Anne Zieger

Three Tips For EHR Transitions

Moving a medical practice from paper to an EHR is no picnic. Staff and physicians both may find the process difficult, and the changes they have to make to be threatening. But there are approaches you can take which can make the process easier. Here’s a nice triad of suggestions from EHR implementation manager Amanda Guerrero:

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow. The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians? The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

* Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most. Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR. Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

* Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests. To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

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May 20, 2013 I Written By Anne Zieger

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Tags:EHR Tios EHR Workflow EMR Workflows Medical Practice

Geisinger Opens Doctors’ Notes To Patients

Geisinger Health System is kicking off a new program under which more than 100,000 patients will have access to their doctors’ notes. Patients will access the notes through the secure MyGeisinger online patient portal, reports Healthcare Informatics.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients. The rest of the patients and doctors were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes. Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200 patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care. Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

EMR, HIE Use Up Sharply In U.S.

A new survey by Accenture has concluded that the number of U.S. doctors using EMRs — either in their practice or at a hospital — has climbed to over 90 percent, and that almost half are using HIEs. More than half of doctors surveyed (60%) report using an EMR in their own medical practice.

The Accenture survey reached out to 3,700 doctors in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the U.S. Data showed a spike in healthcare IT usage across all of the countries surveyed.

In the U.S., doctors had the biggest increase in adoption demonstrated in the survey, up 32 percent in routine use of health IT capabilities, as opposed to an average increase of 15 percent among non-U.S. clinicians, reports HealthcareIT News.

Other standout activities were e-prescribing (65 percent using) and entering patient notes into EMRs (78 percent), a 34 percent annual increase between 2011 and 2012. Forty-five percent of physicians also use IT for basic clinical tasks such as getting alerts while seeing patients (45 percent), according to Healthcare IT News.

Healthcare IT News also caught an interesting detail around lab orders. The magazine notes that 57 percent of U.S. doctors said they regularly use electronic lab orders (a 21 percent annual increase) the volume of physicians doing so internationally dropped 6 percent.

Globally, the number of doctors who “routinely” access clinical data on patients seen by different health organizations has climbed by 42 percent, from 33 percent of doctors in 2011 to 47 percent in 2012. Spain was the leader by a significant margin, with 69 percent of doctors routinely accessing such data.

The study also concluded that internationally, almost 60 percent of doctors customarily enter patient notes electronically either during or after consults.

On the other hand, so-called “digital doctors” are still unlikely to connect or transact electronically with outside organizations. Accenture found that only 10 percent of physicians communicate electronically to support remote consults/diagnostics, and that roughly 20 percent e-prescribe, receive notifications of patients’ interactions with other health organizations and communicate electronically with clinicians in other organizations.

CHIME Seeks Year-Long Meaningful Use Stage 2 Extension

Recently, six senators wrote a letter to HHS Secretary Kathleen Sebelius criticizing the Meaningful Use program. The letter, which came with a white paper listing their concerns about federal health IT policy, questioned whether the $35 billion allocated to Meaningful Use was being spent effectively, especially given the fact that provider interoperability is still minimal.

This week, the College of Healthcare Information Management Executives (CHIME) sent a letter to the six senators responding to their concerns, one which largely defends Meaningful Use though advocating for a one year extension of Stage 2.

In the letter, CHIME leaders concede that that there is some reason to be concerned with the current state of interoperability. However, they note, “we strongly believe that EHR incentive payments under the policy of Meaningful Use have been essential in moving the nation’s healthcare system into the 21st Century.” The incentive payments providers are receiving are critical to the business plans and interoperability solutions they’re developing, CHIME says.

And while we may not have interoperable EMRs in place just yet, the MU program has helped make progress in that direction, they say. “The work accomplished through Meaningful Use to reach consensus on transport, vocabulary and content standards is foundational to advancing interoperability and exchange,” the letter argues.

