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Medical boards keep wary eye on doctors' social media posts -

Medical boards keep wary eye on doctors' social media posts - | EHR and Health IT Consulting |
A survey of board executives finds that inappropriate communication with patients is among online behavior by physicians that could lead to an investigation.


When doctors go to social media websites, they may want to think twice about posting patients’ photos without permission.

Using the images could be considered unprofessional conduct by a state medical board, according to a new study.


Other online physician behavior viewed as troublesome by boards: citing misleading information about clinical outcomes; misrepresenting credentials; and inappropriately contacting patients.

The survey of 48 state medical board executives, published in the Jan. 15 Annals of Internal Medicine, found that these social media activities likely would prompt a board investigation of a doctor. The study concluded that physicians should never engage in such behaviors.

“When you post something publicly online, it’s something that could be online in perpetuity,” said study co-author Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, which represents 70 boards that oversee MDs and DOs.

What triggers an investigation?

One of the survey’s 10 hypothetical vignettes of social media posed to medical board executives shows a photo of three doctors, drinks in hand, at a hospital holiday party. Forty percent of executives said a complaint to the board about the posting would trigger an investigation — a “low consensus” among survey respondents.

But 73% took issue with a vignette of a doctor who posted photos of himself intoxicated.

71% of state medical boards have investigated doctors for violating professionalism online.

Getting a “moderate consensus” among respondents of posts that would prompt an investigation were a scenario of a physician’s blog that used potential patient identifiers and a vignette about discriminatory language on a doctor’s Facebook page. The least troublesome of the 10 vignettes was a doctor’s blog describing a clinical encounter with no patient identifiers (only 16% of executives said it would lead to an investigation).

“People can really do a lot to stay out of trouble by applying common sense and avoiding the trap that you can do something online you wouldn’t do in real life,” said study lead author Ryan Greysen, MD, MHS. He is an assistant professor in the Division of Hospital Medicine at the University of California, San Francisco, School of Medicine.

Previous research has shown that doctors and medical students can get in trouble online. An article co-written by Dr. Greysen in the March 21, 2012, issue of The Journal of the American Medical Association found that 71% of state medical boards had investigated doctors for violating professionalism online. A study, also co-written by Dr. Greysen, in the Sept. 23, 2009, issue of JAMA said 60% of medical schools had incidents of students posting unprofessional content online.

Guidance for doctors

In 2012, the federation issued guidelines to help doctors maintain professionalism when using social media. That guidance discourages physicians from interacting with patients on social networking sites such as Facebook and says doctors should adhere to the same principles of professionalism online and offline.

Delegates to the American Medical Association Interim Meeting in November 2010 adopted policy on social media use that advises medical students and physicians to be professional online. They should keep appropriate boundaries when communicating with patients online and respect patient confidentiality, the policy says.

The Annals study notes that improper behavior online can do more than spark a board investigation; it can lead to loss of employment or lawsuits by patients over privacy violations. The study said greater awareness of potential pitfalls is needed among doctors to avoid unprofessional behavior online.

To avoid problems, Dr. Greysen said, physicians should apply the same ethical and professional conduct online that they do in their daily actions offline.

“This may be a wake-up call to some doctors, not only to the value of Internet communication, but also to the dangers,” Dr. Chaudhry said.

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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Social Media Platforms and Techniques for Medical Practices | EMR and HIPAA

Social Media Platforms and Techniques for Medical Practices | EMR and HIPAA | EHR and Health IT Consulting |

In my previous post I talked about the benefits of using social media in a medical practiceand I said that the next post in the series would take a look at the tools, techniques, and social media platforms you should use to help you realize the benefits of social media. This will not be an exhaustive look at social media platforms or the way to get the most out of them. However, it will be a good place for you to start and will offer some techniques that those who’ve started might not have heard about.

First, a word of warning. When starting to work with social media, be sure to pace yourself appropriately. As you start working with a specific social media platform, you might want to start “sprinting” and dive really deep into the product. That’s a great way to develop a deep understanding of the platform, but it’s not sustainable. After doing a deep dive into a social media platform, find a sustainable rhythm that your practice can sustain long term.

Social media is a marathon, not a sprint.

Facebook – With nearly 800 million active users, it’s hard to ignore the power of Facebook. Given these numbers, the majority of patients are on Facebook and they’re likely talking with their friends about their doctors. Unlike many other social media platforms, most people are connected to their real life friends on Facebook. That means the focus of your work on Facebook should be to help your most satisfied patients be able to remember to share this with their friends as the need arises.

On Facebook this usually takes the form of a practice Facebook page that your patients can “like.” Invite your patients to like your Facebook page when they’re in your office or through your patient portal. You can even test some Facebook advertising using your internal email list to get your patients to like your page. However, the most important thing you can do is to make sure you regularly update your Facebook page with quality content. That way, they will want to like your page when they find it.

When it comes to content, put yourself in the shoes of your patients and think about what content you would find useful as a patient. Don’t be afraid to post things that represent the values of your practice, but may not be specific to your practice. In most cases, what you’re sharing on Facebook is more about helping that patient remember your practice as opposed to trying to sell them something. For example, it’s more effective to post something entertaining that your patients will like and comment on than it is to post some dry sales piece that they’ll ignore.

Twitter – Similar to Facebook, you want to create a two step process with Twitter. First, think about content you can post to your Twitter feed that would be useful to your patients and prospective patients. No matter what marketing methods you employ to increase Twitter followers, if your Twitter account isn’t posting interesting, useful, funny, entertaining, or informative content, then no one will follow you.

Second, find and engage with people in your area that could be interested in the services you offer. Finding them is pretty easy thanks to the advanced Twitter search. When you first start on Twitter you’re going to want to spend a bit of time on that search page as you figure out what search terms (including location) are going to be most valuable to your clinic. Sometimes you’ll have to be creative. For example, if you’re an ortho doctor, you might want to check out search terms and followers of a local youth rec league.

Once you find potential patients on Twitter, follow them from your account and engage with those you find interesting. Just to be clear, a tweet saying “Come visit our office: [LINK]” is not engagement. Offering them answers to their questions or links to appropriate resources (possibly on your website, blog, or Facebook page) is a great form of engagement. You’ll be amazed how consistently following and engaging with potential patients over time will build your Twitter profile. Once they’ve followed your account, you have created a long term connection with that person.

As I suggested in my previous post, Twitter can be a great way to find patients, but it can also be a great way for your practice to connect and learn from peers and colleagues. I’d suggest using different accounts for each effort. The tweets you create for each will likely be quite different so don’t mix the two. However, the same search and engagement suggestions apply whether you’re connecting with patients or colleagues. The search terms will just be quite different.

Physician Review/Rating Websites
There are dozens of physician rating and review websites out there today. Some of the top ones include: Health Grades, Angie’s List, ZocDoc, Yelp, Google Local, and many more. Which of these websites you should engage with usually depends on where you live. In most cases one or two of these websites are dominant in a region. For example, Yelp is extremely popular in San Francisco while Angie’s List is very popular in the south.

Discovering which one is most popular in your region is pretty easy. Many of your patients will have told you that they found your practice through these sites. However, you can also do a search on each of these services and see which ones are most active. A Google search for your specialty and city is another way for you to know which services are likely popular in your area.

Many of these sites will let you claim your profile and be able to respond to any reviews. Do it (although, don’t pay for it). Responding to reviews is a powerful way to engage your patients. If they post a bad review, keep calm and show compassion, understanding, and a willingness to help and that bad review will become good. Plus, that negative review could be an opportunity for you to improve your practice. If they post a good review, show gratitude for them trusting you as their doctor.

Once you’ve discovered which website is most valuable in your region, encourage your satisfied patients to go on that site and post a review of your practice. In some cases that might be handing the patient a reminder to rate you as they leave. In other cases, you might send them an email after their visit asking for them to review you on one of these sites. With mobile phones being nearly ubiquitous, a sign in the office can encourage a review as well.

There are hundreds of social media platforms out there today. However, if you focus on the platforms and techniques I mention above, you’ll be off to a great start. Mastering these techniques will make sure you get the most value out of your social media efforts.

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Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR

Has Epic Fostered Any Real Healthcare Innovation? | Hospital EMR and EHR | EHR and Health IT Consulting |

I think we could broaden the question even more and ask if any EHR vendor has really fostered healthcare innovation. I’m sorry to say that I can’t think of any real major innovation from any of the top hospital EHR companies. They all seem very incremental in their process and focused on replicating previous processes in the digital world.

Considering the balance sheets of these companies, that seems to have been a really smart business decision. However, I think it’s missing out on the real opportunity of what technology can do to help healthcare.

I’ve said before that I think that the current EHR crop was possibly the baseline that would be needed to really innovate healthcare. I hope that’s right. Although, I’m scared that these closed EHR systems are going to try and lock in the status quo as opposed to enabling the future healthcare innovation.

