Standards within an electronic health record (EHR) are the necessary building blocks to interoperability. Interoperability is necessary for one system to communicate with another which is one of the main goals of having an EHR. As it stands, most EHR vendors recognize the importance of interoperability and will have to build in and maintain or update these standards as they change to remain competitive. Make sure your EHR vendor has a plan, because as you can see from this excerpt, things will be changing...
WASHINGTON – The federal advisory panel on health IT standards has approved refined recommendations on how providers may electronically record a physician's observations to qualify for federal recovery bonuses.
The HIT Standards Committee endorsed recommendations to call for SNOMED CT for physician's clinical observations by 2015. In 2010, providers must use ICD-9 or SNOMED CT to qualify, and in 2013 they must use ICD-10 or SNOMED CT.
http://www.healthcareitnews.com/news/snomed-ct-will-be-required-2015-bonuses-under-economic-recovery-law
Tuesday, August 25, 2009
HIPAA Security Rule Standards
If you are looking for the details related to the HIPAA security rules as it relates to technology, administration, and daily operations, this is a great document. It outlines the rules for the various items in each category, providing specific details regarding the HIPAA rules and how to implement these safeguards.
HIPAA Security Rules Standards
HIPAA Security Rules Standards
Wednesday, August 19, 2009
The Importance of a Successful EMR Implementation
I recently read that more than half of medical information systems fail due to user and staff resistance despite the fact that the technology is sound. This statistic is presented in the book Evaluating the Organizational Impact of Healthcare Information Systems by James G. Anderson and Carolyn E. Aydin. That’s a 50-50 gamble that the significant investment in the system you choose for your medical practice may go belly-up when you try to implement it! If you had the option to purchase “implementation insurance,” wouldn’t you do it? Well, consider this advice a step towards purchase of that insurance plan:
“When selecting an EHR, organizations need to thoroughly investigate the product to insure it can adapt to the changing needs of the services they provide. The clinicians and information management staff should have a clear understanding of all the workflow processes that happen within the organization and spend the time analyzing the system to guarantee the appropriate interaction for all the players involved. Spending greater time investing on enterprise process modeling, coupled with HL7 version 3 and XML provides the necessary flexibility for incorporating a variation of healthcare services.”
http://repositories.cdlib.org/cgi/viewcontent.cgi?article=1008&context=ischool
It is extremely important that physicians understand what they are investing in when choosing an EMR. Often, software vendors will overpromise and under-deliver, and physicians need to be aware of the level of support EMR vendors provide so they can fill in the gaps where necessary. Often, the gaps appear in the EMR implementation phase of the project, and can sabotage the success of the EMR software, resulting in one of those EMR implementation horror stories we have all heard about.
When implementing an EMR in your practice, it is important to remember that several things must be accomplished in order for the EMR to be successful:
Having a plan. The practice needs to create a project plan and track the progess of each component to ensure everything is on track. There are many factors that can affect the outcome of an EMR implementation and planning is one of the most effective ways to stay focused and ensure success. Here is an example of an EMR Implementation Outline.
High Acceptance Rate among doctors & staff. If everyone isn’t on board, the transition will be tough. A persistent resister can coerce others into joining their side, causing tension in the office. This can escalate to complete office disruption as staff resists and refuses to use the electronic medical record system.
Effective Training Sessions. If the doctors and staff do not retain the information presented during the training, there will be issues using the EMR in their every day routine. The EMR vendor should provide adequate training and support to help ensure your staff will be successful in using their software.
Expectations & Follow Up. The doctors and staff all must understand their job responsibilities related to the EMR, which will take time for everyone to get into their own routine. To ensure everyone is using the software properly and most effectively, follow up on their progress using the EMR and integrating it into their daily routine should be done regularly.
“When selecting an EHR, organizations need to thoroughly investigate the product to insure it can adapt to the changing needs of the services they provide. The clinicians and information management staff should have a clear understanding of all the workflow processes that happen within the organization and spend the time analyzing the system to guarantee the appropriate interaction for all the players involved. Spending greater time investing on enterprise process modeling, coupled with HL7 version 3 and XML provides the necessary flexibility for incorporating a variation of healthcare services.”
http://repositories.cdlib.org/cgi/viewcontent.cgi?article=1008&context=ischool
It is extremely important that physicians understand what they are investing in when choosing an EMR. Often, software vendors will overpromise and under-deliver, and physicians need to be aware of the level of support EMR vendors provide so they can fill in the gaps where necessary. Often, the gaps appear in the EMR implementation phase of the project, and can sabotage the success of the EMR software, resulting in one of those EMR implementation horror stories we have all heard about.
When implementing an EMR in your practice, it is important to remember that several things must be accomplished in order for the EMR to be successful:
Having a plan. The practice needs to create a project plan and track the progess of each component to ensure everything is on track. There are many factors that can affect the outcome of an EMR implementation and planning is one of the most effective ways to stay focused and ensure success. Here is an example of an EMR Implementation Outline.
High Acceptance Rate among doctors & staff. If everyone isn’t on board, the transition will be tough. A persistent resister can coerce others into joining their side, causing tension in the office. This can escalate to complete office disruption as staff resists and refuses to use the electronic medical record system.
Effective Training Sessions. If the doctors and staff do not retain the information presented during the training, there will be issues using the EMR in their every day routine. The EMR vendor should provide adequate training and support to help ensure your staff will be successful in using their software.
Expectations & Follow Up. The doctors and staff all must understand their job responsibilities related to the EMR, which will take time for everyone to get into their own routine. To ensure everyone is using the software properly and most effectively, follow up on their progress using the EMR and integrating it into their daily routine should be done regularly.
Overcoming Obstacles when Transitioning to EMR
Physicians opening a new practice are readily purchasing EMRs and wouldn’t have it any other way. Physicians who adopt EMRs say they would never go back. Then why are the vast majority of physicians stuck on paper systems…?
