Telemedicine & eHealth 2013: Ageing Well - how can technology help? will be held in London, United Kingdom on November 25th.
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You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the exact reimbursement process will not be known until the fourth quarter of this year, at the earliest.
The difference is in the details
There is one quick way to tell if you’re dealing with a consultant or a reseller. A reseller’s services should be free to you because the vendor is picking up the tab by paying the reseller a percentage of the sale, or some other pre-arranged fee. You know in advance that a reseller is going to steer you toward a particular product, and you can thus take what they say with the same healthy dose of skepticism that we apply to information we receive from drug reps.
On the other hand, if you are paying for services and recommendations, then you are dealing with a consultant who should be giving you unbiased advice. Unfortunately, a good number of consultants accept fees from doctors but then also receive referral fees from vendors for sending them potential clients. These payments may be in the form of cash, discounted hardware and software, or anything else of value.
The wild frontier
You need to ensure that the information you receive from these “experts” is unbiased and based on the reasonable approach of matching your practice’s needs with the available solutions. A few key steps could save you tens of thousands of dollars in hardware and software expenses, not to mention the frustration of being cajoled into purchasing an overpriced and unusable EHR that you’ll regret later:
• When considering an EHR consultant, ask them pointblank if they have any relationship with one or more vendors, and ask exactly how those relationships work.
• Ask the consultant how many practices of similar size and specialty they have helped in the past, and get at least three different practice names and contact information to confirm that they were pleased with the consultant, would recommend their services, and would use them again.
• For smaller practices, be especially wary of consultants who also sell IT hardware and/or technical support. In my experience, IT consultants tend to recommend significantly more complex (and expensive) hardware and software than is necessary for the average small medical practice.
The third point deserves a bit more discussion, since many of the consultants in the EHR space also provide IT services and sell computers, servers, and other hardware. The main problem with hiring an IT consultant for guidance is that all too often these technologically -minded people push equipment and policies that are significantly more expensive and complex than is reasonable to run a small practice.
In my experience as an EHR vendor, all too frequently when an IT consultant is used, the practice ends up not only spending much more on hardware than my non-IT-consultant practices, but they have much less of an understanding of their system and thus an inability to troubleshoot issues that arise from time to time. In fact, Amazing Charts (my EHR company) recently raised prices for additional providers because we found that larger practices tend to have overly complex technology infrastructures based on the recommendations of their IT consultants. These systems take more time and energy to troubleshoot, and much more frequently, hardware and network issues are the source of the difficulties that lead to downtime.
Everybody does it, right?
When a consultant does recommend a specific product, whether an EHR system or anything else, do some online research to find out what others have to say. The American Association of Family Physicians (www.aafp.com) has a good site for researching EHR software (ie, the Center for Health IT). Message boards can be another useful research resource, if you have time to sort through all the garble.
The most important take-away from this month’s column is to make sure that your independent EHR consultant is not actually shilling for someone else. Get it in writing so you have some legal recourse if you make a purchase and have buyer’s regret a few months later
New research, published today in Health Affairs, from the Office of the National Coordinator for Health Information Technology (ONC) show that health information exchange (HIE) between hospitals and other providers jumped 41 percent between 2008 and 2012.
The research – authored by National Coordinator for Health Information Technology Farzad Mostashari, M.D., and ONC researchers – indicates that six in 10 hospitals actively exchanged electronic health information with providers and hospitals outside their organisation in 2012.
The research suggests that electronic health records (EHRs) and health information organisations (HIOs) are complementary tools used to enable health information exchange. Stage 2 Meaningful Use, which requires eligible hospitals to exchange with outside organisations using different EHR systems and share summary of care records during transitions of care, can help accelerate hospital use of HIE as a means to enhance care quality and safety.
“We know that the exchange of health information is integral to the ongoing efforts to transform the nation’s health care system and we will continue to see that grow as more hospitals and other providers adopt and use health IT to improve patient health and care,” said Dr. Mostashari. “Our new research is crystal clear: health information exchange is happening and it is growing. But we still have a long road ahead toward universal interoperability.”
Highlights of the new study show:
Electronic health records save lives by collecting patient data in one place. Artificial intelligence takes it a step further by calling on the expertise of multiple doctors.
While I had heard that almost 400,000 Americans die each year because of medical mistakes, in a recent article Forbes contributor Dan Munro underscored that volume when he asked readers to imagine the largest commercial aircraft -- an Airbus A-380 -- crashing every day for a year: The number of passengers who would perish aboard those imaginary crashes compares to the number of patients really dying annually in our hospitals due to blunders.
People who want nothing to change usually dispute the number of deaths. For the sake of argument, let us assume the actual number could be represented, then, by one crash every four days. Even then, surely it is worthwhile trying to figure out how to prevent these errors.
Certainly, procedural failures or pure accident causes some errors but incomplete or incorrect information about the patient is at the heart of a large percentage of these mistakes.
As Munro points out, a major problem is that the current healthcare industry is incentivized by revenue and profits -- not safety and quality. Therefore, as newly re-elected Florida Governor (and former healthcare CEO) Rick Scottsaid at a recent meeting to discuss cutting costs in healthcare, the industry has been unwilling to voluntarily reduce profits. Since safety and quality using current methods would be expensive and slash profits, perhaps electronic health records (EHRs) and health information technology (HIT) could accomplish the goals of all stakeholders.
EHRs can maintain patients' complete medical histories, along with all known allergies and medications. The record should travel with patients, no matter where they go for treatment. Doctors do not have to rely on the patient's fallible memory at every encounter. The record speaks for patients, even if patients are incapacitated for any reason.
We must recognise that doctors often face points of no return -- and patients get no second chances. Choosing the right medicine or treatment is frequently a game of probabilities. Choose the right medicine and the patient will live. Choose the wrong one and the patient will die. This is why even the most qualified doctors often seek second or third opinions before embarking on a risky treatment plan. Doctors have told me countless stories about their ability to save patients because a complete EHR was available. In these cases multiple doctors were able to view the same information at the same time, often while residing thousands of miles apart. They collaboratively agreed on the best option -- and saved the patient's life.
EHRs also facilitate artificial intelligence. A patient's medical history often is full of reams of data; manually winnowing through that information is a daunting task. Today, teams of top doctors help develop artificial intelligence systems that can quickly determine if a proposed medicine, food, or medical procedure will likely cause the patient greater harm than good. This will reduce a large number of medical mistakes.
There is no cause for concern. Decisions suggested by artificial intelligence systems developed by top-notch doctors likely are more accurate than decisions made solely by humans. Watch Vinod Khosla discuss this fascinating issue. All doctors are not created equal. As Khosla pointed out, studies show that if you give the same data on a patient to a random group of 10 doctors and ask them if surgery is recommended, half will choose surgery while the other half will choose not to perform surgery.
If artificial intelligence systems are built using the medical minds of the doctors that choose the right answers, these technological solutions sift through an incredible amount of data and provide more medically reliable recommendations. Of course, a human doctor still makes the ultimate decision. However, the doctor has the benefit of a large amount of data analysis and is much more likely to make a decision based on complete information, not incomplete data.
Perhaps EHRs plus AI will save many more lives and dramatically reduce medical errors without increasing costs too much.
With the federal government spending tens of billions of dollars to push healthcare providers to install electronic health record systems, health information technology has been at the forefront of innovation in the healthcare industry for most of the past decade.