Of course, I’ll also round out this conversation with a mention of meaningful use. The past 3-5 years meaningful use has defined the development roadmap for EHR companies. Show me the last press release from an EHR company about some innovation they achieved. Unfortunately, I haven’t found any and that’s because all of the press releases have been about EHR certification and meaningful use. Meaningful use has sucked the innovation opportunity out of EHR software. We’ll see if that changes in a post-meaningful use era.

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Three Tips for Struggling Independent Medical Practices | Physicians Practice

Three Tips for Struggling Independent Medical Practices | Physicians Practice | EHR and Health IT Consulting |
Like many ideas, our consulting company wasn’t founded in a garage, but on a napkin. It was the blueprint of a consultancy that would focus on small practices: house-call practices. At that time, we were all executives with a national house-call group and the thought of leaving to start our own company was both thrilling and daunting.

There was considerable risk involved as private practices, and house-call practices specifically, are a small and highly volatile sector of healthcare. But here we stand, one year later, proving that sometimes the risk is worth the reward.

They say that the first year of any new business is the toughest, and we can second that. But the challenges we faced are not unique to our company. In fact, we believe that many independent practices might benefit from hearing about some of the challenges we faced, and some of the lessons we learned along the way. For our one-year anniversary, we've decided to share three of our biggest lessons. We hope they can benefit your practice in some way:

1. Stay flexible. While we originally set out to only serve the house-call market, we started getting inquiries from urgent-care centers, traditional family practice groups, and health. If we elected to work with them, were we losing our focus on the original mission? If we diversified, would we lose our identity as a unique consultancy? Ultimately, we made the decision to diversify and not only have we kept our unique identity, but our non-house call clients have created opportunities for our house-call clients.

Many practices stick to the traditional way of getting patient referrals such as brochures, events, word of mouth, and being part of a hospital. Those are fine methods but with the growing number of individuals who are getting insured that might not be enough to get ahead. One area to look at is sites that provide online appointment bookings through a third-party site. Many times when patients are looking to be seen by a physician they want an appointment that day or the next day. This is a great way to gain patients with little work of actual marketing. So, remember don't be stuck in your ways. Embrace technology.

2. Admit when something’s not working. This can be a tough subject, especially for small practices. We understand the pride in building something from nothing, but not every idea works out the way we hope it will. It could be something as small as changing your patient management software or as large as terminating a long-term employee who is no longer productive. We’ve been there ourselves, recently re-designing our website based on feedback we received from clients and potential clients. It doesn’t mean you failed, it just means it could be done better. We’ve also learned a lot from our clients on what they need, what their concerns are, and what we can invest in to better help them.

3. All work and no play makes Jack a dull boy. This isn’t a reminder to watch "The Shining." This is a reminder to take the occasional moment and have some fun. Your staff will appreciate it, and your turnover rates will decrease. We do it ourselves. We’ve organized a movie club, trivia nights, and other activities that allow us to unwind and come in the next day refreshed.
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SPOK Secure Texing App

SPOK Secure Texing App | EHR and Health IT Consulting |
Encrypted messages protect sensitive information
Separate inbox on smartphone immediately prioritizes business-related messages
Works using cellular and Wi-Fi networks
Supports iPhone® and Android® devices to accommodate personal preferences
Easy installation via an app download and registration
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The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting |
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data. One way to bridge this gap is through standardized role-based education.

Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort. Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT. As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.
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People Aren't Perfect and EHRs Can't Change That | Physicians Practice

People Aren't Perfect and EHRs Can't Change That | Physicians Practice | EHR and Health IT Consulting |
George W. Bush got one thing right and one thing wrong. He was right when he announced that he was "The Decider." He was wrong when he chose where he would get the information on which to base his decisions. He understood that he could never know everything about everything, therefore it didn't really matter if he knew nothing about anything, as long as he could apply his instincts for deciding to knowledge that was supplied and explained by others.

Keep that in mind while we think about healthcare practitioners. Being human, there are two things about which you can be sure:

1. People can't perform an operation flawlessly, in precisely the same way time after time after time; and

2. People can't keep track of (remember) all of the things that hallucinating managers and regulators think that they should.

It's just the way human brains are constructed. It may not be what anyone wants to hear, but it's a fact and no amount of wishing will alter the facts.

So, the worst thing that an EHR can do is to add to the number of procedures that people must perform flawlessly and the number of things that they must remember to do. Being the worst thing possible, that is, of course, exactly what most of them do do (and why some think that they are do-do).

Computer systems will never make good deciders and people will never make good robots.

For an EHR to be useful, it should focus on documenting events, keeping track of work in progress, and alerting people in useful ways when new information becomes available that might require a decision. Then it should present that new information, in context, so that people can make the best decision possible.

When the available information is skewed, biased, incomplete, or just plain wrong, bad decisions will be the result. When information that could be available is not available, the decisions that get made will be a total crap shoot.
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Keeping Up With Technology: A Must for Medical Practices | Physicians Practice

Keeping Up With Technology: A Must for Medical Practices | Physicians Practice | EHR and Health IT Consulting |
Still carrying around that BlackBerry you've had for the last five years? Still using Microsoft 2003 on that XP machine of yours? Still think the "cloud" is a fad? You might be doing yourself and your business a disservice if you answered "yes" to one or more of those questions.

Keeping up with the ever-changing world of technology is tough. Change can be hard. It's much easier to keep the status quo and ignore all the technological advances happening around you. The problem is, if you don't adapt and keep up with technology, you'll miss out on all the advancements and benefits it has to offer.

That trusty BlackBerry took too long to embrace touch-screen technology and missed out on creating a robust app store. The result is you can't check into your American Airlines flight on your phone, you can't use Hailo to get a cab, you can't access your Google Drive documents, and you can forget about looking up restaurant reviews on Yelp. Basically, even though switching to an Android or iOS device may be inconvenient in the short-run, the long-term benefits are well worth it. You'll have to learn how to use a new tool but that took has far more uses.

Technology in the workplace can mean the difference between a successful business and a failing business. Capable hardware and efficient software will keep your office running in tip-top condition and will allow your employees to focus on their jobs instead of troubleshooting their computers.

Look into Web-based programs that can be accessed remotely and that have export features that allow you to easily extract the data you need. Productivity suites like Google Documents are free and offer a comparable experience to the costly Microsoft Office standard (Google documents are compatible with MS Word). If you have to use Microsoft Office, don't skip on more than one major update. The difference between Word 2007 and Word 2010 is probably greater than you think.

The anxiety in introducing new technology to your office staff lies in the assumption that each employee has a different adoption threshold; some will "get it" and others will struggle. That's not as big of a hurdle as it's been in the past, as technology has become more uniform. Most people have a smartphone of some design, and many have households with smart TVs, multiple computers, and other universal technologies. Like all things, it may take a day or two for your staff to become comfortable with the new work flow, but your bottom line...and talent pool...will appreciate it.

In summary, don't be afraid to try new technology. If there's a hot new device or productivity program, there's probably a reason for it being so popular. Don't turn your practice into a technological ghost-town. Think about what your competition is doing.

In regards to technology, it’s good to be a leader and it’s also good to be a follower ... just make sure you’re one of them versus neither of them.
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Millennials want personal health records on the go | Healthcare IT News

Millennials want personal health records on the go | Healthcare IT News | EHR and Health IT Consulting |

Could younger patients be the key to achieving Stage 2 meaningful use patient access requirements? A new report finds strong desire for online medical records among the 18- to 34-year-old generation, with 43 percent of millennials saying they want to access their portals via smartphone.

In its fifth annual survey on the usage of electronic health records, Xerox sees more and more Americans expecting and demanding online access to health data. While aging Baby Boomers are showing keen interest in online access, Millennials are also increasingly expecting they can see their medical information where and when they want it.

The poll shows that the younger generation is much more interested in their medical records (to the tune of 57 percent) than any other content contained in online patient portals. They also say they'd like more personalized recommendations to improve their health and tips about additional services from their doctor (44 percent each).

The survey of 2,017 U.S. adults found that nearly two-thirds (64 percent) of those polled don't use online patient portals at all; still, more than half of that group (57 percent) say they'd be much more interested and proactive in their personal healthcare if they had online access to their medical records.

Many patients are unaware that such tools even exist, according to the report. Among those who don't use patient portals, 35 percent didn't know they were available to them and 31 percent said their physician had never mentioned them. Among Americans who do use PHRs, meanwhile, 59 percent say they have been much more interested and proactive in their personal healthcare since they received access.

"With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals," said Tamara St. Claire, chief innovation officer of Xerox's commercial healthcare division, in a press statement.

With Stage 2 meaningful use's 5 percent view/download/transmit requirements still vexing many providers, the survey suggests that better educating both Millennials and Baby Boomers about portals could help increase patient engagement, accoding to Xerox.

