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How to Adopt Unique Device Identifiers for Medical Devices | EHRintelligence.com

How to Adopt Unique Device Identifiers for Medical Devices | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Unique device identifiers can improve tracking of medical devices for research and patient safety.
In response to new FDA requirements for all medical devices to have a unique device identifier (UDI) within the next few years, the Brookings Institute has helped to develop a roadmap for adopting and integrating UDI technology in order to improve patient safety and provide better data for research and analytics.  The roadmap includes a number of critical steps to help bring UDIs into provider systems, administrative transactions, and patient-directed tools.
“The benefits of UDI implementation across the health care system are significant and, while the path to full implementation is complex, there are relatively straightforward steps that can be done now to begin realizing many of them,” the document says.  “Recording UDIs at the point-of-care (POC) in electronic health records (EHRs) and in claims data could significantly enhance the nation’s ability to conduct medical device safety surveillance and manage recalls.”
“Other benefits include: efficient identification and communication of device safety concerns, active learning about the long-term quality and performance of devices, facilitation of premarket device approval/clearance and expanded indications for existing devices, data collection to support better value, increased reimbursement transparency, and more accurate and efficient supply chain processes.”
The recommendations include the following:
• Providers should incorporate UDIs into their EHR systems, and may consider adopting automatic identification and data capture (AIDC) technology to make the process more efficient.  Patient safety reporting should be automated.
• UDIs should be integrated across the entire healthcare ecosystem, including through the supply chain, clinical processes, and revenue cycle management to achieve the highest return on investment.
• UDIs should be incorporated into the criteria for Stage 3 meaningful use as well as the EHR certification criteria.
• The device identifier portion of the UDI should be included as a situational element at the claim detail level for high risk, implantable devices
• Patient advocacy groups, the FDA, and providers should work together to promote patient education on the subject of UDIs, and encourage patients to be aware of their devices and any potential recalls or issues related to their equipment
• UDIs should be integrated into personal health records to easily provide patients with appropriate device data.  Developers should collaborate with patient organizations to provide proper resources related to UDIs.
• Provider systems, payers, and other stakeholders should commission studies and pilots to highlight use cases for UDIs and demonstrate the benefits of integrating medical device data into the workflow.
The roadmap focuses primarily on the highest risk devices, which are typically implantable, but adds that all medical devices that impact a patient’s care, even transient equipment such as MRI machines, can significantly benefit from UDI labeling and tracking.  “The UDI system, which will be phased in over several years, represents a landmark step towards improving patient safety, modernizing device post-market surveillance, and facilitating device innovation,” the roadmap says. “These promised benefits will only be fully realized with the adoption and integration of UDIs into the health care delivery system.”



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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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Are Medical Practices Taking Advantage of Cloud-Based EHR?  

Are Medical Practices Taking Advantage of Cloud-Based EHR?   | EHR and Health IT Consulting | Scoop.it

In today’s medical field, technology is a big player. With regulations dictating that even independent practices attempt to make the jump to a dedicated EMR/EHR. An EMR/EHR, or electronic medical record/electronic health record interface, provides physicians and patients a way to connect to promote efficient healthcare delivery and organizational profitability. Today, we will look at how smaller healthcare providers are utilizing EMR/EHR solutions that are hosted in the cloud, bucking the trend of hosting their patient information locally.

 

EMR/EHR


For the modern healthcare provider, the EMR/EHR is a major piece of software. The EMR/EHR is an interface that physicians, healthcare providers, and insurers use to update the information on each patient. As the patient has access to their own EMR/EHR file as well, it makes it a very useful guide for all parties involved to manage an individual patient’s care.

 

Major Considerations
With the massive cost of health care, it isn’t much of a stretch to say that there are some very serious considerations that have to be made to the way that doctors and health organizations utilize cloud-hosted technologies. Many providers, however, are reluctant to do just that as there are serious questions about the viability of cloud computing for regulation-covered information such as electronic protected health information (ePHI). One such consideration is the massive incentives offered to organizations who implement “meaningful use” EMR/EHR technology. In order to meet the “meaningful use” criteria, however, many separate variables have to be met, including:

  • Engaging patients in their own care
  • Improving quality, efficiency, safety, and reducing health disparities
  • Improving care coordination
  • Improving public health and health education
  • Meet HIPAA regulations for the privacy of health records

 

So while many of these variables seem to be common sense, there are additional costs that go along with this kind of comprehensive use of EMR/EHR functionality, which, for smaller medical practices, can be enough of an impetus to not meet those qualifications. Cost usually supersedes most other qualifications, even in a high-stakes, results-based business model like healthcare. That means that even though utilizing cloud technology will cut costs, there is no guarantee that a practice will meet the necessary criteria for “meaningful use”.

 

That said, cloud computing has more resources available to maintain data security than ever before, and organizations can still move to an EMR/EHR solution that will benefit their users, and their staff. If you are looking for a solution to help your medical practice cut costs, get dynamic web-based functionality, or get your technology in a position to meet industry regulations, contact the experts

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Fix the EHR!

Fix the EHR! | EHR and Health IT Consulting | Scoop.it

After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.

 

Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing.

 

Mashing up all these functions — charting, clinical ordering, billing/compliance and quality improvement — inside the EHR has been a disaster for the clinical user, in large part because the billing/compliance function has dominated. The pressure from angry physician users has produced a medieval solution: Hospital and clinics have hired tens of thousands of scribes literally to follow clinicians around and record their notes and orders into the EHR. Only in health care, it seems, could we find a way to “automate” that ended up adding staff and costs!

 

As bad as the regulatory and documentation requirements are, they are not the largest problem. The electronic system's hospitals have adopted at huge expense are fronted by user interfaces out of the mid-1990s: Windows 95-style screens and drop-down menus, data input by typing and navigation by point and click. These antiquated user interfaces are astonishingly difficult to navigate. Clinical information vital for care decisions is sometimes entombed dozens of clicks beneath the user-facing pages of the patient’s chart.

 

Paint a picture of the patient. For EHRs to become truly useful tools and liberate clinicians from the busywork, a revolution in usability is required. Care of the patient must become the EHR’s central function. At its center should be a portrait of the patient’s medical situation at the moment, including the diagnosis, major clinical risks and trajectory, and the specific problems the clinical team must resolve. This “uber-assessment” should be written in plain English and have a discrete character limit like those imposed by Twitter, forcing clinicians to tighten their assessment.

 

The patient portrait should be updated frequently, such as at a change in clinical shifts. Decision rules determining precisely who has responsibility for painting this portrait will be essential. In the inpatient setting, the main author may be a hospitalist, primary surgeon, or senior resident. In the outpatient setting, it’s likely to be the primary care physician or non-physician provider. While one individual should take the lead, this assessment should be curated collaboratively, a la Wikipedia.

 

This clinical portrait must become the rallying point of the team caring for the patient. To accomplish this, the EHR needs to become “groupware” for the clinical team, enabling continuous communication among team members. The patient portrait should function as the “wall” on which team members add their own observations of changes in the patient’s condition, actions they have taken, and questions they are trying to address. This group effort should convey an accurate picture (portrait plus updates) for new clinicians starting their shifts or joining the team as consultants.

 

The tests, medications or procedures ordered, and test results and monitoring system readings should all be added (automatically) to the patient’s chart. But here, too, a major redesign is needed. In reimagining the patient’s chart, we need to modify today’s importing function, which encourages users indiscriminately to overwhelm the clinical narrative with mountains of extraneous data. The minute-by-minute team comments on the wall should erase within a day or two, like images in SnapChat, and not enter and complicate the permanent record.

 

Typing and point and click must go. Voice and gesture-based interfaces must replace the unsanitary and clunky keyboard and mouse as the method of building and be interacting with the record. Both documenting the clinical encounter and ordering should be done by voice command, confirmed by screen touch. Orders should display both the major risks and cost of the tests or procedures ordered before the order can be confirmed. Several companies, including Google and Microsoft, are already piloting “digital” scribes that convert the core conversation between doctor and patient into a digital clinical note.

 

Moreover, interactive data visualization must replace the time-wasting click storm presently required to unearth patient data. Results of voice searches of the patient’s record should be available for display in the nursing station and the physicians’ ready room. It should also be presentable to patients on interactive whiteboards in patient rooms. Physicians should be able to say things like: “Show me Jeff’s glucose and creatinine values graphed back to the beginning of this hospital stay” or “Show me all of Bob’s abdominal CT scans performed pre- and postoperatively.” The physician should also be able to prescribe by voice command everything from a new medication to a programmed reminder to be delivered to the patient’s iPhone at regular intervals.

 

Population health data and research findings should also be available by voice command. For example, a doctor should be able to say: “Show me all the published data on the side-effect risks associated with use of pembrolizumab in lung cancer patients, ranked from highest to lowest,” or “Show me the prevalence of postoperative complications by type of complication in the past thousand patients who have had knee replacements in our health system, stratified by patient age.”

 

AI must make the clinical system smarter. EHRs already have rudimentary artificial intelligence (AI) systems to help with billing, coding, and regulatory compliance. But the primitive state of AI in EHRs is a major barrier to effective care. Clinical record systems must become a lot smarter if clinical care is to predominate, in particular by reducing needless and duplicative documentation requirements. Revisiting Medicare payment policy, beginning with the absurdly detailed data requirements for Evaluation and Management visits (E&M), would be a great place to start.

 

The patient’s role should also be enhanced by the EHR and associated tools. Patients should be able to enter their history, medications, and family history remotely, reducing demands on the care team and its supporting cast. Patient data should also flow automatically from clinical laboratories, as well as data from instrumentation attached to the patient, directly to the record, without the need for human data entry.

