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Column: The doctor will see you now — on the Internet

Column: The doctor will see you now — on the Internet | EHR and Health IT Consulting |
Patients like the convenience, and insurers save money. But diagnoses can go awry.


Like many primary-care doctors, I'm seeing many patients this winter who are suffering from colds and/or the flu. Some patients think such ailments are so commonplace that a doctor should be able to prescribe an antibiotic after a conversation with them over the phone or Internet.


If health insurers had their way, more doctors would be performing online video chats with patients. However, I would be wary of this growing trend.

Companies and insurers seem willing to change the physician/patient relationship to cut costs. More are offering services where patients can consult doctors through a webcam-enabled laptop, or smartphone or tablet. According to a survey by Mercer, a human resource consulting firm, 15% of very large employers use some form of telemedicine, and 39% are considering it.


These so-called virtual office visits cost about $40, and patients with minor illnesses can quickly access a physician or nurse practitioner and be prescribed medication online. Patients rave about the convenience, but something is lost through these virtual connections.


Dangers of errors

Accurate diagnoses can be missed without the face-to-face interaction. For example, I've seen a patient convinced he had a sinus infection only to find that he had a tumor inside his nose. Another complained of minor ear pain, but after examining her, I saw that an infection had spread to the point she needed to be hospitalized for intravenous antibiotics.


Without the ability to examine patients, many doctors play it safe and prescribe drugs. A recent study from the Journal of the American Medical Association found that patients who were treated through virtual visits had higher antibiotic prescription rates for their sinus infections than patients who were seen in the office.


Antibiotics overuse

Most sinus infections actually clear up themselves without antibiotics. A study published last year found that patients who had sinus infections felt the same after a few days, whether they received antibiotics or not. Worse, unnecessary drugs contribute to the growing problem of antibiotics resistance. Guidelines from the Infectious Diseases Society of America and Choosing Wisely, a consortium of medical societies that provide evidence-based guidelines, also recommend against knee-jerk antibiotic prescriptions for sinus infections.


More important, consider what would happen if something went wrong after the online-only consultation. For example, what if the patient had an allergic reaction to an antibiotic, or symptoms that got worse? And would a doctor face liability for missing something he or she could not see in a video visit?

There is some room for virtual visits, with stricter conditions. For longtime patients, managing their hypertension and diabetes through a video chat is helpful. But I would not feel comfortable treating new patients on the Web.

Currently, only 13 states allow doctors to prescribe drugs and treat patients online without actually meeting in person first. With the zeal to cut costs and maximize convenience to patients, there will be tremendous pressure to expand that number. Please remember, though, that what is cheapest for insurers, and easiest for patients, isn't necessarily what is best.


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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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EHR Partner Programs

EHR Partner Programs | EHR and Health IT Consulting |

Amazing Charts just announced a new EHR partner program. This isn’t something that’s particularly new for EHR vendors. They all have lots of partners. Some have formalized them into a program like athenahealth has done with their More Disruption Please (MDP) program. Others are much more quiet about the partners they work with and how they work with them.

What’s clear to me in the EHR industry is that an EHR vendor won’t be able to do everything. There are some that like to try (See Epic), but even the largest EHR vendor isn’t going to be able to provide all the services that are needed by a healthcare organization. This is true for ambulatory and hospitals.

Since an EHR vendor won’t be able to do everything, it makes a lot of sense for an EHR vendor to have some sort of partners program. The challenge for an EHR vendor is that a partner program comes with two major expectations. First, the partner has a high quality integration with the EHR software. Second, that the partner is something that the EHR vendor has vetted.

The first challenge is mostly a challenge because most EHR vendors aren’t great at integrating with outside companies. This is a major culture shift for many EHR vendors and it will take time for them to get up to speed on these types of integrations. Plus, these integrations do take some time and investment on the part of the EHR vendor. When there’s time and investment involved, the EHR vendor starts to be much more selective about which companies they want to be working with long term. They don’t want to spend their time and money integrating with a company which none of its users will actually use.

The second challenge is that EHR users assume that an EHR partner is one that’s been vetted by the EHR vendor. Even if the EHR vendor puts all sorts of disclaimers on their partner page, the EHR vendor is still associated with their partners. The written disclaimers might help you avoid legal issues, but working with shady partners can do a lot of damage to your reputation and credibility in the marketplace. I actually think this is probably the biggest reason that EHR vendors have been reluctant to implement partner programs.

I think over time we’ll see the first problem solved as EHR vendors work to standardize their APIs for partner companies. As those APIs become more mature, we’ll see much deeper EHR integrations and the costs to an EHR vendor will drop dramatically when it comes to new partner integrations.

The second problem is much harder to solve. My best suggestion for EHR vendors is to create a platform which allows your users to help you vet potential partners. Not only can they participate in the vetting process, but it can also help you know which partners would be useful to your users. Is there anything more valuable than user driven partnerships? It also puts you in a good position with potential partners if you already have users interested in the integration.

However, an EHR vendor shouldn’t just leave potential partnership requests to their users. Many of their users don’t know of all the potential partner companies. Users are so busy dealing with their day jobs that they often don’t know of all the potential companies that could benefit their practice or hospital. Certainly you should accept user input on potential partnerships, but an EHR vendor should also seed the potential partner feedback platform with a list of potential partners as well. The mix of an EHR vendor created list together with user generated partner lists is much more powerful than one or the other.

We’re just at the beginning of companies partnering and integrating with EHR vendors. I expect that over the next 5 years an EHR vendor will be defined as much by the organizations it chooses to partner with as the features and functions it chooses to develop itself.

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Linking EHRs with medication cabinets for improved safety

Linking EHRs with medication cabinets for improved safety | EHR and Health IT Consulting |

Increasingly hospitals are recognizing the value of interoperabilitybetween electronic health records and automated dispensing cabinets, or ADCs. In addition to eliminating redundancies during the medication ordering process, linking them helps to reduce medication errors at the point-of-care.

Hackensack University Medical Center recently unveiled this interoperability between its ADC from Omnicell and its Epic EHR.

Now nurses are able to easily interface with the complete medication management system within one application at the patient's bedside, said Nilesh Desai, director of pharmacy at HackensackUMC.

"With the addition of the interoperability piece, it is now embedded directly into Epic and as you open a patient's chart, automatically you can launch and schedule the medications and view if the medication has been delivered by pharmacy or not," said Desai.

With this interoperability, he said, that there's not a separate login and the nurse doesn't have to remember another password: It's connected to the EHR and it directly opens up to the patient's chart.

Normally when there is a medication that has to be delivered from the pharmacy, the nurse has to go back to the cabinet or look into the cabinet to see if pharmacy delivered it or not.

"If the medication is not delivered the medication is grayed out and the nurse will be unable to remove it," said Desai. "As soon as a pharmacy technician delivers a medication, it lights up. As a nurse, you don't have to go to the cabinet to find out if the medication has been delivered. A nurse can do it directly from a computer from anywhere in the nursing unit. It saves quite a few steps and time."

Shafiq Rab, MD, vice president and chief information officer at HackensackUMC, points out that there are other benefits of interoperability between EHRs and ADCs. One is that while the drug is being procured from the pharmacy system, it also checks for allergies, drug-to-drug interaction, and drug-to-food interaction.

Clinical inefficiencies raise red flag for hospitals

A benefit analysis extrapolated from a 2013 white paper prepared by Cerner, "The Clinical Benefits of CareAware Enhanced Dispensing," revealed that prior to interoperability between EHRs and ADCs, nurses at Penn State Milton Hershey Medical Center were spending on average of 8.5 minutes on a single patient's medication pass resulting in clinical inefficiencies within the medication administration and reconciliation process. Post-implementation they spend on average 5.8 minutes, a 32 percent improvement.

To address the inefficiencies due to disparate clinical information systems, Penn State Hershey partnered with CareAware, Cerner's device connectivity architecture that provides interoperability between CareFusion's Pyxis MedStation ADC and Cerner's Millennium EHR.  

According to the white paper, CareAware "allows clinical information to be shared seamlessly between the two systems improving workflow and patient safety," while allowing the nurse to view the same information in both systems.

Flip Groves, vice president of business development in the Medication Management Solutions Group at CareFusion/Pyxis, said such interoperability extends not only to the EHRs, but also into the entire, end-to-end, medication-management process.  

"Interoperability means connecting the automated dispensing cabinets into enterprise-wide pharmaceutical resource inventory management system, to IV prep check systems, to microbial surveillance systems, bringing together oversight and optimization of the end-to-end management of medication processes and resources," said Groves.

He added that interoperability also enhances patient safety and clinical workflow by eliminating opportunities to introduce errors, and by providing the users with the right information, through the right application, in the right place, at the right time.

Dan Pettus, vice president for IT in the Medication Management Solutions group at CareFusion/Pyxis, said that interoperability is significant not only for EHRs and ADCs but also for other devices including IV pumps and ventilators.

That capability, said Pettus, is the tie-in to all of the necessary connections that you need to make these applications from products interoperable.

"It's beneficial to our customers to have one-stop shopping when it comes to those technology platforms," said Pettus. "Less interfaces, less complexity, it reduces to maintain these things over time."

Point-of-care medication errors averted

Mark Neuenschwander says that for years he has tried to draw attention to the gap between the point-of-dispensing and the point of administering medications.

"It is possible for nurses to get the right medications for the right patients at dispensing cabinets and then to administer them to the wrong patients," said Neuenschwander, a Bellevue, Wash.-based consultant on bar code-enabled medication dispensing, preparation and administration.