If Millennials expect easy and mobile access to health records and wellness data, Boomers are more interested in using online access to manage their chronic conditions -- and in even greater numbers than younger, arguably more tech-savvy patients -- the poll shows:

  • Those who don't use PHRs say they'd be more engaged in their care if they received access to medical information online (56 percent of those ages 55 to 64, and 46 percent of those ages 65 or older).
  • Those ages 55 to 64 accounted for the highest percentage (83 percent) of Americans who say they already do or would communicate with healthcare providers via a patient portal.
  • Some 70 percent of Boomers say they do or would schedule appointments; 64 percent access/review medical records/test results; 60 percent ask their physicians questions; 58 percent order prescription refills, and 40 percent request a referral.

Providers able to guide "different generations to take advantage of the information available at their fingertips" could see gains in meaningful use readiness and chronic disease management, said St. Claire in a statement. "Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way."

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Electronic Health Record Copy and Paste - Issue at Hand

Electronic Health Record Copy and Paste - Issue at Hand | EHR and Health IT Consulting |

Healthcare personnel are using the copy/paste function in the EHR systems which are a cause for concern.  It has created a serious compliance and payment problems. The technology allows information to be quickly copied from one document into another with the idea being to reduce the time a physician spends typing.  This copy/paste action is also known as ‘cloning’ . The EHR copy and paste function is leading to fraud and abuse of the EHR system. Here are some of the

  • The Electronic Health Record copy and paste technique is being used to get higher reimbursement by upcoding patients’ medical conditions. Medicare is being overcharged and this abuse is running into millions of dollars.
  • Another issue is that as doctors are routinely copying information from one file to another to save time, it may happen that the data they enter is not relevant or even erroneous. A recent article in Healthcare IT News reported on the case of a patient who had a “family history of breast cancer” wrongly entered as “a history of breast cancer”. She almost lost her health coverage because the payer thought she had lied on her initial forms.
  • There have been cases when a physician copied information from one patient record into another patient’s record.

According to the inspector general’s office, Medicare has failed to provide proper instructions to the contractors who handle payments on how to ascertain fraud arising from EHR implementation. It also found that up to 75% of hospitals surveyed had no formal policy regarding the use of cloning.

Efforts to Resolve Medical Billing Errors and Fraud

The American Health Information Management Association says that cut and paste is one of the best ways to manage the documentation process.

Right now we need to find ways to address the flaws in the Electronic Health Record System. Medicare is proposing the following ways to address this cloning issue:

  • Creating better standards and systems for validating electronic health records, which ensures the proposed benefits and at the same time protects taxpayers from fraud and abuse.
  • Developing guidelines and systems for Medicare contractors to identify cases of  fraud by closely reviewing changes to specific patient documents.

It is important to educate and alert staff on the appropriate use of the copy/paste function. It can be used for copying patient regular medications, chronic allergies, demographics, problem lists and labs and treatments – if these are ongoing and the same from visit to visits. The use of internal audits is also a tool to help find errors so that they can be corrected right away.

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Should physicians use the ICD-10 delay to learn how to code?

Should physicians use the ICD-10 delay to learn how to code? | EHR and Health IT Consulting |

As the healthcare industry comes to grips with the reality of yet another ICD-10 delay, providers must turn their attention back to completing the arduous conversion process, albeit with another year of prep time.  The additional twelve months will give physicians more time to get used to clinical documentation improvements and new technologies.

But Ron Rosenberg PA-C, MPH, President of the Practice Management Resource Group, believes physicians should also invest some serious effort in getting to know ICD-10 a little more intimately than many providers have planned.  Rosenberg spoke to EHRintelligence about how physicians should embrace a more complex role in the ICD-10 conversion if they want to see success in 2015.

What are the most pressing challenges involved in the ICD-10 conversion?

The biggest risk for the provider, of course, is not getting paid.  So the big challenge is learning the ICD-10 system, and then the second challenge is making sure your technology will accommodate the system, and that technology really falls into several categories.  The first is the tools you need to select the right code, and then the second is learning how you capture those codes into your billing system, and number three is making sure you get paid.  So to me, those are the big challenges.

How should providers address the education and workflow changes associated with ICD-10?

From my perspective, diagnosis coding is a clinical exercise.  It’s not an administrative exercise. And my bias is that the provider should be assigning the ICD codes: ICD-9 now, and ICD-10 in the future.

I mean, it’s a clinical decision.  Knowing what the diagnosis should be is a clinical decision.  Now, whether the physician documents the patient’s issues, and then somebody else codes the ICD-10 or the physician actually identifies the proper ICD-10 code…that may be arguable.  But ultimately, the physician is the one that has to assign a diagnosis.  And from my perspective, when you look at workflow, it just seems to be much more efficient to have the physicians either completely or partially identify the ICD-10 code.

So for instance, it may be that the physician assigns the first four digits to get in the ballpark, and then somebody else can go down to the last three digits, or the physician should assign the whole thing.  That is going to be up to the provider based on what their practice style is, but it’s really up to the physician to get it into the ballpark.

What would you say to physicians who feel like dealing directly with the code sets is outside their job description, or that they don’t have the time to do so?

What I found is once a clinician gets their hands around the structure and the taxonomy of the coding system, they say, you know, it’s not really that different than ICD-9.  Yeah, there is more specificity, and I may want my coders to be the ones to put in the laterality and the first visit, second visit.  But finding the right first four digits is really not much different.

I hate to use an old, old analogy, but when I was in PA training back in the 1970s, some of the first healthcare informatics was being done at the University of Vermont, and I trained nearby at Dartmouth.  They were developing computer algorithms for diagnoses, and they figured that would be a great way for a PA to be able to assist in the decision making.  And one of the things they found, much to the chagrin of the computer programmers, was that after about the first three tries, the algorithm became embedded in your memory.  You didn’t need the computer anymore.  So I guess that’s a long-winded way of saying that the physicians that have looked at the system and looked at the codes are finding that it’s not quite the big deal that they thought it was going be.

And when I say “learn the system,” I’m not talking about memorizing 75,000, 80,000, or 90,000 codes. I’m talking about understanding the structure and the taxonomy of it.  Many providers might decide that, given their practices setting and given the resources that they have, somebody else should do the coding.  Fine, but they shouldn’t just do it as a knee-jerk, “I don’t want to have to deal with this.”

How will specialists handle the switch?

It’s going to be a difficulty for many specialists.  Primary care physicians really have a challenge with ICD-10 because the universal codes are so huge for them.  But if you take a specialty like ophthalmology or cardiology, one of the places where they’re going to have difficulty is comorbidities.

In other words, you may have a set of 50 or 60 core ICD-10 codes for an ophthalmologist.  But when you start then adding in diabetes and cardiovascular disease and everything else that might also be affecting a patient, then that could be more problematic.  Maybe that’s something that your coder needs to look at because that could really add to the patient visit and add value to the clinical note.

What effect will the newly announced one-year delay have on ICD-10 preparation?

I don’t think it’s going make a difference.  In other words, providers would have been ready October 1, 2013.  They would have been ready October 1, 2014.  They’ll probably be ready in 2015.

From the software perspective and the payer perspective and claims adjudication perspective, I think it’s a much bigger deal.  And I’m sure a lot of them are very upset about this delay because they put all their resources into it already.  But if somehow the carriers aren’t ready, you know, it could have a disastrous disruption in cash flow.

It’s kind of like back in the day, when cameras had real film in them.  You would take pictures, and then you would wait breathlessly for the film to come back from the developer to see if you got anything, because you just didn’t know.  It’s not like a digital camera where you know instantly if you got the perfect shot the first time around.

And I think the go live date, whenever it is, is going to be the same way.  Everybody will be holding their collective breath.  The cost of any kind of fumbling on the part of the payers, or the systems companies, is really going to be placed on the shoulders on the practices. It would be wonderful if payers would do something like a dual coding system in the month of August, for example, where you could submit both sets of codes, and so everyone could test real-time.  Because the testing that’s going on hasn’t been universal. It’s still going to be a collective intake of breath.

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Role of Integrated EHR Technology in Solving Fragmented Care |

Role of Integrated EHR Technology in Solving Fragmented Care | | EHR and Health IT Consulting |
Authors of a recent Harvard Business Review article claim that integrated care hold the key to resolving fragmented healthcare in the United States.

Pioneering healthcare organizations demonstrate that it is now possible “the integrated-care model and accelerate its adoption more broadly and deeply across the American health care system.” This according to the Institute for Healthcare Improvement and Weill Cornell Medical College’s Kedar S. Mate, MD, and the Permanente Federation’s Amy L. Compton-Phillips, MD. Kaiser Permanente just so happens to be one of them.