All that being said, it would be a good idea to extend Stage 2 of Meaningful Use for another year before moving ahead with Stage 3, CHIME contends:

A year extension of Stage 2 will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.

Personally, I hope that HHS agrees to CHIME’s request and moves Stage 2 up a year. After all, the existing timelines aren’t holy writ, and if changing the deadline allows providers and vendors to consolidate their gains significantly, it’s probably worth the wait.

John’s working on an interview with CHIME to discuss their letter. Watch for that over on Hospital EMR and EHR.

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May 8, 2013 I Written By Anne Zieger

Filed Under: Electronic Health Record Electronic Medical Record EMR EMR Adoption Healthcare Healthcare IT Meaningful Use

Tags:CHIME HHS Meaningful Use Stage 2 Meaningful Use Meaningful Use Stage 2

NY Hospital Links DNA Profiles With EMR

New York’s Mount Sinai Medical Center has launched a new program designed to link patient DNA to optimal treatments, in which patients consent to DNA sequencing, contact with researchers and longitudinal studies related to data within their EMR.

To date, 25,000 people have signed up to participate in the biobank program, BioMe. BioMe is designed to access a broad range of clinical and environmental information stored in the EMR and link it with genetic information provided by patients. BioMe also offers doctors the opportunity to give patients more targeted care based on their DNA profile. The program is funded by The Charles Bronfman Institute for Personalized Medicine at Mount Sinai.

As part of this effort, a team of doctors, genetic scientists and IT experts at Mount Sinai are gradually implementing a new program called CLIPMERGE (Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics). CLIPMERGE is using a new tool, developed at Mount Sinai, which gives doctors real-time therapeutic suggestions based on patient genetic profiles. The idea behind these technologies is to link CLIPMERGE and BioMe, bringing up to the moment information on genetic responses to certain medication to the patient bedside.

Right now, real-time feedback on ideal medications based on DNA profiles is available for three conditions related to cardiovascular disease, blood clots and high cholesterol. The idea is that as scientists discover other DNA-specific responses to therapeutics, CLIPMERGE and BioMe will help bring them to practicing physicians quickly.

According to Healthcare IT News, the BioMe databank will include diverse human ancestry, with self-reported 25 percent of African ancestry, 30 percent of European ancestry, 36 percent of Hispanic Latino, and 9 percent of other ancestry.

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May 6, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR Healthcare Healthcare IT Hospitals Population Health Research

Tags:BioMe CLIPMERGE DNA Testing Genetic Medication Genomic EMR Genomics Mount Sinai Medical Center

Study: EMRs Have Saved Canadian Health System $1.3B Since 2006

At our current stage of EMR implementation, the evidence is sketchy at best that EMRs are draining costs from the U.S. health system. But our friends to the north seem to be capturing tangible savings, according to new research by Pricewaterhouse Coopers LLP (PwC).

The PwC study, which was backed by the Canada Health Infoway, a not-for-profit whose focus is accelerating the development of EMRs by family physicians, looked at the implementation of EMRs by family doctors across Canada. The study focused on the period between 2006 and 2012.

Adoption of EMRs by primary care doctors in Canada has more than doubled between 2006 and 2012, from 23 percent to 56 percent, Healthcare Informatics reports. These EMR investments were paid for largely through investments by the provinces and territories in EMR programs, medical practices and Infoway.

According to Healthcare Informatics, PwC found that during that period, the Canadian system saved $800 million Canadian dollars in administrative efficiencies, such as staff spending less time pulling charts and less time by doctors reading and maintaining paper files.

PwC also found savings of $584 million Canadian dollars in health system efficiencies, such a drop in duplicated diagnostic testing and adverse drug events.

In addition to concrete financial savings, EMR adoption improved chronic disease management and preventive care, such as mammogram screening rates. EMR use also improved communication between care providers, as EMRs allowed new providers to quickly and easily research histories on patients without resorting to archaic fax communications.