Bar code medication administration, Neuenschwander says, has matured and become commonplace in today's hospitals to verify patients and medications to address this problem, but be noted that in addition to verification, a sound medication use process requires information.

"In addition to verifying that they have the correct medications for a particular patient, they also need to have access to information about medications both when they come from dispensing cabinets and when they are at the point-of-care."

Neuenschwander, cofounder of the unSUMMIT for Bedside Barcoding, asserted that nurses must document what is administered and that this must occur at the point of care, not at the point of dispensing.

"It is critical that what the nurse sees at any point is up to date. I am thrilled with the ongoing efforts and success in integration information with information systems, dispensing cabinets, and point of care technologies," he said.

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Solo Practitioners Exempt from EHR Implementation in Minnesota

Solo Practitioners Exempt from EHR Implementation in Minnesota | EHR and Health IT Consulting |

One of the key issues that some healthcare providers have found with the Medicare and Medicaid EHR Incentive Programs is the mere financial impact of EHR implementation. In Minnesota, small medical practices – particularly solo practitioners – will no longer have to invest in costly EHR implementation plans due to a bill that was passed by Minnesota lawmakers in both the House and Senate.

Under the Minnesota Department of Human Services policy omnibus bill, there are various healthcare reform objectives including exempting solo practitioners and cash providers from having to invest in health IT systems and EHR implementation.

While this may benefit these providers financially and allow them to run their practice without monetary disadvantages, paper-based patient records could potentially lead to safety issues and additional medical errors that impact population health outcomes across underserved regions within the state.

Nonetheless, Minnesota seems to be the only state in the nation where an EHR mandate required all healthcare providers and hospitals to install and implement EHR systems by January 1 of this year.

The bill’s amendment on EHR implementation is now in place and providers will have to comply with it starting in January 2015, according to a press release from the Citizen’s Council for Health Freedom (CCHF), a Minnesota-based organization aimed at protecting patient privacy and rights.

CCHF feels the EHR mandate that required all providers to participate in EHR implementation was too costly and had patient privacy implications the organization does not support. Essentially, Minessota was the only state that did not have an opt-out option. Other providers across the country could take the payment penalty hit from the Centers for Medicare & Medicaid Services (CMS) instead of being required to adopt certified EHR technology.

In particular, providers in Minnesota were required to implement an interoperable EHR system that was connected to a state government-approved Health Information Organization, which is a costly endeavor.

“We’re pleased that lawmakers have included this important amendment in Rep. Tara Mack’s bill that will allow small clinics and practices to continue to serve patients in Minnesota,” stated CCHF president and co-founder Twila Brase. “Many small clinics and practices cannot afford the cost of the EHR system, and many practices do not want to make their patients’ data accessible online.”

“This amended bill will allow small clinics to thrive in smaller communities,” Brase continued. “And it will allow single doctor’s offices to keep their doors open, rather than be forced to join a big practice.

Patients would be able to search for practitioners who hold their medical data truly confidential and for doctors that look them in the eye rather than turning their back on them and typing into a computer. Minnesota is the only state that, until now, did not allow healthcare providers to opt out of expensive, intrusive online-accessible EHRs. The federal HITECH Act mandates EHRs, but allows any provider to opt out. This amendment begins to give Minnesota the level of freedom and privacy available to doctors and patients in the rest of the nation.”

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EMRs Should Include Telemedicine Capabilities

The volume of telemedicine visits is growing at a staggering pace, and they seem to have nowhere to go but up. In fact, a study released by Deloitte last August predicted that there would be 75 million virtual visits in 2014 and that there was room for 300 million visits a year going forward.

These telemedicine visits are generating a flood of medical data, some in familiar text formats and some in voice and video form. But since the entire encounter takes place outside of any EMR environment, huge volumes of such data are being left on the table.

Given the growing importance of telemedicine, the time has come for telemedicine providers to begin integrating virtual visit results into EMRs.  This might involve adopting specialized EMRs designed to capture video and voice, or EMR vendors might go with the times and develop ways of categorizing and integrating the full spectrum of telemedical contacts.

And as virtual visit data becomes increasingly important, providers and health plans will begin to demand that they get copies of telemedical encounter data.  It may not be clear yet how a provider or payer can effectively leverage video or voice content, which they’ve never had to do before, but if enough care is taking place in virtual environments they’ll have to figure out how to do so.

Ultimately, both enterprise and ambulatory EMRs will include technology allowing providers to search video, voice and text records from virtual consults.  These newest-gen EMRs may include software which can identify critical words spoken during a telemedical visit, such as “pain,” or “chest” which could be correlated with specific conditions.

It may be years before data gathered during virtual visits will stand on equal footing with traditional text-based EMR data and digital laboratory results.  As things stand today, telemedicine consults are used as a cheaper form of urgent care, and like an urgent care visit, the results are not usually considered a critical part of the patient’s long-term history.

But the more time patients spend getting their treatment from digital doctors on a screen, the more important the mass of medical data generated becomes. Now is the time to develop data structures and tools allowing clinicians and facilities to mine virtual visit data.  We’re entering a new era of medicine, one in which patients get better even when they can’t make it to a doctor’s office, so it’s critical that we develop the tools to learn from such encounters.

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Get Your Medical Practice Paid: 4 Revenue Tips

Get Your Medical Practice Paid: 4 Revenue Tips | EHR and Health IT Consulting |

It seems pretty obvious: You do the work, you get paid. But unfortunately for many in the healthcare business, it’s not always that black and white.

There are so many obstacles to proper payment, including: complex and confusing billing systems; patients unable to pay their office copay, co-insurance, or deductibles; high outstanding accounts receivable; improper coding vs. documentation; etc. All this and more can lead to outstanding bills and ultimately low cash flow for the practice.

Here are some tips to make sure your practice gets the compensation it deserves:

The Right Code: ICD-10

With the new ICD-10 rules taking effect Oct. 1, it’s imperative that your practice management software and EHR are up to date and that the billers in your practice are trained and ready to go. Improper documentation at some point in the chain of work can lead to a deficit in your bottom line. Make sure that your software is ICD-10-ready.

Ignorance Is Not Bliss: Pay Attention to the Details

Doctors, office managers, and certain staff should be able to access at-a-glance details and have the ability to generate reports if they are employing an efficient billing system. Every doctor should be able to easily access the following data:

• Average daily and monthly revenue categorized by HCPCs and insurance

• Number of outstanding accounts receivable

• Cash value of outstanding accounts receivable

• Number of audits paid/failed status

• Payment and claim status

• Outstanding revenue by HCPCs and insurance

• Monthly adjustment reports

If you are a doctor in a private practice and can’t access this critical information, then at a minimum, you should require a weekly billing report from billing staff or your outsourced billing service. This weekly report should cover the items listed above and will allow you great insight into the "health" of your practice.

Verify Patients’ Benefits Before Their Visit

At the very least, verify patient's benefits before they leave your office. It sounds fairly obvious, but many practices don’t get the patients’ copay before they see the doctor. This could be rectified as easily as keeping patients’ credit cards on file, so it can be the default if the patient fails to bring cash to their visit. Better yet, utilize a practice management system that seamlessly updates you with this information so that you can easily charge in the office. You’d be surprised how something so simple can increase practice cash flow.

Claim Denied? Don’t Let It Go

Make sure your billing staff is diligent about following up on denied claims. Making sure your billing staff or billing service has the right codes can significantly improve this denial rate, but when it does happen, don’t let it go. There should always be follow up on denied claims, but ideally, your billing staff or service should try to catch coding errors before they’re made. Catching coding errors is often better handled by a sophisticated, outsourced billing service — just make sure it offers a transparent view into billing success.

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Medical Device Vendors Will Inevitably Build Wearables

Medical Device Vendors Will Inevitably Build Wearables | EHR and Health IT Consulting |

As we’ve reported in the past, hospitals are throwing their weight behind the use of wearables at a growing clip. Perhaps the most recent major deal connecting hospital EMRs with wearables data came late last month, when Cedars-Sinai Medical Center announced that it would be running Apple’s HealthKit platform. Cedars-Sinai, one of many leading hospitals piloting this technology, is building an architecture that will ultimately tie 80,000 patients to its Epic system via HealthKit.

But it’s not just software vendors that are jumping into the wearables data market with both feet. No, as important as the marriage of Epic and HealthKit will be to the future of wearables data, the increasing participation of medical device giants in this market is perhaps even more so.

Sure, when fitness bands and health tracking smartphone apps first came onto the market, they were created by smaller firms with a vision, such as the inventors who scored so impressively when they crowdfunded the Pebble smartwatch.  (As is now legendary, Pebble scooped up more than $20M in Kickstarter funding despite shooting for only $500,000.)

The time is coming rapidly, however, when hospitals and doctors will want medical-grade data from monitoring devices. Fairly or not, I’ve heard many a clinician dismiss the current generation of wearables — smartwatches, health apps and fitness monitoring bands alike — as little more than toys.  In other words, while many hospitals are willing to pilot-test HealthKit and other tools that gather wearables data, eventually that data will have to be gathered by sophisticated tools to meet the clinical demands over the long-term.

Thus, it’s no surprise that medical device manufacturing giants like Philips are positioning themselves to leapfrog over existing wearables makers. Why else would Jeroen Tas, CEO of Philips’ healthcare informatics solutions, make a big point of citing the healthcare benefits of wearables over time?

In a recent interview, Tas told the Times of India that the use of wearables combined with cloud-based monitoring approaches are cutting hospital admissions and care costs sharply. In one case, Tas noted, digital monitoring of heart failure patients by six Dutch hospitals over a four-year period led to a 57% cut in the number of nursing days, 52% decrease in hospital admissions and an average 26% savings in cost of care per patient.