 

Of course, a new clinical workflow will be needed to curate all of this patient-generated data and respond accordingly. It cannot be permitted to clutter the wall or be “mainlined” to the primary clinical team; rather, it must be prioritized according to patient risk/benefit and delivered via a workflow designed expressly for this purpose. AI algorithms must also be used to scrape from the EHR the information needed to assign acuity scores and suggest diagnoses that accurately reflect the patient’s current state.

 

Given how today’s clinical alert systems inundate frontline caregivers, it is unsurprising that most alerts are ignored. It is crucial that the EHR be able to prioritize alerts that address only immediate threats to the patient’s health in real time. Health care can learn a lot from the sensible rigor and discipline of the alert process in the airline cockpit. Clinical alerts should be presented in an easy-to-read, hard-to-ignore color-coded format. Similarly, hard stops — system-driven halts in medication or other therapies — must be intelligent; that is, they must be related to the present reality of the patient’s condition and limited to clinical actions that truly threaten the health or life of the patient.

 

From prisoners to advocates. The failure of EHRs thus far to achieve the goals of improving healthcare productivity, outcomes, and clinician satisfaction is the result both of immature technology and the failure of their architects to fully respect the complexity of converting the massive health care system from one way of doing work to another. Today, one can see a path to turning the EHR into a well-designed and useful partner to clinicians and patients in the care process. To do this, we must use AI, vastly improved data visualization, and modern interface design to improve usability. When this has been accomplished, we believe that clinicians will be converted from surly prisoners of poorly realized technology to advocates of the systems themselves and enthusiastic leaders of efforts to further improve them.

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Electronic Health Records Consulting 

Electronic Health Records Consulting  | EHR and Health IT Consulting | Scoop.it

For most health systems, investment in an electronic health record (EHR) is inevitable—and possibly one of the largest expenditures they will make. To achieve the clinical, financial, and operational return on investment, you need to be strategic in your selection, implementation, and utilization.

 

Why the EHR life cycle is just like raising a child 

 

No matter where you are in your journey, our services are designed to produce results that improve efficiency, effectiveness, and quality of health care for patients.

 

Our clinically-experienced IT consultants can support you through the entire EHR lifecycle, including:

 

  • Implementation strategy and planning: We guide clients through everything that goes on behind the scenes before the “go-live,” including a full assessment of current capabilities and workflows to determine what functionalities to look for in an EHR. From there, we lead the selection process for new EHR platforms by vetting qualified vendor options, identifying the initial vendor selection pool, orchestrating product demonstrations, and assisting in the negotiation process.

 

  • Go-live: To increase the usability of the EHR, we give clinicians the ability to learn about and personalize the technology before the go-live date, with items such as common procedures or prescriptions. Once we launch, we provide around-the-clock project management at every level and work to address any challenges that may come up during the process. 

 

  • Optimization: Whether after the “go-live” or as a standalone engagement, we work to develop strategies that optimize the EHR’s capabilities and produce results that drive value and profitability in the healthcare delivery model. We often optimize EHR platforms for:
    • HCC Capture
    • Medicare Annual Wellness Visit
    • Evidence-Based Guidance

 

  • Meaningful use attestation: Attesting meaningful use requires effort from many directions—from navigating regulatory changes to overcoming operational challenges. We take some of these tasks off clients’ plates by tracking federal updates, sending actionable alerts, and validating every aspect of the attestation plan. 

 

  • Life sciences support: To support customers and grow health system partnerships, life sciences firms are leveraging EHR strategies that align with industry trends and consumer priorities. Our experts help these firms determine high-yield, value-add strategy for implementing health IT resources into the EHR. 

 

And while we use these processes to guide our clients through the EHR lifecycle, we also support any IT platform using similar methodologies.

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A prescription for EHRs and patient engagement 

A prescription for EHRs and patient engagement  | EHR and Health IT Consulting | Scoop.it

Most physician practices and hospitals in the U.S. have installed electronic health records. In a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse.

 

“How do we make it easier for patients to request and manage their own data?” asks a report from the Office of the National Coordinator for Healthcare IT-Improving the Health Records Request Process for Patients – Highlights from User Experience Research.

 

The ONC has been responsible for implementing the HITECH Act’s provisions, ensuring that healthcare providers have met meaningful use criteria for implementing EHRs, and then receiving the financial incentives embedded in the Act for meeting those provisions.

 

Now that the majority of healthcare providers in the U.S. have indeed purchased and implemented EHRs, it remains for patients, health consumers, and caregivers to take advantage of them. In my post on the EHR Field of Dreams effect, I highlighted research from the U.S. General Accountability Office that explored the question of how the Department of Health and Human Services should assess the effectiveness of efforts to enhance patient access to EHRs.

 

The ONC team conducted in-depth interviews with 17 patients to understand their health IT personae and personal workflows for accessing their personal medical records. The research also considered medical record release forms and information for 50 large U.S. health systems and hospitals, and interviewed “insiders” – healthcare stakeholders inside and outside of ONC – to assess how patients request access to medical records data and look for solutions to improve that process.

 

Why is it so important for people to access their medical records? By doing so, patients and caregivers can better manage and control their health and well-being, ONC notes, by preventing repeat tests, managing clinical numbers (like blood pressure for heart or glucose for diabetes), and sharing decision-making with doctors and other clinicians – together, the process of patient and health engagement, which boosts health outcomes for individuals and populations.

 

The general process of a patient requesting their health data works like this, illustrated by the patient journey of Melissa and Ava Crawford, a mother and toddler daughter portrayed in the ONC report:

  • A patient/consumer makes an initial inquiry
  • The consumer requests the records, which can be done via a paper authorization form (that is then completed and either mailed or faxed to a provider) or sent online via the portal. Sometimes a consumer must write a letter to request the provider.
  • The consumer waits for a response, which ONC calls “a bit of a black hole for consumers.” This can be as long as 30 days under the HIPAA law.
  • The health system receives and verifies the request, then verifies the patient identify and address.
  • Health systems then fulfill the records request, often a printed copy of the medical record that can be faxed or mailed, PDF files, or a computer disk – CD.

 

ONC conducted research into the consumer journey through this process to identify opportunities to improve the patient experience of requesting and receiving personal health information.

 

Health Populi’s Hot Points: Most Americans see their doctors entering medical information electronically, and most people say accessing all kinds of medical information is important, the Kaiser Family Foundation learned in a health tracking poll conducted in August 2016. However, there are big gaps in the information available to U.S. patients online, such as prescription drug histories and lab results – two very popularly demanded information categories. And through the consumer-patient demand lens, 1 in 2 U.S. adults said they had no need to access their health information online, as the chart from the KFF poll attests.

 

How to bridge the chasm between self-health IT, providers, and patients? The most effective patient engagement technologies are biometric measurement devices like WiFi scales and glucometers, apps, texting, and wearables – with portals ranking last – according to physicians and clinical leaders polled in a New England Journal of Medicine (NEJM) survey published earlier this month.

 

The top benefit of engaging patients with these technologies is to support people in their efforts to be healthy and to provide input to providers on how patients are doing when not in the clinic, this research found.

 

My friend and collaborator Michael Millenson wrote in the BMJ in July about patient-centered care no longer being “enough.” In this era of technology-enabled healthcare, and rising consumerism among patients, three core principles must underpin the relationship between patient and provider:

  • Shared information
  • Shared engagement
  • Shared accountability.

 

Michael quotes Jay Katz from his book, The Silent World of Doctor and Patient, who talked 35 years ago about the concept of “caring custody.” Jay explained this as, “the idea of physicians’ Aesculapian authority over patients'” being replaced with “mutual trust.”

 

It is not enough to build and offer a technology “meant” for patients and people to use for their health and healthcare. Trust underpins all health engagement and must be designed and “baked” into the offering. Today, that trust is built as much on consumer retail experience (the last-best experience someone has had in their daily life, exemplified at this moment by Amazon) as in a new social health contract between providers and patients.

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The EHR and Rage Against the Machine

The EHR and Rage Against the Machine | EHR and Health IT Consulting | Scoop.it

The EHR is the latest focus of our rage against the machine. Case in point: Chrissy Farr’s poke at the EHR in today’s Fast Company. Red meat for angry old doctors.

 

What might be interesting is to take a bunch of millennial doctors and make them work for a month with clipboards, fax machines, mailed letters and emulsion films on view boxes? Then we could write a story about the joy and efficiency of manilla folder medicine.

 

I suspect it would put things in perspective.

We fancy ourselves as victims of our technology. But while EHRs have a long way to go, it’s a long way back to paper.

 

I was in an elevator at Texas Children’s Hospital this weekend where there were a number of people looking at their smartphones.  An older gentleman in the elevator remarked shaking his head, “I remember a time when people used to talk.”

 

Actually, no one talked in elevators.  We’ve always stood the same direction and stared at the numbers at the top of the door.

 

It’s easy to blame technology on our human shortcomings.  It’s been suggested that the adoption of EHR has us ignoring patients.  But in the old days, we scribbled on paper.  Irresponsible resident and medical student conduct with social media are blamed on the platform.  But trainees have always done and said stupid things.

Blame it our chauvinistic human bias:  “It’s not me, it’s the machine.”

 

While there are those of us who share a perverse relationship with our tools, it’s important to remember that the world wasn’t necessarily rainbows and unicorns before [insert technology of choice] appeared.

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EHR and Challenges of the Modern Medical Note

EHR and Challenges of the Modern Medical Note | EHR and Health IT Consulting | Scoop.it

There was a time when documentation was an almost inconsequential process. After seeing a patient, the doctor would scratch a note, close the folder, and file it on a shelf until the next visit.

 

Things are different and the medical note has evolved. As it’s evolved, electronic health records (EHR) have brought efficiencies to the medical note while introducing new challenges. And like the cognitive biases that impact patient care, the problems inherent in documentation need attention.

 

Thinking about these challenges becomes important in documenting care and training the next generation of health professionals. Here are a few that I think about

Auto Documentation

One of the powers of the EHR is that it allows users to auto-populate the medical record with chunks of pre-fabricated text known as smart phrases. But these personally created building blocks of the medical note create the potential for one-clip-fits-all documentation. As I’ve said in the past, the smart phrase is not new technology.