Along with aligning payment with integrated care and other measures, the authors of “The Antidote to Fragmented Health Care” identify the creation of universal EHRs a means of achieving an end to fragmented care:

The lack of a single health record for each patient that clinicians from all specialties can access in both inpatient and outpatient settings is an obstacle to integrating care. In addition, patient privacy protections inhibit the sharing of health information, creating both perceived and real hurdles. Back in the 1990s, the U.S. Veterans Administration developed an electronic health record (EHR) that linked information across venues of care and provider specialties. This early work showed that linking clinicians electronically was transformational.

In addition to the example of the VA and its Veterans Health Information Systems and Technology Architecture (VistA) EHR, the authors highlight the positive experiences of EHR end-users at Kaiser Permanente:

Kaiser Permanente has an EHR that is shared by primary care doctors and specialists who work in hospitals and offices and is also used by nurses, pharmacists, physical therapists, and nutritionists. Their ability to collaborate electronically with patients in their homes and with each other using tools such as electronic consultation has fundamentally changed the way medicine is practiced at KP.

While these examples do make a case for integrated EHR technology, they are short on details about the two EHR technologies being used by providers at the VA and Kaiser Permanente.

Kaiser Permanente is using an Epic EHR although it is one that bears the marks of its own optimizations and enhancements. As noted in a report earlier today, the costs of implementing and maintaining an Epic EHR “are significantly higher than comparable competitor products, and, in at least one study, did not produce savings for payers” based on research published in the Journal of the American Medical Informatics Association. Not all healthcare organizations have these kinds of financial resources at their disposal or the expertise necessary for running this EHR technology effectively.

The example of the VA should raise additional doubts about the concept of a universal EHR. Without taking the Phoenix scheduling fiasco into account, the VA is facing significant pressure from Congress to modernize its EHR platform and achieve interoperability with the Department of Defense’s platform, when one is finally chosen.

The longstanding lack of interoperability between the two departments continues to be an obstacle preventing the records of DoD patients moving seamlessly into the VA’s EHR platform. And even with billions of dollars in funding from the federal government, no solution is in sight.

The EHR marketplace is full of players with products capable of supporting a provider’s pursuit of meaningful use and other financial incentives and still health information exchange varies by region and interoperability remains elusive. Technology is only one component of the authors’ vision of integrated care, but it is much more complicated than they demonstrate.

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iPad & iPhone EHR Medical Records Apple Touch ID

iPad & iPhone EHR Medical Records Apple Touch ID | EHR and Health IT Consulting |

Apple now introduced the biometric “Touch ID” onto the new iPad, latest iPad Air 2 and the iPad Mini 3.  Touch ID is also on the iPhone 5s, iPhone 6 and iPhone 6 Plus.

What is Touch ID? Touch ID is a little biometric finger print reader on the new iOS devices:

  • iPad Air 2
  • iPad Mini 3
  • iPhone 5S
  • iPhone 6
  • iPhone 6 Plus

With Touch ID, you can now do more with just the touch of a finger, you can log in and verify identity in logging into apps. Touch ID is that little metal ring around the home button on the new iOS devices.

With the introduction of “Touch ID” onto the new iPad we have added something amazing. With three taps you can get into a medical record. You will touch once with Touch ID to get into the iPad, tap the drchrono EHR app, once the app is launched, then with Touch ID, get into their EHR. Only three taps, no typing a passcode.

This video show off Touch ID in action:

This feature was also added to the onpatient Personal Health Record.

This video shows off Touch ID on the PHR in action


The great thing about Touch ID is that it only takes a few minutes to setup. To setup Touch ID EHR follow this video, this video applies to all iOS devices with Touch ID, in the video I am showing how you can use an iPhone 6 to setup Touch ID EHR, it is the same for the new iPad Air 2 and iPad Mini 3:

I spoke about Touch ID a number of months ago, it is now a reality and changing the world.

The amazing thing about Touch ID is that people sometimes forget password and pin codes. This changes the game even more of touch technology in healthcare.

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As Adoption Slows, the Market Must Embrace EHR Interoperability |

As Adoption Slows, the Market Must Embrace EHR Interoperability | | EHR and Health IT Consulting |

While medicine is a field focused on helping and healing, at the core of every major industry lies a cold, hard truth: money must be made in sufficient quantities to develop new products, satisfy investors, and employ staff. For many years, EHR vendors have worked to satisfy both sides of the equation, delivering health IT that improves care quality while carving out profits in a market that saw sudden, explosive growth after the EHR Incentive Programs debuted in 2009.

But as EHR adoption and purchasing has started to slow due to the impending saturation of the first-time buyer’s market, vendors are becoming slightly more creative in the way they keep their coffers full, and that often comes at the expense of cash-strapped healthcare providers who are now tied into using EHRs to meet federal expectations. Even though interoperability is becoming an increasingly important part of the EHR landscape, there is an inherent tension in the industry between the adoption of interoperable data standards that promote sharing and the vendors who wish to ensure the loyalty – and continued payments – of their customers.

As the health IT ecosystem matures and providers begin to leverage their data assets in different ways through the growth of analytics and ancillary systems, some EHR vendors have decided to make the storage, transmission, and use patient data into an asset of their own. While the question of data ownership is not a new one, the focus on industry-wide EHR interoperability thanks to efforts from the ONC and other organizations is placing renewed scrutiny on how vendors keep healthcare providers on a short leash by using fees and pricing scales to tie up patient data in inventive and potentially counterproductive ways.

“The vendors are very aware of the way the fees and complexity affect this move towards EHR interoperability,” says Justin Lanning, Senior Vice President and Managing Director of Analytics at Xerox Healthcare Provider Services, and there are few restrictions on the federal side related to how vendors can structure their fees, upgrades, and caveats.

“Sometimes hospitals, even the bigger ones, have to pay thousands of dollars for data sharing capabilities to be turned on or supported.  That can be a significant challenge for some organizations.  I believe it is key for us to assure that the systems already purchased and invested in provide interoperability as part of the system, and not at extra extraneous fees or complexity.”

“Everybody can go get certified, [through the ONC] and they can get certified by module,” Lanning explains. “But the certification process isn’t robust enough. It just doesn’t require enough to get recertification. And then once you get that certification, there’s no part of it that says you have to sell your modules individually. If a vendor collects a certain amount of data, and I show that they can integrate functions just fine with their own CQM module, they can get through certification.”

“But then the vendor can go to a hospital and say, ‘Here’s your EHR and it’s extra for the CQM module. It’s all certified.’ And the hospital says, ‘Well, I don’t want to use your CQM module. I want you to exchange data with this other CQM vendor.’ The vendor will come back and say, ‘We can’t do that unless you buy our CQM module first and they we will exchange data with the other CQM vendor.’ That doesn’t make any sense at all, but since there are no restrictions preventing this behavior that’s how they bundle their capabilities. So we’ve got to work that out.”

Despite a continued interest in EHR replacements that is driving a significant portion of sales as organizations seek to install software that will help them through Stage 2 of meaningful use, EHR vendors that grew rapidly over the past five years need to maintain a certain level of income from their customers if they are to stay afloat.

“With the billions of dollars we have invested privately and as a government with taxpayer dollars to improve the electronic foundation of our healthcare management systems, most of the US market has already made their choice on their long-term EHR partner,” says Lanning. “We likely won’t be seeing big shifts of US based hospitals changing their EHR systems over the coming years. Rather, we are entering a time in the US market of focusing on improving and integrating our existing systems. As we are seeing with many of the public and private EHR companies, a lot of their big growth opportunity will come internationally when it comes to new system sales.”

Some vendors are seeing the business potential in interoperability by joining organizations like the CommonWell Alliance, which is turning data sharing into a saleable service, or working together on the Argonaut Project in response to recent recommendations to the ONC. Surescripts is another health IT vendor that is seeking ways to pry a profit from encouraging health information exchange, and a number of HIE organizations on the local or state level are also striving for similar results.

The ONC and Federal Trade Commission (FTC) recently stated their belief that competition among EHR vendors will eventually lead to interoperability instead of the opposite, as the free market tips the vendor community into giving providers what they want: the ability to seamlessly and affordably exchange vital health information with partners across the care continuum.

“I do feel we need to shift, at this point, from thinking vendors growth will come from charging and often over-charging for many different areas of system functionality and integration that should simply be a part of these expensive systems,” Lanning said. “Some vendors feel that by making it harder to integrate with other vendors, health systems will choose to spend their money on all of the other little things they need to with the same vendor. But health systems are beginning to demand the integration for the flexibility they desire, and we must respond as a market.”

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Lessons learned from an award-winning EHR system replacement | Healthcare IT News

Lessons learned from an award-winning EHR system replacement | Healthcare IT News | EHR and Health IT Consulting |

In 2012, ARcare undertook a fast-paced transition to a next-generation electronic health record system. Less than two years later, ARcare was nationally recognized, receiving HIMSS Analytics' Stage 7 Ambulatory Award, the highest HIMSS honor for EHR adoption.