Being a caregiver is hard, but health IT can help caregivers manage a loved one’s care. From tracking multiple medications to having all your health information in one place, health IT and new mobile technology are proving to be valuable resources to patients and people like me, those of us who take care of a loved one.
For starters, I had no information about my mother’s medical history—she was the superwoman and glue that held our household together. So when I was asked about family history and who her primary care physician was, her ER nurse and doctor were met with my tears and endless blank stares.
How was I supposed to know?
The healthcare system did not care that I didn’t know and my level of readiness was not their concern. My life was transformed and from that day forward, I was dubbed caregiver—care coordinator and documentarian extraordinaire for my sweet mother.
The life of a caregiver is not glamorous—no one aspires to be a caregiver because it usually signals something has gone terribly wrong. More than 90 million caregivers across the U.S. provide nearly $450 billion worth of unpaid care annually. Many of these caregivers are full-time workers. Younger Americans between the ages of 18 and 29 make up 36% of the family caregiver population.
As a family caregiver it means the decisions you make have a direct impact on your patient’s daily comfort and their overall quality of life. We perform both complex medical and nursing services like medication management and wound care for our loved ones, but also the mundane tasks like bathing. I’m frequently responsible for coordinating her care and making sure the proper pieces of health information flow between her primary care doctor and the myriad of specialists.
I’ve essentially become my mother’s medical home, making sure that she followed up with the home care agency when she was discharged from a hospital-stay, or bringing a summary of the last doctor’s visit from her primary care physician in Maryland to her nephrologist in Washington, D.C.
There are also a number of co-morbidities associated with a disease like ESRD, so making sure she has an assigned specialist to monitor her heart, vision, nutrition, etc. was something I needed to stay on top of. Yes, she had a primary care physician, but the reality is, as a caregiver I’m much more sensitive to her needs.
Health Information Technology has been an extremely useful tool in managing/coordinating my mother’s care. The road wasn’t easy, the learning curve was steep, but I’ve been using a number of mobile health applications to help manage my mother’s overall wellbeing a little better. I am much more efficient and have learned to save a lot of time.
With the help of these different health applications, I can compile the summary notes from her visits and document questions I have about her care so that when she does need to see her doctor, the questions are well-informed and very specific. The number of readmissions due to her kidney disease and diabetes has decreased dramatically—from 14 readmits in 2011 to two only admissions so far this year. When healthcare professionals in the hospital can’t seem to talk to one another or share notes, I at least have all the up-to-date insurance information, prescription lists, and her physician contacts centralized in one place.
The other benefit I’ve experienced is with the coordination of her social services. I’ve found there’s a disconnect between the health component and human services. My mother’s diagnosis and disability meant she had to stop work. The best way to describe the coordination of social services, pre-health IT, is “baptism by fire” (no kidding). However, with mobile apps, like Blue Button, I’ve been able to do some of the financial reconciliation on her Medicare claims data, often required for some of the social services offered at the state level.
Health Information Technology can be fun (really). Health IT has helped me become more efficient—I’m now using a number of food apps to get ESRD-friendly recipes (we have to be mindful of things like acid, and potassium among other things). I’ve also downloaded applications that provide us with at-home exercises/activities.
It’s been a rewarding experience as an ONC team member. I’ve had the opportunity to use the tools and better understand the policies that are digitizing health care in a way that offers patients (and their families) better access, better health and lowered costs. As we continue our work on the implementation of meaningful use stage 2, aligning our program work with patient-centered models like ACOs and the medical home.
Providers base their care decisions on a wide variety of patient information, such as patient and family history, vital signs, reports of symptoms or response to treatment. This information traditionally is created in a visit to a provider or laboratory, but there are increasing examples of information being created by the individual or caregiver outside the clinical setting and reported to the provider. This information is known as patient-generated health-information (PGHI) or patient-generated health data (PGHD).
PGHD has been described as health-related data created, recorded, gathered or inferred by or from patients, family personal caregivers or designees to help address a health concern. This data could be an observation, a test result, a device finding, a confirmation or a change/correction/addition of data in the patient’s existing health record.
While PGHD is not new, there are no widely accepted practices or policies to define its best use, much less to support its growth as a valued health care tool. Beginning in 2012, ONC initiated a series of policy activities to advance knowledge of the field and promote implementation. As 2013 draws to a close, we are pleased to report that a lot of progress has made. A report from a Technical Expert Panel, convened at our request by our cooperative agreement partner the National eHealth Collaborative, captures the breadth of issues and opportunities for wider use of patient-generated information. Their work contributed to positive discussions by the HIT Policy Committee and HIT Standards Committee in their respective December meetings about including a PGHD objective in Meaningful Use Stage 3, which is still under development.
Physician burnout isn’t fun. It can lead to increased errors and lower-quality care for patients – and in some cases, consequences for patients are irreversible. Some physicians equate EHR use with more homework, believing the common misconception that spending extra hours each night, finishing up notes, addressing inboxes, and catching up on messages and emails, is inevitable. It’s not. While many physicians feel that technology, along with government regulation and the tremendous change in the healthcare industry, adds to today’s main burdens contributing to burnout – optimizing the right EHR software will actually greatly increase a physician’s efficiency.
A good EHR will serve your workflow, not hinder it; a sophisticated, integrated EMR system will function as a useful physician tool. When all of the components of your software speak to each other seamlessly, the stream of your practice as a whole improves.
Part of making sure your EHR helps you evade burnout (rather than cause it) is learning how to utilize the entire system optimally. You should strategize your EMR use and need to document. Your EHR needs to do everything from allow you to flow efficiently through a chart to improve your revenue cycle time. Optimize all of these functions and you’ll increase your profits and overall quality of patient care. That way, you can enjoy all of the reasons you really became a physician – and go home at a reasonable hour.
Choose your practice’s EHR champion: Figure out who on your team is an EHR power user – this is your technology leader. Just watching his or her process will help you by giving you a plethora of tips and shortcuts to dramatically speed up your process.
Delegate: Allocate duties and tasks in your EHR that don’t require your specific talents or skills to other members of your team, or explore the option of hiring a trained scribe. Use your team; don’t try to do everything on your own. Sharing your workload within your EHR is one of the easiest ways to start alleviating burnout. Begin conversations with your team members on how you can work together to share documentation duties.
Choose a cloud-based EHR with full functionality on an iPad: You shouldn’t have to chart from home – or record the same notes twice. When your EHR is designed for an iPad, you can chart at the bedside or exam room while maintaining eye contact with your patients. Perform a complete SOAP note and chart from anywhere you can connect to the Internet, from your iPad or iPad mini (in addition to any mobile device, tablet, laptop or desktop platform). You can choose to touch, talk or type, depending on what method will be fastest and more efficient for you. Dictation functionality is built in and can be used to replace typing for faster data entry and you can prescribe and check your schedule from your smart phone. Mobile medicine is paramount to efficiency in your practice.
Make sure the system you choose is truly integrated: Piecing together a patchwork structure of tools that don’t speak to each other well will only make for a clunky, inefficient and frustrating process. When your system is seamless across the EHR, Practice Management, Clearinghouse and Patient Portal, you will cut down on errors and a lot of redundant manual data entry.
Use and optimize your integrated patient portal: Correct use of a sophisticated patient portal will undoubtedly reduce clutter and save time. When patients check in well before their visit, and enter their histories and current medications themselves, your staff members can spend their time on other duties – and the patient’s information will be organized before their visit. Having easy access to their lab results and the ability to electronically communicate with your practice will also save time you or your staff spends on phone calls.
