EMR Consulting | EMR and HIPAA

User-friendly EMRs, Meaningful Use Fraud, and DietBet – Around Healthcare Scene

Written by: Katie

Many are concerned with the user experience in Health IT – particularly regarding the user-friendliness of EMRs. While it is easy to be overwhelmed by the negative reports, there are businesses and providers working hard to resolve these issues. McKesson is one of those companies, and they were recently recognized for their work at HIMSS13. Will more companies start making efforts like this?

One step toward making EMRs more user-friendly is, well, making them accessible to patients. Unfortunately, according to a recent Accenture study, 65 percent of doctors believe patients should only have limited access to their health records, and 4 percent believe records should be totally closed. Reasons range from self-consciousness of what a doctor says in a record, to being uncomfortable with using digital records. Allowing patient-access may very well be a huge cultural shift for doctors everywhere.

In order to pass Meaningful Use stage 1, one must indicate which EMR was adopted. But, according to BuildYourEMR.com’s CEO, Mike Jensen, 74 percent of the providers who stated they were using his EMR…weren’t. If this is similar across the board, around 5.4 billion dollars were paid in error for incentives. While this isn’t likely to be the case, it’s pretty sad the lengths people will go to in order to get some extra money. EMR vendors need to start going over their CMS data in order to help prevent this fraudulent behavior.

If money was at stake for you to lose weight, would that motivate you? For most people, it probably would. DietBet takes the desire people have to lose weight and pairs it with the innate desire to have money, and creates a weight-loss game. If you lose 4 percent of your body weight in four weeks, you get part of the money pot for the group you are in. If you don’t, you lose the amount you paid to participate in the first place.

John recently had the opportunity to go to TEDMED as a guest of the Breakaway Group (A Xerox company)
. It was a great experience for him, and highlights can be found @ehrandhit or searching #simplehealth on Twitter. John recounts some of key takeaways from TEDMED, and suggests some of the major themes that will likely be seen in healthcare.

Rural Hospital EHR

Written by: John Lynn

As I mentioned in my previous post on EHR Penalties and Meaningful Use Failure, I had a really good discussion with Stoltenberg Consulting about rural hospital EHR at HIMSS this year. While Stoltenberg no doubt works with hospital systems of every size, I could tell that they had a real affection for the rural hospital EHR challenge. Plus, it was great to be educated some more on the challenges rural hospitals face when it comes to meaningful use and EHR since I’ve been doing a lot more writing about it on my Hospital EMR and EHR website.

I collected a few observations from my chat that I think are worth talking about when it comes to the unique rural hospital EHR situation. One of those ideas is the challenge that rural hospitals have in providing EHR help desk support. It’s worth remembering that hospitals are 24/7 institutions that need 24/7 support in many cases. Now imagine trying to staff an EHR help desk for a small rural hospital. From what I’ve seen, most can barely have an IT support help desk available, let alone an EHR help desk. Stoltenberg Consulting wisely sees this as a great opportunity for EHR consults to provide this type of service to rural hospitals. If you spread the cost of a 24/7 EHR help desk across multiple hospitals, the costs start to make sense.

Another interesting observation was that most rural hospitals are mostly Medicare and Medicaid funded. I’m not an expert on the pay scales of rural America, but when you look at the costs of living in the rural areas you realize that they don’t need to make as much money to live. Plus, I imagine in some cases there just aren’t that many jobs available to them. If they aren’t making as much money, then they’re more likely to qualify for Medicare and Medicaid. Why does this matter?

The amount of Medicare a rural hospital has matters a lot since if they don’t show “meaningful use” of a “certified EHR” then they will incur the meaningful use penalties. It’s simple math to see that the more Medicare reimbursement you receive the larger the EHR penalty you’ll incur.

There’s something that doesn’t feel right about the rich hospitals who’ve likely implemented an EHR before the stimulus getting paid the EHR incentive money while rural hospitals who can barely afford to keep their doors open getting not only penalties, but large penalties because of their large Medicare reimbursement. It’s probably water under a bridge now, but I could see why Stoltenberg Consulting suggested that rural and community hospitals should have been given more time to show meaningful use of an EHR.

As I mentioned, I’m still learning about the rural hospital EHR space, but I found these points quite interesting. If you have a different view or have experience that differs, I’d love to hear about it in the comments. No doubt there are thousands of unique rural environments and I’d love to learn more about them and how they’re approaching EHR. Please share your experiences and thoughts in the comments.