In an effort to foster similar results for other hospitals, Philips is building an open digital platform capable of linking to a wide range of wearables, feeds doctors information on their patients, connects patients, relatives and doctors and enables high-end analytics.  That puts it in competition, to one degree or another, with Microsoft, Qualcomm, Samsung, Google and Apple, just for starters.

But that’s not the fun part.  When things will get really interesting  is when Philips, and fellow giants GE Healthcare and Siemens, start creating devices that doctors and hospitals will see as delivering medical grade data, offering secure data transmission and integrating intelligently with data produced by other hospital medical devices.

While it’s hard to imagine Apple moving in that direction, Siemens must do so, and it will, without a doubt. I look forward to the transformation of the whole wearables “thing” from some high-end experimentation to a firmly-welded approach built by medical device leaders. When Siemens and its colleagues admit that they have to own this market, everything about digital health and remote monitoring will change.

Steve Myers's curator insight, May 26, 12:33 PM

The secret is out!!

Modifications to Meaningful Use Requirements Find Backing

Modifications to Meaningful Use Requirements Find Backing | EHR and Health IT Consulting |

Last month, the Centers for Medicare & Medicaid Services (CMS) released a new proposed rule with several key modifications to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. The general public has until June 15 to submit comments to this particular proposed ruling.

The changes are meant to modify the EHR reporting periods from 2015 to 2017. The new reporting period was transitioned to a 90-day period that would line up with the calendar year. Additionally, patient engagement measures under the Stage 2 Meaningful Use requirements were changed.

If the ruling is passed, no longer will providers have to ensure that 5 percent of their patients download, view, and transmit their health information over the next couple of years. According to the proposed rule, only one patient will need to utilize a portal to view, download, or share their medical data.

The American Medical Association (AMA) recently announced their support of the proposed modifications to the meaningful use requirements. In a press release, the AMA stated their prior advocating of offering more flexibility under the EHR Incentive Programs so that providers and healthcare professionals may adopt and utilize health IT systems in a way that benefits their practice and workflow.

“Physicians want to use new technologies that help strengthen physician-patient relationships, improve health outcomes and make them more efficient,” AMA President-elect Steven J. Stack, MD, said in a public statement. “About 80 percent of physicians have already incorporated electronic health records (EHRs) into their practices, but they have faced significant barriers in participating in the Meaningful Use program and many are receiving penalties despite their investments in EHRs. We believe CMS’ proposal offers common sense solutions that, if finalized quickly, will help more physicians use EHRs in a truly meaningful way while supporting patient engagement.”

Within the letter sent to CMS for public comment, the AMA offered additional advice to the organization that could improve attestation to meaningful use requirements. The suggestions revolve around quality measure reporting and removing the overall “pass-fail structure” so that physicians and hospitals that attempted to meet meaningful use requirements and show positive results are not penalized.

Stack continued by discussing the importance of providing patients with secure messaging tools and patient portals and encouraging their consumers to utilize these platforms. At the same time, Stack mentioned that different physicians and healthcare providers have varying circumstances that may impact their ability to have a high percentage of patients viewing their medical information electronically.

For example, providers serving the elderly population or Medicaid-based patients in underserved areas may not have the key demographic that utilizes the Internet, smartphones, or even computers.

The AMA includes guidelines on its website for physicians looking to better engage their patients in their healthcare and the use of the patient portal. The organization is looking to work with physician groups to further patient education regarding accessing health information digitally.

Through these proposed modifications to the meaningful use requirements, CMS will be able to give providers the flexibility needed to successfully attest to the objectives and bring the healthcare industry into the 21st century.

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Improve Patient Access to Your Medical Practice

Improve Patient Access to Your Medical Practice | EHR and Health IT Consulting |

On a recent morning, like pretty much every morning, my e-mail inbox was full of pitches for seminars, webinars, consulting, software, marketing, and handbooks on improving patient engagement, customer service, patient relations, and a host of related treatments for symptoms that can be cured with a smile and a little common sense. Bet yours was, too.

The one thing those digital bromides missed completely is what patients want most — for you to be there when they need you.

Access to care is overwhelmingly the top patient complaint, and desire. If that seems like an impossible wish to fill in your overburdened, rushed, and demanding schedule, you are missing the solution, an opportunity and insurance to preserve your independence.

The old "doc-in-a-box" is now a corporate cookie cutter "NP-in-a-box." The looming threat about how low-cost hospital and chain store mini-clinics will cause everything from patient poaching to relationship dilution to disruption in continuity of care is only seeing a glass as half full without realizing that you own the house that it's in.

You already own the box and you have a built-in advantage: you and your patient base.

Whether or not you decide to put strategies into place to extend your practice's services, at least do these things:

• Always keep a slot or two open each morning and afternoon for patients that need to be seen now; they will be filled or you will run on time, not a bad outcome either way.

• Educate your patients as to what an emergency is, and is not, when you relentlessly promote your new accessibility policy.

• When you say what you will do, do what you say. Virtually every patient is paying out of pocket for your services to one extent or another; most whole dollar. Their expectations have changed accordingly.

Now for the strategies to employ as an extension of your practice:

Strategy 1: "Call Us First!" Whether you use an answering service or forward non-office hour calls to a designee's cell phone, your office should be the first call, e-mail, or text a patient makes (texting is the best option — and a designated phone that is passed on to on-call personnel makes it easy, immediate, and less intrusive).

Strategy 2: Extend office hours. If you are a primary-care provider, you are the most vulnerable, especially if you are in a value-based program. Losing control of downstream dollars is money out of your pocket. Losing patients to other, more convenient providers will be your undoing. It's a new world, and it will be dominated by ease of access to care. Use the first strategy as cover.

Strategy 3: Transform your office into a dual urgent care. Really, this is just an extension of your practice and triage, but you get paid a premium for providing the service, and, your patients will love you.

Obviously, this is just brushing the surface. If you don't know what to do, you can easily find a peer or consultant to help you.

If you don't want to do it, well, you'll be bumping into your patients at the local big-box, pharmacy, or grocery store a lot more frequently. Just look for them at the in-store clinic.

One last thing: promote, promote, promote. The local NP-in-a-box will.

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EHR Interoperability Stalled Due to Information Blocking

EHR Interoperability Stalled Due to Information Blocking | EHR and Health IT Consulting |

When it comes to the practice of medicine and drug discovery, the federal government plays a role in supporting these sectors and developing legislation that opens up avenues for healthcare professionals and scientific researchers. The House Committee on Energy and Commerce has gone forward with creating legislation called 21st Century Cures that delves directly into stimulating the discovery and development of new treatments and medications for patients across the nation. The legislation also impacts the expansion of EHR interoperability.

While the intentions of the 21st Century Cures legislation is beneficial for drug discovery, the American Hospital Association (AHA) finds that the enforcement strategies under the proposed rules could have negative consequences for providers, particularly in its aim to expand EHR interoperability.

AHA Executive Vice President Rick Pollack stated in a letter to the House Committee on Energy and Commerce that, which the organization appreciates the inclusion of EHR interoperability expansion, the “enforcement mechanisms” could lead to issues for healthcare providers such as putting together an ecosystem in which doctors may be significantly penalized for minor errors.

AHA does support health information exchange and EHR interoperability in pursuit of improving patient outcomes and incorporating new models of care. Nonetheless, AHA finds some issues with the enforcement related to vendors participating in information blocking problematic.

“The bill includes a number of enforcement mechanisms against those who engage in information blocking,” wrote AHA Executive Vice President Rick Pollack in the letter. “On the provider side, we believe that the use of Medicare fraud and abuse mechanisms, such as investigations by the Office of the Inspector General, imposition of civil monetary penalties or exclusion from the Medicare program, is unnecessary and inappropriate to address the concerns that the legislation seeks to remedy. We recommend that you use the existing structures of the meaningful use program to promote information sharing.”

On behalf of AHA, Pollack mentions that the organization appreciates the committee’s aim to ensure EHR vendors are responsible for creating interoperable health IT products. However, Pollack also stated that the committee should instruct the Federal Trade Commission to analyze any anti-competitive behavior among EHR vendors. In particular, Pollack finds the decertification of EHR systems among vendors that participated in information blocking objectionable, as it would affect healthcare providers and disrupt patient care.

“The language also includes decertification as a sanction for vendors that engage in information blocking. Decertification would be disruptive to hospitals and physicians that have invested in and deployed an EHR that is later decertified,” Pollack explained. “However, the inclusion of provider protections against meaningful use penalties if their EHR is decertified makes it more reasonable.”

The protections against payment penalties under the Medicare and Medicaid EHR Incentive Programs would last for more than one year, which would give providers ample time to find a new vendor, develop a suitable contract, install another EHR system, and attest to relevant meaningful use requirements.

Additionally, AHA would like the definition of information blocking to become narrower in order to avoid charges of fraud to be dealt due to standard business practices. Essentially, AHA would like to reduce some of the punitive approaches the committee set forth and develop more positive approaches to expanding health information exchange.

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Adoption Still a Problem for Organizations Swapping EHRs

Adoption Still a Problem for Organizations Swapping EHRs | EHR and Health IT Consulting |

Each year the Health Information and Management Systems Society’s (HIMSS) annual conference is the Super Bowl of health IT. No other conference boasts more attendees ranging from health IT innovators and collaborators to pioneers. This year 40,000 plus participants descended on Chicago, all eager to learn about the new direction, trends, and solutions of the industry.