Here are some top reasons for why existing practices are holding back and what can be done about it.
Change
I would not lie to you and say that it will be easy. It can take from 6 months to a year to fully transition, and in the meantime, you are operating 2 parallel systems. In a busy clinical environment, this can spell disaster. Besides that, how many have wanted to exclaim, “Dammit Jim, I’m a doctor, not a computer nerd!” To me the argument regarding change is probably the most valid one. People do not like change. We are creatures of habit and we like routine because it is comfortable even if things could be done in a more efficient way. I guess the only thing to say is you can do it willingly or not, but sooner or later we all must venture out of our comfort zone. Healthcare has been the “final frontier” (forgive the StarTerk reference again) in the collaboration with IT. It is high time our industry has embraced the idea and began reaping the benefits. Let’s just take it one step at a time. Get a good project management plan and reevaluate goals often. Never underestimate the value of a good consultant. Going it alone can be a borderline brave/foolish thing to do. Once the preparation and purchase is done, become comfortable with your EMR software and slowly start integrating. Documenting in your EMR will start becoming second nature. EMRs have come a long way and good ones are set up to mimic the common sense clinical flow. The key is not to be in an environment of duplicate check in/out, billing, and documentation processes for too long. It is truly a balancing act.
Cost
Well, now with the HITECH Act, the government is trying to incentivize adoption. They are playing nice now, offering the possibility of earning $44,000 under the Medicare plan and $64,000 under the Medicaid plan over 5 years to providers who use qualifying health IT but come 2015 and things will get ugly and penalties will take the place of incentives. The sooner you get on board, the better your incentive will be. This incentive will practically pay for the cost of a correctly implemented system. To me the message is loud and clear: Like it or not, Healthcare IT is a reality. Don’t be stubborn because it will only hurt your pocket more in the long run.
Fear of loss of data
Here’s the scenario…you’re treating patients and then all of a sudden POOF! The internet goes down or the power goes out. Let me begin by saying that the likelihood of that happening once in a year might be correct, and when it does, we have this plan:
battery back ups – in the event of power failure, you will have a back up power supply that will immediately support your office for a couple of hours. Use the time wisely.
Data duplication and back ups – if you are running your software out of a hosted environment, you likely will have the patients on your schedule “checked out” to your system. This means that their record is duplicated on your workstation. You can continue to view history and document notes. When your connection is restored, voila! It’s like it never went away.
Server back ups – your software vendor’s server just exploded. (I got dramatic, but you get my drift…) That server is duplicating real time data on another server located in another part of the country and that one duplicates its data in another part of the country. My point is, you typically have back ups of back ups and the data is safe and sound unless the unthinkable happens.
If you house your information on your own server, be sure to do the same thing! Duplicate your data more than once onsite and take the copy with you offsite when you close your doors.
Security breaches
In several discussions with colleagues, it is inevitably brought up that paper records are in just as much jeopardy of security breach as electronic records. There are steps to ensure that you are doing all you can to protect PHI, such as the use of antivirus software to protect your data from viruses, firewalls to protect from intrusions, etc. Allow only certain people access to certain pieces of the record that they need to do their job by using appropriate permissions. At the end of the day, no system paper or electronic is 100% theft-proof.
Don’t let these barriers prevent you from pursuing an EMR for your practice. Knowledge is power, in this case, empowering you with the knowledge needed to effectively handle the obstacles you could face when transitioning to electronic medical records.
Here are some top reasons for why existing practices are holding back and what can be done about it.
Change
I would not lie to you and say that it will be easy. It can take from 6 months to a year to fully transition, and in the meantime, you are operating 2 parallel systems. In a busy clinical environment, this can spell disaster. Besides that, how many have wanted to exclaim, “Dammit Jim, I’m a doctor, not a computer nerd!” To me the argument regarding change is probably the most valid one. People do not like change. We are creatures of habit and we like routine because it is comfortable even if things could be done in a more efficient way. I guess the only thing to say is you can do it willingly or not, but sooner or later we all must venture out of our comfort zone. Healthcare has been the “final frontier” (forgive the StarTerk reference again) in the collaboration with IT. It is high time our industry has embraced the idea and began reaping the benefits. Let’s just take it one step at a time. Get a good project management plan and reevaluate goals often. Never underestimate the value of a good consultant. Going it alone can be a borderline brave/foolish thing to do. Once the preparation and purchase is done, become comfortable with your EMR software and slowly start integrating. Documenting in your EMR will start becoming second nature. EMRs have come a long way and good ones are set up to mimic the common sense clinical flow. The key is not to be in an environment of duplicate check in/out, billing, and documentation processes for too long. It is truly a balancing act.
Cost
Well, now with the HITECH Act, the government is trying to incentivize adoption. They are playing nice now, offering the possibility of earning $44,000 under the Medicare plan and $64,000 under the Medicaid plan over 5 years to providers who use qualifying health IT but come 2015 and things will get ugly and penalties will take the place of incentives. The sooner you get on board, the better your incentive will be. This incentive will practically pay for the cost of a correctly implemented system. To me the message is loud and clear: Like it or not, Healthcare IT is a reality. Don’t be stubborn because it will only hurt your pocket more in the long run.
Fear of loss of data
Here’s the scenario…you’re treating patients and then all of a sudden POOF! The internet goes down or the power goes out. Let me begin by saying that the likelihood of that happening once in a year might be correct, and when it does, we have this plan:
battery back ups – in the event of power failure, you will have a back up power supply that will immediately support your office for a couple of hours. Use the time wisely.
Data duplication and back ups – if you are running your software out of a hosted environment, you likely will have the patients on your schedule “checked out” to your system. This means that their record is duplicated on your workstation. You can continue to view history and document notes. When your connection is restored, voila! It’s like it never went away.