As part of PwC’s research, they cited examples which paint the picture of how EMRs are changing healthcare in Canada.

Since implementing EMRs, PwC notes, 67 percent of Saskatchewan’s family doctors, office managers and specialists say that their medical practices are more or significantly more productive than before. Also, 94 percent of of doctors enrolled in Alberta’s EMR program said that patients get their test results faster; in addition, 97 percent said that they’re not needlessly repeating tests and investigations.

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May 3, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR Healthcare Healthcare IT International EMR Research

Tags:Canadian EMRs PricewaterhouseCoopers PwC

CMS Plans To Audit 5 Percent of Meaningful Use Participants

Are you ready to be reviewed? Well, get prepared. As part of its ongoing program of supervision, CMS plans to audit 5 percent of participants in the Meaningful Use program for compliance, according to Modern Healthcare.

Since January, CMS has been auditing program participants that have already received their money, as well as those who have applied to receive incentive payments. Going forward, the two groups will receive about the same level of attention, with a total of 5 percent of program participants ending up getting closer scrutiny from the feds, MH reports.

To date, there haven’t been many adverse findings by CMS, though the agency has discovered a few questionable situations, Robert Anthony, deputy director of the HIT Initiatives Group at CMS, told the magazine. But a few providers are already beginning the appeal process, and several providers may face fraud enforcement investigations, he said.

The bulk of the Meaningful Use reviews will be what the agency dubs “desk audits,” done by the CMS audit contractor Figliozzi and Co., in which information is exchanged electronically. However, a few on-site audits may be conducted as well, Anthony told Modern Healthcare.

To date, among the most common problems CMS has learned about has been provider failures to meet the requirement that they complete a data security risk assessment, a step also required by HIPAA. When the auditors find that a provider hasn’t done the required data security risk assessment, they could be referred to the HHS Office of Civil Rights for a HIPAA compliance investigation.

Another issue which has turned up frequently has been a lack of adequate documentation that providers have answered some of the “yes or no” questions which are part of Meaningful Use criteria, such as whether their EMR has been tested for clinical data exchange. In that case, providers must be able to document what happened whether or not the test was successful.

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April 29, 2013 I Written By Anne Zieger

Filed Under: ARRA EHR Electronic Health Record Electronic Medical Record EMR Healthcare Healthcare IT HIPAA Meaningful Use

Tags:CMS Figliozzi and Co. Meaningful Use Audit

DoD Official Challenges Agency’s EMR Approach

Back in 2009, the Department of Defense and the VA began an initiative, the iEHR project, which was supposed to integrate the two sprawling agencies’ EMR systems. That initiative came to a halt in February, with the two organizations deciding make their two independent systems more interoperable and the data contained wtihin more shareable.

At least one DoD official, however, believes that the latest effort flies in the face of President Obama’s directive that agencies adopt and use open data standards. J. Michael Gilmore, director of the DoD’s operational test and evaluation office, has sent a memo to Deputy Secretary of Defense Ashton Carter arguing that the DoD’s plan to evaluate commercial EMR systems is “manifestly inconsistent” with that order.

“The White House has repeatedly recommended that the Department take an inexpensive and direct approach to implementing the President’s open standards,” Gilmore wrote. “Unfortunately, the Department’s preference is to purchase proprietary software for so-called “core” health management functions…To adhere to the President’s agenda, the iEHR program should be reorganized and the effort to define and purchase “core” functions in the near term be abandoned.”

If the DoD actually manages to successfully implement a commercial EMR system, it “would be the exception to the rule, given the Department’s consistently poor performance whenever it has attempted wholesale replacement of existing business processes with commercially derived enterprise software,” Gilmore noted tartly.

Gilmore recommends that the DoD go the open standards route by defining and testing the iEHR architecture, then purchasing a software “layer” to connect DoD’s EMR with other providers using open standards.