As always, buzzwords were aplenty—interoperability, care coordination, patient experience, and value-based care, to mention a few. During her keynote address on April 16, Karen DeSalvo, National Coordinator for the ONC, called the current state of health IT the “tipping point.” In 2011 the ONC released its four-year strategic plan focused on implementing and adopting electronic health records (EHRs). Now, DeSalvo says the industry is changed and ready to move beyond EHRs to technologies that will create “true interoperability.”

Enlightening conversations were happening among the crowded booths, hallways, and meeting rooms between organizations looking to ‘rip and replace’ their current EHR for a new one. While some organizations are struggling to unlock data across disparate systems, others are looking to upgrade their current system for one compatible with ICD-10, Meaningful Use, analytics solutions, or a combination of these. Still others are looking to replace systems they dislike for lack of functionality, vendor relationships, etc. In many cases, replacing an EHR is needed to ensure interoperability is at the very least viable. This buzz at HIMSS is a strong indicator that EHRs are still an important and essential part of health IT, and perhaps some organizations have not reached the tipping point.

In addition to the many challenges these organizations are facing—from data portability, an issue John Lynn wrote about in August 2012, to the cost of replacing the system—leaders are agonizing over the resistance they are facing from clinician end users. How can these organizations force clinicians to give up systems they once resisted, then embraced and worked so hard to adopt? How can leadership inspire the same level of engagement needed for adoption? The challenge is similar to transitioning from paper to an EHR, only more significant. Whereas the reasons for switching from paper were straightforward—patient safety, efficiency, interoperability, etc.—they are not so clear when switching applications.

Clinicians are also making harsher comparisons between applications—from every drop-down list, to icon, to keyboard shortcut. These comparisons are occurring at drastically different phases in the adoption lifecycle. Consider the example of an end user needing to document a progress note. In the old EHR, this user knew how to copy forward previous documentation, but in the new system she doesn’t know if this functionality even exists. Already the end user is viewing the new system as cumbersome and inefficient compared to the old application. Multiply this comparison by each of the various tasks she completes throughout her day, and the end user is strongly questioning her organization’s decision to make the change.

This highlights an important point: Swapping one EHR for another will take more planning, effort, and strategy than a first-ever implementation. The methods for achieving adoption are the same, but the degree to which they are employed is not. Leadership will not only have to re-engage end users and facilitate buy-in, they will have to address the loss of efficiency and optimization by replacing the old application.

Leadership should start by clearly outlining the reasons for change, a long-term strategy, as well frustrations end users can expect. They should establish a strong governance and support structure to ensure end users adhere to policies, procedures, and best practices for using the application. The organizations that will succeed will provide end users with role-based education complete with hands-on experience completing best practice workflows in the application. Education should include competency tests that assess end users’ ability to complete key components of their workflow. Additionally, organizations must capture and track performance measurements to ensure optimized use of the system and identify areas of need. And because adoption recedes after application upgrades and workflow enhancements, all efforts should be sustained and modified as needed.

While HIMSS15 brought to the stage a wealth of new ideas, solutions, and visions for the future of health IT, the struggle to adopt an EHR has not completely gone away. Many organizations are grappling with their current EHR and choosing to replace it in hopes of meeting the triple aim of improving care, costs, and population health. For these organizations to be prepared for true interoperability, they must overcome challenges unseen in paper to electronic implementations. And if done successfully, only then will our industry uniformly reach the tipping point, a point where we can begin to put buzzwords into practice.

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What If Doctors Owned Part of Hospital EMRs?

What If Doctors Owned Part of Hospital EMRs? | EHR and Health IT Consulting |

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.

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Three Steps to Follow Before ICD-10 Conversion Deadline

Three Steps to Follow Before ICD-10 Conversion Deadline | EHR and Health IT Consulting |

If any providers still think there will be another ICD-10 delay, they may be mistaken. The ICD-10 conversion is moving forward and a full implementation will take place on October 1, 2015. The Healthcare Information and Management Systems Society (HIMSS) reports that this major diagnosis coding change is coming in less than five months and providers need to be prepared for the ICD-10 conversion.

Providers will need to be ready to use ICD-10 codes on claims and other transactions with health insurers in order to be adequately reimbursed. The Centers for Medicare & Medicaid Services (CMS) will not be accepting any claims that used ICD-9 coding after October 1, which means providers that utilize old codes will not be paid.

While there are many healthcare providers that have taken the necessary steps to prepare for the ICD-10 conversion deadline, a WEDI survey and other reports illustrate that a significant number of healthcare organizations have not gone forward with preparing for the ICD-10 implementation.

HIMSS states that providers who haven’t taken the necessary steps need to devote as much time as possible over the next few months to prepare for the ICD-10 conversion and conduct testing, upgrading and training in the limited time before October. There are three steps that HIMSS suggests providers follow in order to prevent any major issues with their revenue cycle after the deadline passes.

Identify the Top Medical Conditions

Every healthcare organization has several common conditions that their patients are afflicted with. To prepare for the ICD-10 conversion, it’s vital to identify these diseases and find the corresponding coding set of each. The most common conditions are associated with the largest net of revenue for medical facilities, which is why understanding the documentation of these health problems is so vital.

Hospital coders and claim submitters need to know the key documentation information to ensure they select the right ICD-10 code. Processes surrounding data capture, documentation, and recording will need to be updated to correspond with the new coding set.

Upgrade Health IT Systems

In preparations for the ICD-10 conversion, one of the most important tasks to complete is to update all health IT systems within an organization for ICD-10 capability. If a vendor handles IT updates, be sure they have come to install and test the latest versions of their software, HIMSS explains.

If an internal team handles health IT updates, be sure they have gone forward with all relevant installations especially with coding, documentation, and billing systems. All staff affected by the ICD-10 conversion will also need to be trained before the deadline.

Conduct Internal and External Partner Testing

After all systems are upgraded to the new coding set, it’s vital to conduct ICD-10 testing procedures both on the internal side and with external partners. Dual coding of incoming patients could be very useful information. Additionally, “dummy claims” in which false patient scenarios are incorporated can help test updated systems before the ICD-10 deadline. Any issues that may come up during testing should also be adjusted before October 1. It’s vital to follow these steps and prepare for the ICD-10 conversion before time runs out.

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Patient Engagement: Much Bigger Than Patient Portals

Patient Engagement: Much Bigger Than Patient Portals | EHR and Health IT Consulting |

There is no doubt that the topic of patient engagement has taken center stage in healthcare. It was the hot topic at HIMSS 2015 where a major national study was unveiled, Three Perspectives of Patient Engagement. And that was just one of the many sessions, events, and booths focused on patient engagement at the event.

Thanks to Meaningful Use, a lot of the focus on patient engagement has been around patient portals. It makes sense since practices have to meet specific thresholds in both MU2 and MU3 for portal use. They certainly play a key role in providing patients with access to medical records, test results, and even tools like online scheduling and billpay. The benefits have not gone unnoticed by providers. Over 80% of doctors believe a patient portal helps with patient satisfaction and 71% believe it helps with patient/physicians communication. The benefits haven’t gone unnoticed by patients either. Two-thirds of patients say they would be more loyal to physicians who provides a portal through an EHR.

Despite the undeniable value of portals, they are just one component of true patient engagement. This was clear in the presentation about the new national study released at HIMSS. According to the presentation, the biggest problem in creating patient engagement isn’t providing access to health information. The problem is shifting the attitudes and expectations of both clinicians and patients.

Resolving this problem requires a major culture change in healthcare. Despite the fact that patients and providers say they want improved access, communication, and outcomes and that patient engagement may hold the key, change is slow.

The reason is actually pretty simple. A shift in the culture towards a truly patient-centric model requires changes at every interaction and that involves every person across the spectrum. In many cases this means not only shifting attitudes but also the way things are done. That can require adding, changes, or maximizing technology. While technology plays this critical role, it is much bigger than portals alone.

It starts with finding the appropriate provider and goes all the way until the final bill is paid. The new patient-centric model looks something like this:

Patients can search for providers online, see patient reviews, and book an appointment from home.

Patients can easily find answers to questions about the practice on their website.

When the patient does call the office, the phone is answered quickly and so is the inquiry.

The patient receives a reminder through the means of their choice—text, email, or phone, and can complete pre-registration information to speed up check in and the encounter.

The patient doesn’t have a long wait time after check in, and if there is a delay, someone alerts the patient and gives them the option to reschedule.

In the exam room, the patient encounter runs smoothly as all the relevant patient information is at hand and the provider can refer to their mobile HER, which allows the physician to maintain eye contact and share information and images with the patient.

The patient receives education and a visit summary before leaving the practice.

The patient receives a follow text or email with directions to leave a review of the practice.

The patient can follow up on the patient portal to see lab results or review medical record information.

The patient receives an email or text with a link to their bill to pay online.

The patient has an ongoing connection to the practice through regular emails, social media, practice blog, and/or newsletter.

There are lots of other little things a practice can do to provide a positive experience that makes them want to come back and helps them feel more engaged in their own wellness and can even improve outcomes.

This consumer-like experience is really what patients want not just a portal. They want a strong relationship with their provider and to be in control of medical decisions or participate in shared decision-making with their doctors.

There is a huge opportunity here for all healthcare providers to begin shifting the way they relate to patients and provide care. It’s a chance to go beyond Meaningful Use and portals and look at the entire patient experience, including a new element to patient care—convenience.

As smaller practices are more nimble, they may find it easier to make these changes than large practices. This can be a unique competitive advantage that smaller practices can take advantage of.