Server back ups – your software vendor’s server just exploded. (I got dramatic, but you get my drift…) That server is duplicating real time data on another server located in another part of the country and that one duplicates its data in another part of the country. My point is, you typically have back ups of back ups and the data is safe and sound unless the unthinkable happens.
If you house your information on your own server, be sure to do the same thing! Duplicate your data more than once onsite and take the copy with you offsite when you close your doors.
Security breaches
In several discussions with colleagues, it is inevitably brought up that paper records are in just as much jeopardy of security breach as electronic records. There are steps to ensure that you are doing all you can to protect PHI, such as the use of antivirus software to protect your data from viruses, firewalls to protect from intrusions, etc. Allow only certain people access to certain pieces of the record that they need to do their job by using appropriate permissions. At the end of the day, no system paper or electronic is 100% theft-proof.
Don’t let these barriers prevent you from pursuing an EMR for your practice. Knowledge is power, in this case, empowering you with the knowledge needed to effectively handle the obstacles you could face when transitioning to electronic medical records.
Using Wireless Devices in Healthcare Delivery
Wireless devices have been shown to substantially improve operational performance, clinical workflow and productivity, and quality of care by the promise of real-time point-of-care documentation. This is becoming increasingly important in the increasing adoption of EMR software.
Clinical Documentation at the point-of-care:
Will improve accuracy of entering patient data in conjunction with rules-based, menu-driven EMRs, which will increase patient safety and satisfaction and will eliminate redundant data entry. An exceptionally efficient feature is handwriting recognition capability when free script is necessary to document the plan of care.
Will promote fast access to electronic medical records and reference materials on the go.
Will promote more efficient EMR documentation and higher quality of care by increasing the mobility and productivity of the clinician. This is possible because of no wait times for use of or logins on stationary computers, and there will be a reduced need to clarify information prior to fulfillment of doctor’s orders (tests, prescriptions, etc.)
Will promote security by having one device per user.
Will allow for clinical decision support by quick access to “up-to-the-minute” clinical resources such as drug-drug and drug-allergy contraindications.
Will promote enforcement of the “5 rights”: right drug, recipient, dosage, route, time – which reduces risks to the patient and liability issues.
Increase control and compliance via authentication and electronic time stamps.
To support these statements, I have accessed numerous case studies in support of wireless devices in use for EMR software. A brief excerpt of one of the more powerful studies is summarized here:
Studies have indicated that pharmacist input during the rounding process can decrease the rate of preventable harmful medication errors up to 78% by their consultation in dosing related changes and additional drug therapy recommendations. Their input has also contributed to reducing cost and decreasing length of stay (Kaushal et al., 2001; Kucukarslan et. al, 2003; Leape et. al, 1999; Terceros, Chahine-Chakhtoura, Malinowski, & Rickley, 2007).
Full report available: http://www.motioncomputing.com/about/news/case_study_C5_children_omaha.pdf
Clinical Documentation at the point-of-care:
Will improve accuracy of entering patient data in conjunction with rules-based, menu-driven EMRs, which will increase patient safety and satisfaction and will eliminate redundant data entry. An exceptionally efficient feature is handwriting recognition capability when free script is necessary to document the plan of care.
Will promote fast access to electronic medical records and reference materials on the go.
Will promote more efficient EMR documentation and higher quality of care by increasing the mobility and productivity of the clinician. This is possible because of no wait times for use of or logins on stationary computers, and there will be a reduced need to clarify information prior to fulfillment of doctor’s orders (tests, prescriptions, etc.)
Will promote security by having one device per user.
Will allow for clinical decision support by quick access to “up-to-the-minute” clinical resources such as drug-drug and drug-allergy contraindications.
Will promote enforcement of the “5 rights”: right drug, recipient, dosage, route, time – which reduces risks to the patient and liability issues.
Increase control and compliance via authentication and electronic time stamps.
To support these statements, I have accessed numerous case studies in support of wireless devices in use for EMR software. A brief excerpt of one of the more powerful studies is summarized here:
Studies have indicated that pharmacist input during the rounding process can decrease the rate of preventable harmful medication errors up to 78% by their consultation in dosing related changes and additional drug therapy recommendations. Their input has also contributed to reducing cost and decreasing length of stay (Kaushal et al., 2001; Kucukarslan et. al, 2003; Leape et. al, 1999; Terceros, Chahine-Chakhtoura, Malinowski, & Rickley, 2007).
Full report available: http://www.motioncomputing.com/about/news/case_study_C5_children_omaha.pdf
Addressing Fears of Malpractice Using CPOE System
Given the state of the current malpractice system as briefly described in the article http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.534/DC1 , there is a legitimate fear of being sued for a medical error that was not entirely the fault of one physician. The largest cause of errors tends to fall on the fact that there is a highly fragmented system of care being delivered to patients by several providers without the ability to effectively communicate between one another. CPOE systems can help bridge the communication gaps that occur and help ensure the safety of the patient by eliminating harmful or fatal consequences due to lack of direct communication.
As an example, “Errors of medication use are among the most common types of medical errors and include mistakes of prescribing, dispensing, administering, or monitoring medications.” http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=aps.section.2364
If using a CPOE system, these mistakes can be eliminated by the functions that the system provides. “CPOE uses clinical decision support systems and links to hospital systems to generate prompts and alerts during the ordering session to notify of potential errors such as contra-indicated medications or routes or duplicate orders.” http://muskie.usm.maine.edu/Publications/ihp/CPOE.pdf
In summary, the potential for the most common medical errors can be significantly decreased by the use of a CPOE system.
As an example, “Errors of medication use are among the most common types of medical errors and include mistakes of prescribing, dispensing, administering, or monitoring medications.” http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=aps.section.2364
If using a CPOE system, these mistakes can be eliminated by the functions that the system provides. “CPOE uses clinical decision support systems and links to hospital systems to generate prompts and alerts during the ordering session to notify of potential errors such as contra-indicated medications or routes or duplicate orders.” http://muskie.usm.maine.edu/Publications/ihp/CPOE.pdf
In summary, the potential for the most common medical errors can be significantly decreased by the use of a CPOE system.
