Practice Management | EMR and HIPAA

Problems EMRs Don’t (Necessarily) Cause

In publications like this one, we spend a lot of time and energy clubbing EMRs and EMR vendors for the problems they cause. That’s all well and good, but it’s also worth remembering that some of the big problems surrounding medical operations may not be due to EMR use:

* HIPAA carelessness: When someone shouts private medical information across a room, or loses a flash drive or tablet with records on it, or leaves patient records in a public place, you’ve probably got a nasty HIPAA violation. But the EMR almost certainly had nothing to do with it.

* Clumsy office workflow: Sure, introducing an EMR into a clinical setting can screw up existing workflow. But was it working well in the first place? For those whose business falls apart post-EMR, I’d argue “no.” Businesses that don’t do well after an install had jury-rigged processes in place already, I’d argue.

* Patient care slowing down: As with staff workflow, clinical workflow can be discombobulated — badly — by an EMR installation. Learning to fit practice patterns to the system is a big job for most clinicians, and they may slow down significantly for a while. But if the patient care flow stays “broken” it’s likely that there were aspects of the pre-EMR system that didn’t work.

I realize that I might get flamed for saying this, but I’m pretty confident that a goodly number of problems that are laid at the feet of dysfunctional EMRs don’t belong there. And that’s not a good thing.

After all, there are enough poorly designed, trouble-ridden EMRs out there to keep us busy critiquing them for a century or two. Why distract ourselves by adding more to the pile when the real issues may be elsewhere?

Disaster Planning and HIPAA

Written by: Katherine Rourke

When talk turns to HIPAA, most of us are focused on privacy compliance. After all, privacy is a complex, expensive nightmare, and few hospitals or medical practices feel up to the task, so talking through those issues makes sense.

But as blogger Art Gross points out, the HIPAA Security General Rules require more than protecting a patient’s privacy. They also require that ePHI remains available even in the face of disaster. From the rules (courtesy of Gross, emphasis his):

§ 164.306 Security standards: General rules.
(a) General requirements. Covered entities must do the following:
(1) Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.

Apparently, far too few healthcare providers are paying enough attention to this part of the rules. Gross, who is a HIPAA security consultant, says that when he audits organizations, few have disaster recovery or emergency operations procedures in place.

Now, big enterprise IT departments aren’t going to leave disaster recovery out of their planning; it’s simplly part of the drill for any large installation. But the smaller the provider group gets — particularly when you zoom down to one to three-doctor practices — the story changes.

As people who read blogs like this one know, smaller practices aren’t likely to have so much as a single IT staffer on board. Keeping their EMR up and running is enough of a burden. I’m not at all surprised to hear that they aren’t prepared for disasters like Hurricane Sandy, which brought down even large medical centers.

But with HIPAA demanding immediate access to ePHI, doctors won’t have a choice much longer. And hospitals will want to make sure independent doctors aren’t the weak link in the availability chain.

Yes, it’s asking a lot of small practices to make intellligent disaster recovery plans for their EMR, and even more of their hospital partners if they want to keep access to disparate EMRs out there. But there’s just no getting around the problem.

Clinician Adoption of Healthcare Tech, Patient Satisfaction, and Safety: #HITsm Chat Highlights

Written by: Katie

Topic One: What are keys for successful, sustained clinician adoption of healthcare technology?

T1: Key (as with most things) is communication. Need more talk IT to Doc about how to use tech and doc to IT re:what they need #HITsm

— Nanette Nuessle, MD (@DrNanN) November 2, 2012

T1: Clinicians must be able to truly understand the benefits and incentives of adopting this technology. Training is key. #hitsm

— Omnicell (@Omnicell) November 2, 2012

T1: Make sure that #HealthIT serves the provider and the patient, not the other way around: bit.ly/efg6qU #HITsm

— Keith W. Boone (@motorcycle_guy) November 2, 2012

T1: We take the approach of making the new process as simple as the old process.Then you layer benefits on top of that. #HITsm

— docBeatApp (@docBeatApp) November 2, 2012

T1: HIT has to stop looking “bleeding edge” and like a science project and just work. Then the bandwagon will roll. #HITsm

