vendors to incorporate medication reconciliation tools into their products and more hospitals to use them.” 

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Is the End of the Standalone EHR and PM Near?

Is the End of the Standalone EHR and PM Near? | EHR and Health IT Consulting | Scoop.it

News this week came out that simplifMD and Azalea Health were merging companies. It’s an interesting merger since Azalea Health has been strong on the PM side of things and an EHR that’s not yet MU 2 certified, while simplifyMD has been more focused on the EHR side of things. As one company they can put together their PM and EHR into one standalone system.

As Shahid Shah recently pointed out on his Healthcare IT Guy interview with Melissa McCormack from Software Advice, buyers are decidely more interested in an integrated PM and EHR. Here’s one of the questions and answers:

1. As EHR meaningful use requirements grow more involved, standalone billing or scheduling systems are becoming less viable. In fact, nearly 70 percent of the buyers we spoke with wanted integration between practice management and EHR. The trend of PM buyers looking for robust EHR integration grows more pronounced each year, and shows no signs of tapering off since EHR meaningful use requirements increasingly require physicians to utilize charting, billing and scheduling in tandem. Vendors who can offer seamless integration between these applications will have a clear advantage over those who cannot.

I find this question interesting, because the trend towards an integrated EHR and PM started when I first started blogging about EHR software about 9 years ago. Now there are only a few standalone EHR companies left. There are more standalone PM vendors left, but most of them see the writing on the wall and know that they won’t survive as just a PM. In fact, some of those PM companies have stopped developing their PM and are just at a stand still waiting for their last customers to leave. It’s been amazing to see how long some of these extremely small PM vendors have survived.

With that said, is the end of the separate EHR and PM near? I’d love to hear your thoughts.



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ACOs Report Need for Better Value-Based Financial Software

ACOs Report Need for Better Value-Based Financial Software | EHR and Health IT Consulting | Scoop.it
Value-based financial software remains a priority for operational accountable care organizations (ACOs), according to a recent survey.
 
For the survey, conducted by the New York City-based Black Book Research, researchers asked more than 600 ACO leaders on how they're dealing with infrastructure. Ninety-seven percent confirm that financial software is a priority and 93 percent are struggling to determine how much risk they have assumed without this infrastructure in place. 
 
Furthermore, 78 percent of CFOs at hospitals and healthcare organizations running ACOs say they are caught between two worlds. There is revenue management services and the inflow of cash to sustain present fee-for-service reimbursement and selecting ACO strategic software to assemble the groundwork to succeed with imminent risk-bearing payment models.
 
“Large ACO’s have the capital and provider base to strategically select vendors who can deliver end-to-end financial services and software now, ahead of tackling population health, clinical integration and business intelligence tools into the technology amalgam,” Doug Brown, President of Black Book, said in a statement. 
 
For the survey, Black Book surveyed an array of Medicare ACOs as well as private organizations. They say electronic health record (EHR) vendors are not currently meeting the financial and risk management needs of most (91 percent) ACOs. Ninety-two percent of respondents said their EHR system did not offer the functionality for ACO start up. 
 
The ramp up might not be happening as soon as the ACO leaders would like. Sixty-seven percent say they don't have the financial capital to invest in better financial operations and technology to become competitive in value-based care in 2015. Up to 90 percent say that without better financial software they may have to opt out of risk-based contracts.
 
The survey results paint a grim reality for ACOs. All but five percent of respondents say that claims data, unstructured governance models, physician recruitment and EHR replacements are stopping motions towards taking on higher-risk contracts.



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AHRQ Grant Will Allow for Readmissions Pilot

AHRQ Grant Will Allow for Readmissions Pilot | EHR and Health IT Consulting | Scoop.it

The Agency for Healthcare Research and Quality (AHRQ) has awarded the University at Buffalo School of Nursing a grant to create a pilot project whose goal is to work with primary care physician’s offices, their patients and families to see that patients get follow-up care very soon after leaving the hospital.

According to Sharon Hewner, Ph.D., R.N., assistant professor of nursing and author of the grant, there has been a lack of timely communication between the hospital and community setting. “Our project will use the electronic health record (EHR) to exchange health information across settings in real time and provide decision support to nurse care coordinators in primary care offices to proactively prevent re-hospitalization,” Hewner said in a news release.

As part of the study, Hewner said they will use a care transitions dashboard to incorporate an alert message about a hospital discharge from the regional health information organization, HEALTHeLINK, with information from the electronic health record at Elmwood Health Center in Buffalo.

The dashboard will aim to help guide the nurse care coordinator in developing an individualized plan of care specifically to prevent re-hospitalization through its structured assessment of social factors such as health literacy, home environment, and financial resource issues that may increase the complexity of care after leaving the hospital.

According to Hewner, most post-discharge intervention studies focus on a single disease, such as heart failure, and not a variety of chronic health problems or patients with a number of interdependent health issues. This study will try to improve the identification of patients who are at-risk for being readmitted by using the COMPLEXedex, a hierarchical algorithm which divides the population into healthy, at-risk, chronic and complex cohorts based on nine prevalent chronic conditions, she said.

Health outcomes such as readmissions and emergency department visits in the 90 days after discharge will be compared with another primary care practice using data from the New York State Medicaid Data Warehouse.

Hewner said the study design is significant because it promotes a low-cost, targeted intervention—a health are coordinator using telephone outreach to patients guided by an organized assessment—to ensure that the care is more patient-centered and takes into account that this may be a time when the patient is vulnerable and therefore likely to misinterpret instructions and be too preoccupied, or ill, to arrange follow-up with a primary care health provider on their own.

The grant is valued at $298,934 over a two-year period. The intended outcome of the study would be to develop an automated system, the care transitions dashboard, to notify the primary care practice of real-time discharge and for post-discharge follow-up to happen ideally with 72 hours of discharge, Hewner said.

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Lack of EHR interoperability is 'fraud' against taxpayers

Lack of EHR interoperability is 'fraud' against taxpayers | EHR and Health IT Consulting | Scoop.it

Electronic health record vendors--particularly Epic--may not deserve Meaningful Use incentive money because their systems hinder data sharing, according to physician-turned-lawmaker Rep. Phil Gingrey (R-Ga.).  

In a July 17 hearing of the House Energy and Commerce Committee's subcommittee on Communications and Technology and Health, Gingrey (pictured) questioned whether the nation is currently on a path of interoperability or whether changes to the law need to be made. He expressed concern that according to a recent RAND report, more than half of the $24 billion spent by the Meaningful Use program has gone to Epic, a vendor operating a "closed platform."

Pointing out that the committee has jurisdiction over the Office of the National Coordinator for Health IT and the HITECH Act--which created the Meaningful Use program--Gingrey said that if the RAND report is true, "we have been subsidizing systems that block information instead of allowing for information transfers, which was never the intent of the [HITECH] statute.



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Rhode Island Women & Infants Hospital to Pay Patients $150K for Data Breach

Rhode Island Women & Infants Hospital to Pay Patients $150K for Data Breach | EHR and Health IT Consulting | Scoop.it

Women & Infants Hospital of Rhode Island will pay $150,000 to settle data breach allegations that affected more than 12,000 Massachusetts patients.