Increasing Administrative Efficiency with an EHR
Typically, the administrative role in a health care facility involves billing, transcription, filing and various tasks relating to managing the whereabouts of a patient’s chart. The EHR significantly reduces the time and resources needed to carry out these tasks. The following examples are of ways the EHR accomplishes this, paired with excerpts of case studies supporting the claim.
The EHR eliminates the need for a chart to be pulled and refilled, which saves administrative personnel time. “The average number of chart pulls per day went from 60 in 1995 to zero…three filing clerks were reassigned to other tasks.” 1 The EHR also saves time on searching for lost charts. “We have no more lost charts, and my…physicians are more productive than ever,” said Adams. 2
The EHR enables simultaneous access to various parts of a patient’s record, such as a physician documenting a visit while the office posts a co-payment to the account. Also, through a check-in and check-out process, various clinicians can document within a record. The result is a savings of time with chart “hand offs” to do these types of tasks. “Patient charts…are easily accessible at all times.” 3
Physical storage space and time to archive and retrieve a requested chart is eliminated. “Storage of charts is also no longer an issue.” 4 Transcription is another eliminated burden since the record is automatically populated as the physician keys in information, chooses from a drop down menu, or uses voice recognition features. “After installation of the EHR…my transcriptions costs decreased to zero.” 5
The billing of claims is a more efficient process with an EHR in that procedures are automatically coded properly as well as error checked (“scrubbed”) into interfaced billing systems. “I am charting at the point of care, so I miss nothing and because of that we are billing more accurately…the clinic’s average billing rate has increased more than 30 percent. In addition, Dr. Amos’ clinic has become more efficient. He had previously paid third-party billing companies for years. Now his office manager uses the system to bill electronically, allowing him to reduce his business expenses and add revenue. 6 Claims are also automatically generated and electronically sent in a simple batching process. “Billing code posting has been eliminated.” 7
In conclusion, several tasks can be radically simplified when employing the use of an EHR, specifically in the administrative realm of the healthcare industry. With the main savings of personnel time in the redundancy of duties as well as resources to carry out these duties, it is easy to see how the EHR can claim to be such an efficient tool in health care.
Works Cited:
1 http://www.sunshine-healthcare.org/content/files/davies_2003_primarycare_cooper.pdf
2 http://www.pcc.com/practmgmt/business/CPAcasestudy.lowres.pdf
3, 4 http://www.cchit.org/files/csLanierSurgical.pdf
5, 7 http://www.sunshine-healthcare.org/content/files/davies_2003_primarycare_cooper.pdf
6 http://www.cchit.org/files/csAmos.pdf
The EHR eliminates the need for a chart to be pulled and refilled, which saves administrative personnel time. “The average number of chart pulls per day went from 60 in 1995 to zero…three filing clerks were reassigned to other tasks.” 1 The EHR also saves time on searching for lost charts. “We have no more lost charts, and my…physicians are more productive than ever,” said Adams. 2
The EHR enables simultaneous access to various parts of a patient’s record, such as a physician documenting a visit while the office posts a co-payment to the account. Also, through a check-in and check-out process, various clinicians can document within a record. The result is a savings of time with chart “hand offs” to do these types of tasks. “Patient charts…are easily accessible at all times.” 3
Physical storage space and time to archive and retrieve a requested chart is eliminated. “Storage of charts is also no longer an issue.” 4 Transcription is another eliminated burden since the record is automatically populated as the physician keys in information, chooses from a drop down menu, or uses voice recognition features. “After installation of the EHR…my transcriptions costs decreased to zero.” 5
The billing of claims is a more efficient process with an EHR in that procedures are automatically coded properly as well as error checked (“scrubbed”) into interfaced billing systems. “I am charting at the point of care, so I miss nothing and because of that we are billing more accurately…the clinic’s average billing rate has increased more than 30 percent. In addition, Dr. Amos’ clinic has become more efficient. He had previously paid third-party billing companies for years. Now his office manager uses the system to bill electronically, allowing him to reduce his business expenses and add revenue. 6 Claims are also automatically generated and electronically sent in a simple batching process. “Billing code posting has been eliminated.” 7
In conclusion, several tasks can be radically simplified when employing the use of an EHR, specifically in the administrative realm of the healthcare industry. With the main savings of personnel time in the redundancy of duties as well as resources to carry out these duties, it is easy to see how the EHR can claim to be such an efficient tool in health care.
Works Cited:
1 http://www.sunshine-healthcare.org/content/files/davies_2003_primarycare_cooper.pdf
2 http://www.pcc.com/practmgmt/business/CPAcasestudy.lowres.pdf
3, 4 http://www.cchit.org/files/csLanierSurgical.pdf
5, 7 http://www.sunshine-healthcare.org/content/files/davies_2003_primarycare_cooper.pdf
6 http://www.cchit.org/files/csAmos.pdf
Pro-Adoption of ICD-10 CM
Continued use of the ICD-9 CM presents downfalls to the medical coding system in the United States. Since the development of the ICD-10, “endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994” http://www.who.int/classifications/icd/en/ , the US has continued use of the 30 year old ICD-9-CM system. This system is described as no longer able to “accurately describe today's practice of medicine,” and continued use of the system, “jeopardizes the ability to effectively collect and use accurate, detailed healthcare data and information for the betterment of domestic and global healthcare.” http://findarticles.com/p/articles/mi_m0DUD/is_/ai_n14736317
Even though the ICD-9-CM is updated on a yearly basis, there are “numerous conditions and procedures (that) are outdated and inconsistent with current medical knowledge and application. ICD-9-CM also cannot address the increasing pressure for more specific codes, especially codes that represent new technology. Outdated codes provide inaccurate or limited data and insufficient detail related to health diagnoses, procedures and technologies.” http://findarticles.com/p/articles/mi_m0DUD/is_/ai_n14736317
Getting on a fast track to adopt the ICD-10-CM and ICD-10-PSC is currently hindered mostly by perceived cost. “However, delaying its implementation will actually increase future implementation costs as implementing a new coding system will require systems and application upgrades. This can be avoided if implementation is planned with other system changes to maximize impact and reduce complexity.” Combating the opposition can be facilitated by also considering, “reduced healthcare costs will result in a more specific coding system is employed, facilitating prevention and identification of fraud and abuse or the specificity needed to conduct good quality improvement and error reduction programs. The exchange of additional data beyond the basic claim, and the time it takes to gather and process such detail, will significantly be reduced due to the more specific detail contained in the ICD-10-CM and ICD-10-PCS codes.”
