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A Do-Not-Forget Checklist for EHR Switchers on the Hook for Meaningful Use

The following is a guest post by Tom S. Lee, PhD, CEO and Founder at SA Ignite.

According to a recent survey by Black Book rankings, as many as 16 percent of ambulatory EHR users may become  EHR switchers within the next 12 months.  Large health systems such as Intermountain (a client of ours) and the Department of Defense have recently announced that they are switching EHRs or are currently evaluating a change. Many such organizations are planning to switch EHRs while continuing to meet increasingly difficult Stage 2 Meaningful Use (MU) requirements.  According to past National Coordinator  Dr. Farzad Mostashari, there will be no delay of MU Stage 2. That means your health IT road map may now include switching EHRs, managing Stage 2 attestations, and achieving ICD-10 compliance.

How do you switch jugglers while the number of balls in the air increases at the same time?

We have encountered a common set of issues and questions in our work with clients, discussions with prospects, and exchanges with thought leaders in the industry related to the EHR switching scenario, especially as it relates to Meaningful Use.  Here are some things to consider:

1. Assess and properly store data from your old EHR for future MU audits. A recent wave of MU audit notices has been sent by CMS to some of the country’s leading health systems. Each MU attestation is subject to audit 6 years after the attestation date.  With this in mind, be sure to pull out and securely and centrally store all supporting data from your old EHR before its license expires.  Get expert assistance if needed to understand how to build a comprehensive and solid audit trail.  One great place start is the guidance on audit documentation provided by CMS.

2. Optimize the timing of the EHR switch relative to government reporting timelines.  For example, in 2014 there is a one-time opportunity to report on only a calendar quarter’s worth of data for many eligible providers, rather than the entire year.  This modification to MU was originally made to accommodate delayed Stage 2 certifications by the EHR vendors.  However, it can also be leveraged by EHR switchers who can time the switch to happen within 2014 to benefit from a lower compliance bar while the massive impacts of switching EHRs are absorbed by the organization.

3. Plan to merge data across EHRs to meet MU reporting requirements.  Even with the 2014 calendar-quarter reporting reprieve, for many hospitals and eligible providers to achieve Meaningful Use in an EHR-switching year it’ll be necessary to stitch together Meaningful Use data across the old and new EHRs in order to meet many MU reporting requirements.  For example, this may be required simply to meet the minimum certified EHR usage threshold to be eligible for the MU program in that year.  Assume merging data will be necessary, prepare how to do so before your old EHR license expires, seek help, or do both. An interesting contingency we have seen is to drive eligible providers to “over perform” on their MU measures on the old EHR in anticipation that MU performance will drop at the outset of adapting to the new EHR.  This will increase the chances that providers’ total MU performance within a reporting period spanning both EHRs will end up above threshold.

4. Plan to be supporting two EHRs at the same time.  Although it is sometimes possible to do a “big bang” switchover to a new EHR across an entire organization, we often see that rollout plans for the new EHR are phased across specialty, location, or other sub-groups.  During those periods when the organization could be supporting two different EHRs, such as two ambulatory EHRs in different geographic regions, it is important to organize and align teams to not only handle the immediate demands of MU but also transition completely to supporting the new EHR.  For example, MU data reporting and attestation can be hard enough for just one ambulatory EHR, much less two.  It takes preparation well in advance of the EHR switch and government attestation deadlines to avoid 11th hour fire drills.

Is your organization juggling MU requirements while switching EHRs? If so, I’m sure that you’ve found there are additional considerations surrounding an EHR switch that are important to keep in mind. I’d love to hear your suggestions in the comments.

November 21, 2013 I Written By

Improving the EHR Interface and Topol Saves Patient’s Life on Flight Home

As I thought through my day at HIMSS, a theme started to emerge from all the dozens of meetings I’ve already had at the show (with many more still to come). The theme I saw coming out was ways to improve the EHR interface. This is a much needed change in EHR’s, so it was interesting to see a whole series of companies working on ways to make the EHR interface better. Here are some of the highlights from companies I talked to at HIMSS.