Attorney General Martha Coakley announced that the breach was reported to her office in November 2012, and included patients’ names, dates of birth, Social Security numbers, dates of exams, physicians’ names, and ultrasound images.

The consent judgment was approved July 22 in a Suffolk Superior Court.



According to Coakley:

“This data breach put thousands of Massachusetts consumers at risk, and it is the hospital’s responsibility to ensure that this type of event does not happen again.”

WIH first realized in 2012 it was missing 19 unencrypted back-up tapes from two of its Prenatal Diagnostic Centers, one located in Providence and the other in New Bedford. The tapes had personal information of 12,127 Mass. residents.

Due to “deficient employee training and internal policies,” Coakley said the breach was not reported to the AG’s office nor consumers until fall of 2012.

According to the settlement, WIH will pay a $110,000 civil penalty, $25,000 for attorney’s fees and costs, and a payment of $15,000 to a fund to be used by the Attorney General’s Office to promote education concerning the protection of personal information and protected health information and a fund for future data security litigation.



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Electronic health records don’t increase Medicare fraud, study finds

Electronic health records don’t increase Medicare fraud, study finds | EHR and Health IT Consulting | Scoop.it

ANN ARBOR—Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher health care spending are unfounded, according to a study from the University of Michigan Schools of Information and Public Health and the Harvard School of Public Health.

Following the passage of the HITECH Act in 2009, more than 5,000 hospitals became eligible for financial incentives to adopt and engage in "meaningful use" of electronic health records. Early results show that more than half of all eligible hospitals have qualified for incentives. The Act was motivated by the expectation that electronic health record use would improve the quality of care and reduce costs by avoiding inefficiencies, inappropriate care and medical errors.

However, some experts have suggested that the increased documentation abilities of electronic health records could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up health care costs by documenting and billing for care that did not occur.

The study, by Julia Adler-Milstein, U-M assistant professor of information, and Ashish K. Jha, Harvard professor of public health, is published online in the July issue of Health Affairs.

"There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn't," said Adler-Milstein, who is also an assistant professor of health management and policy in the U-M School of Public Health.

To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted electronic health records had greater subsequent increases in the severity of patents' conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.

Despite widespread stories and concerns among policymakers about the potential for electronic health records to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.

With no empirical evidence to suggest that hospitals are systemically using electronic health records to increase reimbursement, the study's findings should reduce concerns that EHR adoption by itself will increase the cost of hospital care.

The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce health care spending and improve the quality of care.

The paper is titled, "No Evidence That Hospitals Are Using New Electronic Health Records to Increase Medicare Reimbursements." Health Affairs is a peer-reviewed journal focusing on health policy thought and research. The study will be published in an upcoming print edition of the monthly journal.



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eClinicalWorks CEO Girish Navani Talks the EHR’s Role in Population Health Management

eClinicalWorks CEO Girish Navani Talks the EHR’s Role in Population Health Management | EHR and Health IT Consulting | Scoop.it

eClinicalWorks’ CEO Girish Navani discusses the success his company has had with EHR development, the role EHRs play in population health management, and how the latest data-based technologies are opening up new possibilities for providers.

You don’t have to look far to find fault with EHR products these days. In fact, conduct a quick news search online and you’ll find that most of it isn’t too good. The sophisticated possibilities of EHR integration have given way to complex problems for providers, leaving many asking, where did EHRs go wrong?

For that answer, we turned to a company with a thought leader who seems to be getting it right. “Our success has been two fold,” said Girish Navani, the co-founder and CEO of eClinicalWorks, a provider of ambulatory HIT solutions, including EHRs and practice management solutions. “We have built an EHR that is more intuitive, but the fact that our EHR does more than the standard EHR out there is what has helped us really go further.”

It’s that very act of attempting to go further that seems to be snagging many providers’ plans as the move from the lighter criteria of Stage 1 of meaningful use (MU) and onto the more stringent criteria of MU, Stage 2, which includes patient engagement and sharing EHR data as its cornerstones. Organizations looking to satisfy the accountable care models, which rely on population health management (PHM) practices, are hitting the similar snares of interoperability and lack of engagement features with their EHR/EMR products.

As a result, many providers are looking to swap or supplement their technology to gain access to more sophisticated tools. While this has sent some technology vendors scrambling, eClinicalWorks is busy building upon its successful foundation; it’s one of the top two EHR developers in the market serving more than 85,000 providers in all 50 U.S states. The company has moved swiftly from EHR development to offering a variety of products, including its eClinicalWorks CCMR, the most used population health solution across all function ACO categories, according to KLA



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EHR Replacement Roadmap to Success | EMR and HIPAA

EHR Replacement Roadmap to Success | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

We’re just now starting down the road of the EHR replacement cycle. Meaningful use has driven many to adopt an EHR too quickly and now the buyer’s remorse is setting in and we’re going to see a wave of EHR replacements. Some organizations are going to wait until meaningful use runs it course, but many won’t even be able to wait.

With this prediction in mind, I was interested by this Allscripts whitepaper: Key Hidden Reasons Your EHR Is Not Sustainable and What To Do About It. I always learn a lot about a company when I read whitepapers like this one. It says a lot about the way the company thinks and where they’re taking their company.

For example, in the whitepaper, Allscripts provides a list of questions to consider when looking to replace your EHR:

  • How do you DEPLOY the right core IT systems to succeed with value-based care?
  • How do you CONNECT to coordinate care with key stakeholders and manage your population?
  • How do you better ENGAGE patients in their own health?
  • How do you analyze mountains of raw data to ADVANCE patient and financial outcomes?
  • How do you get everyone within your own organization to FOLLOW THE ROADMAP to EHR success?

You can see that these questions share a certain view of where healthcare IT and EHR is headed. Imagine how this criteria would compare with the criteria for EHR selection even five years ago. Although, I wonder how many doctors really share this type of approach to EHR selection. Do doctors really want their EHR to handle the above list? Should they be worrying about the above items?

I don’t doubt that doctors are going to be more involved in population health and they’re going to need to engage patients more. However, this list does seem to lack some of the practical realities that doctors still need from their EHR. In fact, as I write this, I wonder if it’s still too early to know what a next generation EHR will need to include. Of course, that won’t stop frustrated EHR users from replacing their EHR just the same.