 

I work to keep smart phrases out of my history of present illness and impression where individualized narratives show what’s unique about a case. Free text keeps me real.

Replicability

While smart phrases represent the dropping of self-created language, we have the ability to clip and paste information from other parts of the chart. This may include bits and pieces from notes penned by another medical professional.

 

While we all lift bits of language from places like CT and biopsy reports, issues arise when the origination of our language is that of another health professional. Epic now allows visualization of a phrase’s origin when not created by the author.

 

I’m careful about what I copy. I’m twice as careful with what I paste as a representation of my own thinking.

Size and absence of constraint

While smart phrases are limited only by our imagination, a digital note with no constraints predisposes to note bloat, one of the looming threats to modern medicine. Pre-digital notes were constrained by writer’s cramp.

 

I’ve laboured through notes where every single lab drawn on a complicated patient is dumped into the note. Pages and pages of marginally abnormal CBC and metabolic panels create a scenario where it’s difficult, if not impossible, to discern what data is relevant to the decisions made.

 

I try to consider the needs of the end user of the note. Of course, this is challenging when our opinion of what constitutes a ‘good note’ varies from that of the note read.

Ambiguity of purpose

This is the most remarkable phenomenon of the modern medical note. Medical notes have traditionally had pet purposes. Medical students learn early on that ‘the right way to write a note’ varies not only by speciality but by the whim of the individual physician responsible for the note. Physicians with firm views regarding what constitutes the purpose of a note may even morph their perspective depending upon the nature of an individual case.

So if you ask 3 physicians the purpose of a medical note and you’ll get 5 answers ranging from billing and quality documentation to legal coverage and professional communication. Over time the medical note has morphed into all of these things at once.

 

The problem with an ambiguity of purpose is how to manage the expectations of the end user. A physician who feels compelled to paste three months worth of blood results into the data portion of a note will be at odds with someone like myself who believes that a note serves to offer nothing other than concise support for what I’m thinking and planning.

 

As notes become more visible to more folks we can expect ambiguity of purpose to become more pronounced. Digital notes and their capacity for customization amplify this divergence of purpose.

Scaling visibility of the EHR

Once restricted to the shelves of offices in big buildings, medical documentation has traditionally been siloed. This was fine because notes existed for the doctors who occupied those individual offices.  The medical note is now enjoying new freedom in its electronic shape. More notes are more visible to more professionals. This is evident within consolidated health systems where networks of offices connect to big hospitals.

 

Beyond professionals, patients are watching and, in some cases, editing their own notes. OpenNotes is a related program based in Boston’s Beth Israel hospital. Regular patient review and revision represent a revolutionary move in medical documentation.

This scaling visibility of the modern note brings greater scrutiny for what we do or don’t do.

 

This idea of the medical note and its evolution gets little attention yet it represents the core medium of all documentation by medical professionals. It deserves more thorough attention and study.

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EHRs and the Problem of Efficiency

EHRs and the Problem of Efficiency | EHR and Health IT Consulting | Scoop.it

Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.

 

And when it comes to doctors and their EHRs, there’s a fine line between efficient and lazy.

 

Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.

 

Four things I do to fight the downside of efficiency:

  1. Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I’ve typically crossed the line.
  2. Build narrative. My HPI and impressions represent an identifiable stream of thought. I don’t use smart phrases in my HPI or impression.
  3. Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
  4. Stay aware. All of this is a struggle for me. But my discussion and thinking around this make me aware of it. And that’s the first step to staying on top of it.

 

All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don’t be fooled. Take any doctor from the analogue age, give him two glasses of wine and he’ll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analogue pulldown.

 

Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.

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4 Key Considerations for Analysts When Implementing an EHR 

4 Key Considerations for Analysts When Implementing an EHR  | EHR and Health IT Consulting | Scoop.it

Implementing a new EHR system requires a great deal of collaboration between clinical and technical teams. Analyzing the legacy system and operational workflows, then successfully recreating—or better yet, improving—this experience in a new EHR takes finesse.

The foundation of every successful EHR and other large-scale implementation is a team of analysts who are knowledgeable, engaged and passionate about their work. From groundwork and discovery to build, acceptance testing and go-live support, analysts do it all. Here are four key considerations for analysts to keep in mind to help ensure their projects go well and they continue to thrive in their roles.

 

1 – Start with the end goal in mind.

When gathering requirements, project teams will often start by walking through every workflow in the legacy system with end users. This can be a long process and can lead to a lot of information gathering that is ultimately unnecessary. A better approach is to start at the end and work backwards. Ask users why they complete these workflows and what the expected outcome is. This will help get to the root of the requirements and allow analysts to immediately begin thinking in terms of the new EHR.

Here are several questions analysts can ask when gathering requirements:

  • What is the end goal or objective?
  • Why have you traditionally done it this way?
  • What would improve the process?
  • What is the clinical rationale for this workflow?

By starting at the end and asking users why they do what they do and what outcome they are hoping to achieve, analysts can more effectively and efficiently build a system that meets the needs of users.

 

2 – Be aware of the functional limitations of legacy systems.

A key point that is sometimes overlooked is that EHR workflows are often defined by—and limited by—the functionality of the EHR itself. Users will default to what they are familiar with, so if a certain workflow is used frequently in the legacy system, they will assume it is required in the new one. Some workflows may not be needed, however, because the new EHR is designed to achieve the objective in a different, more efficient way. If analysts do not understand this, they risk building in features that are counterproductive, or not needed at all in the new system.

For example, in her current workflow, a clinic manager needs to generate and print a report of all the assessments completed in the office each day. During requirements gathering, she may feel this is an important step to replicate in the new EHR. As it turns out, this workflow is a result of poor auditing functionality in the legacy system – to keep proper records, the clinic manager is required to generate and print these reports. Improved auditing functionality in the new EHR eliminates the need for the daily assessment report and makes this workflow unnecessary.

 

3 – Communication is key.

One of the most important things an analyst can do is to effectively translate the clinical and business needs of end users into technical requirements for the new EHR system. They must also communicate future-state workflows in a way end users can understand and relate to. Communicating effectively is vital to project success.

EHR transitions are often intimidating and frightening for users who have established a comfort level with the legacy system, and likely had little input in the decision to change platforms. Analysts can begin to alleviate concerns and increase user adoption by putting together a few “quick wins.” A quick win is when an analyst identifies a piece of functionality that is very important to users but is also easy to build and demonstrate in the new EHR. Quick wins communicate to users the team is not only listening to their needs but can also deliver solutions quickly and effectively. This also increases confidence, workgroup participation, and communication response time with users and stakeholders, all of which contribute to project success.

 

4 – Strike a balance between functionality and maintainability.

Enterprise EHR systems are complex and, depending on the size and diversity of the user base, may require a team of several hundred application analysts to maintain. In addition, it’s important to remember that every clinical user in a health system is depending on the EHR to complete their documentation and deliver the highest quality of care to patients. Because of this, it is important to strike a balance between functionality and maintainability.

 

If the project team attempts to build in every piece of functionality requested by end users, including things that are nice to have but not critical for the system to function, the EHR will become unwieldy and difficult to maintain. Future updates by the EHR vendor will likely break any customizations, cause unnecessary downtime, and push the volume of help desk requests beyond what the business can support.

In contrast, if the project team oversimplifies and standardizes too much, they risk building a system that does not meet the core requirements of end users. When users can’t leverage the system the way they need, they find “creative” approaches that don’t always work or simply don’t document everything needed. This can lead to a host of problems such as violating operational policy, regulatory reporting issues, loss of revenue due to incorrect documentation, HIPAA violations and, ultimately, lower quality of care for patients. A well-balanced system will keep the support team busy but not overwhelmed, include all required functionality as well as some quality of life features and allow clinicians to be at their best with patients.

In summary, by keeping workflow objectives in mind, understanding legacy system limitations, communicating effectively and balancing functionality and maintainability, analysts demonstrate the value of their critical role in EHR implementation success.

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Are Providers Satisfied With Their EHR?

Are Providers Satisfied With Their EHR? | EHR and Health IT Consulting | Scoop.it

Physicians are expected to document encounters with patients. This ensures there is a record of crucial information for decision-making and dispute. A decade ago, around 90% of physicians updated their patient records by hand. By the end of 2014, 83% of physicians had adopted EHR systems. The combination of government incentives, advances in technology, and improved outcomes and operations fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. Electronic Health Records (EHRs) improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

A national survey of providers highlights their perspective on the benefits of having EHR in their practice:

  • 94% of providers report that their EHR makes records readily available at point of care.
  • 88% of providers report that their EHR produces clinical benefits for the practice.
  • 75% of providers report that their EHR allows them to deliver better patient care.

As the adoption of EHR grew over the last 10 years, so too did the need to change EHR systems within health systems, hospitals, and private medical practices. Growth in M&A activity fueled many healthcare organizations to combine data through EHR data conversion. Provider dissatisfaction has played a key role in encouraging change in EHR systems, also increasing EHR data conversion activity.

A study completed by Health Affairs showed, by and large, providers recognize the important advances that EHRs enable. Fewer than 20% of all providers said they would return to paper records. That being said, providers also noted negative effects of current EHRs on their professional lives and on patient care.  While excited about the possibilities provided by EHRs, providers have ultimately found poor usability that does not match clinical workflows, time-consuming data entry, interference with patient interaction, and too many electronic messages and alerts.

According to a 2014 survey of physicians conducted by AmericanEHR Partners:

  • 54% indicated their EHR system increased their total operating costs.
  • 55% said is was difficult or very difficult to use their EHR to improve efficiency.
  • 72% said it was difficult or very difficult to use their EHR to decrease workload.
  • 43% said they had not yet overcome productivity challenges associated with their EHR implementation.