— Peter Gilbert (@PeterNGilbert) November 2, 2012

T1: Help physicians understand that EHR will redefine workflows, and not try to conform old workflows to new technology#HITSM

— Mark James (@cardiologyHIT) November 2, 2012

Topic Two: How can we improve patient satisfaction? #patientexperience

T2: Sign up for portals too difficult, too long. Many portals limit what info is transparent. Patients frustrated #HITsm

— Nanette Nuessle, MD (@DrNanN) November 2, 2012

T2: Answer this question: “What do I do next?” All our minds detest states of confusion. Give clarity wherever possible. #hitsm

— Leonard Kish (@leonardkish) November 2, 2012

T2: Depends on the “we.” Vendors > Usable apps. Clinicians > Engage w/patients. Patients > Engage w/their health. All > Participate. #HITsm

— Jon Mertz (@jonmertz) November 2, 2012

T2: Improve patient satisfaction by looking at the patient as a customer, not a disease. #HITsm

— Peter Gilbert (@PeterNGilbert) November 2, 2012

T2: The preference of the patient is a big deal. Some of us want details, and some just want a pill. Hard position for docs. #HITsm

— jeffrey zinger (@jdzinger) November 2, 2012

#HITsm T2: Patients are interested in #mhealth, too. Educate them on apps that will improve their health. Look at their numbers, progress.

— Julia Weatherby (@juliaweatherby) November 2, 2012

Topic Three: What is #healthIT’s role in patient safety?

T3: Patient Safety is improved by better communication.Technology can improve communication.So, tech can improve pt safety. #HITsm

— EMR, EHR and HIT(@ehrandhit) November 2, 2012

T3 – Health IT the great enabler. My smartphone + better search results + secure email make my engagement as a patient possible #HITsm

— jeffrey zinger (@jdzinger) November 2, 2012

T3: Timely access to results, charts, medical data from anywhere facilitates quick clinical decisions in life threatening situations #HITSM

— Mark James (@cardiologyHIT) November 2, 2012

T3: IT can improve #Patientsafety thru Interop. 2 entire #patient continuum- labs, home, #LTC, #mentalhealth, prisons #HITsm

— Linda Lia (@EMRAnswers) November 2, 2012

Topic Four: When is a low-tech solution better than high-tech?

T4 Low tech is better when it’s something many people have access to or understand – can improve engagement levels #hitsm

— Perficient Health IT (@Perficient_HC) November 2, 2012

#HITsm T4: When is a low-tech solution better than high-tech? Facial expressions touch all important. I agree a hybrid approach is best.

— Lorri Zipperer (@lzipperer) November 2, 2012

T4: When we recognize that the answer to every patient/provider need is not necessarily “there’s an app for that” #hitsm

— Robert Green (@HealthcareNovel) November 2, 2012

T4: I think trick is to realize #healthit allows for new systems not just digitizing old ones. #hitsm

— CLOUDHealth (@CLOUDHealth) November 2, 2012

T4 is wide open – from low-tech #Sandy thoughts to solutions like, a dog which helps an elderly patient go to another level of care #HITsm

— Melissa Cole(@MelissaColeHTR) November 2, 2012

A Smart Approach To Medicine And Social Media

Written by: Katherine Rourke

It’s always a pleasure to touch base with the thoughtful blog (33 Charts) written by pediatric gastroenterologist Dr. Bryan Vartabedian. This time, I caught a piece on how Dr. Vartabedian handles social media communication with patients, and I thought it was well worth a share.

While your mileage may vary, here’s some key ways Dr. Vartabedian handles medical contact online with consumers:

* He never answers patient-specific questions from strangers

As he notes, people generally ask two kinds of questions, patient-specific and non-patient specific. While he’s glad to answer general questions, he never answers patient-specific ones from strangers, as it could be construed that he’s created a professional relationship with the person asking the question.

* He guides patients he’s treating offline

If an existing patient messages Dr. Vartabedian, he messages back that he’d be happy to do a phone call. He then addresses their concern via phone, while explaining to patients how both he and they could face serious privacy issues if too much comes out online. Oh, and most importantly, he documents the phone encounter, noting that the patient who reached out in public.