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There's more to eRx than you think | Healthcare IT News

There's more to eRx than you think | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

In followup to my guest post from Dr. Marvin Harper about e-prescribing gaps, John Klimek, senior VP of standards and information technology at NCPDP, wrote the following helpful guest post:   The National Council for Prescription Drug Programs leaders and members read with interest the guest post from Marvin Harper, CMIO at Boston Children's Hospital, entitled "Limitations of e-Prescribing Standards." Harper's thoughtful post brings a critical issue to light: the need for increased industry awareness and adoption of the full functionality that already exists in e-prescribing standards – going beyond the core requirements of meaningful use. Electronic prescribing is important in improving both the quality of patient care and patient safety. It provides a key point of communication between care providers and can help improve patient compliance with treatment regimens.   [See also: E-prescribing makes huge gains.]   E-prescribing standards: what's covered Three standards are used in e-prescribing: the NCPDP SCRIPT Standard and the NCPDP Formulary and Benefit Standard, and the ASC X12 Standards for Electronic Data Interchange Technical Report 3 – Health Care Eligibility Benefit Inquiry and Response – 270/271. The eligibility transaction is typically exchanged prior to the patient encounter and can supply the prescriber system with information about the patient's pharmacy benefit, including the payer, member ID, formulary and coverage pointers, and other details. The formulary and benefit standard provides a means for pharmacy benefit payers to communicate formulary and benefit information to prescribers via technology vendor systems at the point of prescribing. The file exchange includes information on formulary status, alternative drugs, co-pays and other information.  The healthcare industry is currently using SCRIPT Standard version 10.6 which contains thirteen different transactional exchanges for e-prescribing functions, including:  

  • Sending a new prescription;
  • changes to a prescription;
  • renewals and resupply exchanges;
  • cancellation of a prescription;
  • fill status notifications;
  • medication history; and
  • census exchanges.

Most of these transactions have been named in the regulations associated with the MedicareModernization Act. While the electronic exchange of new prescriptions, renewals and medication history have grown exponentially, implementation of other transactions has been very slow.   Other capabilities, including the specific issues raised by Harper, are also available in the existing standard, underscoring the urgent need to increase awareness and industry-wide adoption of the breadth of functionality afforded by the e-prescribing standards. Among them are:  

  • Structured and codified sig: promotes greater consistency in specifying directions and for clinical review/analysis. The current version used by the industry contains a 140 byte free text field, along with fields to describe the route, indication, vehicle, site, timing and duration. The structured and codified sig format present in SCRIPT version 10.6 was not intended to support 100 percent of sigs; however a pilot found that 95 percent of the fully parsed sig strings were accommodated by the format. Enhancements incorporated in SCRIPT version 2012+ include a more robust Structured Sig Segment which supports a text field size of 1000, as well as other enhancements, recommendations and clarifications from the pilot.
  • Support for patient observations: allows prescribers to supply patient height, weight, diastolic and systolic blood pressure. Patient weight is useful for validating proper pediatric dosing. Based on questions posed by a Council on Clinical Information Technology Executive Committee article, recommendations for pediatric prescriptions were included in the SCRIPT Implementation Recommendations document publicly available for implementers here under "NCPDP Resources." A challenge is for the prescribing systems to send this information. Enhancements for more observation measurements were included in a more recent version.
  • Support for scheduled medications: provides fields necessary to enable e-prescribing of controlled substances.
  • Compound prescription support: approved in SCRIPT version 10.8 when industry champions came forward to analyze the needs and work through the requirements.
  • Adverse events/reactions: the NCPDP SCRIPT Standard supports the exchange of drug use review fields. The industry is actively exploring adding the use of adverse events/reactions/etc., which is used in other transactions, for the use in the e-prescribing transactions via the NCPDP WG11 e-prescribing Best Practices Task Group.
  • Support for prior authorizations: provides the means to exchange information needed in prior authorization requirements, including access to information on covered medications at the point of care, information on PA approvals and denials. The ePA transactions were added in a more recent version that industry participants are actively implementing.

Moving the needle on adoption and implementation of e-prescribing standards E-prescribing standards have been enhanced based on requests by the industry which has opted to build functionality in layers. For example, the SCRIPT Standard version 10.6 was published in 2008, with enhancements that are approved and published at least twice a year. But publication is one action; implementation is another. So the question is: How do we move the needle to increase adoption and implementation of the e-prescribing standards?   1. Technology/system vendors can take the lead, or wait for a mandate – There are many demands on industry vendors for impact analysis, development, implementation, testing and distribution. Then there is coordination of both prescribing and pharmacy systems implementation, and all within regulatory requirements. In an effort to build a predictable, repeatable process, the industry will be examining if a cyclical implementation timeframe could be adopted to move versions in a more timely and expected manner. In the absence of a mandate, uptake on adoption and implementation depends on technology vendor priorities.   2. Share lessons learned to improve implementation guidance – Implementation can be slow when you are blazing new trails. The data itself is complex. It may be pulled from data that is not discrete or doesn't use the same nomenclature or requires the use of an unfamiliar vocabulary. The electronic exchange can be complicated. It forces analysis of manual workflows. Trading partners may be at different stages of implementation maturity. Benefits are seen from different perspectives. Industry experience in the use of the functionality available is needed, with lessons learned to improve future implementation. NCPDP has active task groups including e-prescribing Best Practices Task Group, Implementation of Structured and Codified Sig Task Group and many others that are open to materially interested parties to come together in consensus to develop industry guidance, implementation guidance and future enhancements to the standards.   The complex but vital enhancements to industry standards are developed by the dedicated volunteers across the healthcare industry who share questions, findings and recommendations. NCPDP, the standards development organization, provides the forum for this important work.



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EHR Incentive Market Share Charts Worth A Thousand Words | EMR and HIPAA

EHR Incentive Market Share Charts Worth A Thousand Words | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

One thing I really love about the government lately is their goal to be as transparent as possible. Certainly they still have a ways to go, but I think healthcare has done some significant things when it comes to transparency into the government health programs. A great example of this is the Health IT Dashboard which has all of the data for the various health IT programs.

I don’t want to steal Carl Bergman’s thunder, because he’s already posted some really interesting Hospital EHR market share data and his previous EHR market share data. Plus, he’s planning to dive into the meaningful use market share data next. I love the approach of multiple sources when it comes to evaluating EHR market share and so I look forward to his analysis of EHR incentive market share against the EHR adoption market share from Definitive Healthcare and SK&A.

Until then, I thought I’d give you a taste of the EHR vendor participation in the EHR incentive program. This data comes from the ONC dashboards listed above and are put into some really nice snapshots of the data by ONC.

First up is the data for EHR vendor attestations by eligible professionals (ie. ambulatory doctors):

And the EHR vendor attestations by hospitals:

It’s worth noting that the above data is just the EHR incentive money data. No doubt the actual EHR adoption data would have a few differences and include some companies in specialties that don’t qualify for EHR incentive money. Not to mention specialty specific EHR vendors who likely don’t make the chart even if they dominate their specialty. These charts do serve as an interesting proxy for EHR market share that’s worthy of discussion even if it doesn’t paint the full picture. Plus, even more important will be to watch the change in these numbers over time.

With that disclaimer, we could analyze this data a lot of ways. I’ll just offer a few interesting insights I noticed. First, 711 vendors have been used in the ambulatory EHR incentive program. That’s a lot of vendors. Only 78 of those 711 supply secondary EHRs as opposed to the primary EHR. 452 EHR vendors supply a primary EHR to less than 100 eligible professionals. 200 EHR vendors supply a primary EHR to fewer than 10 eligible professionals. These observations and a comparison of the ambulatory versus hospital EHR incentive charts’ “Other Vendors” shows how fragmented the ambulatory EHR market share is right now.