These concerns about EHR usability are in alignment with others, including the American Medical Informatics Association, researchers, and practicing physicians. Given the rate at which many healthcare organizations have adopted EHRs, these organizations find themselves unable to wait for the long-run fixes. Healthcare organizations are now looking to change EHR providers in order to fix many of the providers’ concerns.

As healthcare organizations begin the process of changing EHR providers, there is an increased need for solutions to provide access to and maintain the integrity of data stored in the legacy systems. When this need arises, healthcare organizations have the choice to archive the legacy data, run multiple systems simultaneously, or complete an EHR data conversion.

Given the complexity of the data and variety of potential solutions, one might suppose that handling legacy data would be a complex affair. In many ways, that is true. However, it doesn’t have to be. To learn more about the state of EHRs and potential solutions for maintaining access and integrity of legacy data.

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EHR Data Architect: A successful conversion and data integrity

EHR Data Architect: A successful conversion and data integrity | EHR and Health IT Consulting | Scoop.it

Over the last decade, adoption of EHR systems has increased dramatically among providers. While many healthcare providers have made the shift from paper to electronic health records, there has simultaneously been a growing need among healthcare organizations to change EHR providers. The two largest reasons for this change in systems are dissatisfaction and mergers and acquisitions.

When changing EHR systems, many healthcare organizations turn to experienced EHR Data Architects to help ensure the integrity of their patient data. For those EHR Data Architects, it is the process, not the EHR provider, that allows them to guarantee a successful conversion and data integrity. 

As is true with the initial adoption of electronic records, changing EHR providers is a very large project. As healthcare organizations work to convert legacy records and adopt new systems, patients continue to generate more data.

It can be quite challenging to determine the best method for maintaining and storing legacy date while also utilizing a new system. As a result, most healthcare organizations opt to incorporate legacy data into the new EHR system from day one. Out of the myriad of options available for guaranteeing data integrity, the best way to accomplish this is through an automated EHR data conversion.

What is EHR data conversion?

EHR data conversion utilizes a process known as ETL to move patient data from one EHR system to another. During an ETL conversion, patient data is EXTRACTED from the legacy system, TRANSFORMED to align with the map created for the new system, and LOADED into the new system. EHR data conversion can either be performed manually or through an automated process.

 

Manual data conversion carries a significant risk of data manipulation. As a result, many healthcare organizations choose automated EHR data conversion when working with large sets of data.

During an automated data conversion, not a single record is touched. Companies who specialize in healthcare data conversion utilize a failsafe ETL methodology specifically designed to mitigate clinical risk.

What are EHR Data Architects?

EHR Data Architects are the specialists who structure and run an automated data conversion. They are experts in extracting data out of any source system/database, using the necessary means specific to that system. EHR Data Architects have customized toolsets that allow them to transform the data to meet the specific needs of the target system.

An EHR Data Architect has experience working with all genres of data. The process and tools allow for the Data Architect to perform an ETL for data from any system and to any system. They ARE NOT specific system experts, or specialists, in any specific system's operations, usability, or recommended workflows.

While they are not subject matter experts (SMEs) in any EHR system, they are in the process of data conversion. As a result, they are able to successfully convert data no matter what systems are being utilized.

It is important that your data conversion partner has developed a failsafe process for extracting, transforming, and loading data. A strong partner will have experience in many different EHR systems and potentially have extensive experience working with your EHR provider and system. However, experience working with your EHR provider is not enough.

Without a failsafe process and methodology, your patient data is still at risk. Furthermore, when the right process is in place, an EHR Data Architect can convert from any source system to any target system and ensure the integrity of your data.

To learn more about how you can adequate assess a potential EHR data conversion partner’s experience, download the EHR Data Conversion Guide and Workbook.

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EHR Adoption: Benefits and Challenges

EHR Adoption: Benefits and Challenges | EHR and Health IT Consulting | Scoop.it

Electronic Health Records (EHRs) are rapidly becoming an integral component of any efficient healthcare system.  Professional doctors and hospitals are required to demonstrate the meaningful use of certified electronic medical records. Meaningful use criteria in this regard refers to capturing electronic health information in a standardized format, using this information to track key clinical conditions, putting in place a care coordination process, report clinical quality measures and public health information and to use this information to engage with patients and their families. More sophisticated systems would also have the capability of enabling health information exchange, incorporating lab results, e-prescribing, transmit patient care summaries across multiple settings, provide patients access to self-management tools and improve the overall population health.  

 

Approximately, 78.4% of office-based physicians use EHR systems while 48.1% of those work with a basic level EHR system. According to findings of a patient experience survey with EHR systems, it was reported that physicians with EHR systems that meet meaningful use criteria felt that it provided time savings and resulted in enhanced confidentiality and less disruption in doctor-patient interactions. In addition, properly implemented EHR systems also provided greater financial and clinical benefits as compared to basic systems.

 

It is important to remember that electronic health record systems are not a novelty. In one form or another, healthcare providers have been using EHRs for many decades. In the past, doctors used standalone workstations to store patient data. However, with advancement in information technology, data storage as moved to the cloud and has become more efficient, portable and rapidly transferable.  

Benefits

EHR systems have made the healthcare system more efficient in following ways:

 

−    Ability to transfer medical records across geographic borders, to another hospital or department. This enables access to complete and accurate information at the point of care.

−    Help improves patient management and engagement. With just a few clicks providers can not only access patient medical records anytime and anywhere but also coordinate care with their peers to improve the quality of care delivered.

−  Lower operational costs with less labor expense to maintain paper records and reduced need for transcription services. Once a medical record has been added in electronic format, it requires almost no management which directly impacts operational cost.

−   Safer and reliable workflows with EHRs to enable e-prescribing, laboratory, and X-RAY ordering and reporting. An efficient EHR-based workflow can reduce chances of error and eliminate lost records to deliver effective and safer care.

−  Enabled Increased patient engagement between patient and providers. Electronic records allow patients to participate in their own care and let provider-patient to work on delivering better patient care collectively.

Challenges

Even with these benefits, implementation of EHR systems has proven to be a significant challenge for healthcare organizations.

 

−  EHR adoption substantially increases the effort needed to manage the privacy and protection of the patient records. Over the years,  there have been numerous incidents of security breaches and stolen patient health information. Although, healthcare organizations invest heavily in creating secure and compliant solutions but securing and managing connected electronic records is a dynamic process and requires constant monitoring and auditing to track down threats and flaws before they happen.

−   Higher start-up and maintenance cost of transitioning to electronic medical records – larger the organization, greater the cost. Resource training, culture change, new workflows adoption and constant need for support make EHR adoption an intimidating task for any organization.  The higher start-up costs for smaller practices make it difficult for them to recoup.

−    Delivering education & continuous training on the usage of the EHR is another challenge faced by organizations. Healthcare staff needs to be trained for compliance, maintenance, confidentiality, and various workflows on effective use of the system. Without a proper training program, user do not understand the system completely which directly impacts the quality of care.

−   Perceived depersonalization of provider and patient relationship as providers feel that they are spending more time interacting with the computer than with the patient.

−   Extensive data capturing hampers the clinical workflows of physician. Not only data entry is both cumbersome and time-consuming but providers are also put-off by UI/UX to manage  their workflows. Although keeping everything electronic gives them an ability to remain connected to their patients but unnecessary alerts and notifications also create an alert fatigue on both patient and provider side.

 

While the general dissatisfaction remains with adoption of EHRs, the fact remains that addressing above mentioned challenges as per your organizational goals can definitely lead  better, coordinated and cost-effective care.

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The Limits on Healthcare Learning From the Business World 

The Limits on Healthcare Learning From the Business World  | EHR and Health IT Consulting | Scoop.it

A favorite criticism of EHRs is that they are glorified billing platforms, rather than clinical tools.

 

Despite being sold to — and subsequently, by — the federal government as being healthcare’s ticket into the modern age, and to leveraging big data, EHRs haven’t so far facilitated the kinds of analytics initially touted as the new standard in medicine.

 

Part of the shortfall in realizing the potential of EHRs may be fairly ascribed to overselling; new technology and new applications of existing technology tantalize imaginations. In an industry with as many challenges and problems to solve as healthcare, it is understandable that advocates got carried away with silver bullet thinking about EHRs and let development and implementation — not to mention security — fall behind.

 

But part of the problem is also an overextension of the analogy that what works for the business world, ought to also work for healthcare. Even outside of EHRs and questions of technology, the assertion that business leaders, models, systems, and tools have pedagogical value for healthcare leaders, and practical value for clinics, has become so popular that for many it sounds indistinguishable from conventional wisdom

That may have its merits, but the reality (all too familiar for those actually working in healthcare) is that business lessons very often don’t apply to the health sector.

 

Are EHRs Failing to Deliver Analytics?

When big data doesn’t work, it isn’t necessarily a failure of information, but a user error; a failure to properly organize information, or to ask the right questions of that information. In other words, big data doesn’t just happen by virtue of keeping digital records or even hiring data scientists to get things in order. There has to be a compelling use case, a specific goal associated with the data to turn raw information into something actionable. This is where business and healthcare diverge most dramatically.

The business use case for big data is, first and foremost, about competition. A forensic look at marketing initiatives, supply chains, tax planning, even compensation, all serves to make businesses more lean, more efficient, more profitable, and ultimately, more resilient in the face of stiff competition. McDonald’s managed it before “big data” was a buzzword, by simplifying its menu and streamlining its kitchen. Today, it is synonymous with “fast food” not because it is holistically the best, but because it led the pack in turning analysis into a competitive advantage. And it continues to use technology, analytics, and big data to further hone everything from sandwich assembly to locating new franchises around the world.

 

It should hardly require saying so, but healthcare has no McDonald’s model to follow.