Today, there are also a lot of affordable, easy-to-use solutions for patient engagement and practice marketing that can help. A practice can now easily create an engaging website, provide an online scheduling widget, share positive reviews, and send mass emails and texts with news and information. When combined with an electronic health record and best practices in billing, any practice can become a truly patient-centric practice. Then, the ability to meet those portal use thresholds becomes an easy to achieve by-product of a larger patient engagement strategy.

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Documentation by Exception is the Dredge of EHR Documentation

Documentation by Exception is the Dredge of EHR Documentation | EHR and Health IT Consulting |

There was a very bad practice that was started thanks in large part to EHR software implementations. That practice is called documentation by exception and it’s employed by many (most?) EHR vendors. For those not familiar with documentation by exception, here’s a definition:

Charting by exception (CBE) is a shorthand method of documenting normal findings, based on clearly defined normals, standards of practice, and predetermined criteria for assessments and interventions. Significant findings or exceptions to the predefined norms are documented in detail.

In the US, we all know why this type of documentation was implemented. By documenting all of the normal finding along with the exceptions, then the doctor is able to bill the insurance company at a higher level. I totally understand why doctors want to bill at a higher level. In fact, it was the argument that most EHR vendors would make when they were selling their product to doctors. The EHR was able to help doctors bill at a higher level and get paid more.

While this is going to be hard to change for this reason, there are so many unintended consequences associated with using documentation by exception in these practices. I know so many doctors that are literally embarrassed to share their chart notes with their colleagues because their chart notes are these long, cumbersome notes that are filled with normal findings that provide no value to anyone. Many of these doctors have resorted to creating a separate “short” note that only has the relevant “exceptions” detailed when they send their chart notes to another doctor.

Every doctor knows what I’m talking about, because they’ve found these long lengthy notes that are totally unusable. Plus, in many ways it puts a doctor at some risk if they documented a long list of “normal” items when in fact they didn’t actually check to see if everything was normal or not. However, more important than this is that the doctor can’t even read their own historical notes because they’re so cluttered with all these “normal” findings that it takes real work and effort (Translation: Wasted physician time) trying to search through these awful notes.

If somehow all of these normal findings that were being documented could add some value down the road, then I might change my mind about documentation by exception. However, I can’t imagine any useful clinical benefit to documenting a bunch of normal findings that weren’t actually checked or that were only casually observed. If you didn’t document something was wrong, then we can assume that everything else was normal or at least the patient didn’t complain of anything else. Why do we need to document it clinically? The answer is we don’t and we shouldn’t (except for the getting paid comments above).

We need to find a way to abolish these documentation by exception notes from healthcare. In the US this will be hard since it’s so tied to the payment system, but I’m sure smart minds can figure out a way to fix it. Every doctors I’ve ever talked to wants this solved. It almost makes the EHR notes useless to document this way. This is one more driver in the US system towards concierge and direct primary care models. In these cases, the doctors aren’t worried about reimbursement and so I can’t imaging they’d even consider documenting a patient visit in such an awful manner.

A part of me wonders if EHR vendors will work to solve this problem as well. They could have the beautiful note and the crappy, mess of a note. They’ll use less vulgar terms like the “clinical note” and the “billing note” or something like that, but maybe that’s a small step in the right direction to satisfying the clinical needs (short, concise, relevant notes) together with meeting the billing requirements note. It’s sad that EHR vendors need to do something like this, but it would be better than the current state of EHR notes.

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Do Certified EHR Technology, Alerts Risk Patient Safety?

Do Certified EHR Technology, Alerts Risk Patient Safety? | EHR and Health IT Consulting |

After the HITECH Act was passed and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers began computerizing their patient records and adopting certified EHR technology in an effort to promote care. However, integrating electronic records into the physician workflow has led to a variety of issues, according to the Agency for Healthcare Research and Quality (AHRQ).

While certified EHR technology has been considered a surefire way to improve patient safety, there are many examples proving the opposite and finding that these health IT systems may lead to medical errors that threaten patients’ lives.

The majority of medical technologies – whether infusion pumps, cardiac monitoring devices, or certified EHR technology – have warnings that tell physicians when an action is unsafe for the patient. Through these alerts, clinicians are expected to stop a prescription or a medical procedure deemed dangerous for a particular patient. In particular, some important alerts are meant to notify a doctor whether a patient will have an allergy or negative drug reaction.

However, the widespread computerization throughout the clinical setting has brought an enormous number of alerts among different medical devices, which physicians manage every day. A study conducted last year shows that monitoring devices across 66 patient beds in an academic hospital generated at least 2 million alerts throughout a single month.

In another study surrounding ambulatory care, computerized provider order entry (CPOE) systems generated alerts for as much as 6 percent of all orders entered, which means doctors dealt with dozens of warnings per day.

When it comes to managing these large amounts of warnings, many clinicians experience alert fatigue and become desensitized to the safety alerts. This could be a major problem for the healthcare sector, as physicians may ignore some warnings due to alert fatigue and cause serious medical errors within the clinical setting. The results show that many physicians override most CPOE warnings.

With more exposure to these warnings and additional use of health IT systems, physicians become even more prone to alert fatigue. This problem is also due to the mere fact that many of these alerts generated via CPOE systems are often “clinically inconsequential,” AHRQ reports. The problem with ignoring certain alerts that do not pose harm is that clinicians will also bypass any warnings that could lead to a serious safety issue for a patient.

Essentially, alert fatigue and the high number of warnings may be leading to additional medical errors and patient safety issues throughout the healthcare industry. The widespread use of certified EHR technology may not have the intended consequences once hoped for with regard to quality care improvements.

In fact, a Boston Globe investigation from 2011 shows that alert fatigue and the failure to respond to critical warnings via medical devices led to more than 200 fatalities across a five-year period.

AHRQ gave some recommendations to prevent some of the issues associated with alert fatigue. Increasing alert specificity and eliminating inconsequential alerts, customizing alerts to each individual patient, providing tiers for alerts with regard to severity, and using human factors strategies when designing the warning systems may all lead to greater patient safety and a reduction in medical errors associated with alert fatigue.

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Study: Scribes Have Positive Financial Impact

Study: Scribes Have Positive Financial Impact | EHR and Health IT Consulting |

Many hospitals, and some larger medical practices, have been using scribes to capture medical documentation within EMRs — leaving the provider free to make old-fashioned eye contact with patients.

Using the scribe might sound like a crude workaround to techies, but it’s been a hit with emergency department doctors, who prefer to focus on their brief, critical encounters with patients rather than the hospital’s expensive toy.

While it was clear from the outset that doctors loved having a scribe to support them, there’s been scant evidence that the scribe was anything other than an added cost.

A recent study, however, has concluded that at least from a Case Mix Index standpoint, scribes can have a meaningful impact on a hospital’s revenue.  The study, which evaluated the use of scribes between 2012 and 2014 across a group of hospitals, concluded thatthe scribes save money and boost patient-doctor communication.

The study, which was designed to capture the impact of medical scribes on a hospital’s CMI, linked Best Practices Inpatient Care Ltd. with Advocate Good Shepherd Hospital, Advocate Condell Medical Center and hospitalist-specific medical scribes from ScribeAmerica LLC.

Kicking things off to a good start, ScribeAmerica and Best Practices put scribes through a jointly-developed course that emphasized workflow, productivity and accurate inpatient documentation. The researchers then tallied the results of using trained scribes over a two-year period in the two hospitals.

From 2012 to 2014, researchers found that for both Advocate Condell Medical Center and Advocate Good Shepherd Hospital, CMI values climbed after medical scribes came on board.  Advocate Good Shepherd’s CMI grew by .26 and Condell Medical’s CMI rose .28. These are pretty significant numbers given that a CMI growth of 0.1% typically translates to a gain of about $4,500 per patient. In this case, the hospitals gained roughly $12,000 per patient.

These findings make sense when you consider that using scribes seems to have served its purpose, which is to be extenders for providers who’d otherwise be hunched over an EMR screen.

Researchers found that inpatient physicians at the two hospitals studied were able to cut time spent on chart updates by about 10 minutes per patient on average. This profit-building effect is enhanced by the fact that scribes often get discharge summaries prepared immediately, rather than within 72 hours as is often the case in other hospitals.

That being said, it should be noted that the study we’ve summarized here was co-written by the CEO of Best Practices, which clearly invested a lot of time and effort training the scribes for the specific tasks important to the study.

Still, the study does suggest, at minimum, that scribes need not necessarily be written off as an expense, given their capacity for freeing providers for billable clinical activity. Ideally, IT vendors will develop an EMR that doctors actually want to use and don’t need an intermediary to work with effectively.  But until that happy day arrives, scribes seem like they can make a difference.

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Medical Data Exchange, Cloud Solutions Impact EHR Design

Medical Data Exchange, Cloud Solutions Impact EHR Design | EHR and Health IT Consulting |

Over the last two decades, the medical industry has changed drastically in terms of patient care and access to medical records. It was nearly impossible to obtain one’s own health record 20 years ago. Forbes reports that patients had little choice but to press legal action if they wished to access their own medical data.

In 1996, however, the Health Insurance Portability and Accountability Act (HIPAA) was passed, which did offer legal protections to patients who needed to see their health records. Nonetheless, there was still significant difficulty in accessing this information and most people never went through the challenging process.

Today, these problems are slowly disappearing, as patients have more ability to readily view their medical history and test results via patient portals and through other electronic means.

A study published earlier this year shows that after three hospital systems in separate states offered their patients the ability to view their health records and physician notes, nearly 70 percent of patients reported understanding their conditions better and taking better care of themselves including remaining vigilant about taking their medications on time. The results from the study also showed that providing patients with this ability did not majorly impact the physician workflow.