I was also intrigued that Mitochon Systems, Inc. was on the list even though they shut down their Free EHR software in May 2013. They had white labeled their EHR software to a number of other companies and so it will be interesting to see how that number evolves. I assume they sold the software to those companies, but I hadn’t heard an update.

On the hospital side of things, MEDITECH certainly doesn’t get the credit they deserve for the size of their install base. The same goes for CPSI, MEDHOST and Healthland. I think their problem is that people only want to read about the Mayo, Cleveland Clinic, and Kaiser’s of the world and so the articles about Billings Montana Hospital (I made that hospital up) rarely happen. I should find more ways to solve that since the small hospital market is huge.

I do wish that there was a way to divide the ambulatory chart into hospital owned ambulatory practices and independent ambulatory practices. That would paint an even clearer picture of that market.



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What If Your EHR Only Had 25 Doctors? | EMR and HIPAA

What If Your EHR Only Had 25 Doctors? | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

I recently had lunch with an EHR vendor that had an extremely small number of providers. I’ve known this EHR vendor for about 5 years, so this isn’t a new EHR vendor that’s trying to establish themselves in the industry. Instead they’ve focused on having a small, nimble team that’s focused on making the EHR work the right way for the doctors. It’s a novel approach I know, but pretty interesting that his business can survive with so few providers. Also worth noting is that the EHR is certified for meaningful use stage 2 as well.

Now think for a minute how the development process of an EHR vendor would be better if your EHR only had 25 doctors (For the record, the EHR vendor above has a few more than 25 doctors). Would it be much easier to satisfy just 25 physician users? Imagine the personalized service you could provide your users.

One of the real challenges I’ve seen with EHR vendors is that when they’re small, they are extremely responsive to their end users and the end users are very happy. As the EHR vendor grows, they lose that personal touch with the end users and many of those originally happy end users become dissatisfied with their EHR experience.

The problem with scaling an EHR user base is that you can’t make everyone happy. You have to make compromises that will be great in some people’s eyes and terrible in another person’s mind. What large EHR vendors do to try and solve this problem is they create configurable options that allow the end user to customize their system to meet their personal needs. Problem solved, right?

The problem with these configurations is two fold. First, you can’t make everything configurable. Once you go down the path of making everything configurable, it never ends. There’s always something else that could be made more configurable. So, the culture of configurability leads to unsatisfied users who can’t customize everything (even if what they want to customize shouldn’t matter).

Second, if everything is configurable, then it makes the implementation that much more complex. I’ve written before about the need for EHR vendors to have great “out of the box” user experience, but balancing that with allowing the user to configure everything that’s needed. This is a real challenge and most fail. Just look at the number of high priced EHR consulting companies out there. Many of them could better be defined as EHR configuration companies since the configuration needs are so large and complex.

Returning to where we started, when you’re an EHR vendor with 25 doctors you don’t have to build in all the flexibility and configurability. You’re small enough that as an EHR vendor you can do any needed customizations and configurations for the end user. Plus, with this kind of personalized service you can charge a little extra as well.

When you look at EHR development, there’s a spectrum of approaches starting with a fully in house, custom designed EHR through a fully outsourced EHR that can apply to any organization or specialty. In many ways a 25 doctor EHR has a lot of the same benefits of a fully custom EHR software, but spreads the costs of development across more doctors.

As a business, maybe a 25 doctor EHR company won’t dominate the world. Maybe they won’t have a huge exit to some other company or an IPO. However, that doesn’t mean it’s not a great small business if it’s doing something you love. Once you get World Domination out of your sites, it changes a lot of things about how you do business.



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Standardize EMRs, For Security & Safety's Sake - InformationWeek

Standardize EMRs, For Security & Safety's Sake - InformationWeek | EHR and Health IT Consulting | Scoop.it

Electronic medical records help healthcare organizations improve patient care, but lack of standardization could cause safety and security problems.

The foundation hospitals built when they overwhelmingly adopted electronic medical records is trembling under the weight of concerns over security and lack of standardization.

Healthcare organizations already see plenty of benefits from EMRs. The Internet is full of success stories detailing how hospitals save and improve lives, reduce costs, and enhance research capabilities through new access to real-time data. Many EMR applications are high-quality tools that take users' needs and wishes into account and evolve to meet mandates and clinicians' changing requirements.

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Yet healthcare sometimes seems to operate in a vacuum. It appears determined to repeat the steps already taken by industries such as finance instead of skipping the proprietary isolationist years and leaping right into the era of standards, collaboration, and data-sharing. The government is starting to shake an interoperability stick, but the industry should act on its own initiative to allow disparate systems to work together -- and not only to cut costs for healthcare provider implementations. Standardizing also will improve patient safety, care, and results, experts say, resulting in reduced care costs and data security. Establishing standards will accomplish this by enforcing guides for healthcare employees and restricting access against unauthorized users.

[Developing a healthcare app? Make sure you understand the legal requirements. Read HIPAA Compliance: What Every Developer Should Know.]

At least one report suggests these predictions are on track. Concerned that increased use of EMRs tallied with an uptick in "patient safety events," the Division of Laboratory Programs, Standards and Services in the Center for Surveillance, Epidemiology and Laboratory Services, within the Centers for Disease Control and Prevention (CDC), studied errors in labs based on electronic health record (EHR) data. In some cases, labs used outdated software that didn't support current coding -- an issue that might increase when ICD-10 finally arrives.

Different facilities also use dissimilar codes for the same tests, creating confusion -- especially among staff members who move among different hospitals and clinics, according to a CDC report. In one case, the report cited, a woman required a hysterectomy after an EMR moved her abnormal test results to the bottom of the screen instead of placing the most recent results at the top. In another, a male patient received a double dose of a blood thinner due to an EMR error.

Other areas of concern: inadequate data transfer from one EHR to another, data entry in the wrong patient record, incorrect data entry, failure of the system to function correctly, and incorrect configuration, patient safety organization ECRI Institute wrote in a separate report.



"Recognizing that such errors can occur without health IT systems, there is cause for concern as an occasional error in a health IT can be replicated very quickly across a large number of patients," the CDC's report said. "Combining documented patient safety events with the anecdotal evidence shared by individual laboratory professionals across the US presents enough concern to warrant further investigation and mitigation."

The lack of EMR standards creates a greater security burden on healthcare organizations and professionals. But the stakes are incredibly high, not only because of the number of patients who could be impacted by a single breach, but also because of the sensitive nature of the date stored in EMRs and the potential for damage to an organization's reputation.

"We're in an historic time within healthcare. The impact from a healthcare perspective has the same impact as, say, a retail breach, but you're talking about personal health information, things that should be very private," said Ken Bradberry, CTO and vice president at Xerox Healthcare Provider Solutions, in an interview. "We're talking about strategies in healthcare that haven't evolved at the rate they should have. Security has to evolve and align with where we're at with the delivery of electronic health records and the delivery of services in general. The detection and [prevention] of security breaches [and] threats has to be of paramount importance to healthcare providers."

Now that more than 93% of hospitals use at least one EMR, government agencies, researchers, and pundits point to worrisome trends that could -- left unfixed -- jeopardize patients' faith in providers, payers, and the overall system. The drive among providers to forge partnerships and integrate EMRs between smaller practices, hospitals, accountable care organizations (ACOs), health information exchanges (HIEs), and other members of the healthcare ecosystem creates additional links in the chain -- and more potential points of breach, loss, or theft.