 

Healthcare data analytics — carried on the backs of EHRs — are not necessarily intended to support competitive improvements or advantages. By and large, major clinics and hospitals have a virtual monopoly, if not geographically, then often in terms of insurance networks, or both. So the idea that competition drives innovation, optimization, or introspection is a non-starter.

 

The Profit Motive

Businesses are looking for improvement opportunities not just to aid the bottom line, but to boost profitability. The majority of clinics in the United States are, at least on paper, nonprofits (or government-operated). So in these hospitals, that “bottom line” under scrutiny by CEOs and data scientists often has more to do with volume, sustainability of operations, and especially coordinating with insurers in order to remain solvent.

Big data in business enables corporations to minimize the costs of their own operations, and to pass on some measure of savings to customers. That boosts profitability not just by making the cost of business lower, but by incenting consumers to buy more, or at least, to elect to buy from the optimized company. Everyone along the supply chain is looking for the best, for the least.

 

Healthcare is never so straightforward. Prices are hopelessly opaque in healthcare, and the relationship between the many stakeholders along the supply chain — from universities to providers, clinics to insurers, consumers to pharmaceutical companies — is all but impossible to optimize because there are so many different motives, inputs, and contradictions involved. People are looking for the best, but seldom have any way to judge quality, or have no access to competitive alternatives, or to balance quality with cost, or to hold anyone along the way accountable for quality or, for that matter, setting prices.

 

What this all amounts to is a limitation on the ability of healthcare organizations to make use of their data in the same way their business sector counterparts have been doing with any hope for success, insight, or actionable conclusions. That the finances of free market corporations and health systems are different is itself not an especially novel observation, but the fundamental difference of motivation extends further than price-setting and value-shopping.

 

Optimizing for Engagement

Although broadly similar, and often looked for in the data, the effect of “engagement” in a normal business setting is critically different from the sort of engagement providers and health systems are trying to achieve with patients.

 

Engagement in marketing is a matter of driving conversions; the more consumers hang out on your site or are exposed to your brand, the more likely they are to convert to buyers. This kind of engagement takes shape as funnel: get the widest possible audience to begin engaging, then optimize every node, webpage, or conversation to drive them all toward one destination: purchase.

In the business world, you see this driven by big data in the form of things like A/B testing to maximize webpage performance. Optimizing ecommerce or brand websites, targeting marketing messages, streamlining design for user experience and ease of navigation — it all funnels down to that old bottom line. When a given consumer’s experience seamlessly and pleasantly flows from landing on a website to buying a product or service, the engagement effort has worked. Engagement for business, in other words, is discrete.

 

Engagement in healthcare has a very different connotation, with extremely different end goals: engagement is about adherence, first and foremost. Getting patients engaged with their care is a function not of encouraging brand loyalty or making a sale, but of trying to optimize the value of the care they have already received. In other words, engagement after the sale is more important than leading up to the sale, because what happens after a visit to the hospital can be more critical to patient health than the limited encounter they have with providers.

 

In medicine, engagement is continuous, and more a matter of perpetual relationship-building, of exchanging feedback, than of driving everyone to one universal outcome. Individual patient health goals are unique; sales goals are easily generalized. A/B testing a patient portal may help improve general user experience, but the substance of a patient’s chart, or conversation with a provider, can’t be optimized the same way a product page can. While a specific retailer or brand can optimize experiences to their specific consumer demographic, healthcare organizations have the impossible challenge of optimizing all patient engagement pathways to anyone and everyone who needs medical attention.

 

Redesigning Health Data

The other example of A/B testing in healthcare, of course, is the control study for medications, new procedures, or determining best practices. This is where the real value, the maximum return on investment, from adopting EHRs should be sought. The big data EHRs deliver can only do so much to highlight wasted revenue, inefficiencies, or optimized patient experiences in the sense that the business world so often makes use of. But outside of the profit motive, or of engaging consumers to make a sale, big data in healthcare can begin to reveal population trends, problems with current standards, pathways of disease, and where health resources are needed most.

 

The best use case for data in healthcare is not a matter of competition as it is in the business world. It is a matter of learning, of monitoring populations not to take advantage of trends, but to anticipate and prevent disaster or outbreaks. The best use of the data is not presenting it to leadership or business-minded members of the C-suite, but making it accessible to the academic community, to researchers and scientists who can turn it into a competitive advantage against death and disease, rather than the marketplace.

 

Achieving this takes standardization, interoperability, and some amount of relief for providers feeling taxed by the need to play data scientist and doctor at the same time. All easier said than done; what’s worse, interoperability among legitimate and authorized users is lagging behind security failures and vulnerabilities across the healthcare industry. But progress can start with recognizing that EHRs don’t need more help from the business world to fulfill their promise. EHRs, like scalpels or stethoscopes, don’t belong in the boardroom, and their use and design is best left not to administrative types, but to medical professionals.

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Is an Automated EHR Data Conversion Right for You?

Is an Automated EHR Data Conversion Right for You? | EHR and Health IT Consulting | Scoop.it

EHR data conversion is the process of taking data from a legacy electronic health record system and transferring it to a new system. EHR data conversion can either be performed manually or through an automated process. Manual data conversion carries a significant risk of data manipulation. As a result, many healthcare organizations choose automated EHR data conversion when working with large sets of data.

 

Determining if an automated data conversion is right for your healthcare organization can be a difficult challenge. Below you will find the types of questions you should ask your in-house team when considering if an automated EHR data conversion fits your organization’s needs.

 

In an automated conversion, source values are extracted from both the legacy (source) system and new (target) system to create a conversion map. That map is entered into a conversion utility software. Data from the legacy system is run through the conversion utility and transformed to meet the needs of the new system. While it is being transformed, the conversion utility is monitoring for errors and success rates. After the data has met the standards, it is then loaded into the new system.

 

  • Have we acquired or do we plan to acquire facilities with disparate EHRs?
  • Are we going to continue to acquire new practices or hospitals?
  • Are we struggling with a plan for handling and storing the data?
  • Do our providers and staff function out of more than one system?
  • Does our EHR have capacity we are not using?
  • Does our legacy system require internal experts?
  • Do we have specialties, such as Obstetric Gynecology or Pediatrics, that are required to store data for longer periods of time?
  • Do we have more than 30,000 records we need to convert?

If you answered “yes” to any or all of these questions, an automated EHR data conversion might be a good fit for your healthcare organization.

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EHR Market Needs Competition & Innovation

EHR Market Needs Competition & Innovation | EHR and Health IT Consulting | Scoop.it

I spend a fair amount of my days engaged in conversations with family physicians and policymakers on how to improve our nation's health care system. These conversations and the feedback they generate are the engines that drive the AAFP's advocacy. There are dozens of pertinent issues impacting family physicians and their patients, but there are two themes that emerge in every conversation. The first is the disdain family physicians, really all physicians, have for electronic health records. The second is how the EHR industry, to date, has failed in its core mission.

 

On Jan. 20, 2004, President Bush made the following statement as part of his State of the Union Address: "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care."

 

On April 26, 2004, the Bush Administration formally launched the Promoting Innovation and Competitiveness campaign(georgewbush-whitehouse.archives.gov), which was aimed at accomplishing the goals outlined in his SOTU address. The campaign made several observations and had several goals, but I would like to highlight three:

 

A patient's vital medical information is scattered across medical records kept by many different caregivers in many different locations – and all of the patient's medical information is often unavailable at the time of care.


Innovations in electronic health records and the secure exchange of medical information will help transform health care in America -- improving health care quality, preventing medical errors, reducing health care costs, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care.
Within the next 10 years, electronic health records will ensure that complete healthcare information is available for most Americans at the time and place of care, no matter where it originates.
Within the next 10 years?

 

Guess what? Time's up, and none of this happened. It is reasonably safe to say that in the 14 years since President Bush issued his call to action, the promise of EHRs has failed epically to meet the expectations outlined in the SOTU speech -- avoid dangerous medical mistakes, reduce costs and improve care. Some would argue that we have digressed in each of these areas.

 

I struggle to find an articulate and elegant way to describe what is so frustrating about electronic health records, but I think I have found a way to do so succinctly -- they suck. They suck as products, and they suck the life out of everyone that uses them.

 

Ponder this, since President Bush issued his 2004 challenge, the following innovations hit the market -- Facebook (2004), Reddit (2005), Twitter (2006), iPhone (2007), Airbnb (2008), Thumbtack (2008), Rent the Runway (2009), Uber (2009), Instagram (2010), Pinterest (2010), Snapchat (2011), Alexa (2014), Bumble (2014), and dozens of others targeted at specific industries or activities. Each of these platforms changed an industry or changed the way we communicate and share information with each other. They have made positive contributions to our economy and our lives.

 

It is a shame that the efficiencies realized from these platforms have not translated to health care via EHRs. Instead of streamlining the healthcare industry, EHRs have created a plethora of cottage industries and consultants; required physicians to incorporate "workaround;" and, most sadly, the EHR has contributed significantly to the onset of an actual epidemic -- physician burnout.

 

A few weeks ago, I was in San Francisco and had the opportunity to meet Andrew Hines(canvasmedical.com), an engineer who has spent his professional career working in and around the technology industry, including work for a major EHR company. During our conversation, he said something that really stuck with me, both for the boldness of the statement and the fact that, deep down, I think we all know it may be true. He said, "I used to think we could improve the electronic health record from within, but now I realize the only way to truly improve electronic health records is to start over."

 

A Harvard professor known for his work in disruptive innovation, describes this as sustaining versus disruptive innovation. Incumbents focus on incremental improvements in their products whereas new entrants succeed with disruptive innovations. The problem with healthcare and EHRs specifically, is that incumbents have all the market power.

 

Steven Waldren, M.D., director of the AAFP Alliance for eHealth Innovation, summed it up as follows: "The reason EHRs suck is not due to a lack of innovation in technology but rather in a lack of innovation in health care. It seems that the health care industrial-complex, unlike other industries, is insulated from such innovative challenges from new players."