Blueprints: Software is meant to be automated. While templates are helpful in the automation process, blueprints take the level of sophistication and flexibility steps beyond templates. Your system should provide the blueprints and customization you need. You should be able to repurpose old encounters as favorite blueprints, making them easily accessible.
Coding: Using an EHR with advanced ICD-10 coding features and enhancements will save you time by guiding you to the most precise code appropriate for the clinical presentation of your patients. An efficient ICD-10 code search and conversion tool will eliminate many hours you would otherwise spend manually looking up codes, especially when the coding requirements become much more stringent late in 2016.
e-Prescribe: Most EHR systems have an e-Prescribing module, but did you know that over 200 EHRs borrow their interface from a third party? Working on an EHR that has a fully integrated e-Prescibing interface will enhance workflows and save time. In addition, providers should only work with e-Prescribing modules that have been awarded the Surescripts White Coat Quality “seal of approval.” Remember, high quality electronic scripts reduce the time providers spend managing rejections or phone calls from their local pharmacist.
Alerts: Alert overload kills productivity. Alerts should only be disruptive to a workflow in the case of a serious patient health risk, like a drug to allergy alert. Less critical alerts should be subtle, enough to notice but not disruptive to workflows. MediTouch Health Maintenance alerts are a good example, they are obvious enough to have prevented a case of colon cancer (see our blog post about how our Health Maintenance Alert helped a patient receive the care he needed) but not disruptive to the typical SOAP charting workflow.
Don’t employ a dinosaur-era EMR system. When you choose state-of-the-art software, your EHR should cut the effects of burnout for every member of your practice. MediTouch is cloud based, truly integrated, with mobile-friendly interfaces; optimizing all of MediTouch’s features will help your practice run smoother so that you can get home on time.
IT innovation, global medicine and frustrated medical patients drive the demand for medical travel. But telemedicine also improves patient care and the customer experience of medical travelers. Once again, we welcome medical IT entrepreneur, Agha Ahmed, Managing Partner of GHIMBA, as we explore how IT innovations help patients get high-quality healthcare outside of the USA.
How do IT innovations help provide services that medical travelers can benefit from?
IT helps deliver safe medical care and a pleasant trip to facilities overseas. For more than 20 years, IT innovations have improved patient care worldwide. Now, these innovations are helping medical travelers, too.
In telemedicine and m-health, telecommunications, mobile devices and information technologies provide clinical health care at a distance. (M-health is the practice of using mobile technology in healthcare.) There are three important devices and software capabilities that help deliver the promise of medical travel:
These innovations work with participants in the medical travel industry to deliver value to patients and business opportunities to entrepreneurs.
What’s the most important thing that IT provides patients and entrepreneurs?
Powerful data sharing and analysis, anywhere in the world. Cloud computing and modern IT devices make it easy to transfer, analyze and share massive amounts of medical data, quickly and safely. IT contributes medical services that patients and overseas healthcare providers can be confident in. There are three notable capabilities.
Cloud computing and other IT innovations can help make offshore treatment a safe, cost-effective alternatives to U.S. healthcare. These innovations can be used with medical travel facilitators and solution providers to deliver world-class medical services.
Where can we find out more about IT and medical travel?
Telemedicine is a major topic in an upcoming conference, the Medical Travel and Global Healthcare Business Summit in Tampa, Florida. If you’re wondering about medical travel business opportunities, you’ll want to check out the conference, which will be held on June 14th through 17th. The summit is designed for healthcare and wellness providers, IT services business leaders, and hospital and clinic administrators.
The conference discusses business and technical aspects of medical travel, including how IT, telemedicine and m-health support travel logistics and patient care. The emphasis is on finding and making the most of the many business opportunities available to entrepreneurs and healthcare industry professionals.
It’s common knowledge that backing up data for your medical practice is critical forprotecting against devastating losses of patient data in the event of a natural disaster, system glitch, or hardware failure. But practices should go further than simply backing their data up; testing these backup and restoration processes is just as important for ensuring data safety as the initial backup itself.
Why Backups are Important
For practices that utilize EHRs, having backups is critical for a number of reasons. While the first scenario that many imagine is a catastrophic loss of data resulting from a server malfunction or local event, this is not the only reason to have a data backup.
Experts recommend backups to protect againstsecurity breaches or viruses, to provide continuity of care across multiple providers or in the event of an outage, andthe protection ofvaluable assets for research and analytics.
Medical practices should establish scheduled, automatic backups as well as perform manual backups after making any system changes.
Your Backup is Only as Good as its Restore
When preparing an EHR data backup procedure, it’s important to remember that the value of your backup is congruous to the quality of the restore. A backup is no good if the restore is incompatible with current hardware or software, which is just one example of what can go wrong.
Particularly for practices using an EHR vendor, it’s essential to confirm compatibility of the restore with current systems. This restore must also be promptly accessible, and establishing synchronization with an EHR vendor is importantfor this timeliness. Checking post-restore integrity as a routine part of testing can ensure that once your restore is complete, your data will be accessible and useable.
How Will You Know if Your Backup is Good?
One of the most effective ways to know if your backup is good is to run a test. The test should exercise the system using common work processes that access multiple types of data. The worst case is when a practice believes they have beensuccessfully backing up their data, only to find out that the backups are incomplete.
Other restore fail scenarios include practices that have discovered that theyhave only been backing up their software (URL: http://www.americanehr.com/blog/2011/12/data-backup-information-protection/), not their data. This kind of loss can be devastating for patients and providers alike, and regularly running tests can protect against these situations.
Scheduling Your Backups
Aside from testing the functionality of backups,strategically determining the times that these systems will run will prevent interference with staff or clinic activities. Frequency also depends on how much data the practice can afford to lose. If a backup runs weekly, this means that a worst-case scenario could result in the loss of six days’ worth of data.
Depending on practice volume, agenda, and other factors, setting goals and quantifiable standards for backups ensures alignment with best practices.
Protection against disaster-borne data loss, along with the convenience of external management,has led many practices to choose third parties or their EHR vendor to administrate backups. Don’t rely on external entities to validate your backups. Internally test and verify your systems restore process too.
At ZH Healthcare, our BlueEHS services offer complete peace of mind with multiple layers of protection, including automated backups and “snapshot” components which can be used to restore your systems quickly. In addition, we offer on-demand download access from the cloud, and in-house data storage.
Medical Records Briefing (MRB) is conducting its benchmarking survey on electronic health record implementation, and we would appreciate your input. Please take a few moments to complete this survey.
To show our thanks, we will select one respondent at random to win a complimentary HCPro webcast of his or her choice. To enter to win, please include your contact information at the end of the survey once you have answered the questions.
Entering your contact information will also enable us to email you the results of the survey along with commentary from industry experts. The results will also be featured in the October 2015 issue of MRB. The link below will take you to the survey’s website; simply click on the link to answer the survey questions online.
If the click-through does not work, please copy and paste the URL below into the address bar of your browser.
In order to respond to the question of survey populations, I would like to provide a summary of the survey oversight and governance process as well as a more detailed explanation of the methodology that American EHR uses to conduct EHR surveys.