http://findarticles.com/p/articles/mi_m0DUD/is_/ai_n14736317
Even though the ICD-9-CM is updated on a yearly basis, there are “numerous conditions and procedures (that) are outdated and inconsistent with current medical knowledge and application. ICD-9-CM also cannot address the increasing pressure for more specific codes, especially codes that represent new technology. Outdated codes provide inaccurate or limited data and insufficient detail related to health diagnoses, procedures and technologies.” http://findarticles.com/p/articles/mi_m0DUD/is_/ai_n14736317
Getting on a fast track to adopt the ICD-10-CM and ICD-10-PSC is currently hindered mostly by perceived cost. “However, delaying its implementation will actually increase future implementation costs as implementing a new coding system will require systems and application upgrades. This can be avoided if implementation is planned with other system changes to maximize impact and reduce complexity.” Combating the opposition can be facilitated by also considering, “reduced healthcare costs will result in a more specific coding system is employed, facilitating prevention and identification of fraud and abuse or the specificity needed to conduct good quality improvement and error reduction programs. The exchange of additional data beyond the basic claim, and the time it takes to gather and process such detail, will significantly be reduced due to the more specific detail contained in the ICD-10-CM and ICD-10-PCS codes.”
http://findarticles.com/p/articles/mi_m0DUD/is_/ai_n14736317
EHR vs. PHR
With all the acronyms surfacing in the IT world, it is no suprise people use the terms EHR and PHR interchangeably. However, each has a distinct definition, as well as some overlap.
The EHR, being originated and maintained by a provider, will encompass pieces of information relevant to the condition for which his or her profession dictates. It will also encompass any and all treatment rendered to the patient in that provider’s office, as well as any relevant medical history, labs, and imaging. The EHR is populated at the point of service. The EHR can pull relative information from the PHR, and the EHR can provide general encounter information back to the PHR.
The PHR encompasses much more data from various providers but to a lesser extent of detail. A general synopsis of each medical encounter would be noted. The PHR should also contain all family medical history pertinent to the individual, personal medical history beginning with the earliest recordable information (ie: immunizations, allergies, all drugs prescribed and/or being taken in the past and present, illnesses and hospitalizations, surgeries, etc.) The PHR should be able to provide information to a physician relevant to the reason for which the patient is being seen. The PHR can be updated with the general encounter information from the EHR after the visit.
The EHR, being originated and maintained by a provider, will encompass pieces of information relevant to the condition for which his or her profession dictates. It will also encompass any and all treatment rendered to the patient in that provider’s office, as well as any relevant medical history, labs, and imaging. The EHR is populated at the point of service. The EHR can pull relative information from the PHR, and the EHR can provide general encounter information back to the PHR.
The PHR encompasses much more data from various providers but to a lesser extent of detail. A general synopsis of each medical encounter would be noted. The PHR should also contain all family medical history pertinent to the individual, personal medical history beginning with the earliest recordable information (ie: immunizations, allergies, all drugs prescribed and/or being taken in the past and present, illnesses and hospitalizations, surgeries, etc.) The PHR should be able to provide information to a physician relevant to the reason for which the patient is being seen. The PHR can be updated with the general encounter information from the EHR after the visit.
DEA Imposed Barrier to e-Prescribing
E-prescribing software has been free to physicians for some time now, yet many are hesitant to take that step. One reason for this is that the DEA prohibits e-prescribing controlled substances such as pain killers and antidepressants. Because of not allowing the ability to fully use an electronic prescribing system, physicians would have to use a paper prescription pad in addition to their e-Rx system for certain drugs. Simultaneously operating two systems for prescriptions is not only unwise, but terribly inefficient. One of the main reasons to adopt an e-Rx system is to increase patient safety.
According to an article in the Wall Street Journal, “E-prescribing can catch many dangerous mistakes, studies show. The software automatically checks a patient's drug history for potential hazards such as improper dosages, medication allergies and adverse interactions with other drugs the patient is taking. More than four billion prescriptions are written in the U.S. annually, and studies show that as many as 4% contain an error with serious patient risks.” http://online.wsj.com/article/SB123249533946000191.html
Since one of the functions of the software is to check drug-drug interactions, if one drug is entered in a system and another is not, haven’t we just taken that safety opportunity away? To learn more about e-prescribing, visit http://learnabouteprescriptions.com/
If this issue becomes resolved in a timely manner, can we expect to see more physicians jumping into the world of e-prescribing?
According to an article in the Wall Street Journal, “E-prescribing can catch many dangerous mistakes, studies show. The software automatically checks a patient's drug history for potential hazards such as improper dosages, medication allergies and adverse interactions with other drugs the patient is taking. More than four billion prescriptions are written in the U.S. annually, and studies show that as many as 4% contain an error with serious patient risks.” http://online.wsj.com/article/SB123249533946000191.html
Since one of the functions of the software is to check drug-drug interactions, if one drug is entered in a system and another is not, haven’t we just taken that safety opportunity away? To learn more about e-prescribing, visit http://learnabouteprescriptions.com/
If this issue becomes resolved in a timely manner, can we expect to see more physicians jumping into the world of e-prescribing?