 

Waldren summarized his thoughts in a simple statement, "Without competition, we will not see the technology innovations in health care we have seen in other industries."

 

There are no easy solutions in health care, and improving EHRs is no different. However, we desperately need innovation and meaningful competition in the health information technology and EHR space. The following are three objectives the AAFP is pursuing to increase competition and spur innovation:

 

Make it easier for new companies to enter the health IT marketplace -- The AAFP continues to work on expanding interoperability to allow appropriate access to data stored in EHRs, in a timely manner. The AAFP is aggressively advocating for policies that force EHR vendors and other health IT products to be interoperable based on a defined set of standards. We also believe that all data in the EHR should be available for use by third-party vendors, of course with appropriate privacy.


Make it easier for innovators to design smarter health IT products -- One of the differences between health care and the general IT space is the complexity and fuzziness of the semantics of clinical data. The AAFP is committed to working with others to model clinical data in standard ways that allow developers to make health IT systems that can reason about clinical data and therefore help automate tasks physicians must perform.
Eliminate or reduce administrative requirements placed on health IT products -- The poor usability of EHRs is often due to external requirements established by regulators and payers, such as clinical documentation, which does not add clinical value. The AAFP is actively promoting policies that eliminate or, narrow, those requirements. We believe a reduction in administrative burden will help physicians, and also allow health IT developers to focus on features and functions that add clinical value.
Closing Thought


As you can tell, I am frustrated with the performance of current EHRs and the negative impact they are having on our health care system and each of you personally. The dominant companies in the market have produced products that have largely failed at the core goals established in the early 2000s. As I have noted, technology in every other industry tends to result in rapid improvements to function and efficiencies. Health care simply hasn't seen the same improvements, and the companies that make these products have seen windfalls in the billions, yet their products continue to underperform and fail to meet expectations of patients, physicians, and policymakers.

 

I remain a strong supporter of the broad use of EHRs in our health care system. The EHR still stands to improve the aggregation and distribution of medical information, which would improve our health care system. Without a doubt, the ability to access and transmit medical information among care sites and physicians would improve care and result in efficiencies for patients and the system overall.

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From EHR to Paper to EHR .. to Paper??

From EHR to Paper to EHR .. to Paper?? | EHR and Health IT Consulting | Scoop.it

I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know.

When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like a LAB, ER, and X-RAY.

 

Patients always assume that medical records transfer seamlessly between practices. They don’t, even between clinics that use the same EMR vendor. The stack of papers gets scanned in, as images or PDFs, but they don’t appear in the searchable, tabular or report-compatible form. Often, they don’t each get labeled, but are clumped together under headings like “Radiology 2010-2017”.

 

In one of the clinics I work in, a Registered Nurse enters patients’ medical history in the EMR before each new patient’s first appointment. In the other, it is my job. In both cases, only a fraction of he information is usually carried over from one EMR to the other, and the patient’s life story risks getting diluted, even distorted.

 

It doesn’t take much imagination to understand why things work this way:

 

Once upon a time, the Rulers of a great country handed out money to all the medicine men so they could start using computers to document what they did (and what they charged for, which was the real reason the Rulers handed out money the way they did).

 

This was a gift, not only to the medicine men but also to a lot of computer companies, who quickly geared up and made EMRs that the medicine men needed to buy before the deadline the Rulers had imposed.

 

Soon the medicine men gave all their newfound money to the computer makers. One of the things they thought they remembered hearing about was “interoperability”, but the computer makers were no fools. By making it just about impossible to transfer data between EMRs, the computer companies figured they could keep their respective customer's hostage because no matter how much they hated the slapped-together systems, it would be too costly to start over with another system.

 

Eventually, each vendor secretly hoped they would end up with the most users and thereby becoming the industry standard when the medicine men and the Rulers caught on to the lack of interoperability.

 

That, I explain to those of my patients who were around for it, is like the early days of VCRs – Betamax or VHS – more than 100 times over or, think about it, 100 times worse.

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Moving into post-EHR era

Moving into post-EHR era | EHR and Health IT Consulting | Scoop.it

Consultants weigh in on what hospitals should expect from them as healthcare moves beyond digitization and into the age of consumerism.

 

Healthcare information technology is evolving in many ways, and quickly so. That means health IT consulting has to change with the times, to evolve alongside the technology consultants help healthcare provider organizations, master.

 

Consultants from top firms across the health IT consulting spectrum have various ideas about what firms must do next to successfully aid provider organizations with technology. Call them next-generation health IT consulting goals.

 

For example, health IT consultants must move beyond prediction, said Jeff Geppert, a senior research leader at Battelle, an independent research, consulting and development organization that applies science, technology, and engineering to challenges in various industries, including healthcare.

 

“The current narrative on health IT consulting services is becoming commonplace,” he said. “The focus is on data science and applications that leverage large and connected datasets, powered by predictive analytics and artificial intelligence/machine learning running in the cloud.”

 

However, there is nothing very transformative about prediction, he cautioned.

 

“It is by necessity short-term and event-driven,” he said. “Healthcare provider organization CIOs should be looking for health IT consultants with a compelling long-term and goal-driven vision, and a plan to work with them to bring that vision about.”

 

"The focus [of health IT consulting] will shift to extracting more value from investments and identifying which new investments are necessary to drive competitive advantage for the system."

“Health IT consulting today seems like the auto industry a hundred years ago with multiple companies competing to build the most technologically advanced car,” he said. “Somewhere out there is the Henry Ford of health IT who will build something inexpensive, standardized, aligned with the needs of people, and scalable from individuals to the federal government.”

 

Healthcare provider organization CIOs should be looking to partner with health IT consultants with demonstrated longevity across multiple industries, he added.

 

John Curin, vice president of innovation at Burwood Group, a healthcare consulting firm that focuses on direct acute care, physician workflow and health IT, said he sees healthcare CIOs watching consulting services expanding beyond the EHR.

 

“The vast majority of the health IT consulting space has been overwhelmingly EHR-centric up to this point,” he contended. “Today, EHR and revenue cycle systems migration is largely complete or well-understood. The focus will shift to extracting more value from those investments and identifying which new investments are necessary to drive competitive advantage for the system.”

 

Further, consultants will offer services to help healthcare providers transition – the shift will be toward internally developed interdisciplinary strategies with a focus on systemwide financial and clinical outcomes improvement, Currin said.

 

“For example, to make IT more successful, CIOs will stop reacting to external plans and timelines, such as regulatory compliance introduced by meaningful use or vendor roadmaps based on product lifecycle and implementation schedules,” he said. “Instead, they will start building frameworks to drive better financial and clinical performance.”

"The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage"

On another note, consumerism is significantly affecting healthcare today, forcing healthcare provider organizations to meet changing patient expectations. Along with receiving the best medical care available, today’s health care consumers also expect a first class experience across every touchpoint at an organization.

 

“With expectations becoming increasingly ‘consumerized,’ executives are realizing that their healthcare organization will be judged on how patients rate their overall experience,” said Rob Barras, executive leader, health solutions, at CTG Health Solutions, a clinical and financial IT consulting firm that serves healthcare provider, payer and life science organizations. “This means that meeting these demands needs to be front of mind for CIOs.”

 

This trend toward a consumerism approach will accelerate significantly, and health IT consultants will have to be on top of it to successfully assist healthcare provider organizations, Barras said. Soon, Amazon, Wal-Mart, CVS, and Apple will consider themselves care providers, he added. And while most traditional health systems are doing business as usual, smart CIOs will plan ahead to match the future expectations set by these retail giants in yet another industry, he said.

 

“Many of these major players believe there is an opportunity to capitalize on what they believe traditional providers have been slow to do – provide easy access and quality care at a reasonable and transparent price,” he said. “The time is now for CIOs to embrace consumerism and create a digital strategy that becomes a competitive advantage, and for consulting firms to rush to assist with this stage in the planning process.”

 

And Barras said that moving forward, health IT consultants have to be getting healthcare provider organizations implementing the latest healthcare information technologies now, not later.

“For the past couple of years, many healthcare organizations have treated emerging technologies as somewhat of a luxury and not as something with immediate business value,” he said. “However, technologies have matured quickly and already are being implemented to meet business needs, meaning organizations without structured plans to roll out the latest in analytic, AI and IoT solutions are in danger of falling out of step with competitors.”

This means that health IT consultants must focus on becoming innovation hubs – as opposed to internal caretakers – of technology to provide true value to healthcare clients, Barras added.

 

“The right CIO can help change the mindset of an organization, but that change must be supported from the top down,” he advised. “A key to this is working with consulting partners who understand that using technology is a way to create a competitive advantage for the future. Providers should engage partners who can clearly articulate the value of their work and the vision.”

 

 

 
 
 
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Getting the Most Out of Your EHR - Healthcare IT Consulting

Getting the Most Out of Your EHR - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.

 

8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and training can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.

 

EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.

 

EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.

 

Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.

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When Doctors Choose a Job Based on the EHR

When Doctors Choose a Job Based on the EHR | EHR and Health IT Consulting | Scoop.it

I recently had lunch with a young doctor new to our community. The conversation wandered on to how she settled on her new position and the EHR was identified as one of her key selection criteria. She heavily favored positions with institutions running EPIC.

 

Interesting, I thought. Because when I took my first job, the brand of manilla folder used in the patient chart played no role in my decision. Clearly, times have changed. And so have the doctors.

What does this tell us about doctors and technology?

 

Not everybody hates electronic health records. The generation that never felt paper has officially entered the clinical workforce. And despite the popular press and their drive to perpetuate anti-EHR sentiment, not everyone hates EHRs.

 

Our experiences are increasingly defined by our tools. The clinical tools that surround us go a long way in determining our quality of life. So the EHR is likely to shape how we view a position. I’m working on my second EHR system in a decade and my day-to-day life is very different.