ARcare, a private, non-profit corporation providing primary care in rural Arkansas and Kentucky through a network of clinics, pharmacies and wellness centers, is the first Federally Qualified Health Center – and was one of only two ambulatory practices not connected with a hospital – to receive a Stage 7 ambulatory award.

On the way to a successful implementation, ARcare learned a great deal about the relationship between ongoing physician involvement and final clinical training – information that may help our peers who are moving forward with similarly ambitious systems replacements.

Managing change during the transition

ARcare’s system replacement involved moving from comparatively basic EHR use to a more comprehensive system with clinical event functionality that would enable us to better manage patient conditions across multiple care venues. A primary goal was to have the system drive orders and events rather than merely document clinical activity.

Migrating to next-generation technology across an enterprise requires significant IT resources, training, management support and workflow changes. Our strategy was to tie these elements together with a carefully constructed change-management plan, in which a highly experienced, multi-disciplinary team with C-level support facilitated all aspects of system adoption. The change-management team was tasked with creating a continuum of sustained change with a primary focus on improved patient care, stripping away governance of information silos. In this spirit of change management, each identified issue was relevant to the team – rather than individual roles – without regard to reporting structures.

The importance of keeping physicians in the change-management loop

Although ARcare achieved significant success in the arena of change management from an IT perspective, and within an aggressive timeframe, we also found in hindsight that keeping physicians in the loop throughout the transition can simplify clinical training during the final stages of implementation.

While ARcare actively sought input and buy-in from physicians on the front end of the transition, our sensitivity to the demands on physicians’ available time led us to remove most of them from the actual transition process, preserving involvement to a select few clinical staff members as physician representatives. While physicians remained involved to provide input to the new standardized workflows required by the new system, most of them had minimal exposure to the new system prior to clinical training.

The scheduled training sessions involved the clinical staff who were part of the change-management team performing training duty: nurse practitioners training other nurse practitioners and physicians training other physicians. We had anticipated this to be one of the easier tasks of implementation, and hadn’t fully accounted for the learning needs of clinical staff.

Although our physician leadership group requested they be the trainers, it soon became apparent that many healthcare professionals are simply uncomfortable voicing the need for additional help, especially to their peers. We also learned that having select clinical staff involved in the overall process didn’t necessarily translate directly to building teaching skills; the ability to understand complex technology and to teach its use are quite different. We decided to revisit training with the assistance of our own KMS – knowledge management systems – education team.

Getting clinical training back on track

Together with the KMS education team and led by four top instructors, we created a new, three-day program that integrated training for physicians, nurses and physician assistants.

Working in small groups, clinical staff participated in the training program, which was rolled out across facilities in series. Feedback gathered at the end of each training session helped to improve each subsequent session. Satisfaction increased quickly and steadily, and ARcare has continued to provide training updates on a regular basis to ensure continued optimal performance.

Well worth the effort

Five months after going live with our new system, ARcare became the first ambulatory practice that was not part of a hospital to achieve Stage 6 on the HIMSS Analytics EMR Adoption Model. One year later, we became the first FQHC to achieve the highest level of EHR usage, Stage 7.

The overall experience helped the organization recognize and develop an appreciation for the fact that change can and should be a positive experience. ARcare has developed a level of confidence across the organization where employees are less reluctant or fearful of change, and where learning from failure produced valuable outcome – not just in successful training, but in the successful adoption of a new Greenway Health EHR that brought with it substantial benefits, including:

  • Improved patient management with better information access for providers and clinical event management that drives events and orders, computerized provider order entry and closed-loop medication administration, and other advanced functions that improve patient care
  • The ability to exchange data directly with the state health department
  • Streamlined access to patient records across the network of primary care clinics, dental clinics, pharmacies and wellness centers

During the transition to the new system, ARcare successfully converted more than 17.2 million records, including clinical notes, images and test results. Now, when ARcare identifies and secures a new clinic site, the new site can be completely operational from an IT perspective in 30 days or less thanks to advanced system capabilities for scalability and extremely fast implementations. As of today, the system provides paperless charting and order entry for 37 ARcare clinics.

In all, it’s been a very satisfying transition in which the gains were well worth the pain – pain that can be avoided by following the lessons learned in ARcare’s approach and re-working of clinical training. In short: It’s all about identifying an effective training team.

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EHR Data, Decision-Making Ultimately Lie in the Patient’s Hands |

EHR Data, Decision-Making Ultimately Lie in the Patient’s Hands | | EHR and Health IT Consulting |

Patients should have the right to control their own healthcare and their own EHR data regardless of a provider’s opinions or disagreements, state David Blumenthal, MD, MPP and David Squires, MA in a commentary published in the Journal of General Internal Medicine.  Even though some patients withhold critical information from their physicians or refuse to comply with treatments, clinicians are nothing more than “guests” in a patient’s life and must act with respect and understanding, the authors say.

The question of whether patients should be able to control the information in their electronic health records (EHR) provokes strong opinions, says Blumenthal, a former National Coordinator for Health IT and current President of the Commonwealth Fund.  “Some argue that the information rightfully belongs to patients, and they should be able to decide what is recorded and who can access it. Some clinicians, however, argue that because they have a duty to provide their patients with the best possible care, doctors should have unfettered or nearly unfettered access to any information needed to meet that obligation.”

Blumenthal and Squires, a senior researcher at The Commonwealth Fund, come down on the side of the patient’s rights to make their own choices about the quantity and completeness of the data they share with their clinicians, as well as the access, use, and transmission of information stored in their EHRs.

As privacy and security concerns continue to affect the way patients view the use of EHRs, patients must be properly educated about data security, health information exchange, and the benefits of providing complete and accurate data to their physicians.  Providing this education is a “considerable challenge,” the authors note, as many patients do not understand the details of how data is exchanged between providers or even what privacy protections are built into HIPAA.

While patients may have the right to withhold information based on these concerns, incomplete or incorrect data can have significant impacts on a patient’s health and wellbeing in unanticipated ways.  “A patient’s decision to withhold data about a sensitive medication—such as a psychotropic or HIV-related drug—may have later consequences that neither patients nor clinicians could have anticipated,” Blumenthal and Squires write. “Beyond this, when evaluating a patient, experienced clinicians often rely on an array of data, including information not obviously related to the current problem, to raise and evaluate hypotheses about diagnosis and treatment.”

EHR developers are still working to refine and implement technologies that deal with patient consent for the sharing of specific pieces of information, such as HIV status, sexual orientation, or mental health diagnoses.  Even when these capacities are more mature, the authors point out, there will always be instances when clinicians feel they must override a patient’s wishes in order to provide proper care or protect other patients from communicable or infectious disease.

However, Squires and Blumenthal caution providers who wish to assert their unrestricted rights to a patient’s health information that “if patients do not trust the health system to protect them, their relationships with their clinicians will suffer, they will withhold information, and the value of the health information contained in the EHR will be undermined. In the long run, clinicians as well as patients will benefit from a health information system that patients feel they can depend on to protect their privacy.”

As EHR adoption reaches the majority of healthcare providers and the tension over issues of consent, data exchange, and data usage become more complex, these questions will continue to prompt discussion among healthcare professionals on both sides of the argument.  “Continued research on how to inform patients, support their choices, and understand the consequences for their care is essential,” the article concludes. “And while caution cannot be thrown to the wind, our prejudice should be to give patients a chance to express their views, and then abide by those as best we can.”

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Seven Ways PAs Strengthen the Team, Deepen the Bench | Physicians Practice

Seven Ways PAs Strengthen the Team, Deepen the Bench | Physicians Practice | EHR and Health IT Consulting |

Physicians often ask me whether they should consider hiring a PA and how to integrate one into their practice.

Much like a sports team’s game plan, every practice functions differently. But if you need to draft a new player, consider what areas of your practice could use some relief and what skills that player needs to complement your practice. A PA can be the leadoff batter, collaborating partner, supporting player, or the rebounder.

At the core of PA training is team-based care through the medical model. We practice with our physician partners and enjoy being the all-around players that execute the fundamentals of medicine in a way that expands the team’s capabilities, resources and positive outcomes.

Here are seven ways PAs may benefit your practice:

1. Make room for more patients. If you are already working overtime, another provider may be the only way you can grow your practice. For services that are incident-to a physician’s services, the reimbursement rate is at 100 percent. For other services, reimbursement is 85 percent of physicians' fees. Our ability to see our own panel of patients, or share yours, will generate revenue and more than cover the cost of our salary and benefits.

2. Free you up to handle the most-complex medical cases or those that will generate more revenue. For example, surgeons want to operate and can turn over some of the pre-op and post-op care to PAs.

3. Improve your work-life balance. Having a PA manage patients with chronic conditions, help manage phone calls, and share other responsibilities can give you back hours in your day.