The VA, meanwhile, has formally proposed that the DoD migrate from its existing AHLTA EMR to the VA’s popular VistA EMR, already in place successfully throughout the agency’s hospitals and clinics. VistA is deployed at more than 1,500 sites of care, including 152 hospitals, 965 outpatient clinics, 133 community living centers and 293 Vet Centers.

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April 26, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR EMR Adoption EMR Technology Healthcare Healthcare IT

Tags:AHLTA DoD iEHR VA Vista

Study: Open Source On A Growth Path In Healthcare

A new survey has concluded that open source software has reached a high enough maturity and quality level to attract users in formerly commercial settings. The study, the seventh annual “Future of Open Source Survey,” has concluded that open source software is rapidly changing the way organizations inside and outside of healthcare do business, according to Open Health News.

More than 800 respondents participated in the survey, which is backed by North Bridge Venture Partners and Black Duck Software, including both vendor- and non-vendor representatives.

Researchers found that healthcare users, as well as those in government and media, are increasingly swayed to use open source, thanks to advantages in collaboration, transparency and speed, Open Health News reports.

There’s indications that healthcare players are willing to embrace the technology — and by extension the open source development community — in the data gathered by the survey. Over the next two to three years, 15 percent of respondents said health and science would be most affected by open source software trends.

Generally speaking, cutting across healthcare and non-healthcare industries, respondents seemed willing to embrace open source’s challenges if it met their needs. When choosing open source software over proprietary solutions, 45 percent of respondents chose technical capabilities and features as important, while only 12 percent chose commercial vendor support as an important buying criterion.

Another broad trend which emerged was that open source buyers were becoming convinced that open source solutions were of high quality; in fact, quality jumped from third place to first as a reason to adopt open source software. Freedom from vendor lock-in came in at second place in in the list.

Another very interesting observation, cutting across industries, was that lower costs, big data and systems integration were the top three business problems open source software is solving. I can certainly see those as advantages healthcare needs to leverage, don’t you?

Meaningful Use Attestations With Faked Vendor Info?

When providers attest to Meaningful Use Stage 1 compliance, they have to identify the vendor whose EMR they used. But what if a large number of providers were faking this step in an effort to get incentive money that they don’t deserve? That would be a lot of fraud, no?

Well, according to one vendor CEO, this could be happening on a large scale. Mike Jenkins, CEO of cloud-based vendor BuildYourEMR.com, reports that after going over CMS data on Meaningful Use, he found that a whopping 74 percent of providers who attested to using his company’s technology were not his customers.

Jenkins points out that if fraud were actually this common, a full $5.4 billion of the $7.6 billion paid out to providers would have been paid out in error. He admits that there could be something wrong with the CMS data, or that providers selected his company’s product name by accident, but concedes that it’s possible attestation fraud is more common than we think.

I’m not telling you this to suggest that the Meaningful Use program is riddled with fraudulent activity. I’m doubful, in fact, that even a fraction of providers would dare incur the wrath of Medicare by making such a traceable error, much less consciously try to rip the incentive program off.

This does suggest, however, that more healthcare IT people should take a look at the CMS data and go over it themselves, especially EMR vendors. While there may not be a hailstorm of fraud going on, something may be seriously amiss in how CMS collects data or how providers report on their attestation. It’d definitely be good to get ahead of any pending troubles with CMS, for sure.

Three Tips For EHR Transitions

Geisinger Opens Doctors’ Notes To Patients

EMR, HIE Use Up Sharply In U.S.

CHIME Seeks Year-Long Meaningful Use Stage 2 Extension

NY Hospital Links DNA Profiles With EMR

Study: EMRs Have Saved Canadian Health System $1.3B Since 2006

CMS Plans To Audit 5 Percent of Meaningful Use Participants

DoD Official Challenges Agency’s EMR Approach

Study: Open Source On A Growth Path In Healthcare

Meaningful Use Attestations With Faked Vendor Info?

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