"The government is pushing for EHRs, but no one is overseeing the security and privacy of the records," said Karl Volkman, chief technology officer at Microsoft Gold Certified partner SRV Network. "Instead, it's left up to the individual organizations, which may allow medical personnel to alter records incorrectly with little oversight -- or the entire system may not have the capacity to protect from fraudulent encounters. Instead of rewarding and punishing those who have or have not switched to EHRs, the government should consider instilling standards to identify inappropriate use of the records, fraud, and breaches."



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Do we already have data proving that EHRs save lives? | Government Health IT

For at least the last decade, the health IT field has seen a scholarly back-and-forth on the effectiveness of electronic medical records. As soon as one study is published that finds technology has little impact on patient outcomes, another emerges that seems to show just the opposite.

These studies are frequently limited by the size of the data set or scope of the analysis. Take, for example, a June 2014 JAMA article that found meaningful users of electronic health records failed to deliver improved care for five chronic diseases. According to one news report, the new study cast “doubt on whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes.”

The analysis, it turns out, included just three months of data from 818 physicians (about .1 percent of the 834,769 active physicians practicing in the United States) across seven clinical quality measures. By the way, all those physicians were employed by a single hospital or its affiliated practices.

And the variable being studied? It distinguished physicians who qualified for MU1 against those who did not. Considering the low bar set by MU1, the distinction might not signify all that much.

So what if, instead, you had a data set that drew from ALL the hospitals in the United States. And what if that data ranked healthcare IT adoption not on MU1, but on a multi-tiered scale, from no technology use to completely paperless systems? And what if the outcomes studies included 19 patient cohorts in five service lines, from heart failure and pneumonia to sepsis and stroke, with findings adjusted for risk and other differences in patient health status?

That study might be a little more authoritative when it comes to evaluating "whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes."

[See also: The great EHR market shakeout - it's coming, but when?]

And the good news is, that study now exists and it has found that EMRs do have a measurable, positive impact on care as measured by clinical outcomes of risk-adjusted mortality rates. 

The preliminary analysis is the first fruit of an effort to connect data from the HIMSS Analytics Database, and its comprehensive EMR adoption model (EMRAM), with Healthgrades' own hospital performance database, which measures hospitals on mortality and complication rates across multiple service lines.

Based on the joint study by HIMSS Analytics and Healthgrades, hospitals with high EMRAM scores showed improvement in the capture of data about the patient, measured by the predicted mortality rate in the Healthgrades model. And the actual performance (based on the actual number of mortalities) for hospitals with high EMRAM scores was significantly better than hospitals with low EMRAM scores in four specific conditions, indicating a relationship between the use of an EMR and the actual outcome.

One example is mortality from heart attacks. The mortality rate at high EMRAM facilities (9 percent) is half that of heart attack mortality at low EMRAM facilities (18 percent).

Of course, not all cohorts and service lines were equally affected by differences in health IT adoption. With neurosurgery, there is no mortality difference between high and low EMRAM facilities. But overall, all five service lines studied show statistically significant positive relationships to EMRAM scores for at least one group of diagnoses and procedures.

“For patients, they should know that the risk-adjusted outcomes – and the actual outcomes in some cases – are better at hospitals with higher EMRAM scores,” says Healthgrades Senior Data Scientist William R. Wyatt.

In total, 4,583 facility records were selected from HIMSS Analytics data, a segment that represents the total number of facilities with complete data from 2010 through 2012. That three-year time period was chosen because it aligns with the most recent Healthgrades reporting period.

"This effort is quite remarkable," notes Lorren Pettit, vice president of market research at HIMSS Analytics. "By working together, we’ve been able to provide one of the most comprehensive and detailed analyses of the association between EMR capabilities and quality outcomes."

Wyatt and Pettit say the collaboration is likely to continue and grow. Researchers from Johns Hopkins are now working with Healthgrades and HIMSS Analytics on a grant application to the Agency for Healthcare Research and Quality to move beyond these preliminary findings and assess the impact of EMRs on other outcome measures.



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Study: Despite Concerns, EHRs Don’t Increase Medicare Fraud

Study: Despite Concerns, EHRs Don’t Increase Medicare Fraud | EHR and Health IT Consulting | Scoop.it

Concerns that nationwide electronic health record (EHR) adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan Schools of Information and Public Health and the Harvard School of Public Health.

Early results of the meaningful use program show that more than half of all eligible hospitals have qualified for financial incentives. However, some experts have suggested that the increased documentation abilities of EHRs could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up healthcare costs by documenting and billing for care that did not occur.

"There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn't," Julia Adler-Milstein, Ph.D., U-M assistant professor of information said. The study, by Adler-Milstein and Ashish K. Jha, Ph.D., Harvard professor of public health, is published online in the July issue of Health Affairs.

To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted EHRs had greater subsequent increases in the severity of patents' conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.

Despite widespread stories and concerns among policymakers about the potential for EHRs to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.

The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce healthcare spending and improve the quality of care.



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Maryland HIE Seeks to Add Image Exchange Service

Maryland HIE Seeks to Add Image Exchange Service | EHR and Health IT Consulting | Scoop.it

The statewide health information exchange in Maryland is seeking to enhance the value of its query portal by adding an image exchange service. In July the Chesapeake Regional Information System for our Patients (CRISP) issued a request for proposal to software vendors.

CRISP receives data from all 47 Maryland hospitals, most of the District of Columbia’s hospitals, and more than a dozen other participating long-term care facilities, reference laboratories, and radiology centers. Information such as lab results, radiology reports, medication history, and transcribed documents may be available through the query portal. However, most of the use involves basic querying and viewing of textual documents.

CRISP also provides an automated alert system for providers to receive notification when their patients visit the emergency room, are admitted to, or are discharged from the hospital. A separate reporting system aggregates hospital ADT notifications with geo-mapping to generate inter-hospital readmission reports for public health purposes.

More than 50 hospitals and radiology facilities are contributing their text-based radiology reports via an HL7 v2.x ORU feed to the CRISP query portal. In an average month, CRISP receives over 10 million total clinical messages of which 500,000 are finalized or corrected copies text-based radiology reports, according to the RFP.

The aim of the pilot project involving a small group of hospitals would be to prove the business case for image exchange services with the goal of expanding to all the providers. “CRISP envisions that when a user drills down into a specific textual radiology report within a patient record inside the CRISP query portal, that the user will somehow be notified that the radiology image is available to view. From this screen, a web-based viewer could be launched from inside that radiology report to allow the user to view the associated image,” the RFP says. “Once the image-review was complete, the user would return to the patient summary or result screen within the existing web interface.”

A second major objective is to provide the functionality for a facility to ingest a copy of a patient’s radiology images into a hospital’s local PACS system. The hope is to eventually eliminate the need for manual transmission of medical images and reports between sites contributing data to the service.