EHR Penalties after Meaningful Use Failure

Written by: John Lynn

While at HIMSS I had a discussion with the consulting firm Stoltenberg Consulting. I was really intrigued by their approach to EHR consulting and will likely write more about it later. Plus, the started what in many ways became a theme of my HIMSS experience around rural healthcare EHR. You can be sure I’ll be writing about rural EHR here on this site and on Hospital EMR and EHR much more in the future.

In our casual introductory conversation we had a good discussion about how many of the smaller hospitals look at meaningful use and the EHR incentive money. Needless to say, many of these smaller institutions are faced with a huge challenge when it comes to adopting an EHR and showing meaningful use. Many of these rural hospitals barely have an IT staff and the CFO usually takes care of the IT environment. I heard one story at HIMSS where the IT person at a rural hospital started out as the janitor and his home IT skill made him the most qualified person to help.

Needless to say, rural and smaller hospitals have some real challenges facing them when it comes to EHR adoption and showing meaningful use of that EHR. Although, an even worse thought struck me in my discussions about these smaller hospitals.

Imagine many of these smaller hospitals making a good faith effort to adopt EHR and show meaningful use. It’s not that hard to see many of these hospitals falling short of the meaningful use standard. What will this mean to that organization? They’ve spent millions on an EHR. They won’t get the EHR incentive money they likely used as a justification for the EHR spending. To add insult to injury, now they’re going to get penalized for not being meaningful users of an EHR.

This scenario honestly makes me sick to even consider. Something similar could easily happen in small ambulatory practices as well. The scale of the damage will just be different. I expect in meaningful use stage 1 this won’t likely be a problem since it’s self attestation. However, this could become a much bigger issue in meaningful use stage 2.

Although, consider an organization who fails a meaningful use stage 1 audit. In most cases you can’t go back and fix whatever you failed in the audit. You’d be in a very similar situation where you have to return the EHR incentive money and would be open to the meaningful use penalties. At least that’s my understanding of how the EHR penalties will be implemented. If you know otherwise, I’d love to hear it.

While I think the above scenarios are brutal, hopefully this will also serve as a warning for those hospitals pursuing EHR and the EHR incentive money. Be sure you are able to show meaningful use or you’ll not only lose out on the incentive money, but you’ll also be open to the EHR penalties. Not to mention, are you ready for a meaningful use audit?

EMR Companies, Leveling the Playing Field, and The Eatery: Around Healthcare Scene

Written by: Katie

EMR and EHR

What Really Differentiates EHR Companies?

EHR companies are a dime-a-dozen. So what makes them different? While price is sometimes a big deal to some, it isn’t an indicator of success. Marketing and sales can make a difference as well to some. However, there are a few things that should differentiate EHR companies. This includes the importance of efficiency.

Android’s Advantage Over iPhone in Mobile Health Applications

While many in the healthcare world love the iPhone, Android devices may present more options to healthcare professionals. Android offers more customization than the iPhone, and has more flexibility. It may cause developers more headaches, as the iPhone only requires them to only code their application once to work with most iOS devices. But the benefits are countless.

Hospital EMR and EHR

Level the Playing Field with RACs as They Enter Practice Settings

This article is by Lori Brocato, Director of Audit at HealthPort. She lists four ways that hospitals can do to level the playing field with RACs. These reasons are: knowledge is power, it’s a team effort, connect the dots, and learn from mistakes.

How EMR Vendors and Providers Can Partner Effectively

The LinkedIn HIMSS group posed the question — what does a good partnership between an EMR vendor and a provider look like? This post includes a few of Anne Zieger’s thoughts on this question.

Smart Phone Healthcare

The Eatery: A Visual Food Diary

The Eatery puts a twist on the typical food diary — instead of recording food, you take a picture. The user then can rate their food, and others can too.

Telemedicine, Accenture, and Influenza App – Around Healthcare Scene

Written by: Katie

EMR and EHR

When The EMR *Is* The Problem

Anne Zieger talks about a recent experience at the doctor’s office that took more time than it needed to because of an EMR. While EMRs are meant to increase efficiency and workflow, it isn’t always the case. How can these problems be addressed?