4. Give patients what they want. Patients want to spend time with their provider, and you want to extend this coverage so patients feel good about their care. When you and a PA work as a coordinated team, patients will not feel slighted if you do not see them on each visit.

5. Assume administrative roles. PAs can create wellness programs, initiate and lead group appointments, and perform as lead PA or the clinical interface to the business office.

6. Improve care coordination. PAs can help you coordinate care between your office and other providers or locations, for example specialists, physical therapists, or hospitals/outpatient surgery centers.

7. Focus on CMS requirements. There are many new requirements for quality outcomes, EHR use, and patient engagement. A PA can give the team the additional knowledge, skills, and time that it needs to hit these goals.

Currently there are approximately 100,000 certified PAs in the United States. According to the National Commission on Certification of Physician Assistants (NCCPA), every week certified PAs work 3.8 million hours enabling them to increase healthcare access by treating 7 million patients in every clinical setting across the U.S.

PAs can increase team wins:
Ultimately, patients seek healthcare from providers with whom they are most comfortable and get the best service. PAs can help meet the needs of your most demanding patients, deliver on quality and satisfaction targets, and increase revenue.

So if you are considering adding a player to your team, now is the time to make your move. Assess current strengths, determine skills needed, and draft a PA to be the utility player, who can help bring your team to the next level.

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How to Deal with an Annoying Medical Practice Coworker | Physicians Practice

How to Deal with an Annoying Medical Practice Coworker | Physicians Practice | EHR and Health IT Consulting |

It can be hard to get over things that get under our skin. While colleagues are often oblivious to their irritating habits, the rest of us go stir-crazy looking for ways to ignore their eccentricities. Unfortunately, it seems the more we try to minimize their mannerisms the more magnified those mannerisms become.

How can you diplomatically deal with other people's peculiarities? These suggestions will equip you to cope with three kinds of irksome quirks.

1. Frustrating physical habits

Even when there are medically sound reasons for someone's repetitive throat clearing, nose sniffling, or deep sighing, being around a person with these chronic behaviors can be off-putting.

When dealing with someone exhibiting these habits, it's best to begin by presuming they have an underlying condition such as GERD or post-nasal drip. You can explore this by asking if they are even aware of their persistent sniffles and sighs. Though you're not in the position of being a diagnostician in this circumstance, it may be appropriate for you to suggest they mention these symptoms to their physician. While they explore potential diagnoses, you need to grin and bear it.

It can be equally challenging to cope with idiosyncrasies like habitual whistling, humming, and tabletop drumming. What brings a grin to one person's face can grate on another person's nerves.

Once a medical cause for these behaviors has been ruled out, you can cautiously proceed to the next step; letting them know that you find their habit distracting and asking if they can please try to control it.

Whether the irritating issue is medical or melodious in nature, you must be sensitive when you bring it up. It's better to have a respectful, private conversation with the offending party than to reach your breaking point and shout, "Stop doing that! You're driving me mad!"

2. Exasperating emotional habits

Two common emotional habits that get old fast are chronic complaining and colleague parenting. What is colleague parenting? That's when someone constantly questions and advises you by saying things like, "Have you taken a break for lunch yet? You need to eat!" or, "What took you so long? You should have been able to examine that patient in two minutes."

In their minds, these "helicopter coworkers" have your best interests at heart. It just doesn't feel that way when you're on the receiving end of their coddling. You can nip this behavior in the bud by letting your colleague know that you're perfectly capable of taking care of yourself and there's no need for her to oversee your routines. Keep in mind that these caring people can be easily hurt if you're too harsh, so soften the blow by pre-empting your comments with a word of thanks for their concern.

Chronic complainers are more challenging to deal with because they tend to see the world through ipecac-colored glasses. Usually, nothing you can say or do will sway their glass-half-empty perspective. You can only get past their doom and gloom by focusing on your own positive attitude. The downside to this is that the chasm between your perkiness and their pessimism may continue to grow, putting you in the position of becoming yet another thorn in their side.

3. Conflicting communication habits

Failure to listen leads to failure to thrive — in relationships, that is. Some people are so anxious to express what's on their mind that they'll routinely cut to the chase by interrupting or finishing your sentences for you. Others, who have less confidence in their communication skills, may mumble or become mute when asked to chime in.

When someone interrupts you, make eye contact while raising your hand a bit and say, "Please let me finish this thought and then the floor is all yours. Thanks." If that doesn't work, take the oral offender aside and politely inform them that in future you'd appreciate the chance to say what you have to say before they interject with their point of view. You may need to reinforce this appeal by reminding them about your request each time they verbally butt in.

When dealing with people who are less communicative, invite their input by asking direct questions and engaging them in conversation. They may feel intimidated or insecure, but the more dialogue you can create, the more expressive they're likely to become. You can gain their trust by letting them know how much you value their contribution to the conversation.

No matter what annoying habits are bothering you, there's no need to sacrifice your saneness by staying silent. But before speaking out, take a look at yourself. Is there anything you're doing that might be irritating others?

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CMIO role evolving in wake of EHR implementation

CMIO role evolving in wake of EHR implementation | EHR and Health IT Consulting |

Healthcare organizations tend to be unclear about what the chief medical information officer's role is after the implementation of electronic health record systems, according to an article at Healthcare Informatics.

Chris Wood, M.D., CMIO of Loyola University Health System in Maywood, Illinois, is a "second-generation CMIO." Wood, who last summer came from a position as medical director of information systems at Intermountain Healthcare in Salt Lake City, advocates that CMIOs should be leaders in determining the future of the position.

"This is a new functionality that the entire health system is looking at. Instead of doing procedure after procedure, we have to step back and ask what is best for the patient, and how we can get rid of waste, improve quality and lower costs. If you are passionate about it, find ways to go out and get training," he says in the article. "You are better positioned than people who don't have that informatics background."

Since Loyola has years of EHR use under its belt, Wood says he sees his job as helping clinical staff gain more useful insight from the data being generated.

Wood reports to a chief of operations, but also works closely with the chief quality officer--who runs a center for clinical excellence and studies all the metrics reported to state and federal government and to private payers.

"He has data needs. Clinical programs trying to drive out waste individually have data needs. Researchers at the med school have data needs. The CMIOs who can partner with the most important clinical business goals of the organization are going to succeed," he tells Healthcare Informatics.

Improving care requires a greater willingness to share information and interoperability between systems, Sutter Health CMIO Christopher Jaeger said in an interview at Becker's Hospital CIO.

Just as in the case of healthcare chief information officers, workload and responsibility are growing for CMIOs, which could explain why fewer say they're satisfied with their jobs, though recently their salaries have increased.

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Six Action Items for Every Medical Practice in 2015 | Physicians Practice

Six Action Items for Every Medical Practice in 2015 | Physicians Practice | EHR and Health IT Consulting |
We have all experienced a multitude of changes to the healthcare industry in the last year, and that trend of constant change is going to continue into 2015. The medical practices that thrive in the new healthcare environment will be the ones that take a proactive approach to managing these changes.

Here are six action items I recommend for every practice in 2015:

1. Develop your patient portal. Clearly patients today desire the ability to know more about their issues as well as communicate more to their practitioner. Long waits both in the waiting room and when attempting to make appointments has damaged patient relationships while also creating numerous communication gaps. The family practice that communicates more effectively with patients will gain more referrals and be more highly respected within the community. In the coming year, focus on developing your portal and promoting its use to patients (or purchasing one if you do not have one). Many portals allow patients to order medication refills, obtain lab and test results, and even e-mail staff about appointments or schedule changes. The new technology creates not only better communication, but also less need to request an appointment because data is available online.

2. Implement an EHR, if you don't already have one. If your practice does not already have en EHR, it's time to get one. While there are many practitioners still using files and travel cards, EHRs provide better efficiencies for billing, reimbursements, audits, etc. Admittedly, there are more systems (so it seems) than doctors, but acquiring an EHR allows better practice efficiencies and perhaps more money for the practice.

3. Develop your website. Doctors in 2015 need to think in terms of the patient. On the day I wrote this article, I found that 1.67 billion searches had been made on Google. Doctors and their practices will be required to develop and implement websites so that patients can find them. True, many insurance companies refer prospective patients to physicians, but the fact remains that most patients conduct their own research. A great website will ensure that patients find you.

4. Get active on social media. As of January 2014, 74 percent of Internet users used social networking sites, according to the Pew Internet Project. Understand that not every form of social media is useful, but doctors and staff that engage in social media will create pockets of community to discuss the doctor and help with external marketing efforts. Additionally, social media forms such as Twitter or even Facebook enable staff to communicate messages to patients such as, “The doctor is running late," or, “The office is closing early due to inclement weather."

5. Prioritize cyber security. Many medical practices have very limited knowledge and resources to consider cyber security, but they must. The 2012 Data Breach Investigations Study by Verizon shows that in 855 data breaches they examined, 71 percent occurred in businesses with fewer than 100 employees.Similar to the manner in which many large corporations have prioritized cyber security, so must medical practices.