SwiftKey – While the SwiftKey product can be used in the consumer space as well, it was interesting to see the technology applied to healthcare. SwiftKey is basically a replacement for your mobile device keyboard. In fact, I’d call SwiftKey a smart keyboard for your mobile device. What does it do to make your mobile device keyboard smart?

First, it offers word suggestions you can easily choose as you start to type. Most people are familiar with this base functionality because it exists in some form in most mobile keyboards (or at least it does on my Android). However, they’ve taken it a couple steps further. They actually use the context of what you’ve typed to predict what word you may want to type next. For example, if you type, “nausea and” then it predicts that you’ll want to type vomiting. If you type “urinary” then it will predict tract and then infection. Plus, they told me their algorithm will also learn your own colloquial habits. Kind of reminds me of Dragon voice recognition that learns your voice over time. SwiftKey learns your language habits over time.

I’m sure some of these predictive suggestions could lead to some hilarious ones, but it’s an interesting next step in the virtual keyboards we have on mobile devices. I’ll be interested to hear from doctors about what they think of the SwiftKey keyboard when it’s integrated with the various EHR iPad apps.

M*Modal and Intermountain – Thinking back on the demos and products I’ve seen at HIMSS 2013, I think that the app M*Modal has created for Intermountain might be the coolest I’ve seen so far. In this app, a doctor would say an order for a prescription, and the M*Modal technology would apply voice recognition and then parse the words into the appropriate CPOE order fields. It was pretty impressive to see it in action. Plus, the time difference between speaking the order and trying to manually select the various order fields on the mobile device was incredible.

I was a little disappointed it was only a demo system, but it sounds like Intermountain is still doing some work on their end to make the CPOE happen. I’m also quite interested to see if a simple mobile app like this will see broad adoption or if more features will need to be added to get the wide adoption. However, it was almost like magic to see it take a recorded voice and convert it into 5-7 fields on the screen. I’d be interested to see the accuracy of the implementation across a large set of doctors, but the possibilities are quite interesting for transforming the CPOE interface.

Cerner Mobile – One of the new Cerner ambulatory EHR features is an iPad interface for the doctor. I’m sure that many will think this is old news since so many other iPad EHR interfaces are out there. In some ways it is, but there was a slickness to their app that I hadn’t seen a lot of places. In fact, the demo of their ambulatory EHR iPad app reminded me a lot of the features that I saw in this video Jonathan Dreyer from Nuance created (bottom video) that demonstrated some of the mobile voice capabilities. Plus, the app had a nice workflow and some crazy simple features like doing a refill. One swipe and the med was refilled. Almost makes it too easy.

Canon – This is a little different than some of the other EHR interface things I talk about above. In the case of Canon it was interesting to see the tight integration that’s possible between the Canon scanners and EHR software. Instead of the often laborious process of scanning to your EHR and assigning it to a patient, Canon has a scan direct to EMR option including analyzing the cover sheet to have the scanned document attached to the right patient and EHR chart location. While we’d all love to have paper gone, it will be a part of healthcare for the forseeable future. The scan direct to EMR is a pretty awesome feature.

Those are a number of the EHR interface things that I’ve seen so far at HIMSS. I’m sure there are dozens of others out there as well. I think this is a great trend. Sure, each of these things is only a small incremental change, but with hundreds of EHR vendors all doing small incremental changes we’re going to see great things. That’s good, because many of the current EHR interfaces are terribly unusable.

In an related topic, Eric Topol gave a keynote address at HIMSS today. He had glowing reviews from what I could tell. Although, what’s an even more powerful story is to see the message he shared at HIMSS in action. On Topol’s flight home to San Diego a patient was having some medical issue. He did the ECG right on the plane using his smartphone and the passenger was able to make it safely to the destination. You can read the full story here. What’s even more amazing is that this is the second time something like this has happened to Topol. This probably means he flies too much, but also is an incredible illustration of the mHealth technology at work. Truly amazing!

Full Disclosure: Cerner and Canon are advertisers on this site.

March 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.