New Telemedicine Starts Bode Well For EMRs

Jennifer Dennard interviewed Sande Olson, a senior health consultant at Olson & Associates about the future of telemedicine technology. She discusses how it has changed recently, a possible trick down effect from the ACA, and integration of telemedicine into EMRs.

Hospital EMR and EHR

What Hospitals Can Learn From Hospitals

Airports are crowded, filled with germs, and just frustrating sometimes. However, there are a few things, technology-wise, that airports do well with, and hospitals should pay attention to. This post talks about three different things hospitals can learn from airports, including having kiosks and big screen displays.

Accenture: Five Questions Hospital Boards Should Ask Before EMR Buys

A study done by Accenture found that about four percent of hospitals will be making an EMR purchase in the next year. Partly because of this, Accenture has compiled a list of questions that should be asked before purchasing an EMR. They suggest having these questions answered by an independent analysis of EMR vendors.

Smart Phone Healthcare

CDC Release Influenza App

The CDC has released another app. This time, it focuses on the flu. Because this year’s flu season has run rampant throughout the United States, this app can be very helpful, particularly for physicians. It contains information concerning where outbreaks are happening, the vaccine, and tips on how to stay healthy.

Health IT Hazards, Selecting the Right EHR, and Withings Wireless Scale – Around Healthcare Scene

Written by: Katie

Hospital EMR and EHR

Health IT Stands Out In Health Technology Hazards List

The Top 10 Health Technology Hazards list was recently released by ECRI. And this year, two of the hazards that made the list are health IT related – patient/data mismatches in EHRs and other HIT systems, and, interoperability failures with medical devices and health IT systems. Anne Zeiger predicts that more HIT issues will top this list in the future.

Patients Accessing Online Medical Records Use More Services

A new study revealed something interesting — patients who use online access to medical records are likely to use more clinical services than those who do not. The Journal of the American Medical Association drew this conclusion after studying members of Kaiser. Kaiser has had a patient portal in place since 2006, which made it an ideal candidate for this study.

EMR and EHR

10 Tips for Selecting the Right EHR

In the market for a new EHR? Or perhaps just implementing one? This post highlights 10 tips on selecting the right EHR for your practice, as presented by Insight Data Group. Some of the suggestions include making sure the EHR is easy to use and customized, and use the government’s money to pay for your EHR.

Meaningful Healthcare IT News

Social and Mobile Continue to Converge in Healthcare

An interesting infographic is shown and discussed in this post. It is called “How Health Consumers Engage Online,” and reveals some interesting facts about the digital and health world. According to it, more people in the United States own a smart phone than a tooth brush, and 23 percent of people use social media to follow the health experiences of a friend. This definitely presents some fascinating data that is worth reading.

Smart Phone Health Care

New Withings Wireless Internet Scale Hits the Market

A new scale was recently released, and it does more than just tell a person how much they weigh. It tracks numerous variables, including BMI, and can be synced to various mHealth apps. There is also an app that goes along with the scale as well. It is a bit pricey at over $100, but it definitely “tips the scales” when it comes to scales.

Smart Phone Enabled Thermometer Approved By FDA

The “Raiing” is the newest in smart phone technology. It’s a high-tech, yet easy-to-use, thermometer, designed for iOS devices. It is placed under the armpit, and can actually track a person’s temperature over time. If a temperature reaches a certain number, an alarm will go off on the connected smart phone. This can help give parent’s peace of mind, as a sick child sleeps.

Verizon Launches HIPAA-Compliant Cloud Services

Written by: Katherine Rourke

Last month, I shared some of Verizon’s big plans for the medical space with you, including their desire to become the industry’s default carrier of secure healthcare data. This week, Verizon has launched its cloud service line, and I wanted to share some of the details on how it’s set up with you.

Verizon’s Enterprise Solutions division is offering five “healthcare-enabled” services, including colocation, managed hosting, enterprise cloud, an “enterprise cloud express edition” and enterprise cloud private edition. In addition to the services, Verizon provides a HIPAA Business Associate Agreement which, one would assume, is particularly stringent in how it safeguards data storage and tranmission between parties.

The new Verizon services will be offered through cloud-enabled data centers in Miami and Culpeper, Va. run by Terremark, which Verizon acquired some time ago. Security standards include PCI-DSS Level 1 compliance, ITIL v3-based best practices and facility clearances up to the Department of Defense, Verizon reports.

In addition to meeting physical standards for HIPAA compliance, Verizon has trained workers at the former Terremark facilities on the specifics of handling ePHI, Verizon exec Dr. Peter Tippett told Computerworld magazine.