 

Technology can draw or repel talent. The technology we use and the systems we choose are likely to impact the docs we recruit and the talent we retain. Hospital systems that use dated and/or dysfunctional EHR systems are likely to feel the impact at some point.

 

An isolated case you might think. But the truth is that millennial physicians see the world and the workplace through a very different lens.

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EHR and the Failure to Communicate

EHR and the Failure to Communicate | EHR and Health IT Consulting | Scoop.it

Clinical workflow in my early career included the ritual of phone messages. Every day, at least once and usually in the afternoon, I would sit with my clinic nurse and a pile of manila folders to discuss phone calls. Details were discussed, recommendations were made, triage assessments were cosigned and I would hold the charts of those patients needing a callback. The ritual began with the daily call to action, “Let’s do calls.”

EHR and the disruption of the nurse-doctor interaction

About 15 years ago when our first EHR, Logician (evolved as Centricity), came along the process of handling calls changed. It was Texas Children’s first venture into EHR and with it we began the long calculation of how electronic records fit our clinical flow.

My nurse at the time was a pediatric nurse with years of experience. Seasoned and crusty, her capacity for laser-sharp phone triage was impeccable. She was a stickler for tight documentation.

 

As we grew comfortable with Logician, the ritual of call review evolved. While we began doing calls around the screen, my nurse began to insist that our daily rendezvous was no longer necessary. “It's’ all in the message. Just read the message, Dr V,” she would crow from her cramped desk. “And the documentation is better. Trust me.” Despite my insistence, she ultimately became an unwilling partner in a clinical dance for two.

 

Our digital phone messages involved a back and forth of queries and replies through the EHR. Documentation was tight. But something was missing.

Not all media are created equal

When it comes to communication not all media are created equal. The assumption on the part of my nurse was that communication through the EHR was the same independent of how it was transmitted. A message, in the end, was just a message.

As it turns out, there are different ways for patients and health professionals to exchange information with one another. All bring different affordances to a human encounter.

 

  • In person (mano y mano)
  • Asynchronous text (Epic MyChart, email)
  • Synchronous text (Live texting)
  • video stream (Skype)
  • audio transmission (phone)
  • And there are lots more.

 

All represent ways for us to exchange health information. As I have written, different problems call for different media depending on the type of problem at hand. Text works well for simple problems. But the text isn’t always enough. A video is an overkill for simple issues. And as inconvenient as it may be for both the patient and the doctor, sometimes a patient needs to be seen, heard or touched in person.

The EHR and the subtle dimensions of the human experience

So when my nurse stopped talking to me about my understanding of what was happening with my kids fell off significantly. The notes were impeccable and the transmission instant. But something was missing.

 

So what was missing from the EHR? As it turns out in human exchange there are subtle elements that get lost in the type. There are critical bits of information during a phone exchange that get picked up by an experienced pediatric nurse. Often there are subtle contextual elements of a social situation that are never properly documented. Some of these things can’t be documented.

 

Sometimes these details only come to my attention when face-to-face with my staff. And there are things that come from the gut that we don’t share in the record.

 

Paper charts didn’t solve this problem with the EHR. Written messages are exactly the same. They just forced us to sit at a table because there was no way to send a paper message across the office and easily back again.

 

Humans are messy. They rarely fit the constraints of the technology we create. The dimensions of the human experience are rarely felt through typewritten messages. Consequently, the accurate exchange of information and documentation of human interaction is potentially more challenging than we think.

 

Communication through and around the electronic health record is an inevitable part of medical practice. But we have a long way to go with regard to capturing the subtle elements of human engagement.

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The future of EHRs - and it's not even in the EHR 

The future of EHRs - and it's not even in the EHR  | EHR and Health IT Consulting | Scoop.it

Voice recognition and natural language processing will enable doctors and nurses to interact with electronic health record platforms in more comfortable ways.

 

Along with a fistful of cutting-edge technologies, an interesting trend has begun to emerge that may help predict a direction forward for the way users interface with electronic health records.

Hint: It’s not in the EHR. Instead, emerging technologies such as ambient listening, voice assistants and natural language processing will provide a subtle buffer between EHR data and users. Clinicians will be able to access and contribute to data within electronic health records software or cloud services, in fact, without having to touch the EHR itself.

 

Let’s take a look at how this could play out.

EHRs today

As they have evolved, EHRs have also become more complicated and “busy.”  They require significant investment in training, both prior to adoption and ongoing as new features are released. 

Telling a primary care group back in 2000 that 6-8 hours of classroom training was required for every physician would have been the ultimate non-starter. Today, this is the norm and accepted as reasonable and it also holds true for the analysts who configure and support these systems of record.

 

Documentation requirements continue to increase, too. The push to document in a codified way has become more important in order to inform not only electronic decision support but also to support population health management initiatives and advanced data analytics. Plus, medical knowledge is eclipsing providers’ capabilities to internalize it and incorporate it into their practice.

So what does this point to?

Voice recognition, NLP and remote scribes

Providers have already begun to adopt technologies such as voice recognition and natural language processing that allow them to distance themselves from the complexities of the EHR.

Since a clinician is technically in the record while dictating via voice recognition, he or she is interacting with the system with a software buffer that the typist does not have.

 

A more pronounced example is the scribe. Far from a new idea, the scribe allows the provider to see the patient and remain fully focused on the task at hand while someone else does the documentation on their behalf.  While this comes with a certain level of awkwardness for the patient, it has been widely adopted in some clinical settings.

 

Natural language processing has been discussed in concept and used in pockets for many years. While loaded with potential and extremely appealing, it has yet to take off as a full-fledged documentation solution.

 

More innovative alternatives are also being explored. Remote scribes allow the transcriptionist to listen to the visit in real time and document as the provider speaks their way through the examination.  his may be implemented as an audio-only solution or with audio and video through the use of a tablet or some other video-enabled device in the exam room. Ambient devices are also being investigated as alternatives — pairing voice recognition with a mostly hands-free documentation experience minus the scribe. Google Glass is another interesting alternative. In this concept, the provider is not only dictating as they examine the patient but also visualizing elements of the record as they go without having to refer to a computer or tablet.

Tech challenges and costs

These novel technologies are not without challenges.  For the remote scribe model to be successful – especially in the case of audio-only – providers need to run through their visits in a common way for the process to be accurate and efficient. The scribe also must document the right information in the right place in the record. If they are merely typing a free text note – the value of the data is lost. Decision support is one of the most compelling reasons to use an EHR. How can the provider receive this guidance if they are not interacting directly with the system? A hybrid solution could solve for this – with the provider manually performing order entry and prescribing tasks. Alternatively, technology developers may come up with an innovative solution to address the requirement in the future.

 

Patient perception is also a concern. As with the traditional human scribe, patients may react negatively to the notion of a virtual third party participating in their visit. How can the patient be sure that only the identified third party is listening/watching? How can they be assured that the visit is not being recorded or shared? What type of consent is required and what details need to be shared with the patient in order for them to be aware of the process? What if the patient declines to participate in this type of visit?

 

Security, of course, will be paramount both for the patient and the hospital.  We all hear of major security breaches on a weekly basis. Executives and (increasingly) patients will need guarantees that these solutions are secure and insulated from the risks that come with the possibility of a data breach.

 

Traditionally the solutions that allow providers to document patient care without interacting with the record have been utilized mainly in the ambulatory, urgent care, and emergency department settings. Is there an option that would work for inpatient providers? Is there an option that would be suitable for nursing documentation? It may very well be that the answer is “no” and that these caregivers will continue to document directly in the record (either manually or with traditional voice recognition) for the foreseeable future.

Back to the future

There is, of course, a financial component to all this as well. Scribes and the more advanced technologies described are not inexpensive.  It will be up to technology developers and service providers to clearly articulate the return on investment.  It is noteworthy that some of that ROI will be difficult to quantify in terms of dollars or efficiency as it relates to provider happiness.

Even with all of these questions, it is clear that the trend of providers moving further away from direct interaction with the EHR is real and likely to continue. 

 

Ideally, EHR developers and regulatory agencies will see this as a challenge to simplify their products and documentation requirements. It’s possible that this is the push the industry needs to rethink usability and truly develop intuitive systems that are easy to learn and easy to use. This will require not only creativity and skill but also a willingness to rethink many of the constructs the industry has operated under for the last decade-plus.

 

It is more likely that the burgeoning trend will continue to progress and we will find ourselves in a “Back to Future” scenario where providers use the medical record to access information but harness various forms of new age dictation to keep it updated.

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5 Steps to EHR Data Conversion

5 Steps to EHR Data Conversion | EHR and Health IT Consulting | Scoop.it

EHR data conversion is the process of moving patient data from legacy EHR system to a new EHR system. While automated EHR data conversion seems like a complex affair, it doesn’t have to be. When an experienced vendor partners with strong internal leadership, the data conversion will follow a proven, 5-step process, and the data will undergo a failsafe ETL.

Why Change EHR?

Healthcare providers are expected to document patient encounters. Traditionally, this documentation has been completed on paper and stored in file cabinets. However, the last decade has seen significant growth in provider adoption of Electronic Health Records (EHRs). The combination of government incentives, advances in technology, and improved outcomes and operations have fueled this growth.

When healthcare providers have access to complete and accurate information, patients receive better care and have better outcomes. EHRs improve providers’ ability to diagnose disease and reduce medical errors. EHRs further help providers meet patient demands, provide decision support, improve communication, and aid in regulatory reporting.

While EHR adoption has increased, so too has the need to change systems while maintaining the access to and integrity of patient health information. Healthcare administrators point to provider dissatisfaction and mergers and acquisitions as the primary contributors for changing EHR providers within their organization. In preparing for the implementation of a new EHR, healthcare organizations have been grappling with how to handle the data in the legacy systems.

What is EHR Data Conversion?