Survey sample selection
When conducting a survey in conjunction with a professional society partner, for example the Physician Use of EHR Systems report, a randomized sample of members from each participating organization are surveyed. As the professional society partners are regularly surveying their members on a variety of topics, and in order to prevent over-surveying, each provides a random sample of members with active email addresses in order to conduct the American EHR survey. Each survey group receives an initial invitation to complete the survey as well as 1-2 reminders. Because the sample is selected randomly from the member database, we expect that some individuals will not be using EHRs. These individuals are excluded in the survey registration process. While it is desirable to be able to survey an entire professional organization’s membership, this is not possible due to the number of additional surveys that each organization conducts of their members as well as the issue of survey fatigue.
Prior to collection of data for the Physician Use of EHR Systems report, an extensive review process was undertaken to update the American EHR survey in conjunction with the American Medical Association, American College of Physicians and the American Academy of Family Physicians. In particular, American EHR worked with AMA Market Research staff to formulate new questions designed to examine the economic impact of EHR use and the role of scribes. In order to keep the overall length of the survey at its current level, AMA and American EHR agreed to eliminate questions that were not effective and/or addressed in other parts of the American EHR survey.
When the 155 question survey is conducted, all physicians are verified either directly in conjunction with their professional society through a verified sample, against the AMA Physician Masterfile or in limited situations through a manual process.
Due to the comprehensive nature of the EHR survey, the survey takes approximately 20 minutes to complete. However, the detailed nature of the data collected also provides key insights into the adoption and use of EHR systems by clinicians in varying practice sizes and by specialty.
We stand steadfastly behind the methodology, process, collection of data as well as the interpretation of the results as presented in our most recent report. In particular, we believe that the ability to survey physicians in conjunction with their professional organizations provides the most relevant and representative information on actual experiences in the use of EHRs.
Migrating EHR data can look daunting. But there are many reasons a practice may wish to migrate its EHR data. But even after weighing costs and benefits of porting data elsewhere, some practices choose to avoid a potentially beneficial migration because of the complicated nature of the transition. However, there are many benefits that are well worth the effort of a successful migration of EHR data.
Why Do People Migrate Their EHR Data?
Some practices choose to migrate their data as a result of dissatisfaction with their EHR vendor. Others migrate because of a hospital acquisition, or to secure a vendor certified for Meaningful Use, or to move away from a vendor that could not certify.
And in the era of Big Data and analytics, it’s increasingly common to see EHR data migrations to vendors or analytics platforms with superior data management and analysis services.
A surge in EHR utilization has also heralded a rise in competition amongst EHR vendors. As of 2014, over 80% of office-based physicians had adopted EHRs. This rush in utilization has led to improved service offerings by vendors, spurring more movement of practice data.
The Cleanse: What Can You Clean Up in Your EHR
While data migration can be stressful for any practice or physician, the process also presents itself as an opportunity to clean up systems and organizedata. And practices don’t have to accomplish this all on their own. EHR vendors can assist with porting and cleaning up data, presenting a valuable benefit to migrating practices.
Thistype of project is especially helpful for the cleaning of legacy data, which is often essential to best practices (but frequently impossibly disorganized).
What if You Need to Convert Migrated Data?
If a data conversion is required, vendors can support this as well. Often, legacy data requires conversion when undergoing EHR data migration to a new system. Butin some cases, such data may not need to be immediately accessible. Experts recommend nonetheless that providers know how to access this information efficiently if the need arises.
Some firms may look to hire a data analyst who will have a better understanding what data you have to convert. These professionals advise that if not all your data is being converted; you need to know what is and where it’s going to be so you can get access to it.
Categorizing legacy data and conversions can be another great way to clean up databases, but it’s critical to generate backups and test the conversion with a small sample before full execution.
An EHR data migration is a greattime to establish a healthier vendor relationship, clean up data, and review policies for access, utility, and backups.
Access your Data
At ZH Healthcare, we believe that it should be easy to migrate your data and that you should always have access—no matter what. Explore our EHR, and especially OpenEMR, migration solutions like data conversion that puts the ownership and backups in the hands of medical providers and practices.
Our services are designed to make data transitions as simple and beneficial as possible for medical practices and professionals.
As more healthcare facilities, from hospitals to private practices, move from paper charts to electronic medical records, the benefits will increase to both practitioners and patients: Electronic health records can be accessed on demand, and can potentially save lives.
Benefits to Patients
Electronic health records contain significantly fewer errors than paper records, according to experts.
Communication between physicians can be greatly improved with the use of EHR, allowing each party full access to a patient’s medical history rather than a snapshot-type overview from a current visit. This access allows for a more in-depth evaluation, and enables doctors to reach an accurate diagnosis more quickly.
In addition, electronic health records can make it easier for doctors to follow up with patients and track continuing care, both under their supervision and that of the patient’s other doctors.
"I can quickly and easily pull up test results in the exam room to review with my patients," Sandhya Pruthi, M.D., of Mayo Clinic in Minnesota says on the Mayo Clinic website. "I also can verify when they had past exams or procedures. I can even show them results of their imaging tests on the screen."
At the very least, electronic health records can save time during a doctor’s office visit. And in case of emergency, these records can provide critical, life-saving information to emergency care providers.
People who find themselves in mass casualty situations, such as natural disasters, can benefit greatly from electronic medical records. Healthcare providers can use EHR in an emergency situation to get a more accurate picture of a patient’s medical history more quickly than with traditional means.
Catastrophic events have demonstrated that patients in these situations are often confused and frightened, making it easy to forget personal medical details. Every second counts during an emergency, so having access to a patient’s medical history, blood type and allergy information, when the patient is unable to communicate can be the difference between life and death. Also, the digital format can make quick access more scalable.
Benefits to Healthcare Providers
When a patient is under the care of multiple doctors, tracking his or her history, including allergies, blood type, current medications, past procedures and other relevant information, can be problematic when relying on paper charts. The use of electronic health records allows multiple care providers, regardless of location, to simultaneously access a patient’s record from any computer. The electronic record can provide up-to-the-minute information on the patient’s full history, including current test results and the recommendations of other physicians, allowing more efficient collaboration on multiple facets of a patient’s care.
Medical practitioners can quickly transfer patient data to other departments or providers, while also reducing errors, which yield improved results management. Both patients and employees often respond positively to these process improvements, as it can help keep a facility’s schedule on track.
Reducing medical errors is obviously of tremendous benefit to both doctor and patient. An electronic health records system of information eliminates the problem of lost and/or misplaced patient files while also naturally eliminating data errors that can occur from transcription.
According to experts, the advantages of emergency health records produce a marked increase in the health-related safety of patients.
The following are the most significant reasons why our healthcare system would benefit from the widespread transition from paper to electronic health records.
Paper records are severely limited
Much of what can be said about handwritten prescriptions can also be said about handwritten office notes. Figure 4.2 illustrates the problems with a paper record. In spite of the fact that this clinician used a template, the handwriting is illegible and the document cannot be electronically shared or stored. It is not structured data that is computable and hence shareable with other computers and systems. Other shortcomings of paper: expensive to copy, transport and store; easy to destroy; difficult to analyse and determine who has seen it; and the negative impact on the environment. Electronic patient encounters represent a quantum leap forward in legibility and the ability to rapidly retrieve information. Almost every industry is now computerised and digitised for rapid data retrieval and trend analysis. Look at the stock market or companies like Walmart or Federal Express. Why not the field of medicine?