6. Pay attention to your reputation. According to one survey from practice management research group Software Advice, 62 percent of respondents said they turn to online reviews in order to find a new doctor. These review sites include Healthgrades Yelp, Vitals, ZocDoc and WebMD. Doctors that become more attentive to these sites will protect their reputations because they can monitor both positive and negative comments. Those that are more attentive to their reputation will have better searchable results on the Internet as well as have more visitors in the waiting and treatment rooms.
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Four Ways Your EHR Can Improve Patient Engagement | Physicians Practice

Four Ways Your EHR Can Improve Patient Engagement | Physicians Practice | EHR and Health IT Consulting |
EHRs are often blamed for a decline in patient interaction, as some physicians are forced to spend more time looking at their screens and less time making eye contact with their patients. However, if leveraged properly, EHRs can actually allow for more effective interactions with patients during visits. The result will be a more collaborative form of care.

Here are four specific ways that physicians can use EHRs to enhance patient engagement:

1. Take advantage of your patient portal.

The patient portal can play a big role in increasing patient engagement since it is a secure repository and communication tool for a practice. It is a tool that both physicians and patients can actively use for sending/receiving reminders for preventative or follow-up care, sending patient education materials, receiving patient questions and requests, scheduling/changing appointments, and more.

A patient portal can be extremely beneficial to patients because it allows them to actively manage their care and can also help solve their common pain points. For example, getting lab results has traditionally been a tedious process, but the ability to access results on-demand through a portal can be a huge time saver for patients.

2. Leverage solutions that extend your EHR capabilities.

There are various forms of technology that can help physicians achieve a higher level of patient engagement, working in conjunction with your EHR, such as interfaces connecting to other products or solutions.

John SquireJohn Squire For example, using speech recognition software can increase the speed and accuracy with which patient records are created. As a result, physicians have more time to interact with patients in the exam room during visits. According to a 2014 Medscape EHR report, 70 percent of respondents said their EHR "decreases their face-to-face time with patients." Leveraging speech recognition software can allow physicians to directly combat this common barrier.

Laboratory, radiology, and medical device interfaces can also help support patient engagement — these interfaces allow physicians to automate their work flow, and import results into patient portals for patients to access at their leisure. Additionally, there are features built into many EHRs that physicians can leverage to encourage patients to be more proactive in their healthcare, such as reminders, clinical decision support alerts, a report writer, etc.

3. Empower patients through visual display data.

Another common pain point for patients is the amount of time physicians spend typing, touching, and looking at the computer screen during visits. One easy way to remove the barrier of the computer screen is by involving the patient through visual display of their data in the exam room. Visual integration connects patients with the process without them feeling overwhelmed.

Internist James Legan does exactly this in his practice by projecting Amazing Charts EHR from his laptop onto flat screen TVs in his exam rooms, inviting patients to view their medical charts, prescriptions, lab reports, radiology images, and more. "Most of my patients really enjoy seeing their BMI graphs, medical history, radiology images, and other medical information. It gets them more engaged with their own health," explained Legan.

Legan's approach is just one way to use visual integration of data to encourage patients to participate in shared decision making. Other solutions can be as simple as physicians sitting next to patients and sharing their screen.

4. Use the EHR for shared decision making and education.

Shared decision making involves physicians and patients determining the best care options together, rather than the clinician making care decisions for the patient. This modern approach of delivering care can play an integral role in patient engagement since it empowers patients to choose care based on their unique values and perspectives.

EHRs allow physicians to easily share their role in the shared decision-making process with patients by demonstrating the use of clinical decision support tools. EHRs can also make it easy for patients to review education materials along with their clinician, giving them a better understanding of their conditions and providing deeper insight into their clinician's recommendations than previously available. Many EHRs have a collection of educational materials physicians can access at a moment's notice and share with patients via patient portal or through printouts sent home with the patient.

Patients can play a role in optimizing their outcomes through activities such as identifying individual values, motivations, and health management skills prior to their next visit, reviewing literature provided via the EHR, and using the patient portal to communicate between visits.
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5 things EMRs should learn from social media

5 things EMRs should learn from social media | EHR and Health IT Consulting |

1. Likes. Health care providers should be able to “vote up” an excellent note in the medical record. Let’s face it, not all doctors are equally good at documentation. Untold hours of our time are spent trying to cull through pages of auto-populated, drop-down-box checks to figure out what’s actually going on with a patient on a particular day. Once in a while you stumble upon some comprehensive free text that a physician took the time to type after a previous encounter, and suddenly everything becomes clear. If there were a way to flag or “like” such documents, it would help other readers orient themselves more quickly to a patient’s history. A “liking” system is desperately needed in EMRs and would be a valuable time saver, as well as encouragement to physicians who document notes well. Hospitals could reward their best note makers with public recognition or small monetary bonuses.

2. #Hashtags. Tagging systems are sorely lacking in medical records systems, which makes them very difficult to search. Patients make multiple visits for various complaints, often with numerous providers involved. If physicians had the ability to review notes/records unique to the complaint that they are addressing, it would save a lot of time. Notes could be tagged with keywords selected by the author and permanently recorded in the EMR. This would substantially improve future search efforts. Even if the EMR generated 10 search terms (based on the note) and then asked the physician to choose the 3 most relevant to the current encounter, that would be a step in the right direction.

3. Selfies. Medical records would benefit from patient-identifier photographs. In a busy day where 20 to 30 patients are treated and EMR notes are updated after the patients have gone home, a small patient photograph that appears on each documentation page will serve the physician well in keeping details straight. Patients should be able to upload their favorite portrait to the EMR if the standard one (perhaps taken during the intake process) is not acceptable to them. In my experience, nothing brings back physical exam and history details better than a photograph of the patient.

4. Contextual links. All EMRs should provide links to the latest medical literature (on subjects specifically related to the patient’s current diseases and conditions) in a module on the progress note page. and other reference guides could easily supply the right content (perhaps based on diagnosis codes). This will help physicians practice evidence-based medicine and keep current with changes in recommended treatment practices.

5. Microblogging. Sometimes there are important “notes to self” that a physician would like to make but don’t need to be part of the official medical record. EMRs should provide a free-text module (like a digital sticky note) for such purposes. These sticky notes should not be admissible in court as part of the medical record, and should not be uploaded to the cloud. Content included in these notes could include social information (patient’s daughter just had a healthy baby girl), hunches (patient looks slightly pale today — will check H&H next time if no change), and preliminary information (remember to review radiology result before calling patient next Tuesday).

It is my hope that EMRs will slowly adopt some best practices from top social media platforms. After all, if millions of users are effectively using voting, tagging, linking, searching and imaging in their daily online lives, it only makes sense to capitalize on these behaviors within the constraints of the medical environment. Maintaining strict confidentiality and appropriate professional boundaries (often missing in the social media world at large) is certainly possible with EMRs. Let’s build a better information capture and retrieval process for the sake of our patients, and our sanity.

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Stage 2 just too tough? | Healthcare IT News

Stage 2 just too tough? | Healthcare IT News | EHR and Health IT Consulting |

In November, a fresh batch of disheartening Stage 2 attestation numbers prompted several industry groups to once again implore the Centers for Medicare & Medicaid Services for relief.

CMS numbers released Nov. 4 show that fewer than 17 percent of U.S. hospitals have demonstrated Stage 2 capabilities. Even worse, fewer than 38 percent of eligible hospitals and critical access hospitals have met either stage of meaningful use in 2014.

As for eligible professionals, just 2 percent have managed to meet Stage 2 so far, and it seems unlikely that very many more will have reached that threshold by the Feb. 28, 2015, attestation deadline.

Officials from the AMA, CHIME, HIMSS and MGMA said in a joint press release that the numbers are "disappointing, yet predictable," and reiterated their calls for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.

"Providers have struggled mightily in 2014, in many instances for reasons beyond their control," said CHIME CEO Russell Branzell. "If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use."

Given the disappointing numbers so far, and the "tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015," the stakeholders have asked CMS numerous times for a shortened, 90-day reporting period in 2015.

If CMS continues to hold fast on a full-year of reporting data for 2015, she said, "we anticipate that large segments of providers will no longer be able to participate in the program," said Carla Smith, executive vice president of HIMSS.

It was a common refrain in the second half of 2014, as it became more and more clear just how hard a time hospitals and practices were having complying the stringent measures of Stage 2.

Beyond a shorter reporting period, many have called for more flexibility, especially around problematic measures around electronic transmission of care summaries and patient access,

"CMS must end its one-size-fits all approach to achieve the goals of the meaningful use program, which are to create a secure and interoperable infrastructure," said AMA President Elect Steven J. Stack, MD. "We believe the stringent pass fail requirements for meeting meaningful use, combined with a tsunami of other overlapping regulations, are keeping physicians from participating in the meaningful use program."