You won’t be surprised to learn that Verizon is also pitching its (doubtless very expensive) health IT consulting services as well to help clients take advantage of all of this cloud wonderfulness.

Not surprisingly, Verizon notes in its press release that “each client remains responsible for ensuring that it complies with HIPAA and all other applicable laws and applications.” If I were Verizon, I’d be saying that too, and doubtless states the obvious. That being said, it does make me wonder just how much they manage to opt out of in their business associate agreement. Call me crazy, but I think they’d want to leave as much wiggle room as humanly possible.

The bigger question, as I see it, is how big the market for these services really is at present. According to the Computerworld story, only 16.5 percent of healthcare providers use public or private clouds right now. Verizon may be able to turn things around on the strength of its brand alone, but there’s no g uarantees. I guess we’ll have to wait and see.

HITECH Privacy Compliance Gets Trickier – Meaningful Use Monday

Written by: Katherine Rourke

It’s been a very interesting few weeks for privacy protection under HIPAA. Just in case you haven’t had a chance to catch up on them, here’s what’s going on. The OCR has announced the protocols under which it’s going to perform audits required by HITECH.

Here’s how OCR is going to check both you and business associates for compliance with the HIPAA Privacy Rule, Security Rule and Breach Notification Rule. Here’s a summary from the Beyond Healthcare Reform blog from lawfirm Faegre Baker Daniels:

Privacy Rule	Security Rule
Notices of privacy practices	Administrative Safeguards
Right to request privacy protection for PHI	Physical Safeguards
Access to PHI	Technical Safeguards
Administrative requirements
Uses and disclosures of PHI
Amendment of PHI
Accountings of disclosures

Meanwhile, there’s the matter of the temperature being turned up on your relationship with your business partners. As things stand, maintaining HIPAA-level control over information once it leaves your facility or office is hard enough. Since 2009, HITECH has required covered entities and business associates to disclose if they’d used information on patients — including for treatment, payment or operations — if the access was through an EMR.

While that’s sticky to enforce, it mostly affects providers, not the business associates in most cases. But things could get a little trickier going forward. A new proposed rule would now require a basic access report applying not just to EMRs, but also to uses and disclosures of e-PHI in a designated record set.

As the Beyond Healthcare Reform blog notes, this could mean that health plans and business associates (if they have a designated records set) would have to provide the access reports for everything, including treatment, payment and operations.

I doubt any of us are surprised to see OCR getting tougher on data sharing; in fact, I’d argue that it’s overdue. The question is whether in the mean time, the near-daily data breaches we see (stolen laptops with unencrypted data, lost data disks) still haunt us. Scary times.

Great Advice – Check Your EHR Bill

Written by: John Lynn

In a post done in 2009 that’s still getting comments, Diane G. offered some interesting commentary that I think is fair warning for those purchasing an EHR (names removed since it could apply to a lot of EHR vendors):

We use Software A for our EMR, but Company A provided the equipment and installation quote for Software A and I can tell you, you’ll want to look at EVERY line they bill to your company. We have been billed for equipment that we never received and interfacing that was never launched. I have spent hours explaining to them what services they have billed us but didn’t provide. I am extremely grateful that we did not purchase their EMR and/or Practice Management product!!

Definitely a good warning for all purchases, but applies to EMR software as well. A number of EHR software companies have really simplified the way they bill and so this is less of a problem with those EHR vendors. However, many EHR vendors still try to pilfer doctors for the extras which can often add up to more than the core product. It’s ugly and unfortunate since it leaves a bad taste in doctors mouths.

Along these same lines is making sure your EHR contract is sound. There’s a whole section on EHR contracts in my EHR Selection e-Book that is worth looking at if you’re going through the EHR process.

EHR Data Extraction and Clinical Conversion

Written by: John Lynn

I think it’s quite easy to predict that 3-5 years from now, one of the top topics on this blog and in the EHR world as a whole is going to be around EHR data extraction or if you prefer EMR data conversion. I’ve previously predicted that by the end of the EHR stimulus money we’re be lucky to achieve 50% EHR adoption. So, you’d think that in 3-5 years we’d still be talking about EHR selection and implementation. Certainly, that will still be a topic of discussion. Not to mention, which EHR vendor they should go to for their second EHR. However, I am certain that 3-5 years from now we’re going to see a mass of doctors switching EHR vendors.