Friday, August 14, 2009
As EHR Adoption Increases, so does Fears of Medical Identify Theft
There is more talk of medical identity theft and its direct correlation to increases in EHR adoption. While this is an exremely important and necessary topic to discuss, I have found that all parties involved, from vendor to physician, understand this threat and the need to protect medical data. According to the article Medical Identity Theft Concerns Grow as EHR Adoption Increases, "A 2007 federal report on crime -- the most recent year for which data are available -- found that more than 250,000 U.S. residents annually are victims of medical identity theft, the New York Times reports." The article goes on to explain that due to the increase in EHR adoption, the number of medical identity theft cases are also increasing.
I've seen countless analogies comparing the banking industry 15 years ago (when they first started converting to a computerized system) and the healthcare industry today, and here is another one. If the banking industry can figure out how to keep our financial information secure and, for the most part, safe from identity theft while creating and maintaining all financial data electronically, then the healthcare industry can do the same.
I've seen countless analogies comparing the banking industry 15 years ago (when they first started converting to a computerized system) and the healthcare industry today, and here is another one. If the banking industry can figure out how to keep our financial information secure and, for the most part, safe from identity theft while creating and maintaining all financial data electronically, then the healthcare industry can do the same.
Monday, August 10, 2009
Convincing Doctors to Manage Health Records Electronically
The Wall Street Journal published an edited transcript of the interview with National Coordinator for Health Information Technology Dr. David Blumenthal about how he plans to convince hospitals and doctors to use EHRs.
When asked about the potential cost savings, Dr. Blumenthal said "There are disputes about how much we'll save and how we'll show the benefits of health IT. The combination of an improved payment system, an improved education system about health IT and improved governance of the health care system that prioritizes quality and efficiency together with health information technology is where the real payoff is."
Why can't the government provide hard data on cost savings for physicians? Sure, there are a lot of factors involved, but surely they could do a study and have a range showing cost savings based on certain criteria. Doctors want to see hard facts and statistics, not generalized statements.
When asked about the potential cost savings, Dr. Blumenthal said "There are disputes about how much we'll save and how we'll show the benefits of health IT. The combination of an improved payment system, an improved education system about health IT and improved governance of the health care system that prioritizes quality and efficiency together with health information technology is where the real payoff is."
Why can't the government provide hard data on cost savings for physicians? Sure, there are a lot of factors involved, but surely they could do a study and have a range showing cost savings based on certain criteria. Doctors want to see hard facts and statistics, not generalized statements.
Thursday, August 6, 2009
DEA Imposed Barrier to e-Prescribing
E-prescribing software has been free to physicians for some time now, yet many are hesitant to take that step. One reason for this is that the DEA prohibits e-prescribing controlled substances such as pain killers and antidepressants. Because of not allowing the ability to fully use an electronic prescribing system, physicians would have to use a paper prescription pad in addition to their e-Rx system for certain drugs. Simultaneously operating two systems for prescriptions is not only unwise, but terribly inefficient. One of the main reasons to adopt an e-Rx system is to increase patient safety.
According to an article in the Wall Street Journal, “E-prescribing can catch many dangerous mistakes, studies show. The software automatically checks a patient's drug history for potential hazards such as improper dosages, medication allergies and adverse interactions with other drugs the patient is taking. More than four billion prescriptions are written in the U.S. annually, and studies show that as many as 4% contain an error with serious patient risks.” http://online.wsj.com/article/SB123249533946000191.html
Since one of the functions of the software is to check drug-drug interactions, if one drug is entered in a system and another is not, haven’t we just taken that safety opportunity away? To learn more about e-prescribing, visit http://learnabouteprescriptions.com/
If this issue becomes resolved in a timely manner, can we expect to see more physicians jumping into the world of e-prescribing?
According to an article in the Wall Street Journal, “E-prescribing can catch many dangerous mistakes, studies show. The software automatically checks a patient's drug history for potential hazards such as improper dosages, medication allergies and adverse interactions with other drugs the patient is taking. More than four billion prescriptions are written in the U.S. annually, and studies show that as many as 4% contain an error with serious patient risks.” http://online.wsj.com/article/SB123249533946000191.html
Since one of the functions of the software is to check drug-drug interactions, if one drug is entered in a system and another is not, haven’t we just taken that safety opportunity away? To learn more about e-prescribing, visit http://learnabouteprescriptions.com/
If this issue becomes resolved in a timely manner, can we expect to see more physicians jumping into the world of e-prescribing?
Wednesday, August 5, 2009
President Acknowledges EHR Successes
In the Healthcare IT News article “Obama: IT is still a critical part of healthcare reform”, it talks about a letter sent to Sens. Edward M. Kennedy (D-Mass.) and Max Baucus (D-Mont.), in which President Barack Obama stated "We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country."
Finally, there is some talk about EHRs working successfully with documented benefits! With all the negativity surrounding EHRs, it is so great to see the President identify and applaud the achievements medical offices have experienced with the assistance of an EHR.
Finally, there is some talk about EHRs working successfully with documented benefits! With all the negativity surrounding EHRs, it is so great to see the President identify and applaud the achievements medical offices have experienced with the assistance of an EHR.
Monday, August 3, 2009
Healthcare Providers Support EHR Adoption, but are Cautious due to Costs
How many times have you discussed or read something related to the question, is HIT worth the investment? I don’t know how many times this has to come up, but it seems to be a trend that will most likely continue until a well respected organization conducts a survey and produces statistical data showing how EHRs decrease costs and increase revenue. There are success stories out there, but they don’t seem to make the headlines.
In this article, the providers of IVANS are surveyed about the ARRA, the use of IT, and healthcare reform. The article states that 66 percent of those surveyed said EHRs will have a positive impact on their business yet only 39 percent said they plan to implement it within the next 12 months.