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Hospital hit with $150K breach fine | Healthcare IT News

Hospital hit with $150K breach fine | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

A Rhode Island hospital, who nearly two years ago notified 14,000 patients of a HIPAA breach involving their data, agreed Wednesday to hand over $150,000 to settle allegations that it failed to safeguard patient information.    The Women & Infants Hospital of Rhode Island, or WIH, will pay the civil penalty to the Massachusetts Attorney General who slapped the hospital with a lawsuit after discovering 12,127 of those patients were Massachusetts residents.    Mass. Attorney General Martha Coakley, Photo: Martha Coakley, Flickr The HIPAA breach, which was reported in September 2012 despite occurring in the spring, involved 19 unencrypted back-up tapes that went missing. Contained on the tapes were patient names, dates of birth, Social Security numbers, ultrasound images, dates of exams and physicians' names.    [See also: Groups hit with record $4.8M HIPAA fine.]   "Personal information and protected health information must be properly safeguarded by hospitals and other healthcare entities," Massachusetts AG Martha Coakley said, in a prepared statement. "This data breach put thousands of Massachusetts consumers at risk, and it is the hospital's responsibility to ensure that this type of event does not happen again."   Following an investigation, officials discovered the backup tapes were originally supposed to be mailed to a central data center and subsequently shipped off-site to transfer legacy radiology data to a new PACS.   However, due to an "inadequate inventory and tracking system," reportedly, hospital officials did not learn of the missing tapes until spring 2012Inadequate employee training and lacking internal policies also contributed to the breach not being properly reported, according to AG officials.    [See also: Massachusetts hospital to pay $750,000 to settle data breach case.]   Settlement terms require WIH to maintain an up-to-date inventory of locations, custodians and descriptions of unencrypted devices containing PHI. It also will need to perform regular security audits and take subsequent actions according to findings.    Of the $150,000 settlement, WIH will pay a $110,000 civil penalty, $25,000 for attorney fees and $15,000 to a fund to be used by the Massachusetts Attorney General's Office to promote education concerning the protection of personal information and PHI and a fund for future data security litigation.    The Massachusetts Attorney General's office has a history of enforcement regarding healthcare data breaches.    In 2012, it hit South Shore Hospital with a $750,000 settlementafter the hospital failed to safeguard the data of 800,000 patients after 472 boxes of unencrypted backup tapes went missing.   

In January 2013, former owners of a medical billing practice and four pathology groups handed over $140,000 to settle breach allegations after groups dumped the medical records of 67,000 patients at a public transfer station. 



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How do mandates affect docs, health IT staff differently? | EHRintelligence.com

Legislative changes have already begun or are beginning to leave an impression on the healthcare industry and impacting healthcare professionals differently depending on their role in an organization, in the clinic or in support of health information technology (IT). The Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act (ACA) are two such examples. The effects, however, are not necessarily the same.
Recent survey results published by healthcare staffing firm Jackson Healthcare reveal that the ACA has not led to changes in terms of their patient populations and practices for the majority of physicians.
While 23 percent and 15 percent of 1,527 surveyed physicians reported losses in the number of patients as a result of insurance policy cancellations or inability to accept insurance plans, respectively, 19 percent indicated additions to their patient panels as a result of individuals obtaining insurance through the health insurance exchanges.
“Some physicians are pleased to be able to offer care to patients who haven’t seen a doctor in years — especially patients with conditions in need of treatment,” write Sheri Sorrell and Keith Jennings. “Other physicians have increased or maintained their patient panels, but are seeing patients less often as a result of high deductibles.”
A positive takeaway from the findings is the rise in participation in accountable care organizations (ACOs) by physicians, which appears to have an encouraging effect on physician satisfaction and career outlook despite longer workdays and zero change to income.
ACO participation tends to be more common among physicians younger than 54 (54% of those working in an ACO v. 46% not working in an ACO), working in urban areas (42% v. 37%), and employed by a hospital and never having working independently (50% v. 42%).
Despite the ACA having a relatively negligible effect on physicians currently, it still has many of them concerned moving forward. Physician productivity is decreasing as a result of sicker patients requiring more care and uncertainties related to reimbursement and collection challenges are preventing many physicians from making strategic decisions concerning their practices.
Compared to physicians, the outlook for healthcare IT professionals remains promising. Healthcare IT staffing company Healthcare IT Leaders recently unveiled the results of its first-ever HIT workforce engagement report. Comprising responses from close to 460 healthcare IT professionals, the report shows high levels of job satisfaction among full-time employees (FTEs) and consultants — 64 percent of the former and 86 percent of the latter were very or somewhat satisfied with their current jobs.
Satisfaction with their jobs is apparently commensurate with satisfaction with pay. A majority of FTEs were very and somewhat satisfied with their current pay (60%) as compared to a vast majority of consultants (80%).
Given the high demand for IT expertise in healthcare, healthcare IT professionals are being actively approached by recruiters and responding to these inquiries. High numbers of FTEs and consultants — 85 percent and 84 percent, respectively — have received messages from recruiters. A slightly smaller number has responded to these inquires, 62 percent and 72 percent, respectively.
“Only a small minority of the HIT workforce said they would not consider a new job, meaning most would change employers if the circumstances were right,” state the report.
All of this positivity comes at a time of significant expenditures by healthcare organizations and providers looking to receive incentives or avoid penalties linked to health IT adoption (e.g., meaningful use). It is no surprise then that healthcare IT professionals are feeling the benefits of being wanted.



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Why the Long-Term Care Industry Needs to Get Connected (And Supported)

Why the Long-Term Care Industry Needs to Get Connected (And Supported) | EHR and Health IT Consulting | Scoop.it

I’ve been reading and writing so much about the long-term healthcare industry lately that I may have forgotten I write for Healthcare Informatics and not our sister publication, Long-Term Living.

But perhaps my inclination to write about the long-term care market—and its growing need for health IT—is because others have ignored the industry. According to a January 2014 report from the California Healthcare Foundation and Bluepath Health, a Calif.-based consulting firm, “HITECH [the Health Information Technology for Economic and Clinical Health Act] ignored most critical skilled nursing and interim care facilities, resulting in an enormous disconnect between the acute site and rehabilitative care. This disconnect may prove to be a significant barrier in achieving new payment models that rely on providing seamless care transitions.”

HITECH, of course, focused on the hospital and physician practice side—as such, EHR adoption has been boosted to approximately 80 percent of doctors in the U.S. Comparatively speaking, according to a National Center for Health Statistics data brief released in September 2013 that relied on the 2010 National Survey of Residential Care Facilities, just 17 percent of the nation's assisted-living and other residential care communities use electronic health records (EHRs).

If you have read my two recent articles on the long-term care market—one on how the industry has begun to embrace technology, and the other on how health IT has specifically helped one assisted living facility—you probably have seen these statistics in one form or another. To me, they’re pretty telling numbers, especially when you consider the rising acuity in these communities.

It seems fairly apparent at this point that the need for new technology in this market is there. But can the supply meet the demand? The Ontario, Canada-based PointClickCare, a cloud-based software provider for long-term care, is one vendor that has been recognized by KLAS as the top-rated software vendor for meeting the fundamental needs of senior care providers. PointClickCare is the EHR of choice at American Baptist Homes of the West (ABHOW), a Pleasanton, Ca.-based provider of senior housing and care, where the EHR platform streamlines workflow and improves documentation, leading to improved care, according to the organization.