The design and evolution of certified EHR technology and health IT systems that held medical data are now changing toward a more cloud-based and mobile platform. This leads to more digitizing of medical records and providing more flexible solutions for healthcare professionals within the clinical setting.

Both mobile health and wearables are also impacting the design of certified EHR technology. The Apple watch, for instance, could potentially hold relevant medical data for physicians to view and patients to access. Additionally, mobile apps on smartphones or tablets could be used by patients to request drug refills and securely message doctors or nurse practitioners.

In a new report from market research firm IDC, Judy Hanover, Research Director at IDC, explains, “The new concept of flexible, mobile, cloud-based acute care EHR supports digitizing paper workflow and reengineering processes … There’s a huge appetite for getting better workflows into healthcare, looking at department specific and mobile apps. I would see an environment where hospitals and health systems would perhaps rip out and replace in some cases.”

According to the report, it is expected that over the next few years, providers will begin to replace their current certified EHR technology with cloud-based solutions instead. Greater investment will continue to be poured into the health IT industry as providers move onto meeting Stage 3 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs.

Additionally, the future of EHRs will continue to depend on EHR interoperability and the ready access of medical data across the healthcare industry. Forbes states that many within the medical sector believe EHR interoperability will be the “biggest game changer.” However, it may take longer than expected for interoperability and medical data exchange to expand across multiple healthcare settings, as this industry “moves slowly.”

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Key Steps for ICD-10 Preparation before October 1 Deadline

Key Steps for ICD-10 Preparation before October 1 Deadline | EHR and Health IT Consulting |

The ICD-10 compliance deadline will be here momentarily. Healthcare providers have little more than four months left before October 1, which means their ICD-10 preparation efforts must move forward quickly in order to be ready for the transition and avoid any reimbursement delays from the Centers for Medicare & Medicaid Services (CMS) as well as other health insurers.

To learn more about ICD-10 preparation and where providers should be heading, spoke with Pam Jodock, Senior Director of Health Business Solutions at HIMSS. “Where should a healthcare organization be in terms of ICD-10 preparations right now?”

Pam Jodock: “Ideally, they will have already gone through making sure all their systems are remediated, their documentation has been updated, and hopefully they’ve trained their physicians on documentation. The need for the more detailed elements of documentation on ICD-10, they’ll have trained their coding staff.”

“If they have 3rd party vendors, they’ll have received confirmation from their vendors that they’re ICD-10 ready and that their clearinghouse has tested with their payers. Larger organizations, especially, will have completed testing with CMS both on the end-to-end and acknowledgement testing. That’s the ideal situation.”

“For those entities who are that far along the path, who have continued their implementation efforts despite the delay, they should be in pretty good shape. What they can be focusing on in the next few months before October 1 is looking at their reports. They need to make sure they’re ready to make the transition to ICD-10 and can account for any abnormalities that may occur because of the differences in coding.”

“The more detailed information might alter their numbers slightly on pay-for-performance. If they’re tracking patient activity related to diabetes, they may see those numbers go up slightly or go down slightly because of individuals they might not have captured under the ICD-9 coding. Those individuals may show up under ICD-10 because of additional detail. Looking at the reports and making they’re prepared for that [is important].” “What health IT solutions and services are working for providers with regard to ICD-10?”

Pam Jodock: “HIMSS is not in the position of endorsing specific vendors. We’ve been hearing a lot of positive reports from individual practices that are using vendors and clearinghouses for their solutions. We even saw in testimonies before Congress a few months ago where there was a solo practitioner who talked about the solutions in his office where the vendor essentially said, ‘On this day, you can code on ICD-9 and on this day, we may need to practice coding in ICD-10,’ and this was working.”

“We’re hearing a lot of end-to-end testing results are demonstrating that preparations organizations have made are working well for them. We’re hearing there is not a substantial increase in rejected claims under the testing area for ICD-10 than there were under the existing ICD-9. CMS had projected there might be one to two percent increase, but what we’re seeing is that it remains pretty stable. Regardless of the solution that’s being offered, they’re all working well.” “What testing plans should providers have for the months ahead especially providers that are behind in their ICD-10 preparation?”

Pam Jodock: “We do know that there are some solo and small practitioners out there who have not been able to dedicate as many resources to preparation because they’ve been hit with many other demands for their resources. They’re just now starting their preparation.”

“Testing with commercial carriers, you may have a very limited window left. A lot of commercial carriers will be ending their testing in June or July to focus on completing their transition. If there is still an opportunity to test with external partners, we would strongly encourage organizations to do so.”

“What we would recommend that they look at, is identify those ICD-9 codes they bill most frequently, identify the ICD-10 codes that they would bill for those procedures going forward, and also to look at those ICD-9 codes that generate the greatest percentage of their revenue and make sure they know what ICD-10 codes they will billing for those services going forward. They should create test scenarios using those codes and, if they can find a payer for end-to-end testing, use 25 to 30 scenarios. They can also use those same scenarios for acknowledgement testing with CMS all the way up until September 30.” “What is your viewpoint on Representative Diane Black’s ICD-10 bill?”

Pam Jodock: “This is a conversation we’ve had before. It would essentially require a period of dual coding. She has language in there about penalties. What I would note is that there is no penalty stage, technically, for ICD-10. If you’re not prepared to do ICD-10, if all you’re prepared to do is ICD-9, it may be viewed as a penalty in that there is no allowance for submitting ICD-9 claims.”

“The default penalty is that your claims will not be accepted. If you code in ICD-9 for services after October 1, your claim would automatically be rejected because it’s not coded properly. That is not considered a penalty phase. It’s just considered noncompliance.”

“She’s suggesting that we offer dual coding so that we can ease providers into the ICD-10 world. The challenge with that is that systems have been remediated across the industry based on date of service. For claims that are processed prior to October 1, there’s a whole different set of business rules and payment methodology that are applied to them. If you get to the fork in the road in the claims processing system and your date of service is before October 1, you go to the left. If your date of service is after October 1, you go to the right because the systems are not coded the same.”

“If you were to do dual coding, that would require an additional period of time for payers to again remediate their system and it would essentially result in a defacto delay.”

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EHR System Selections Vary by Practice Size, Survey Finds

EHR System Selections Vary by Practice Size, Survey Finds | EHR and Health IT Consulting |

Providers' selections of electronic health record systems tend to vary by physician practice size, according to a survey by AmericanEHR Partners, Becker's Health IT & CIO Review reports.

The survey -- conducted between Jan. 1, 2013, and Nov. 6, 2014 -- yielded responses from about 1,400 clinicians.

Findings on EHR System Selection

According to the survey, large practices tended to select EHR systems from a limited pool of products, compared with smaller practices.


  • 60% of respondents from practices with 26 or more clinicians reported using one of just 10 different EHR systems; and
  • 51% of respondents from practices with one to three clinicians reported using one of 10 EHR systems.

According to Shari Erickson -- senior vice president of the division of governmental affairs and medical practice of the American College of Physicians, which co-founded AmericanEHR Partners -- the 40% of larger practices that used an EHR system other than the top 10 were spread out among 86 vendors.

Top Vendors

Overall, the two top vendors were:

  • Epic, with 14% of the market share; and
  • Allscripts, with 9% of the market share.

Meanwhile, the top vendors among practices with one to three clinicians were:

  • Practice Fusion, with 15% of the market share among solo practices and 12% among those with up to three clinicians;
  • eClinicalWorks, with 9% of the market share among both solo practices and those with up to three clinicians;
  • Epic's ambulatory EHR system, with 5% of the market share among both solo practices and those with up to three clinicians; and
  • Amazing Charts, with 5% of the market share among solo practices.

Epic's ambulatory EHR system was the top product among practices with:

  • Four to 10 clinicians, with a 14% share;
  • 11 to 25 clinicians, with 25%; and
  • 26 or more clinicians, with 16%.

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Why You Should Support the Safe Harbor ICD-10 Conversion Bill

Why You Should Support the Safe Harbor ICD-10 Conversion Bill | EHR and Health IT Consulting |

The ICD-10 conversion brings with it many complications and physician groups across the country are looking to avoid putting additional time and monetary strain among providers from implementing the new coding set. In that attempt, Representative Diane Black (R-TN-6) issued bill H.R.2247 called Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act).

Instead of seeking to delay the ICD-10 conversion any further or put an end to the new coding system altogether as prior proposed bills have suggested, it mandates an ICD-10 transition period – or a “safe harbor” period – before which the Department of Health and Human Services (HHS) would perform end-to-end testing among all providers to determine whether the fee-for-service reimbursement system is working properly and complies with ICD-10 codes.

Dr. Will Harvey, a practicing rheumatologist and Government Affairs Committee Chair for the American College of Rheumatology, is a strong supporter of bill H.R.2247 and spoke with about why this legislation is so important.

When asked his reasons for supporting the ICD-10 bill, Harvey answered, “There are two reasons. One, in particular in the specialty of rheumatology but certainly true in all of medicine, a large number of our practices are small solo or small group practices with many in rural or other under-served areas, which leads us to be concerned about our ability to adequately test our systems. The reason is the end-to-end testing that’s being performed by CMS right now is restricted to around 2,500 testers who are selected because of their prototypical nature.”

“If these 2,500 people do okay with testing, then there will be enough practices like those 2,500 out there that will feel comfortable about their ability to successfully use the system,” Harvey continued. “The thing that concerns us about this is that if there are 10 electronic health records, 10 billing systems, 10 clearinghouses, and 10 revenue management software vendors out there, then that leads to 10,000 different permutations of different software types that one would use to transmit their bill from the practice to CMS and back. And, of course, there are many more than 10 of each of those things.”