With the relatively recent healthcare models of pay-for-performance, patient centred medical home model and accountable care organisations there are new reasons to embrace technology in order to aggregate and report results in order to receive reimbursement. It is much easier to retrieve and track patient data using an EHR and patient registries than to use labour intensive paper chart reviews. EHRs are much better organised than paper charts, allowing for faster retrieval of lab or x-ray results. It is also likely that an EHR will have an electronic problem summary list that outlines a patient’s major illnesses, surgeries, allergies and medications. How many times does a physician open a large paper chart, only to have loose lab results fall out? How many times does a physician re-order a test because the results or the chart is missing? It is important to note that paper charts are missing as much as 25% of the time, according to one study.Even if the chart is available; specifics are missing in 13.6% of patient encounters, according to another study.Table 4.1 shows the types of missing information and its frequency. According to the President’s Information Technology Advisory Committee, 20% of laboratory tests are re-ordered because previous studies are not accessible.This statistic has great patient safety, productivity and financial implications.
Need for improved efficiency and productivity
The goal is to have patient information available to anyone who needs it, when they need it and where they need it. With an EHR, lab results can be retrieved much more rapidly, thus saving time and money. It should be pointed out however, that reducing duplicated tests benefits the payers and patients and not clinicians so there is a misalignment of incentives. Moreover, an early study using computerised order entry showed that simply displaying past results reduced duplication and the cost of testing by only 13%.If lab or x-ray results are frequently missing, the implication is that they need to be repeated which adds to this country’s staggering healthcare bill. The same could be said for duplicate prescriptions. It is estimated that 31% of the United States $2.3 trillion dollar healthcare bill is for administration. EHRs are more efficient because they reduce redundant paperwork and have the capability of interfacing with a billing program that submits claims electronically. Consider what it takes to simply get the results of a lab test back to a patient using the old system. This might involve a front office clerk, a nurse and a physician. The end result is frequently placing the patient on hold or playing telephone tag. With an EHR, lab results can be forwarded via secure messaging or available for viewing via a portal. Electronic health records can help with productivity if templates are used judiciously. As noted, they allow for point and click histories and physical exams that in some cases may save time. Embedded clinical decision support is one of the newest features of a comprehensive EHR. Clinical practice guidelines, linked educational content and patient handouts can be part of the EHR. This may permit finding the answer to a medical question while the patient is still in the exam room. Several EHR companies also offer a centralised area for all physician approvals and signatures of lab work, prescriptions, etc. This should improve work flow by avoiding the need to pull multiple charts or enter multiple EHR modules. Although EHRs appear to improve overall office productivity, they commonly increase the work of clinicians, particularly with regard to data entry. We’ll discuss this further in the Loss of Productivity section.
Quality of care and patient safety
As previously suggested, an EHR should improve patient safety through many mechanisms: Improved legibility of clinical notes, Improved access anytime and anywhere, Reduced duplication, Reminders that tests or preventive services are overdue, Clinical decision support that reminds clinicians about patient allergies, correct dosage of drugs, etc., Electronic problem summary lists provide diagnoses, allergies and surgeries at a glance. In spite of the before mentioned benefits, a study by Garrido of quality process measures before and after implementation of a widespread EHR in the Kaiser Permanente system, failed to show improvement. To date there has only been one study published the authors are aware of that suggested use of an EHR decreased mortality. This particular EHR had a disease management module designed specifically for renal dialysis patients that could provide more specific medical guidelines and better data mining to potentially improve medical care. The study suggested that mortality was lower compared to a pre-implementation period and compared to a national renal dialysis registry. It is likely that healthcare is only starting to see the impact of EHRs on quality. Based on internal data Kaiser Permanente determined that the drug Vioxx had an increased risk of cardiovascular events before that information was published based on its own internal data. Similarly, within 90 minutes of learning of the withdrawal of Vioxx from the market, the Cleveland Clinic queried its EHR to see which patients were on the drug. Within seven hours they deactivated prescriptions and notified clinicians via e-mail. Quality reports are far easier to generate with an EHR compared to a paper chart that requires a chart review. Quality reports can also be generated from a data warehouse or health information organisation that receives data from an EHR and other sources. Quality reports are the backbone for healthcare reform which are discussed further in another chapter.
According to a 2006 Harris Interactive Poll for the Wall Street Journal Online, 55% of adults thought an EHR would decrease medical errors; 60% thought an EHR would reduce healthcare costs and 54% thought that the use of an EHR would influence their decision about selecting a personal physician. The Centre for Health Information Technology would argue that EHR adoption results in better customer satisfaction through fewer lost charts, faster refills and improved delivery of patient educational material. Patient portals that are part of EHRs are likely to be a source of patient satisfaction as they allow patients access to their records with multiple other functionalities such as online appointing, medication renewals, etc.
EHRs are considered by the federal government to be transformation and integral to healthcare reform. As a result, EHR reimbursement is a major focal point of the HI-TECH Act. It is the goal of the US Government to have an inter-operable electronic health record by 2014. In addition to federal government support, states and payers have initiatives to encourage EHR adoption. Many organisations state that healthcare needs to move from the cow path to the information highway. CMS is acutely aware of the potential benefits of EHRs to help coordinate and improve disease management in older patients.
The Centre for Information Technology Leadership (CITL) has suggested that ambulatory EHRs would save $44 billion yearly and eliminate more than $10 in rejected claims per patient per outpatient visit. This organisation concluded that not only would there be savings from eliminated chart rooms and record clerks; there would be a reduction in the need for transcription. There would also be fewer callbacks from pharmacists with electronic prescribing. It is likely that copying, faxing and mail expenses, chart pulls and labour costs would be reduced with EHRs, thus saving full time equivalents (FTEs). More rapid retrieval of lab and x-ray reports results in time/labour saving as does the use of templates. It appears that part of the savings is from improved coding. More efficient patient encounters mean more patients could be seen each day. Improved savings to payers from medication management is possible with reminders to use the drug of choice and generics. It should be noted that this optimistic financial projection assumed widespread EHR adoption, health information exchange, inter-operability and change in workflow. EHRs should reduce the cost of transcription if clinicians switch to speech recognition and/or template use. Because of structured documentation with templates, they may also improve the coding and billing of claims. It is not known if EHR adoption will decrease malpractice, hence saving physician and hospital costs. A 2007 Survey by the Medical Records Institute of 115 practices involving 27 specialities showed that 20% of malpractice carriers offered a discount for having an EHR in place. Of those physicians who had a malpractice case in which documentation was based on an EHR, 55% said the EHR was helpful.
The timing seems to be right for electronic records partly because the technology has evolved. The internet and World Wide Web make the application service provider (ASP) concept for an electronic health record possible. An ASP option means that the EHR software and patient data reside on a remote web server that users can access via the internet from the office, hospital or home. Computer speed, memory and bandwidth have advanced such that digital imaging is also a reality, so images can be part of an EHR system. Personal computers (PCs), laptops and tablets continue to add features and improve speed and memory while purchase costs drop. Wireless and mobile technologies permit access to the hospital information system, the electronic health record and the internet using a variety of mobile technologies. The chapter on health information exchange will point out that health information organisations can link EHRs together via a web-based exchange, in order to share information and services.