PointClickCare is one example of a relatively new but good and aggressive IT company that seems to be putting some of the “legacy” long-term care IT vendors to shame. According to a 2013 report from the LeadingAge Center for Aging Services Technologies (CAST), “The market is highly volatile: vendors come and go, merge and get acquired, and fail to respond to surveys or regulatory changes. Many claim that they have an EHR when by most definitions they do not.” Of course, vendors come and go and merge in ambulatory and inpatient settings as well, but with less backing from the government, vendor/caregiver relationships in the long-term care market are probably murkier.

To that end, on the policy side, federal policymakers, including the Office of the National Coordinator for Health IT (ONC), are beginning to understand the important role that long term post-acute care settings can play in care transitions. ONC recently published an issue brief about health IT in this environment, in addition to awarding challenge grants to help four states promote long term post-acute care health information exchange (HIE) initiatives for transitions of care. However, despite this, providers in this industry are not eligible for meaningful use dollars.

Additionally, Majd Alwan, Ph.D., senior vice president of technology at LeadingAge, a Washington, D.C.-based nonprofit organization for institutions that serve the aging population, said in an interview last year that LeadingAge hopes Congress expands the meaningful use program to include long-term and post-acute care facilities.

Although it is just my opinion that the long-term care market has been neglected for the most part when it comes to IT, it is a fact that assisted living communities are caring for residents with more complex healthcare needs than just a few years ago—most adults aged more than 65 years (80 percent) have one chronic condition, and 50 percent have two or more, notes the Centers for Disease Control and Prevention. Again, more evidence of the need to move away from paper-based processes.

Going forward, I’m probably going to leave most of the long-term care writing to our friends at LTL. But I have thoroughly enjoyed the past month of reading, writing, and researching an industry that hopefully gets the support it deserves.



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What is the difference between an EMR and an EHR? - Practice Fusion Blog

What is the difference between an EMR and an EHR? - Practice Fusion Blog | EHR and Health IT Consulting | Scoop.it

An electronic medical record (EMR) is a digital version of a chart with patient information stored in a computer — not a filing cabinet. The electronic file contains everything you’d find in a paper chart, such as medical history, diagnoses, medications, immunization dates, allergies. While EMRs work well within a practice, they’re limited because they don’t easily travel outside the practice. In fact, the patient’s record might even have to be printed out and mailed for another provider to see it.

What is an EHR?

An electronic health record (EHR) does everything an EMR does, but with the added benefit of making health information instantly accessible to authorized providers across practices and health organizations. One EHR can bring together information from current and past doctors, emergency facilities, school and workplace clinics, pharmacies, laboratories, and medical imaging facilities. It can also contain insurance information, demographic information, and even data imported from personal wellness devices.

EHRs are the future of healthcare because they provide critical data that informs clinical decisions, and they help coordinate care between everyone in the healthcare ecosystem. EHRs also have the ability to:

  • Streamline the workflow of providers
  • Reduce duplicative testing
  • Reduce delays in treatment
  • Offer access to evidence-based tools to support clinical decisions



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Capitol Hill turns up heat in EHR interoperability — Could a digital health startup save the VA? — No sign of slowdown in health IT lobbying - POLITICO Morning eHealth

Capitol Hill turns up heat in EHR interoperability — Could a digital health startup save the VA? — No sign of slowdown in health IT lobbying - POLITICO Morning eHealth | EHR and Health IT Consulting | Scoop.it

CAPITOL HILL TURNS UP HEAT ON INTEROPERABILITY: Senate Democrats have joined Republicans in demanding an investigation into whether heavily subsidized electronic health records systems are blocking the free exchange of patient health information that was a major objective of the multibillion-dollar federal program. The comments, accompanying a spending bill, signal that dissatisfaction with the meaningful use program among doctors and health IT professionals is bubbling up in both houses of Congress, though it isn’t clear whether it will lead to short-term action. Federal health IT officials have been trying to prompt better health exchange among EHR systems and have made interoperability — the free flow of information among health systems — a central goal of their efforts over the next year. Without freer data exchange, say those who should know, the electronic health records won’t lead to the kind of health care improvements and cost controls sought under the Affordable Care Act and the 2009 HITECH Act

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EHRs key to medication reconciliation | Healthcare IT News

EHRs key to medication reconciliation | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

Electronic health records have a big role to play in improving hospitals' medication reconciliation, a new study finds, but challenges related to data quality, technology and workflow remain.

[See also: Barcoding still a key tool for safety]

Medication reconciliation is a systematic way to reduce medical errors by ensuring accurate patient medication lists at admission, during a hospitalization and at discharge. Unintended discrepancies are common, with some research finding they affect as many as 70 percent of hospital patients at admission or discharge – with almost one-third of those potentially causing harm.

Still, despite hospital accreditation and other requirements, use of med rec technology has lagged for many reasons – including insufficient physician engagement, which stems, in part, from lack of professional consensus about which physician is responsible for managing a patient's medication list, according to the new report from National Institute for Health Care Reform.

[See also: Medication tracking system helps Ohio hospital cut waste]

NIHCR is a nonpartisan, nonprofit organization launched by United Automobile Workers, Chrysler, Ford and General Motors. Between 2009 and 2013, it contracted with the Center for Studying Health System Change to conduct objective research and policy analyses of the organization, financing and delivery of healthcare in the U.S.

Conducted for NIHCR by researchers Joy M. Grossman, Rebecca Gourevitch and Dori A. Cross, this study examined how 19 hospitals nationwide were using EHRs to support medication reconciliation.

They found that key challenges to effective medication reconciliation include improving access to reliable medication histories, refining EHR usability, engaging physicians more fully and routinely sharing patient information with the next providers of care.


"Enhancing ways for key stakeholders – patient safety advocates, policy makers, researchers, EHR vendors, hospitals and clinicians – to share the best EHR designs and hospital implementation strategies will be key to realizing the potential safety and efficiency benefits of EHR-based medication reconciliation," they write.

The NIHCR Research Brief, "Hospital Experiences Using Electronic Health Records to Support Medication Reconciliation," also finds:


  • While hospitals reported that EHR vendors have been adding and enhancing medication reconciliation functionality over time, more than a third of the hospitals in the study still used a partially paper-based process at admission, discharge or both.
  • Many hospitals had at least some access to external electronic sources of medication histories to generate more accurate pre-admission medication lists, for example, from affiliated physicians practices' EHRs. But use of this feature varied, reflecting mixed views on whether the added information was reliable enough to be worth the effort to incorporate it into the record.
  • The hospitals with fully electronic processes at admission or discharge had implemented EHR medication reconciliation modules, which like paper forms, allow comparison of medication lists at those transitions. Actions taken on each medication are then automatically converted into orders, substantially streamlining the workflow by eliminating the need to re-enter data.
  • Hospitals with fully electronic processes at discharge also were able to take advantage of the discharge medications in the EHR to electronically generate legible and more patient-friendly discharge instructions and electronic prescriptions. Less commonly used features included the capability to incorporate the same medication list into the discharge summary and electronically share discharge medication information with the next providers of care.