“Our concern is that the 2,500 prototypical testers is not enough to reassure providers – particularly ones in rural or small areas – that their systems will work because often they have unique software products that may not be adequately tested,” Harvey mentioned.

When discussing his second reason for supporting Representative Diane Black’s ICD-10 bill, Harvey explained, “The concern related to the safe harbor period or the implementation period of 18 months is that there’s a lot of learning that will have to happen around ICD-10 after October 1. This is due to the combination of people being inadequately prepared and things like payer edits and different ways in which the codes will be used that we don’t even understand yet.”

“One of our big concerns is that the added specificity contained within ICD-10 will be used to deny or modify payment or even more egregiously be used to assess waste or fraud. We are trying to help people understand that – because of the complexity of the system – minor mistakes in sub-codes are not fraud, they’re just mistakes. Because the learning curve will continue after October 1, we think it’s very reasonable to allow providers this implementation period where they will not be penalized or denied payment on the basis of a simple mistake in a sub-code.”

“We’re not suggesting that any code be accepted,” Harvey further explained his points. “We’re just suggesting that sub-codes are the ones that are the least important when determining payment. They’re more important for epidemiological and public health purposes rather than payment.”

When asked which providers might be negatively affected by the ICD-10 conversion, Harvey replied, “From a technical perspective, it’s always more difficult for small groups or solo practitioners or people who are working in traditionally underserved areas because they work on much, much smaller margins to operate their business.”

“They often run on margins of a couple percent. Even a couple percent increase in rates of claims denial will threaten the viability of those practices and ultimately affect patient access,” Harvey stated. “From a practical perspective in who will have the most difficulty handling the increase in the number and complexity of codes based on their specialty, cardiology is one affected and oncology is another. Orthopedics perhaps has the greatest increase in the number of codes. Emergency physicians are affected [by the ICD-10 conversion] because of the large amount of specificity around accidents and injuries of various types. The number of codes that rheumatoloigists will consider for rheumatoid arthritis goes from one to 246.”

With regard to whether the ICD-1o conversion could severely impact reimbursement among a large number of providers, Harvey stated, “Unfortunately, I’m not sure [whether this would occur]. That’s part of why we would like more comprehensive testing before October 1 because it will give us that answer.”

“Our software that we have right now does not support dual coding,” Harvey continued. “We can’t run any analytics to find out whether our providers are adequately coding at an ICD-10 level. We will only be able to do that after October 1 when we turn on the ICD-10 functionality inherent in our system.”

“If we can’t start doing analytics until after October 1, how can we possibly answer how much we’ll be impacted financially, but also how can we train people if they can’t on a day-to-day basis use the new system in their daily practice? This will all happen to a large extent after October 1, which is why we’re pushing so strongly for the safe harbor period.”

When asked what safeguards under the proposed legislation are the most important, Harvey replied, “I think the most important for America’s small and solo practitioners is the testing piece because they’re at high risk. For everyone else and for those people, I think the safe harbor piece is the most important. It’s well known among the health IT industry that we have accuracy problems already with ICD-9 and that problem will only get worse during the implementation with ICD-10. We feel that it’s common sense to let everyone learn on the job for 18 months before we’re held to strict accountability for the specificity held in the coding set.”

Harvey also gave tips to healthcare providers to mitigate risk when it comes to the ICD-10 conversion by the October 1 deadline.

“Even if you cannot participate in the CMS-sponsored end-to-end testing, I hope every provider is testing their own internal systems or getting documentation from their various vendors that their systems will be ready on time,” he stated. “I think another point is to get providers and their staff trained on the new code set so that we’re minimizing the learning curve that has to happen on October 1.”

Dr. Will Harvey concluded by mentioning how it would benefit providers if the Centers for Medicare & Medicaid Services (CMS) was more transparent with regard to theircontingency plans for the ICD-10 conversion.

“They [CMS] haven’t released [the contingency plans] publicly,” Harvey concluded. “One thing we would very much like is for them to put out their contingency plans so that we can review them and see whether they’re adequate. We generally don’t feel as though legislation should be necessary to deal with these issues, but in part it’s because of CMS’ lack of transparency in this regard that we feel compelled to support this legislation.”

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ICD-10 Implementation Vital for Value-based Care Payments

ICD-10 Implementation Vital for Value-based Care Payments | EHR and Health IT Consulting |

When the SGR bill was passed by the Senate without any ICD-10 implementation delays, the proponents of the new coding set rejoiced. Not only did passage of this bill bring about a stronger formula for Medicare reimbursements but it also meant that the ICD-10 implementation would most likely take place by the scheduled deadline of October 1, 2015.

When President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on April 16, the legislation moved American physicians away from fee-for-service payments toward value-based care and accountable care delivery, according to the Healthcare Information and Management Systems Society (HIMSS).

Additionally, the new SGR bill includes innovative objectives for establishing the meaningful use of certified EHR technology. These payment models will be key for improving population health outcomes throughout the country. The volume-based payment reductions under the prior sustainable growth rate formula will now be altered with a new annual payment update of 0.5 percent through 2019.

By 2019, doctors will be able to choose their reimbursement method among two options: the Merit-Based Incentive Payment System or the Alternative Payment Model. While the Merit-Based Incentive Payment System will depend upon the performance of physicians, doctors who choose the Alternative Payment Model must utilize certified EHR technology standards and authorized quality measures as well as assume financial risk.

The overall push toward value-based care among the federal government, patient advocacy groups, and healthcare providers will require the medical industry to quickly and efficiently transition to the ICD-10 coding set. Documenting patients’ medical histories as well as accurately reporting and coding diagnoses and treatments is vital in the quest to pay for value and enhance population health outcomes across the sector.

The Coalition for ICD-10 also reports on the importance of the ICD-10 implementation in the move toward value-based care, as ICD-9 codes do not have the same capabilities as the newer coding set. While the healthcare community supports the SGR reform bill, many physician groups are still against the ICD-10 implementation and are hoping for additional delays.

However, a move toward measuring and paying for value-based care is not possible without transitioning to a modernized form of diagnostic and procedure coding. In order to accurately measure the value of a healthcare service, it is vital to have the detail available in the ICD-10 coding set, the coalition explains.

One example of the subpar quality of ICD-9 codes involves putting two patients with similar conditions but differing symptoms under the same code while ICD-10 accounts for a variety of divergence among patients. Essentially, ICD-10 codes will include key information about patients and record their medical history more accurately with additional detail.

“Despite opposition to ICD-10 by some physician groups and a few isolated state medical societies, there is general recognition in the medical community that a modern and precise coding system like ICD-10 is essential for measuring and paying for value,” the Coalition for ICD-10 stated. “ICD-9 represents medicine of a bygone era. It cannot support a move to measuring and paying for value. To meet the demands of SGR there can be no further delays in the ICD-10 implementation date.”

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Six Ways to Improve Patient Satisfaction Scores

Six Ways to Improve Patient Satisfaction Scores | EHR and Health IT Consulting |

Large physician practices and hospitals already have a portion of their payments linked to patient satisfaction. Over the next few years, it will be an integral portion of physician payment, including penalties possibly dwarfing those under meaningful use. More about this program, known as the Clinician & Group Consumer Assessment of Health Providers and Systems (CG-CAHPS) can be found on the Agency for Healthcare Research and Quality's website.

Here's the government's hypothesis in a nutshell:

• Patients who like their doctors are more likely to be compliant patients;

• Compliant patients are healthier patients;

• Healthier patients are less expensive; so

• Physicians with satisfied patients should be paid more than physicians with dissatisfied patients.

The Affordable Care Act introduced a different set of quality metrics than used by the Institute of Medicine (IOM): quality, patient satisfaction, and payment. Quality is a key element with both programs, but there's an important difference with the reform law: your patients are the arbiters of quality. Quality more or less equals patient satisfaction.

What's being measured?

CG-CAHPS measures the patient experience, an expansive proxy for quality that takes into account the following:

• Timely appointments

• Timely care (refills, callbacks, etc.)

• Your communication skills

• What your patient thinks about you

• What your patient thinks about your staff

• Your office running on schedule

I have been in enough medical practices — both as a patient and as an administrator — to know there's a method to this madness. It's less about the care and more about the caring. Here's what I suggest for improving your quality measures via these proxies.

1. Hire sunshine.

I can train anyone* to do anything in our office, but I can't train sunshine.  Look to hire positive and happy people, particularly for roles with lots of patient interaction. Your patient satisfaction — and thus, your "quality" — will improve. You'll also find a cost-saving benefit to this hiring tactic: employee turnover will shrink.

2. Start on time.

CG-CAHPS asks patients whether they were seen within 15 minutes of their appointment times; it's even underlined for emphasis. Physicians who start on time are more likely to run on time, so have your feet set before you start running.

3. Set patient expectations.

It's helpful to share with patients the FAQs about your practice so that they know what to do for refills, after-hour needs, appointment scheduling, etc. By making these answers available on your website, on your patient portal, and in your print materials, you'll better align patient expectations with patient experiences and thereby score better on quality surveys.

Some patients gauge quality by whether or not they get the antibiotic they think they need. It's helpful for primary-care physicians to include education on antibiotic overuse in their patient education materials.

Along these lines, it is important for your patient to know what to expect after their visit in terms of test results, follow-up visits, etc. I receive more complaints about the back end of our patients' experiences than anything else. Make sure you and your staff do not drop the ball as you near the goal line.