That is a very powerful statistic. Even though the majority believes that transitioning to an EHR will benefit their business, 27% will not pursue it as a business strategy. Now, I have encountered people resistant to change in my career, but this is staggering! Doctors need to look at EHR implementations from a different perspective. Is it a huge upfront cost? Yes. Is productivity going to suffer? Initially, yes. Are there ongoing maintenance costs? Yes. However, all of these yes’s are countered by benefits. Let’s face it, IT is expensive, but it is an investment. Once the upfront costs are paid, you will see your overall costs go down. You won’t need to pay for dictation anymore (or whatever method being used for documentation); as efficiency improves, you may be able to reduce staff; and better quality billing reduces billing costs and can increase revenue. By weighing the benefits as well as the negatives, doctors can get a better idea of the big picture and build a strong business case to implement an EHR, further enhancing their ability to take advantage of all the benefits EHRs have to offer.
In this article, the providers of IVANS are surveyed about the ARRA, the use of IT, and healthcare reform. The article states that 66 percent of those surveyed said EHRs will have a positive impact on their business yet only 39 percent said they plan to implement it within the next 12 months.
That is a very powerful statistic. Even though the majority believes that transitioning to an EHR will benefit their business, 27% will not pursue it as a business strategy. Now, I have encountered people resistant to change in my career, but this is staggering! Doctors need to look at EHR implementations from a different perspective. Is it a huge upfront cost? Yes. Is productivity going to suffer? Initially, yes. Are there ongoing maintenance costs? Yes. However, all of these yes’s are countered by benefits. Let’s face it, IT is expensive, but it is an investment. Once the upfront costs are paid, you will see your overall costs go down. You won’t need to pay for dictation anymore (or whatever method being used for documentation); as efficiency improves, you may be able to reduce staff; and better quality billing reduces billing costs and can increase revenue. By weighing the benefits as well as the negatives, doctors can get a better idea of the big picture and build a strong business case to implement an EHR, further enhancing their ability to take advantage of all the benefits EHRs have to offer.
Thursday, July 30, 2009
Stimulus Package EMR Programs Encounter Execution Issues
If you want to read thought provoking articles on EMRs and the Stimulus Package, the below links offer interesting perspectives and relevant facts, providing readers with the knowledge needed to make informed decisions regarding EMRs usage in their practice.
EMR and HIPAA: Allscripts CEOs stunning take on Obama’s EMR Plans
Healthcare Informatics Blog: Ephraim Schwartz: Financial and Technology Issues make Obama’s EHR push not so Easy to Execute
EMR and HIPAA: Allscripts CEOs stunning take on Obama’s EMR Plans
Healthcare Informatics Blog: Ephraim Schwartz: Financial and Technology Issues make Obama’s EHR push not so Easy to Execute
Wednesday, July 29, 2009
Healthcare Reform
The AMA has created a series of white papers addressing Healthcare System reform. The Obama Administration as stated that Health System Reform is a top priority, and the AMA encourages doctors to use this as an opportunity to resolve current issues to enhance patient care. With a standardized health system, increased quality of patient care will inevitably occur as systems work among various medical institutions to deliver more efficient and effective treatment options. Visit the AMA website for more information.
Thursday, July 23, 2009
Change Management Reported to be the Cause of Majority of EMR Issues
Do doctors have a reason to worry about transitioning to an EMR? Once you start talking about technology, software vendors, and EMRs, doctors who haven’t transitioned to an EMR can get nervous about how this would work in their practice. However, that’s not what they should be worried about.
According to Wikipedia, the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology report that EMR implementations follow the 80/20 rule; where 80% of the work of implementation is spent on issues of change management, and only 20% is spent on technical issues related to the technology itself.
Since much of my professional career has involved EMR implementations, I agree with this statement. Time and time again I have seen offices fear the software and struggle with fitting their current business processes in with how the software functions, and this can lead to frustration and failure. Almost anything can be carried out more efficiently when proper planning has been done, and implementing an EMR is no exception.
Long before the software is installed on the computers in the office, doctors should be analyzing their current business processes to identify bottlenecks and areas of improvement. This can serve as two purposes. You can identify the areas that will affect the EMR implementation (staff's level of technology expertise) and have an action plan on how to resolve it prior to the EMR implementation, and you can also identify areas that you want the EMR to resolve. Finally, you can address the issue with staff spending countless hours searching for paper medical records!
According to Wikipedia, the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology report that EMR implementations follow the 80/20 rule; where 80% of the work of implementation is spent on issues of change management, and only 20% is spent on technical issues related to the technology itself.
Since much of my professional career has involved EMR implementations, I agree with this statement. Time and time again I have seen offices fear the software and struggle with fitting their current business processes in with how the software functions, and this can lead to frustration and failure. Almost anything can be carried out more efficiently when proper planning has been done, and implementing an EMR is no exception.
Long before the software is installed on the computers in the office, doctors should be analyzing their current business processes to identify bottlenecks and areas of improvement. This can serve as two purposes. You can identify the areas that will affect the EMR implementation (staff's level of technology expertise) and have an action plan on how to resolve it prior to the EMR implementation, and you can also identify areas that you want the EMR to resolve. Finally, you can address the issue with staff spending countless hours searching for paper medical records!
Sunday, July 19, 2009
Physician Frustration Grows with EMR Vendors
“It’s difficult to keep IT interested in the discussion. They don’t take the time to really understand the problem and want us to adapt to whatever software they come up with.”
This was one of comments made about EMR vendors in the 2009 ACPE Health Care Technology Survey. I find this so unfortunate, that physicians feel that IT vendors do not want to improve and enhance doctor performance. There is truth, though, with saying that IT wants physicians to adapt to the software they create. Unless the software company builds custom software applications, there is no way that a vendor can create software that will work for every single physician practice. There are too many variations to how offices perform daily tasks. So, there really isn’t any getting around this, there will be some modifications needed to the practices daily business processes. However, this shouldn’t be misconstrued that IT doesn’t take the time to understand the issues.