Need for integrated data
Paper health records are standalone, lacking the ability to integrate with other paper forms or information. The ability to integrate health records with a variety of other services and information and to share the information is critical to the future of healthcare reform. Digital, unlike paper-based healthcare information can be integrated with multiple internal and external applications:
EHR is a transformation tool
It is widely agreed that US Healthcare needs reform in multiple areas. To modernise its infrastructure healthcare would need to have widespread adoption of EHRs. Large organisations such as the Veterans Health Administration and Kaiser Permanente use robust EHRs (VistA and Epic) that generate enough data to change the practice of medicine. In 2009 Kaiser Permanente reported two studies, one pertaining to the management of bone disease (osteoporosis) and the other chronic kidney disease. They were able to show that with their EHR they could focus on patients at risk and use all of the tools available to improve disease management and population health.In another study reported in 2009 Kaiser-Permanente reported that electronic visits that are part of the electronic health record system were likely responsible for a 26.2% decrease in office visits over a four year period. They posited that this was good news for a system that aligns incentives with quality, regardless whether the visit was virtual or face-to-face. Other fee-for-service organisations might find this alarming if office visits decreased and e-visits were not reimbursed. Kaiser also touts a total joint registry of over 100,000 patients with data generated from its universal EHR. As a result of their comprehensive EHR (KP Health-Connect) and visionary leadership they have seen improvement in standardisation of care, care coordination and population health. They also have been able to experience advanced EHR data analytics with their Virtual Data Warehouse, use of artificial intelligence and use of computerised simulation models (Archimedes). In addition they have begun the process of collecting genomic information for future linking to their electronic records.
Communication gaps and data-sharing challenges are pervasive in healthcare, persisting between different providers, hospitals and payers, and even various departments within a health system. While technology promises a future of connected networks and free-flowing information, the challenge remains bridging the gap between data silos to improve patient care.
Connecting the plethora of data sources relevant to patient outcomes and care management is overwhelmingly cumbersome. The burdensome task of integrating all of these data sources distracts organizations from their core competency, effectively acting as a blockade to healthcare innovation. Clinical health records, including both primary care and hospital visits; payment information and history; patient-generated health data; pharmacy and prescription information; patient and family-health history; genomics; clinical-trial data; and so on – all of this information needs to be easily accessible digitally for providers as well as patients to realize the full potential and promise of interoperability.
Traditional EHR companies such as Cerner, Meditech, and Inter-systems are building patient-management tools that will help coordinate a patient's care beyond the four walls of any one health system. Healthcare technology leaders, like the aforementioned, are taking steps to capture patient-generated health data from outside of the clinical setting and bring it back into the patient's clinical story.
A common misconception is that EHRs are the lone solution to interoperability. EHRs were not designed as open systems that can easily pull in information from outside the clinical setting or connect data across multiple providers. Rather, these tools were created to coordinate patient care within a hospital, replacing paper records and filing cabinets. EHR vendors are unfairly blamed for the fact that healthcare is not more interoperable. Like any technology company, they build what their customers want to buy. EHRs are a part of the overall solution to interoperability; really, all healthcare technology is only part of the means to which we will achieve interoperability. Changes to physician workflow and new models of care – working in parallel with technology such as EHRs, patient portals and care management tools – are necessary for interoperability to be fully achieved.
We need buy-in from physicians and administrators to build care programs utilizing this technology. Too often, care teams are spending their time calling other providers about patient information, faxing paper records and trying to coordinate care efforts across a disjointed and disconnected system. This is a drain on resources that could be better spent with patients on site or remotely monitoring patients with chronic conditions. We need a network connecting this data to create more effective workflows, care coordination, and prevention-based models of care.
Whatever you choose to call it (interoperability, data liquidity or care coordination), we need data to flow easily throughout the healthcare ecosystem to improve the lives of patients. Expecting EHR vendors to solve this challenge alone will further delay an already long-overdue solution. We need all stakeholders – patients, physicians, technology companies, providers and payers to challenge existing conventions in order to make interoperability a reality.
It is tempting to believe that your hospital is now paperless once you’ve implemented an electronic medical record (EMR) system or completed an EHR conversion. While EHRs are the biggest step toward going paperless, most organizations still manage volumes of paper which prevents the establishment of a truly integrated care team – one in which all information is available to all providers in near real time. Organizations that are not completely paperless cannot meet HIMSS Stage 7: a full digital environment where all clinical documents are available electronically within 24 hours of creation or receipt. Documents such as outside records, telemetry strips, ancillary results, signed consents, and “shadow charts” that are part of a patient’s overall record often remain on paper, and leave healthcare organizations with paper to manage and a disjointed care environment. The good news is that going paperless can be achieved in a variety of patient care settings and with minimal disruption.
Eventually it will be possible for patients, healthcare staff and clinicians to enter all data into a patient’s EHR and little or no paper will be required. Until then, improved workflows and exciting new technology can support going virtually paperless. Interested? Then keep in mind a few facts, and don’t let them go as you consider implementing at your facility:
1. With the right technology, scanning can take LESS time than filing to a paper chart
2. Scanning is a form of clinical documentation, it is NOT an “administrative task”
Paperless Is Possible
At Freed Associates, we’ve worked with several healthcare organizations, both large (400 beds) and small (30 beds), to implement a decentralized Point of Service (POS) scanning model to create paperless systems that are improving quality of care, safety and performance. This POS model required the real time scanning of thousands of pages in clinical and registration settings. It eliminated virtually all paper, and expedited the creation of a single and complete EHR. Physicians and care providers no longer have to wonder where documents are or when they will be viewable in the chart.
Since the American Recovery and Reinvestment Act – which included the creation of the Medicare and Medicaid EHR Incentive Programs – was signed into law, the nation has seen unprecedented growth in the adoption and meaningful use of electronic health records (EHRs). Between 2009 and 2012, EHR adoption nearly doubled among physicians and more than tripled among hospitals. Every month, thousands of providers join the ranks of hospitals and professionals that have adopted or are meaningfully using EHRs. As of October 2013, 85 percent of eligible hospitals and more than six in 10 eligible professionals had received a Medicare or Medicaid EHR incentive payment. Moreover, nine in 10 eligible hospitals and eight in 10 eligible professionals had taken the initial step of registering for the Medicare or Medicaid EHR Incentive Programs as of October 2013.
The Centers for Medicare & Medicaid Services (CMS) today proposed a new timeline for the implementation of meaningful use for the Medicare and Medicaid EHR Incentive Programs and the Office of the National Coordinator for Health Information Technology (ONC) proposed a more regular approach to update ONC’s certification regulations.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.
This new proposed timeline tracks ongoing conversations we at CMS and ONC have had with providers, consumers, health care associations, EHR developers, and other stakeholders in the health care industry. This timeline allows for enhanced program analysis of Stage 2 data to inform the improvements in care delivery outcomes in Stage 3.
The proposed timeline for meaningful use would have a number of benefits, such as:
Expected Timing for Rulemaking
We expect that in the fall of 2014 CMS will release proposed rulemaking (NPRM) for Stage 3 and corresponding ONC NPRM for the 2017 Edition of the ONC Standards and Certification Criteria will be released in the fall of 2014, which will outline further details for this proposed new timeline. The final rule with all requirements for Stage 3 would follow in the first half of 2015. All stakeholder comments will be reviewed and carefully considered before the release of the final rules.
What the New Timeline Would Mean for Providers
Eligible providers who have completed at least two years of Stage 2 would begin Stage 3 in 2017. We currently anticipate that eligible professionals would begin in January 2017, at the start of the calendar year, and eligible hospitals and critical access hospitals would begin in October 2016, at the start of the federal fiscal year.
Breaches of patient information are on the rise—138% from 2012 to 2013, according to breach data reported to the Department of Health and Human Services (HHS). And no system is completely theft-proof. However, there are steps you can take to make your privacy harder to invade. That’s important because many data thieves are opportunists who will bypass difficult targets in search of easier quarry.