4. Listen with your eyes.

Nothing says "I don't care" like having your physician focus on a computer screen rather than on the patient. This is particularly true in the first couple of minutes of each visit, and especially important with new patients. One virtue of using medical scribes is that you can listen with your eyes a whole lot more.

5. Put your staff in their place.

Your staff has an important bearing on the patient experience. I'm a big fan of letting them know their actions influence quality. It's pretty cool, for me as a mere bureaucrat, to know that I can improve quality simply by being friendly and helpful to our patients. Make sure your staff knows that making a patient's day is a beautiful act.

6. Monkey see, monkey do.

Staff will follow your lead. If your thoughts and actions emphasize running on schedule, being kind to patients and their families, and not dropping balls, they'll be stronger teammates for you.

Patient satisfaction has always been a gauge of quality, just as patient referrals remain the lifeblood of most practices. Treat this next wave as an opportunity to show off the caring that has always been a big part of the medical care you offer your patients.

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Just Say It, a solution to your EMR data entry dilemma

Just Say It, a solution to your EMR data entry dilemma | EHR and Health IT Consulting |

For as long as I can remember (and that’s a very long time), clinicians have been complaining about the burden of entering data into the EMR. For most of us who started practice when medical records were primarily on paper there were basically two modalities for documenting our work. One was the pen. It worked pretty well for SOAP notes and brief encounters. I even recall documenting full physical exams on paper. The problem with writing things down on paper was that my hand would get tired, and my handwriting was awful. Sometimes after a long day of patient care, even I couldn’t read my notes.

For longer or complicated patient exams we had the luxury of dictation. In fact, I worked in several organizations where all of my notes were dictated and later transcribed by professional transcriptionists. Then along came the EMR, and the expectation that our clinical notes would be entered using keyboard and computer. Thank goodness my mother made me take touch typing in high school. None-the-less, compared to the speed of dictation, typing patient data into the computer was a burden and a significant time sink to my productivity.

Of course, for many years there have been software solutions for voice recognition and today they are substantially better and more accurate than they used to be. They work best when the user “trains” the software to understand his or her own voice, and even the best software will miss words now and then. Also, because medicine has its own language you generally cant’ use just any old software for voice recognition. You must buy speech recognition software written specifically for medical professionals, and it was usually quite expensive.

When I went to work for Microsoft, it always bugged me that our own very robust speech recognition engine, the one that comes free with Windows, couldn’t easily be used for medical dictation. Therefore, clinicians had to install expensive software that used an entirely different speech engine. Because Windows didn’t have a lexicon for medical terminology that worked with our Windows speech engine, that’s just the way it was. That is not the case anymore. Thanks to some innovative partners and the advent of cloud computing, there are now some excellent, cost-effective solutions for clinicians who are ready to ditch the keyboard and start using their voice to enter EMR data. One of those solutions is SayIt, by nVOQ.

This year at HIMSS we demonstrated the nVOQ SayIt solution on our Surface Pro 3 tablets. This marriage of a great, clinical grade device connected to a robust, cloud-based medical speech recognition solution is  guaranteed to delight clinical end-users.

I’ve gotten to know the crew at nVOQ over the past few years. In fact, one of their executives is a former colleague of mine here at Microsoft. nVOQ has been working tirelessly to bring forward and continuously improve a medical, speech recognition solution that is suddenly gaining a lot of traction in the market.  

SayIt is a cloud-based speech recognition solution that converts spoken words into text within seconds. It can be used for free-form dictation, front-end transcription and for navigating EMRs using voice commands or shortcuts. SayIt supports 35+ medical specialties and works with virtually any EMR (PC and Mac-based). The solution enables healthcare providers to:

Work more quickly and effectively in the EMR

Spend less time on clinical documentation, more time with patients

Take more detailed notes for clearer assessments

Document care in their own words for improved patient outcomes

Simplify clinical workflow for time and cost savings 

If it has been awhile since you tried speech recognition for data entry into your EMR, and particularly if you haven’t tried a cloud-based solution, I’d urge you to take another look. I think you’ll be surprised by how much the technology has improved. I also think if you treat yourself to a “clinical grade” device like our Surface Pro 3 that you just might begin to love, rather than loathe, your EMR.

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A “Collaborative Consult” Could Greatly Improve EMR Value

Over the past several years, EMRs have taken some steps forward. At least in some cases, analytics have improved, vendors have begun offering cloud or on-premise install versions of their products and user interfaces have even improved.

But one problem with EMRs that seems to be nearly unfixable is the need for providers to stare at an EMR screen, leaving patients to fidget uncomfortably while they wait for a bit of face-to-face contact and discussion. Sure, you’ll see scribes in hospital emergency departments, allowing ED docs to speak to patients without interruption, but in the outpatient settings where patients spend most of their time, the EMR screen is king.

Such a focus on the EMR display isn’t unreasonable, given the importance of the data being entered, but as critics have noted countless times, it does make it more likely that the provider will miss subtle clues as to the patient’s condition, and possibly end up offering lower-quality care than they would have if they had an old-fashioned computerless encounter.

I have long thought, however, that there’s a solution to this problem which would be helpful to both the physician and the patient, one which would literally make sure that patients and doctors are on the same page. I’m speaking of a new group of settings for EMRs designed specifically to let patients collaborate with physicians.

Such an EMR setting, as I envision it, would begin with a section depicting a dummy patient of the appropriate gender.The patient would touch the areas of the body which were causing them problems, while the doctor typed up a narrative version of the problem presentation. The two (patient and doctor) would then zoom in together to more specific descriptions of what the patient’s trouble might be, and the doctor would educate the patient as to what kind of treatment these different conditions might require.

At that point, depending on what condition(s) the doctor chose as requiring further study, lists of potential tests would come up. If a patient wanted to learn what these tests were intended to accomplish, they’d have the liberty to drill down and learn, say, what a CBC measures and why.  The patient would also see, where possible, the data (such as high cholesterol levels) which caused the doctor to seek further insight.

If the patient had a known illness being managed by the physician, such as heart disease, a tour through a 3-D visual model of the heart would also be part of the collaboration, allowing the doctor to educate the patient effectively as to what they were jointly trying to accomplish (such as halting heart muscle thickening).

The final step in this patient-doctor process would come with the system presenting a list of current medications taken by the patient, and if appropriate, new medications that might address any new or recurring symptoms the patient was experiencing.

The final result would come in the form of a PDF, e-mailed to the patient or printed out for their use, offering an overview of their shared journey. The doctor might have to spend a few minutes adding details to their notes after the patient left, but for the most part, the collaborative consult would have met everyone’s needs.

Now you tell me:  Why aren’t we doing this now?  Wouldn’t it make much more sense, and take much more advantage of the powerful desktops, tablets and smartphones we have, than having a provider stare at a screen for most of their visit with a patient?

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6.5 Billion Transactions Boost Health Information Exchange

6.5 Billion Transactions Boost Health Information Exchange | EHR and Health IT Consulting |

The quick and efficient access to healthcare data among medical organizations is vital in pursuit of improved quality of care, better patient health outcomes, and lower costs. In general, health information exchange helps reduce hospital readmission rates, target symptoms before a disease progresses, and prevent medical errors across the healthcare continuum.

One announcement from Surescripts – the largest health information network across the country – shows how devoted the medical industry is to advancing health information exchange and quick access to pertinent data in pursuit of better patient care. Last year, Surescripts processed 6.5 billion health data transactions, which was published in the 2014 National Progress Report. The large amount of health information exchange Surescripts conducted amounts to more than either PayPal or American Express handled in 2014.

“Connecting the nation’s healthcare system is a monumental task, and while more work is needed to ensure true interoperability nationwide, there is no question that the Surescripts network is more connected than ever before,” Tom Skelton, Chief Executive Officer of Surescripts, said in a public statement. “Healthcare is evolving and our collective ability to share health information is addressing a major pain point for providers and patients that ultimately saves time and money and improves the quality of care.”

The statistics show it all – Surescripts exchanged data transactions among 900,000 healthcare professionals, 61,000 pharmacies, 3,300 hospitals, 700 EHR systems, 45 immunization registries, and 32 state and regional networks. The health information that Surescripts shared belonged to approximately 230 million patients, which represents seven out of ten US residents.

Through the Surescripts network, 1.2 billion electronic prescriptions were processed by pharmacies and physicians. Additionally, healthcare professionals accessed and shared 764 million medical history transactions and 7.4 million clinical messages.

Throughout 2013, the access of medication history data rose 75 percent in acute care settings like emergency rooms. Some other key information that Surescripts is capable of sharing among healthcare organizations includes patient charts, visit summaries, and referral orders.

When compared with 2013, the amount of clinical messages that were transferred across the Surescripts network rose by 1,300 percent. This type of extensive health information exchange complies with many regulatory policies and raises patient health outcomes across the nation.

Additionally, sharing electronic data access throughout the industry is a major driver toward combatting prescription fraud and drug abuse. Electronic drug prescription plays a huge role in reducing the abuse of prescription painkillers, for example. Paper prescriptions are relatively easy to forge and medical facilities that transfer to electronic prescribing will make it virtually impossible for addicts to transcribe a false prescription.

“I see the physical and emotional toll that opioid abuse takes on patients and their families every day in the emergency room. E-prescribing can be an effective tool in fighting that abuse,” Dr. Sean Kelly, FACEP, CMO, an emergency physician at Beth Israel Deaconess Medical Center, stated in the press release. “Physicians are eager to embrace technology – as long as it is good technology that speeds our workflows and allows us to make better informed decisions that increase patient safety.”

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