* He flatly turns down requests for info from people he loosely knows

The only exception he makes is for family and very close friends. In those cases he arranges evening phone time and spends 45 minutes getting facts so he can offer high-quality direction.

I really like the way Dr. Vartabedian has outlined his options here — it’s clear, simple, and virtually impossible to misunderstand. It’s hard to imagine anyone being offended by these policies, or more importantly, having their privacy violated. Good to see!

If you’re a doctor how do you handle your social media interactions with patients?

Where is the Value in Health IT?

Written by: John Lynn

What a powerful question that I think hasn’t got enough attention. Everyone seems to be so enamored with EHR thanks to the $36 billion in EHR incentive money. I seem to not be an exception to that rule as well. Although, at least I was in love with EHR well before the government started spending money on it.

While so many are distracted by the government money I think it’s worth asking the question of where the value is in healthcare IT.

Practice Management software has a ton of billing benefits. Is there a practice out there that doesn’t use some sort of practice management software? I don’t know of any.

Health Information Exchange (HIE) has a ton of value for reducing duplicate tests. Certainly we have challenges actually implementing an HIE, but the value in reducing healthcare costs and improving patient care seems quite clear. Having the best information about someone clearly leads to better healthcare.

Data Warehouse and Revenue Cycle Management (RCM) has tremendous value. RCM is not really sexy, but after attending a conference like ANI you can see how much money is on the table if you deal with revenue integrity. I add data warehouse in this category since they’re often very closely tied together.

Since this is an EHR site, where then does EHR fit into all this? What are the really transparent benefit of using an EHR. I know there are a whole list of EHR benefits. However, I think it is a challenge for many doctors to see how all of those benefits add up. EHR adoption would be much higher if there was one big hair benefit to EHR adoption. Unfortunately, I don’t yet think there’s one EHR benefit that’s yet reached that level of impact. I hope one day it will. Not that it matters right now anyway. Most practices wouldn’t see the benefit between the EHR incentive weeds.

Major EMR Vendor Consolidation On The Verge

Written by: Katherine Rourke

Note: This is a post by Katherine Rourke. Tomorrow watch for a post by John on EMR and EHR where he discusses some of his views on this discussion.

While it may not be immediately obvious, the EMR industry is at a major turning point in its history. Any day now, we’re going to see a bunch of mergers and acquisitions go off like a string of firecrackers, some of which may have a direct impact on your business.

Now, I don’t know how many EMR companies there are out there. In fact, I’m not sure anyone has a precise count. But can we agree that we’re looking at 1,000 or more, no? And, heck, there’s probably thousands of companies pitching practice management + EMR, medication management systems, clinical decision support, apps, mobile health plug-ins to EMRs and so on. Just visualize it all — you’ll get a headache but you’ll doubtless agree that we’re dealing with a raging flood of technology.

And most of it won’t stand alone forever. Every vendor likes to say that their product line has all the solutions, but even the most green sales rep doesn’t really believe that. Smart EMR tech firms and their natural allies are already beginning the mating dance, and quietly but inexorably, hooking up.

Since this isn’t the Wall Street Journal, I’m sure we don’t need to dig into deep financial discussion over this. And anyone who’s a regular reader of this site knows why software companies often buy rather than build the technologies they need to fill out their portfolio.

But I thought it was still worth noting that within, say, 18 months, the EMR world could look fairly different in the following ways:

* EMRs aimed at doctors are overabundant, to put it mildly. I predict that there will be a dozen or so well-publicized failures or buyouts in this space within the next year.

* Big vendors that pitch to both enterprises and medical practices will largely have to pick one,and it’s the enterprise side that will win. If you’re a doctor running a giant company’s EMR, stay in regular touch with your vendor and get their support promises in writing!

* There will be a flurry of mHealth activity, with EMRs that play nicely on tablets in center stage. It’s possible the market will even support another IPO or two this year by EMR vendors if they’re offering a nifty mobile health aspect integrated with their core product.

* Doctors, in particular, risk finding that their product becomes abandonware this year as the market consolidates. Have a Plan B available, and I mean a written plan developed by a consultant or tech-savvy senior member of your team.