If a data breach does occur, inform those affected as soon as possible, and identify the information that has potentially been compromised. Keep in mind you won’t be able to do this if you don’t know what data resides in your practice or what systems are networked.
HealthITNews reports that the Centers for Disease Control and Prevention is expressing increased alarm about patient care errors that are being introduced as a result of poorly designed or poorly implemented electronic health record solutions. The US Food and Drug Administration has also be weighing in lately on whether Health IT solutions should be more tightly regulated.
Whether or not more regulatory oversight of Health IT is needed, I suspect many of us have experienced instances where health information about us is found to be in error. I recall when my mother was hospitalized for chest pain that doctors were treating her as though she had been a life-long smoker. In fact she had never, ever been a smoker. At some point in time, information about smoking history had been erroneously entered into the electronic record. Now, the doctors treating her for chest pain were making decisions about the likelihood of heart disease based in part on that information about smoking history. In my own medical records I have also found, and had to correct, occasional errors in medication history, allergies, and immunizations over the years.
Despite this, I would tend to put the blame not on the computer or the software. It is not generally these systems making the errors, but rather the people using them. Sometimes the wrong information has been entered into the system, as in the case of my mother. Sometimes, errors are made because the information being displayed is in the wrong chronological order or is buried in a user interface that is out of synch with real-world, clinical workflow. In both instances, the problem is with people—those who designed the software and those who use it, but not with the software itself or the machines running it. How can we improve on this situation? Here are four ideas:
Involve the Patient Right from the Start
In gathering the information that becomes the foundation of our medical records, we are putting too much burden on caregivers. How much of the complete medical history or SOAP note is information that comes directly from the patient? Chief complaint, history of present illness, past medical history, social, family and occupational history, medications, allergies, review of systems? All of this information is retrieved by “interviewing” the patient. Perhaps it would be more efficient and more accurate if the patient himself entered all that information into a kiosk, or some other kind of fully automated, information intake solution. Surely with today’s technology we could design systems that would do a more consistent and comprehensive patient interview and subsequent documentation of information without taking even a minute of clinical staff time. Patients could then review the information captured about them for accuracy before it was officially entered into their record.
Ease the Documentation Burden on Clinicians
We need to ease up on documentation requirements for clinical staff. The patient-centered machine capture solution mentioned above would help remove a lot of the documentation burden. The remaining documentation of the exam, differential diagnosis, and treatment plan could be better facilitated by free text, medical dictation solutions with natural language processing and coding technology on the back end. Nothing is more important that freeing our clinicians of the time currently being spent doing data entry.
Prohibit Templates, Cut and Paste
Templates simply don’t work because it is impossible to template the “patient story” and all of the other nuances of a good clinical exam. Likewise, cut and paste solutions are probably responsible for more medical misinformation and errors than anything else. EHRs should ban “cut and paste” capabilities altogether.
Share Information with Patients
At the end of the day, I believe all information in the medical record should be shared with the patient. The patient is an extra set of eyes, an extra check point if you will, against medical errors. Giving patients complete and full access to the information about them is not only a better way to engage patients in their care, but also a way to help make sure everyone is on the same page about their care. As eHealth advocates proclaim, “Nothing about me, without me!” I think this is sage advice for preventing misinformation and the introduction of errors in our medical records.
I would also be the first to admit that many, if not most of today’s electronic health record solutions are still too hard to use. They have been poorly designed in our attempt to replicate a clinical workflow previously based on paper records. As I have stated many times before, there is a unique opportunity to design solutions that really take full advantage of today’s technology
Some of the most frequent questions I receive these days surround data interoperability and integrating multiple health IT systems. One of the biggest problems in connectivity is matching patient record data and ensuring that the same patient data in different systems is linked properly. Given how many times this topic comes up, I reached out to Cameron Thompson, Acxiom Healthcare Group Managing Director. Acxiom has an interesting method of patient data matching, called persistent links, and when I saw what they were doing for matching consumer records in non-healthcare settings (e.g. marketing) I thought some of you might want to learn about it. Here’s what Cameron had to say about the various techniques for matching patient data:
The promise of secure and seamless exchange of patient healthcare information is powerful. As payers, providers, Health Information Exchanges (HIXs) and Accountable Care Organizations (ACOs) move rapidly toward the full deployment of electronic medical records, healthcare IT professionals are grappling with a fragmented network of systems and data silos. These disparate systems and databases often house redundant copies of patient medical data in multiple formats, which limits the ability to see a true 360-degree view of the patient. The benefits from connected patient data are many, including:
To reduce these inefficiencies and solve the underlying problem, the new healthcare ecosystem needs an accurate means of identifying and matching patient record data to the correct individual across internal and external healthcare systems, including collaborative care delivery models.
Multiple systems across the healthcare enterprise produce duplicate patient records that are not easily recognizable as matches. Recognizing that Mary Jane Smith at 123 Elm Road in the 2009 clinical laboratory system is also Mary Collins of 78 Oak Street in the 2011 patient registration system is a challenge for any organization. Identifying a solid method for distinguishing patient information across multiple data systems and combining the data accurately will be pivotal to the effective adoption of Electronic Health Records (EHRs) and successful implementation of Health Information Exchange (HIE).
As organizations take on this challenge, several methods have been identified and considered to recognize an individual. Three leading methods can to be explored to achieve your business goals of continuity and cost reduction. These are:
1. Algorithm or String-Based Matching
An organization can develop an algorithm with string-based matching using identifiers in the existing data to uniquely identify individuals. The benefits of string-based matching include:
Some of the challenges with this strategy include:
2. State-Issued Number
An organization can use another state-Issued number such as a state of issuance and birth certificate number. Benefits of this method include:
Some challenges with this strategy include:
3. Persistent Links
Healthcare organizations should consider the use of highly accurate match technology that delivers knowledge-based persistent linking. This match technology delivers a set of persistent links a company uses to recognize their patients across a fragmented network of systems and data silos. Persistent Link match technology is regarded as the most precise match technology available to accurately resolve patient identity (such as AbiliTec, the linking technology offered by my company, Acxiom). The link provides a consistent, client-specific ID, across data variations, and it can be applied at all touch points and databases within an organization.
The use of persistent links, created from knowledge-based match technology, can provide:
There are also some challenges related to using persistent links:
As healthcare organizations move forward by adopting technology to improve patient experience they will find that the accuracy of the data will drive their success. Organizations should consider each of these methods for recognizing patients, each have their benefits and select the method that best meets specific organizations needs.
The concept of healthcare and EHR data ownership carries many implications for patients, providers, and medical practices. While experts agree that EHR vendors do not own the data, this has not prevented vendors from winning court disputes that resulted in serious financial losses for medical providers.
These considerations make the discussion of data ownership critical for any physician or medical practice that utilizes electronic health records.
Defining Data and Data Ownership
Healthcare data comes from a variety of sources. One is the patient themselves, who individually provide data to platforms such as patient portals. Another is the physician or healthcare team in the form of examination findings and clinical observations. Results from laboratory studies or radiology, along with data from other external healthcare providers or practices, also contribute to EHRs.
The number of parties who lay claim to healthcare data makes grappling with EHR data ownership even more complicated. Patients, providers, vendors, and the medical practice itself all have aninvestment in healthcare data, and there is often uncertainty over EHR data ownership. Amazingly both of these groups report that 20% simply don’t know who owns the data.