As part of my EHR blog week challenge (if you’re a blogger, you should participate too), today I’m going to highlight one of the foremost EHR professional and technical services company’s blog, Galen Healthcare Solutions which focuses on EHR data conversion.

I know I’ve written about EMR data conversion a number of times before. Although, I haven’t written about it much for quite a while. I guess meaningful use and the EHR incentive money has kind of dominated the conversation. However, there’s much that can and should be said about EHR data conversion.

The first thing anyone should know about EHR data conversion is that it’s not easy. In fact, it’s quite frankly an incredibly painful experience in almost every regard. Just take a look at this blog post summary of the EHR Clinical data conversion process by Justin Campbell of Galen Healthcare Solutions. He summarizes the steps as follows:
* Data Extraction
* Data Analysis: Cross-Referencing
* Design: Data Filtering, Matching (Provider, Patient Item), and Exceptions/Errors
* Testing
* Go-Live

I believe the most challenging item on this list is likely the Data Extraction. Sure, the data analysis and design are a pain to do and do well. However, the data extraction is often the most difficult part of an EHR data conversion, because you’re often working with an unfriendly EHR vendor that has lost you as a customer. Unfortunately, many EHR vendors haven’t heeded my call for EHR data independence, and so it can be a miserable experience trying to get the information and access you need to do an EHR data conversion. In some cases the EHR vendors will try and hold that data hostage.

The key for those selecting an EHR software is to be sure that the process for exporting your data from the EHR is part of your EHR contract. If it’s not, then add it to your contract. If they won’t add it to your contract, there are 300+ EHR vendors to choose from. Certainly it’s a part of the EHR contract that you hope to never have to use. Don’t take that risk.

Justin Campbell has also posted a few different data conversion success stories on the Galen Healthcare Solutions blog. Obviously, Galen has a lot of experience with the Allscripts Professional EHR software and so you’ll note this bias throughout the blog. However, the experience of the conversion is very interesting.

Here’s a paragraph from one of their data conversion success stories: Azalea Orthopedics.

To facilitate this conversion, flat-file extracts were obtained from MedManager for dictionaries, demographics and appointments. However, instead of using these extracts to import into Allscripts PM, an alternative approach was taken in which real-time appointment and demographic interfaces were deployed from the client’s existing Allscripts Enterprise EHR to the new Allscripts PM environment. This offered the flexibility of having the PM data populate real-time. Interfaces were also required from Allscripts PM to Allscripts Enterprise EHR. Thus as part of the go-live, existing reg/sched interfaces from MedManager to Allscripts Enterprise EHR needed to be deployed.

I have to admit that this kind of complexity in healthcare is what drives so many doctors nuts. I’m sure there were some functional reasons that they had to do all these interfaces between the systems. What I don’t understand is why the interfaces need to stay in place after the conversion is complete (at least if I understand it correctly). Did Galen really have to implement an interface between Allscripts PM and Allscripts Enterprise EHR? I’m sure there’s some long history for why this has to happen, but it’s such a terrible design. Certainly this isn’t Galen’s fault, but Allscripts. Interfaces are really great….when they work. When they don’t work, they drive a clinic, the IT person and even the EHR vendor absolutely nuts. I’ll be interested to learn more from Galen about why they did what they did.

I did find their report on the number of transactions processed fascinating:
Demographics: 156,900 processed in 491 minutes (8.18 hours)
Appointments; 313,280 processed in 1570 minutes (26.17 hours)

That’s a lot of data being processed. Can you imagine having to run the 26 hour data conversion twice if you messed it up the first time? Yep, data conversion is a tricky thing and can be very time consuming if you’re not really thorough in the process.

Imagine how much data will be collected 5 years from now with all these EHR implementations happening. Plus, the above data was only appointments and demographics. It doesn’t even include the physicians charting and other clinical data.

Rural Hospital EHR

EHR Penalties after Meaningful Use Failure

EMR Companies, Leveling the Playing Field, and The Eatery: Around Healthcare Scene

Telemedicine, Accenture, and Influenza App – Around Healthcare Scene

Verizon Launches HIPAA-Compliant Cloud Services

HITECH Privacy Compliance Gets Trickier – Meaningful Use Monday

Great Advice – Check Your EHR Bill

EHR Data Extraction and Clinical Conversion

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