What doctors may not realize is that many EMR vendors employ business analysts who are experts in their industry and are trained to analyze business processes, then convert them into a software program for a programmer to code. Once the core product is ready, vendors will typically release updates to the software, which are additions to the core product to handle the many variations, thus accommodating more practices and how they currently run their business, with minimal changes needed in their current business processes.
Ultimately, doctors need to realize that EMR vendors do want to solve problems. While there are always exceptions to the rule, physician practices need to be open and accept the changes outside of the technology that will occur with the use of an EMR. We can all agree that email is much faster, reliable and preferred to regular mail. However, we all had to change how we communicated in writing to people through shorter, more frequent messages versus less frequent long letters. We also had to adapt to the changes in time management this caused since messages could be delivered instantly versus 1-7 days by regular mail, depending on where the recipient lived and what mail method was used to send the letter. This is a very simple and basic example, but you get my point. Sometimes, changing business processes is a good thing.
Read the full survey at http://net.acpe.org/MembersOnly/pejournal/2009/MarchApril/Weimar1.pdf
This was one of comments made about EMR vendors in the 2009 ACPE Health Care Technology Survey. I find this so unfortunate, that physicians feel that IT vendors do not want to improve and enhance doctor performance. There is truth, though, with saying that IT wants physicians to adapt to the software they create. Unless the software company builds custom software applications, there is no way that a vendor can create software that will work for every single physician practice. There are too many variations to how offices perform daily tasks. So, there really isn’t any getting around this, there will be some modifications needed to the practices daily business processes. However, this shouldn’t be misconstrued that IT doesn’t take the time to understand the issues.
What doctors may not realize is that many EMR vendors employ business analysts who are experts in their industry and are trained to analyze business processes, then convert them into a software program for a programmer to code. Once the core product is ready, vendors will typically release updates to the software, which are additions to the core product to handle the many variations, thus accommodating more practices and how they currently run their business, with minimal changes needed in their current business processes.
Ultimately, doctors need to realize that EMR vendors do want to solve problems. While there are always exceptions to the rule, physician practices need to be open and accept the changes outside of the technology that will occur with the use of an EMR. We can all agree that email is much faster, reliable and preferred to regular mail. However, we all had to change how we communicated in writing to people through shorter, more frequent messages versus less frequent long letters. We also had to adapt to the changes in time management this caused since messages could be delivered instantly versus 1-7 days by regular mail, depending on where the recipient lived and what mail method was used to send the letter. This is a very simple and basic example, but you get my point. Sometimes, changing business processes is a good thing.
Read the full survey at http://net.acpe.org/MembersOnly/pejournal/2009/MarchApril/Weimar1.pdf
Wednesday, July 15, 2009
Business Justification to Implement an EMR
A study from the New England Journal of Medicine shows that 66% of physicians surveyed are not using an EMR due to cost. This is an overwhelming sign that physicians cannot make a business justification to implement an EMR in their practice. This article talks about that study in more detail http://localtechwire.com/business/local_tech_wire/biotech/story/3114344/.
However, a significant business justification can be made for most practices and it’s important not to cut corners with cost because you could end up trading quality for a cheaper price. Yes, the upfront costs can be hefty, but a cost analysis projecting 3, 4, 5 years ahead will show how technology lowers costs. Consider this:
However, a significant business justification can be made for most practices and it’s important not to cut corners with cost because you could end up trading quality for a cheaper price. Yes, the upfront costs can be hefty, but a cost analysis projecting 3, 4, 5 years ahead will show how technology lowers costs. Consider this:
Financial
An EMR will replace your current documentation system (dictation, voice recognition, etc.). Therefore, you will immediately save money by eliminating your current documentation process.
By using technology, you will decrease your use of paper, postage, & printer ink, an additional cost savings.
With a quality PM & EMR system and effective implementation with doctors entering information real-time, billing is a more efficient process, often with a decrease in billing errors. This often results in a reduction in billing staff, an additional cost saving.
Many EMRS & PM systems provide high quality error checking capabilities, reducing medical errors, and increasing reimbursement.
Productivity
By utilizing electronic billing, payments are received in half the time of paper claims, creating a more efficient billing and accounts receivable process.
Office workflow can be altered to implement more efficient procedures & eliminate duplicate work and redundant processes, thus increasing office staff productivity.
The reliability and ease of use of EMRs & PM systems will also increase staff productivity. When information in a chart is needed, staff members can search for that information at their desk on their computer, while still being available to answer phones and interact with patients. This is a much better scenario than having to send a staff member away from their desk & other job responsibilities to search for the information in a file cabinet.
Patient Care
Many EMRs will help guide the physician based on the symptoms of possible diagnoses & treatment methods, increasing the quality of patient care.
With a more efficient office, the average patient wait time can decrease significantly, increasing overall patient satisfaction.
While the business justification to implement an EMR will vary practice to practice, these main benefits will affect a majority of practices to varying degrees. It is important to know and understand how these factors play a role in your practices EMR implementation to maximize the return on your investment.
Wednesday, February 25, 2009
EHR Data Flow Diagram in Physician Office
This data flow diagram shows the typical business and data flow of a physician office utilizing an EHR. This helps to show how the information is gathered and processed as well as identifying all the business processes involved in the entire life cycle of a patient visit.
Business & Data Flow Diagram
Business & Data Flow Diagram
Sunday, January 25, 2009
EMR Vendor Rating
Many physician practices are interested in shopping the market before they engage in a long-term committment with an EMR vendor. And rightly so! This certainly isn't a cheap endevear! However, with the right tools and evaluation methods, selecting an EMR vendor doesn't have to be a difficult task. This Vendor Rating Sheet is very useful for practices conducting their own research on EMR vendors.
Subscribe to:
Posts (Atom)