Establishing Data Ownership
The best method of minimizing disputes over EHR data ownership is prevention. Measures such as establishing data ownership early, defining terms, and enforcing guidelines are critical to minimizing trouble down the road. With EHR vendors, defining conditions of data exportation in the event the practice wishes to end a business relationship is critical.
For all parties, the concept of access must also be clearly defined. Terms include practice or provider access to data from the vendor’s servers, as well as patient access to healthcare data via portals or other mechanisms. The most common source of disputes is when a party wishes to leave the relationship; either the practice decides to select a different EHR vendor, or a patient wishes to port their data to a new provider.
Vendor Red Flags
For a medical practice, establishing terms of EHR data ownership must begin at the time of vendor selection. Identifying warning signs during this process can help providers avoid much larger issues in the future.
When choosing an EHR, keep an eye out for red flags such as unstructured data formatting (i.e. PDF instead of CCDA), an inability to meet the National Coordinator for Health Information Technology’s certification requirements,or restrictive contracts thatdemand exorbitant financial charges to port data in the event of a vendor switch.
Establishingproductive EHR data ownership for a healthcare organization takes careful planning.
The ZH Healthcare HITaaS (Health IT as a Service) architecture is designed with the needs of medical professionals and their patients in mind, meaning, among other things, that you own your data, and have complete administrative control.
These days it seems that everyone in healthcare is buzzing about big data and analytics, and no wonder. Transforming, if not reimagining, healthcare is going to take everything we’ve got. Achieving the triple aim of higher quality, better access and lower cost of care cannot be done without being able to measure what we do. As the old adage says, “if you can’t measure it, you can’t improve it”. To that I might add, “if you can’t see it, you can’t improve it”.
Anyone who has walked the halls of a hospital or clinic knows there is no shortage of data. We just aren’t very good at knowing exactly how to get our arms around it. Data is only meaningful if it is organized in ways that we can truly comprehend what it is telling us. Today, the smart money is on technologies that help us visualize and therefore understand data without the need of a PhD in advanced analytics.
One such tool is something we call Power Map for Excel. This 3D visualization add-in is now a centerpiece (along with Power View, Power Query, and Power Pivot,) within the business intelligence capabilities ofMicrosoft Power BI in Excel.
Information workers with their data in Excel have realized the potential of Power Map to identify insights in geospatial and time-based data that traditional 2D charts cannot communicate. For instance, digital marketers can better target and time their campaigns while environmentally-conscious companies can fine-tune energy-saving programs across peak usage times. These are just a few of the examples of how location-based data is coming alive for customers using Power Map and distancing them from their competitors who are still staring blankly at a flat table, chart, or map.
Please take a look at the video below. Then ask yourself, what if instead of mapping U.S. Power Production we were looking at:
Do you have a story to tell or experiences using health information technology? How would you like to share those experiences with American EHR’s 26,000+ members who represent all 52 states and territories and 152 medical specialties?
Whether positive or negative, shared experiences surrounding the usage of EHR’s or other technologies such as mobile apps or web-based tools are extremely valuable to clinicians, ancillary caregivers, and staff who work in clinical patient settings.
Whether you’re a primary care clinician, a practice administrator, or a technology expert, please take a few moments to share your experiences and insights.
What are we looking for?
500–700 word articles on topics such as the following:
All submissions are reviewed by our editorial team prior to publication, and must be educational in nature. Open to clinicians, practice managers, consultants, CIO’s, or other health IT professionals.
Your medical records are a gold mine for cybercriminals
Some say privacy is an illusion. I hope that isn’t true, but I do know that our medical records are not safe. Why should you care? Because our medical records contain our social security numbers, health insurance information, our home addresses, phone numbers, emergency contacts and their phone numbers, our email addresses, possibly our driver’s license numbers, and likely credit card payment information. Ever paid your co-pay with a credit card?
Your medical record is worth ten times more to a cyber criminal than your credit card number. And with health care’s mandatory transition to electronic medical records, cyber thieves have taken full advantage.
If you think major institutions are immune to cyber attacks, think again. You might recall the cyber attacks on our U.S. government. One in particular compromised personal information on 22.1 million people and 5.6 million fingerprints were stolen.
No doubt you’re aware of the major ransomware attacks on hospitals across the country where cyber criminals seized patients’ electronic medical records and held them for ransom to be paid in Bitcoin.
According to the Ponemon Institute’s Fifth Annual Study on Medical Identity Theft, 90 percent of health care organizations have been hacked, exposing millions of patients’ medical records.
You probably remember the cyber attacks on these major health insurers, Blue Cross Blue Shield. Over 10 million patients’ medical records were exposed. 65 percent of medical theft costs each victim $13,500 to resolve the crime.
According to Modern Healthcare, nearly one in eight patients have had their medical records exposed in breaches in the United States. Since that article was published in 2014, that number has likely doubled.
You might be asking yourself, “What could cyber criminals do with my personal information housed in my medical records?”
Cyber criminals can monetize your personal information to obtain credit cards or loans, commit tax fraud, send fake bills to insurance providers, obtain government benefits from Medicare and Medicaid, and much more. Your personal information can also be used to purchase health care services, prescription medications, and medical equipment. It can also be used to obtain your credit report.
The above can also corrupt your medical history with inaccurate diagnoses and treatments.
This is pretty scary stuff. I’ve heard from friends and colleagues that they can only take in small amounts of this information because it’s frightening and they feel it’s beyond their control.
There is something you can do.
It is up to doctors, hospitals, and other healthcare organizations/companies to secure their electronic medical records, backup hard drives, use secure cloud platforms, encrypt emails, update software and more. Many just aren’t doing it.
According to the HIPAA Breach Notification Rule, a hospital or health insurance company that has been victim of a security breach, must inform patients. Unfortunately many do not. Patients find out about errors on their Explanation of Benefits (EOBs,) in letters from collection agencies, by finding mistakes in their health records or on their credit reports.
As a patient, you are at risk. So am I. And we are all patients even if we just see a physician once every year or two. Had a baby? Had a vaccine? Been treated for the flu? All of us are patients and have been since we saw pediatricians when we were kids.
What you can do to protect yourself
1. Read your Explanation of Benefits (EOBs) that are sent from your health insurance plan. Call your health insurance company if you do not recognize a charge.
2. Get copies of your medical records from medical providers and review them for errors. Look out for misdiagnoses, incorrect pre-existing conditions, procedures you didn’t have, incorrect treatments, and more. If you have trouble understanding your medical records, ask your doctor or his/her nurse to help you understand the information.
3. Monitor your credit reports and billing statements for errors.
4. Do not give out your social security number to anyone unless absolutely necessary. Often the last four digits will do.
5. If you have your medical records or any personal information on your smartphone, be careful about using public Wi-Fi. This includes any hospital. If you are a patient or visitor at a hospital, make sure the Wi-Fi is encrypted If you send or receive an email or browse the internet while using public Wi-Fi that is not encrypted, a hacker can eavesdrop on your transmission and gain access to the information on your device.
6. Set your laptop or computer to manually select the public Wi-Fi network in the healthcare facility you are in.
7. Look for web addresses that begin with https. These are more secure.
8. Do not share personal information on file sharing sites. Often they are not secure, according to Becker’s Hospital Review, “10 Ways Patient Data is Shared With Hackers.”
For computers, the FBI recommends:
For more information on cyber attacks, cyber security, data mining and patients medical records, see the following:
Martine Ehrenclou is a patient advocate. She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and the Take-Charge Patient.
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