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Electronic health records don’t increase Medicare fraud, study finds

Electronic health records don’t increase Medicare fraud, study finds | EHR and Health IT Consulting | Scoop.it

Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher health care spending are unfounded, according to a study from the University of Michigan Schools of Information and Public Health and the Harvard School of Public Health.

Following the passage of the HITECH Act in 2009, more than 5,000 hospitals became eligible for financial incentives to adopt and engage in "meaningful use" of electronic health records. Early results show that more than half of all eligible hospitals have qualified for incentives. The Act was motivated by the expectation that electronic health record use would improve the quality of care and reduce costs by avoiding inefficiencies, inappropriate care and medical errors.

However, some experts have suggested that the increased documentation abilities of electronic health records could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up health care costs by documenting and billing for care that did not occur.

The study, by Julia Adler-Milstein, U-M assistant professor of information, and Ashish K. Jha, Harvard professor of public health, is published online in the July issue of Health Affairs.

"There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn't," said Adler-Milstein, who is also an assistant professor of health management and policy in the U-M School of Public Health.

To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted electronic health records had greater subsequent increases in the severity of patents' conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.

Despite widespread stories and concerns among policymakers about the potential for electronic health records to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.

With no empirical evidence to suggest that hospitals are systemically using electronic health records to increase reimbursement, the study's findings should reduce concerns that EHR adoption by itself will increase the cost of hospital care.

The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce health care spending and improve the quality of care.

The paper is titled, "No Evidence That Hospitals Are Using New Electronic Health Records to Increase Medicare Reimbursements." Health Affairs is a peer-reviewed journal focusing on health policy thought and research. The study will be published in an upcoming print edition of the monthly journal.



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The Lessons Thus Far From the Transition to Digital Patient Records

The Lessons Thus Far From the Transition to Digital Patient Records | EHR and Health IT Consulting | Scoop.it

Soon after the financial crisis hit, the Obama administration decided to toss into the economic stimulus package a carrot to accelerate the computerization of health care. Within the roughly $800 billion pump-priming project, the health technology initiative could be seen as a modest down payment on the future: about $20 billion in incentives spread over several years to encourage doctors and hospitals to move from paper records into the computer age. The Bush administration had championed the cause, and, seizing a crisis-created opportunity, the Obama administration put up the money.

But ever since, the government-promoted drive for electronic health records has been assailed as everything from a handout to greedy tech companies to the advance guard of socialist medicine. In an editorial in February 2009, The Wall Street Journal called the program a “stalking horse for government-run health care.” Forecasts and studies of the impact of the incentive program have been similarly varied. Some predicted big dollar savings and improved care, while others came to the opposite conclusion, seeing higher costs and medical errors induced by complex technology.

At first glance, a new research paper, published in this month’s issue of Health Affairs, only adds to the confusion. The research paper found no evidence that hospitals adopting electronic health records were systematically using them to drive up their billings. The research by Julia Adler-Milstein, an assistant professor at the University of Michigan School of Public Health, and Ashish K. Jha, a professor at the Harvard School of Public Health, would seem to contradict an analysis done in 2012 by The New York Times and a similar one by the Center for Public Integrity, a nonprofit investigative journalism group. Both those analyses found higher costs for Medicare patients at hospitals using electronic health records.

In an interview, Dr. Jha said his research with Ms. Adler-Milstein did not refute the findings of The Times and the Center for Public Integrity. Certainly, Dr. Jha said, there were cases of doctors, nurses and clinic assistants using the automated point-and-click and cut-and-paste features of computerized health records to change the billing codes for treatment to patients and to charge more. But the new research, Dr. Jha said, covered a broader slice of data, including inpatient hospital billing as well as the emergency room reimbursements that, along with visits to doctors’ offices, were the main focus of the Times analysis.

The research with Ms. Adler-Milstein, he noted, also included a control group to adjust for factors like digital-record users being more likely to be larger institutions and teaching hospitals, which are more effective at billing and may be sent more seriously ill patients.

The researchers did not find systematic higher Medicare billing in hospitals that was attributable to electronic health records. “The bottom line,” Dr. Jha said, “is we didn’t see it.”

The Health Affairs article refers to the Times analysis, which “pointed to an association between E.H.R.s and higher payments” as helping to fuel concern about the potential for fraud and abuse. Dr. Jha said the Times analysis also prompted his research with Ms. Adler-Milstein — to look for how widespread the problem might be, or not.

Dr. Jha said he was surprised they did not find systemic higher billing, but Ms. Adler-Milstein, a former graduate student of his at Harvard, said she was not. Her assumption, she said, was rooted in simple economics. Hospitals in general operate on slender profit margins, she observed, so “lots of resources are devoted to maximizing coding using all available information in the paper or electronic record.”

The concerns raised have also brought government scrutiny to the potential for using digital technology to overbill and inflate costs.

Dr. Jha has been studying the impact of digital health records for years. A research paper he published in late 2009, as the federal government was about to embark on the incentive program, cast doubt on how much hospitals that had already adopted electronic health records had achieved lower costs and improved care.

Today, Dr. Jha says he remains skeptical. Some things have changed markedly. In 2008, 9.4 percent of the nation’s hospitals were using basic electronic health records, according to the American Hospital Association. By 2013, the percentage had soared to 59.4 percent, propelled by the federal incentive program.

“So far,” Dr. Jha said, “we’ve mostly spent a lot of money to transition from paper to electronic records.”

No one thinks a modern health care system can cling to paper records. But the policy goal of the federal incentive program was to use digital technology to curb costs and improve care. The legislation was called the Health Information Technology for Economic and Clinical Health Act. And there are examples of health care providers that use digital patient records effectively — mostly large medical groups, like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and the Marshfield Clinic, that have worked with the technology for years.

But Dr. Jha said there was “certainly not yet” evidence of a payoff nationally from the federal incentive program.

That is hardly surprising. The economic dividend from any technology, from steam power to the electric engine to the computer, takes time to appear, as people figure out how to make the best use of the new tool. In 1987, when the personal computer revolution was more than a decade along, Robert M. Solow, a winner of the Nobel in economic science, mordantly observed, “You can see the computer age everywhere but in the productivity statistics.” By the 1990s, the impact on productivity became evident.

The principle of the technology-payoff time lag is true in many industries. But in health care, there is a case for special vigilance as well as for patience. The more digital patient records and decision-support software become part of diagnosis and treatment, the higher the stakes: In health information technology, there are no clinical trials or tests with randomized controls, as there are for drugs, for example. True, digital data does not go into the body, but it can increasingly guide what does.

That is why the Food and Drug Administration, in cooperation with the National Coordinator for Health Information Technology and the Federal Communications Commission, is developing what the government calls a “risk-based regulatory framework” for digital health technology. It is also a reason Dr. Jha says he believes the federal incentive program, which got under way in earnest in 2011, will be stretched out to eight or 10 years rather than the five years of the original plan.



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