So, what else do you think will happen as the market absorbs excess players and recombines relationships?

New Ways Of Leveraging EMRs For Quality Measurement

Written by: Katherine Rourke

Helping to measure care quality is supposed to be one of the best tricks EMRs can do. After all, EMRs can round up data in seconds that would take weeks or months to abstract from a paper chart. More importantly, they can pick up patterns that paper charts don’t contain, such as the speed at which some behaviors take place.

The thing is, most providers are still taking little advantage of EMRs’ quality research functions, according to a new study published in the International Journal for Quality in Health Care. Researchers point out that while EMRs can capture many classes information, most of the time users are limiting themselves to measures lifted from paper-based research studies. They propose creating a new set of measurements known as electronic quality measures, or e-QMs. Here’s how Information Week summarizes the measures:

–Translated e-QMs. Measures designed for use with paper records, such as whether patients with diabetes have received HbA1c tests. These measures can use claims data or information from chart abstraction, as well as EHRs.

–Health IT-assisted. Measures that could be derived from non-EHR data sources, such as blood pressure or body mass index information, but that require EHRs for reporting on 100% of a patient population.

–Health IT-enabled. Metrics that take advantage of an EHR’s features, such as the percentage of abnormal test results read and acted upon by a clinician within 24 hours of receipt, or the percentage of relevant clinical alerts that are acted upon.

–Health IT system management. Measures of how providers use health IT systems, such as the percentage of all prescriptions ordered via electronic prescribing.

–E-iatrogenesis. Measures of patient harm caused at least in part by the health IT system, such as the percentage of patients for whom the wrong drug was ordered because of an error in an e-prescribing system, or the percentage of critical lab findings that did not lead to patient notification.

This sounds pretty neat, and with any luck, most providers will end up using their EMRs to conduct more-thorough measurements of this type. At the moment, though, less than a quarter of all care is “substantially documented,” and only half of U.S. doctors have some form of EHR, according to the researchers.

In the mean time, let’s hope providers who do have advanced EMR installations are taking steps like these. They make a lot of sense.

Few Doctors Ready To Qualify for Meaningful Use

Written by: Katherine Rourke

A new study published in Health Affairs has confirmed what I, at least, have suspected for some time about physicians and their EMRs. The study, which surveyed 3,996 physicians, found that while 91 percent were eligible for Medicare or Medicaid Meaningful Use programs, only 11 percent of those intending to apply had their act together.

Researchers, who analyzed data from the 2011 mail survey supplement to the annual National Ambulatory Medicare Care Survey, found that 51 percent of respondents were planning to apply for MU Stage 1 incentive programs. However, it seems that only 11 percent of doctors planning to apply have a capable enough EMR set-up to support up to two-thirds of Medicare Stage 1 core objectives.

Now, this was not completely unexpected. In the final Stage 1 MU rule, CMS had estimated that 10 to 36 percent of Medicare eligible pros, and 15 to 47 percent of Medicaid eligibles, would end up meeting the agency’s criteria.

And it should be noted, the HealthAffaits authors remind us, that about 124,000 eligibles had registered in 2011, and that CMS had paid out $275 million to 15,000 participants. Also, Medicaid programs paid out about $220 million to about 10,500 physicians.

Still, you can’t bury poor performance like this in a pile of data. Clearly, a program is lacking something important just over 1 in 10 physicians manage to set themselves up for Meaningful Use cash — especially if they were trying hard to do so.

The problem with news items like these is that they don’t get into what’s holding physicians back. It’s actually a bit disappointing that the HealthAffairs study didn’t offer any red meat on the “Why Can’t Doctors Qualify?” issue, as we all know that talking about problems doesn’t make them go away. (I do admit that in the world of public policy at least, simply underscoring a problem gives rulemakers ammunition to dig deeper into an issue.)

Still, I’d love to know what you’re seeing out there in terms of unprepared physicians. Are we talking practices that got fast-talked into buying inappropriate or junky technology? Lack of understanding what they bought? Slow-moving practices that are on the right track?

Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth

Written by: David

Here is a quick look at some of the other articles recently posted on some of the other HealthcareScene.com websites:

EHR and EMR Videos

David Collins of HIMSS Discusses the Course of Global Health at the 2011 mHealth Summit- David Collins, Senior Director of Professional Development at HIMSS, speaks at the 2011 mHealth Summit about HIMSS’ involvement in this year’s Summit, and about how HIT X.0 is affecting the course of Global Health.

Cerner Smart Room Technology Overview Video- An updated view of Cerner’s Smart Room technology. The Cerner Smart Room incorporates technology and workflow software to improve consumer care and clinician efficiency. The Smart Room is powered by CareAwareTM device connectivity architecture.

EHR and EMR Screenshots

These three posts provide numerous screenshots from the DentiMax Dental Practice Management Software. Are there special considerations for a dental practice as opposed to a regular medical practice when it comes to EHR/EMR/PM?

Screenshots from the DentiMax Dental Practice Management Software
More Screenshots from the DentiMax Dental Practice Management Software
Appointment Book Pro Screenshots from the DentiMax Dental Practice Management Software

Smart Phone Health Care

How to Get Physicians Onboard with mHealth- No matter how great an app or device may be, it will be difficult for any developer to be successful if they don’t get some level of buy in from physicians in general. People will always resort back to their physician when it comes to the quality of medical products.

Axial’s Care Transition Suite Wins “Ensuring Safe Transitions from Hospital to Home” Mobile App Challenge- In a recent online discussion I had concerning an article I recently wrote, the point was raised that for an app or device to be successful it must fulfill a need. While I don’t think that it is absolutely essential to success, it certainly makes the path to success much more realistic.

Do You Trust the Cloud for EHRs?

Written by: Neil Versel

A blog post today by Microsoft’s Dr. Bill Crounse got me thinking again about the cloud.

Crounse cited a new CDW poll showing that 30 percent of healthcare organizations could be considered “cloud adopters,” and for good reason. “The flexibility, scalability and lower costs associated with moving certain line of business applications to the cloud are compelling, especially for an industry like healthcare. After all, the primary focus of hospitals and clinics is caring for patients, not running an IT empire. There’s not a CIO, CFO, CEO, COO, CNO, CMIO, or CMO who wouldn’t love to shift some of their IT spending to delivering better care to the communities they serve,” Crounse wrote.

They were more likely to turn to the cloud for “commodity” services such as e-mail, file storage, videoconferencing and online learning. “Moving your ‘commodity’ applications to the cloud is an excellent place to start,” Crounse said. “I’d suggest first reaching out to your health industry peers and professional organizations to get a better sense of who’s doing what. I think when you’ve learned about some of the best health industry practices in cloud computing, you’ll be ready to explore what might be possible in your own organization.

But the fact that 30 percent of healthcare organizations use the cloud means that 70 percent do not. I suspect a lot of hospitals and physician practices still run aging, legacy client-server management systems in-house, just because that’s how people did things when those systems were first installed. As they replace their legacy technology, expect more healthcare organizations to opt for cloud services for these commodity-type services.

And what about clinical services?

At HIMSS11 back in February, Athenahealth honcho Jonathan Bush, a longtime fan of the cloud, told me he wanted to lead the “Cloud Cavalry” into Las Vegas (there’s no better place for an over-the-top spectacle, of course) next winter for HIMSS12. (See the second video for that.) Athenahealth, which has a certified, cloud-based EHR, straddles the line between clinical and administrative, and it’s not alone. I can’t think of a single ambulatory EHR vendor that doesn’t offer at least a cloud option if not a full-fledged SaaS product.

But is the cloud truly reliable for critical applications such as inpatient EHRs? In the wake of April’s Amazon EC2 cloud outage, I can imagine more than a few CIOs, practice managers and, especially, physicians are a bit skittish now.

What do you think?

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Problems EMRs Don’t (Necessarily) Cause

Disaster Planning and HIPAA

Where is the Value in Health IT?

Major EMR Vendor Consolidation On The Verge

New Ways Of Leveraging EMRs For Quality Measurement

Few Doctors Ready To Qualify for Meaningful Use

Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth

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