In response to this challenge, many healthcare organizations are turning to automated EHR data conversion to maintain data integrity. An automated ETL (Extract, Transform, Load) process avoids risks related to data manipulation, because not a single patient record is touched.

 

In an automated conversion, source values are extracted from both the legacy (source) system and new (target) system to create a conversion map. That map is entered into a conversion utility software. Data from the legacy system is run through the conversion utility and transformed to meet the needs of the new system. While it is being transformed, the conversion utility is monitoring for errors and estimated completion. After the data has met the standards, it is then loaded into the new system.

The process of an automated EHR data conversion may seem like a complicated and difficult undertaking. It doesn’t have to be when it is handled by an experienced vendor working with strong internal leadershipundergoing a recognized data conversion process.

5 Steps to EHR Data Conversion

1. Discovery

During the discovery phase of the process, the healthcare organization team will play a large role. An EHR vendor will ask internal IT staff to extract all data from the current system. Working together with an internal designated leader, IT staff, and Physicians Advisory Committee (PAC), the data conversion vendor will work to identify how much data is available, what data needs to be converted, and the accuracy of the legacy data.

2. Scope Definition

The scope definition phase of the process is the point at which both parties come to an agreement on which portions of the data need to be converted, the method of the conversion, and the prioritization of the data. During this time, the two teams should schedule time to review the records, format them to meet the new formatting requirements, and set the processes to updated record fields not available in the conversion.

3. Testing

Once the scope has been fully defined, and the formatting requirements are completely understood, the primary responsibility of the conversion then shifts to the vendor. Based on the input gathered during the scope definition step, the data architects working for the vendor will map the data fields and formatting from the old system to equivalent data fields and formatting in the new systems. After the map has been created, the data architects upload the test conversion data to a testing site.

4. Validation

This step is a shared responsibility between the healthcare organization and EHR data conversion vendor. Once the data has been loaded to the test site, the data architects validate the data. Then the healthcare organization leaders review the content, validate the records, and sign off on the final data set. This step may require several cycles. However, it is imperative for the success of the conversion.

5. Migration

Once the data has been validated, the vendor will executive the final migration. While the data is migrating, the vendor’s conversion utility should be monitoring total errors, parsing errors, mapping misses, percent complete, date/time to finish, and success rate. When all the data is converted and migrated to the new system, the healthcare organization will go live!

Throughout the EHR data conversion process, healthcare organizations are tasked with making important, and often tough, decisions about how to handle data, the methods of conversion, and data prioritization. It is important that healthcare organizations plan ahead, schedule the necessary time, and work closely with EHR data conversion vendors who are well versed in the each step of the process.

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What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration | EHR and Health IT Consulting | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

 

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

 

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS? Learn how Pivot Point can help with your value-based strategy.

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Tips for Fixing a Botched EHR Implementation

Tips for Fixing a Botched EHR Implementation | EHR and Health IT Consulting | Scoop.it

Organizations face many challenges when implementing electronic health records platforms (EHR), but fixing a botched implementation can be among the most stressful.  Problems with EHR implementation can reverberate throughout a healthcare organization and must be recognized and fixed as soon as possible.

The first step of a successful remedy is to create an action plan that prioritizes the fixes that will have the most immediate impact in helping operations return to optimal performance. Once those pressing problems are solved, it’s time to address all of the other issues. Here are a few useful tips to help guide you through that process.

Establish A Task Force

It’s wise to establish a task force to deal with each particular problem. The task force should include members whose specialties overlap with the problem area. For example, someone directly involved with the revenue side should be involved with resolving all revenue issues.

The task force should closely analyze the problem, and look for the breakdowns in the system. One might start by looking at whether staff members are able to input data. If so, check to see where it ends up. By taking a systematic approach, the task force will be able to get to the root of the problem more efficiently.

Carefully Calibrate Staffing

It’s quite common for healthcare organizations to wonder whether outside resources should be brought in to help rectify problematic EHR implementations. There are a couple of different approaches that work quite well.

[Related: How “The RightFit” Process Guarantees You’ll Get the Best Quality Consultants]

One option is to remove the appropriate internal staff from their normal day-to-day duties and have them focus exclusively on fixing the EHR platform issues (staff augmentation). Outside resources would then be brought in to handle the day-to-day responsibilities of those internal staff resources until the issues are resolved and they can resume their normal duties.

Another option is to bring in third-party consultants to solve the EHR application problems and allow the internal staff resources to continue concentrating on their normal day-to-day duties.

Which option is better depends on a variety of factors, including the size of the organization, the nature of the EHR problems, and the level of expertise the internal staff resources have in regards to the EHR platform.

Ensure Sufficient Resources and Track Progress

It’s important to engage key stakeholders throughout this process. The financial side of the organization must be included in the decision-making, so that adequate support can be provided to execute the fixes. To help build trust with the financial side, it’s imperative to establish metrics for success. This not only serves to prove the business case for the implementation fixes, but also ensures the project stays on track throughout the process.

Engage with End Users

In a situation in which the EHR solution is not performing as expected, perhaps the most vital tip is maintaining some degree of buy-in among the clinicians and staff who use the application on a daily basis. It’s essential to work closely with key stakeholders and influencers, like the chief medical officer, the nursing leadership, and even the financial department to ensure that everyone is on the same page. Have them propagate the message that the problems are being worked on and will soon be fixed.

After a botched implementation, IT staff might encounter a lot of resistance, but it’s important to break through this and emphasize what the long terms benefits of the EHR project will be once it is done correctly. By making these benefits clearer, it will become easier to keep everyone on board during a period of difficulty.

By following these EHR best practices, organizations will be able to more effectively overcome botched implementations, and will be better situated to have more success once they start on their EHR optimization projects.

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Digital Health Funding On The Rise

Digital Health Funding On The Rise | EHR and Health IT Consulting | Scoop.it

The digital health industry is continuing its growth in record-breaking ways, as funding to the industry pushed past $6.5 billion in the first half of 2017, according to a recent report by StartUp Health. This year’s numbers are already well on their way to overtaking the annual totals of previous years.

 

As the digital health industry has continued to mature, interest from new investors has likewise grown. This was noted in Rock Health’s comprehensive Digital Health Funding 2017 Midyear Review, a report that analyzed US deals disclosed at over $2 million during Q1 and Q2.

 

Pull factors, such as (but certainly not limited to) Apple’s not-so-secret work on diabetes health tech, have contributed to investors seeing the industry as a more attractive, tangible marketplace. More investors are interested in the industry, and more importantly, they’re investing much more on average: seven out of the top ten deals this year so far have involved over $100 million each. Outcome Health, the company that set the largest digital health deal on record, came out with $500 million in funding earlier this year.

 

The widely accepted reality is that the health industry is taking an inevitable shift towards digital health aids. And as digital health technology advances, their use becomes more widespread, with hundreds of millions of potential users in some cases. Belief in this potential can be seen in this year’s top deals in digital health. As the health industry continues its transition towards digital health aids, and as digital health companies continue to develop pertinent, breakthrough technology, the industry is poised to continue its growth undeterred.

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How to Get More Loyal Patients

How to Get More Loyal Patients | EHR and Health IT Consulting | Scoop.it

The success of your practice is dependent on your patients. The more loyal patients you have, the better your practice’s growth. But good treatment alone is not sufficient. For loyalty, you need to build an emotional connection with your patients that makes them feel valued and cared about.

Establishing an emotional connection helps patients remain stress-free, adhere to your advice and talk about their health issues honestly. Let’s see the possible ways to create a connection with your patients when they visit your practice and after they leave.

During visit to practice

Stay calm: Off course, you have a very limited time of 15 minutes for face-to-face interaction with your patient. Being in a rush and showing impatience would look awful. Instead, you should stay calm and make your patient feel relaxed with a warm handshake or a pat on the shoulder.

Be empathic: You need to offer an empathic response, especially when discussing life-threatening diagnoses. Likely the response of patients get better and descriptive. You and your team need to develop empathy skills. Also, make conversation with patients; don’t conduct an interrogation. Along with health issues, discuss different subjects such as pets, celebrations, etc. that makes them feel comfortable and more like they’re talking to a friend. Be an active listener. It gives your patient silent support. Instead of looking at your watch or a laptop screen, nod in agreement to what your patient says. For emotional connection, it is necessary to listen to your patients, express empathy and offer personal warmth.

Follow-up plans

To ensure loyalty, you need to make efforts to stay in touch with your patients after their visit to your practice. This makes them feel cared for.

Emailer: Email is one of the best marketing mediums to interact with your patients. Connect by sharing health-related newsletters that focus on patient ailments or general health issues. Don’t send out the same mailer to everyone; rather, use segmentation. Craft each mailer to focus on a set of people based on age, gender, geography or ailment. Also, keep your newsletter crisp and concise instead of publishing long stories.

To get more leads, put a call to action (CTA) button at the top. Another major characteristic of a successful mailer is a catchy subject line. Set regular intervals for email campaigns. Too many mailers can get you dumped in the spammer list, but too few mailers can make you lose potential patients.

Social media: Another way to connect with your existing patients and potential ones is via social media platforms. So you need to stay active on your social media accounts. Follow a trend in your posts such as daily posts, weekly posts, etc. Showcase your thought leader personality by sharing your blog posts or webinars. You can send appointment reminders or general health tips via social media channels such as Facebook, Twitter, etc.

Website: Your website should have a patient portal where they can post their question, check their appointment schedule, view their test reports and much more. This is a kind of communication initiator that helps you connect better with your patients.

Seminars: Last but not least, participate in local healthcare campaigns and seminars to get involve with people living around you. Participate in school and college health camps. These places help you to interact with more people and showcase your skills and knowledge to your potential patients.

A connection is necessary for building any relationship. The better connections you have with your patients, the stronger your relationships will be. Subsequently, they will do word-of-mouth marketing for you, thereby building your practice.

Technical Dr. Inc.'s insight:
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