At the CHIME 2014 Fall CIO Forum in October, a big topic of concern is is the start of Medicare penalties in 2015 for hospitals failing to meet those meaningful use standards.

As Healthcare IT News contributor Neil Versel reported, CHIME Vice President for Public Policy Jeff Smith said the dearth of hospitals with Stage 2 success was a "troubling" trend – never mind the fact that "hospitals, by comparison, are leagues ahead" of their physician practice counterpart.

Even if thousands more docs were to attest to Stage 2 before the end of the year, he pointed out, the vast majority of more than half a million EPs are at risk of being penalized.

That, said Smith, means many will be calling their representatives in Congress – and about the only thing Congress knows how to do with something like meaningful use is to kill it, Versel wrote.

"I think meaningful use has been to a degree a victim of the federal rule-making process," Smith said. "We're still engaged with CMS to try and figure out a way to make these (attestation) numbers better," said Smith.

CMS has made conciliatory gestures – such as reopening the submission period for meaningful use hardship exception applications (some 44,000 providers applied for exceptions before the initial deadline). But for the most part it has held firm on MU's most contentious measures, so far.

Meanwhile, exasperation has only increased.

"I've never seen this level of frustration in our membership, as I have in the past six to eight months or so," says MGMA Senior Policy Advisor Robert Tennant. "It's not just meaningful use. But that is certainly one of the catalysts."

What that means for the future of a program that initially showed so much progress remains to be seen.

In September, an alphabet soup of industry groups – HIMSS, CHIME, MGMA  AMA, AHA and AAFP co-signed a letter to CMS in which they reiterated their concerns that "the pace and scope of change had outstripped our collective capacity to comply with meaningful use requirements," and warned that continued intransigence on the rules could result in otherwise well-meaning providers "having to drop out of the program."

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ONC Should Decertify Products that Block EHR Interoperability |

ONC Should Decertify Products that Block EHR Interoperability | | EHR and Health IT Consulting |
Congress attempts to further EHR interoperability by asking the ONC to decertify EHRs that don’t meet data sharing standards.

Congress has instructed the ONC to “take steps” to decertify EHR products that actively block the sharing of information or the interoperability of health IT systems in the 2015 omnibus appropriations bill.  The $1.1 trillion spending bill, which has a number of health IT implications, asks the Office of the National Coordinator to ensure the integrity and value of the Certified EHR Technology (CEHRT) program to healthcare providers and to the taxpayers whose dollars are invested in the EHR Incentive Programs.

The language in the bill firmly directs the ONC to meet Congressional expectations about the future of interoperability in the healthcare industry.

“The Office of the National Coordinator for Information Technology (ONC) is urged to use its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers,” Congress says.

“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”

This is not the first time that questions have arisen about the seeming laxity of some provisions of the EHR certification requirements.  Earlier this summer, the Health IT Now Coalition posed the same query to the ONC: if federal and industry roadmaps focus so sharply on the need for widely-adopted data standards, health information exchange, and the fluid transfer of data across the healthcare continuum, why are providers still being encouraged to purchase EHR software that doesn’t allow them to achieve these goals?

“Taxpayers have paid $24 billion over three years to subsidize systems that block health information in a program Congress created to share health information,” said Joel White, Executive Director of Health IT Now, at the time.  “We call on HHS and Congress to use their authority to investigate business practices that inhibit or prohibit data sharing in federal incentive programs. We also call on HHS to work to decertify systems that require additional modules, expenses, and customization to share data.”

While the omnibus bill may have done little to satisfy critics on either side of the aisle, the Congressional injunction to speed interoperability by withdrawing certifications from EHRs based on closed, proprietary technologies may go a long way towards cheering up health IT pundits over the holiday season – even if it brings no small amount of anxiety to the healthcare providers who have already invested heavily in EHR technology that may come on the certification chopping block.

If a number of products are decertified, will the ONC provide any type of compensation for healthcare organizations that will be required to purchase new technologies in order to continue to meet meaningful use criteria?  Will those organizations be eligible for extensions or exemptions as they try to adopt new software and reengineer their processes accordingly?  How will significant changes to the certification process affect the timelines for Stage 3 of the EHR Incentive Programs?

Congress has asked the ONC to produce a report on the interoperability landscape, the challenges to industry-wide data exchange, and its plans to retool the certification process, in which some of those answers may be revealed.  “The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee,” the omnibus says, and must be delivered no later than 12 months from now.

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Effects of Interoperability on Health Data Privacy Policies |

Effects of Interoperability on Health Data Privacy Policies | | EHR and Health IT Consulting |

Interoperability enables healthcare providers to make the most well-informed decisions for individual patients, but it introduces the potential for sensitive patient health data to become compromised if the technologies exchanging information or the pipeline between these systems are unsecured.

“In terms of what I think some of those challenges are, it’s no big secret; we’re working on interoperability,” Lucia Savage, the new Chief Privacy Officer for the Office of the National Coordinator for Health Information Technology, recently told

“Of course there are the topics that have been well-discussed in the press, like data lock and all that stuff that have to with people’s proprietary systems,” she continued. “But what’s really more essential in the privacy and security realm is making sure people understand how are current legal and regulatory environment actually help support interoperability — right now, at this very moment in time.”

New models for care delivery (e.g., accountable care organizations) emphasize the need for interoperable EHR and health IT systems, added Savage. Interoperability, however, is limited to certain geographies and contexts. In short, there is tremendous room for improvement.

“For example, insurance companies contract with large systems to the ACOs. For that to succeed, just like the Medicare ACOs, data has to flow between the two parties,” Savage explained. “That data is flowing right now in some ways, and in some ways it could flow better and could make better use of the delivery system was built with the meaningful use incentive.”

According to the ONC’s Chief Privacy Officer, a lack of health information exchange (HIE) as a result of limited interoperability comes as a surprise to patients who “thought their doctors were doing this already.” And what is essential is that the healthcare organizations and providers, both private and public, make use of new forms of exchanging information while adhering to the privacy and security rules laid out by HIPAA.

“The HIPAA environment we have is perfectly designed for that. It’s media-neutral, meaning 20 years ago when faxes were new, that’s how the information started to move. Now the information is moving through other media but the rule hasn’t changed. We’re going to capitalize on that,” she maintained.

The next step involves the building of trust among providers and patients, which will come with time and use:

When we introduce a pretty significant technological innovation it takes optimally to breed trust. If through interoperability it facilitates physicians engaging their patients through electronic health record systems and the portal, and giving patients access, giving dialogue with patients about their data that they collect and share about themselves, then patients confidence in the system will grow because they’re using it too.

For the ONC, the path forward requires the federal agency to gather information and listen carefully to the insights of subject-matter experts so that the “potential benefits and the possible risks” of a fully interoperable, HIE-enabled healthcare environment are understood and incorporated into emerging and evolving regulation and oversight.

“Most of the people in the know understand well how HIPAA works for these big data analytics, but there’s new sources of data, whether its wearables or patient generated data or the way people want to take a healthcare transactional data and add data from public records systems to it for analytics purposes,” Savage said.

Not only is interoperability a challenge from the technology side of healthcare, but it also presents new challenges to health IT security and privacy.

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How Is Your Hospital Approaching ICD-10? | Hospital EMR and EHR

How Is Your Hospital Approaching ICD-10? | Hospital EMR and EHR | EHR and Health IT Consulting |

I’ve been writing quite a bit recently about ICD-10. You may enjoy this post I wrote about the real problem of ICD-10 being UNCERTAINTY. I’ve seen a lot of good reasons why we should go forward with ICD-10 and there’s no doubt that the move to ICD-10 does not come without a cost (training, implementation, system testing, etc). Although, not knowing if ICD-10 is coming or not is absolutely killer.

There are a lot of great ICD-10 resources out there to help you with your ICD-10 transition strategies. Although, I think most hospitals are wondering if they should prepare for ICD-10 or not. Those that were getting prepared last year got burned. Now they’re likely wondering if they’re going to get burned again. Those that weren’t prepared for ICD-10 last year were saved and they’re likely hoping to be saved again.

How is your hospital approaching ICD-10? Are you going forward with ICD-10 preparation using projects that are masked as Clinical Documentation Improvement (CDI) programs? Are you in wait and see mode? Are you going full bore in preparing, training, and testing for ICD-10?

I said that last one kind of ironically. I haven’t seen any organization that’s doing that right now which is really amazing. Last year at this time, I knew a bunch of organizations that were fully engage in preparations for ICD-10. This year, no such message. Last year at this time, many were calling for ICD-10 preparation. This year, people are afraid that they’re going to be “the boy who cried wolf.” There’s only so many times you can cry ICD-10 before people stop listening. We might be there already. It’s amazing the power of uncertainty.

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