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Did Meaningful Use Try to Do Too Much?

Posted on February 12, 2014 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I was reading Michael Brozino’s post on EMR and EHR about the Value of Meaningful Use, I was hooked in by his comment that meaningful use standards only went halfway. I’m not sure if this was the intent of his comment, but I couldn’t help but sick back and consider if meaningful use missed the mark because it only went half way.

When I think about all of the various features of meaningful use, it really feels to me like ONC and CMS tried to bite off more than they could chew. They tried to be all things to everyone and they ended up being nothing to no one. Ok, that’s not perfectly correct, but is likely pretty close.

Think about all of the meaningful use measures. Which ones go deep enough to really have a deep and lasting impact on healthcare? By having so many measures, they had to water them all down so it wasn’t too much for an organization to adopt. I’m afraid these watered down measures and standards render meaningful use generally meaningless.

Certainly the EHR incentive money has stimulated EHR adoption. However, could this EHR adoption have had even more impact if it would have just focused on two or three major areas instead of dozens of measures with good intentions but little impact?

In many ways, this is just a variation on my wish that EHR incentive money would have focused on EHR interoeprability. As meaningful use stands today, we’ve made steps towards interoperability, but we’re still not there. Could we have achieved interoperability of health records if it had been our sole focus? Instead, we’re collecting smoking status and vital signs which get stored in an EHR and never used by anyone outside of that EHR (and some would argue rarely inside of the EHR).

The good news is we could remedy this situation. ONC and CMS have something called meaningful use stage 3. How amazing would it be if they essentially through out the previous stages and built MU stage 3 on 2-3 major goals? The foundation is there for MU stage 3 to have an enormous impact for good on healthcare, but I don’t think it will have that impact if we keep down the path we’re currently on.

Yes, I realize that a change like this won’t be easy. Yes, I realize that this means that someone’s pet project (or should I say pet measure) is going to get cut. However, wouldn’t we rather have 2-3 really powerful, healthcare changing things implemented than 24 measures that have no little lasting impact? I know I would.

Side Note: Think how we could simplify EHR Certification if there were only 2-3 measures.

Meaningful Use Program a Success…Depending on How You Measure Success

Posted on January 22, 2014 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The new National Coordinator of Health IT, Karen Desalvo, MD, published a blog post on The Health Care blog that proclaims that the “EHR Incentive Program Is on Track.” Of course, many would argue that it’s her job to be a cheerleader for healthcare IT, but I think this post is an important look at the measures that ONC and HHS have of what they consider a success.

If the goal of the EHR incentive money is just to get doctors and hospitals using EHR software, then indeed it’s been a big success. EHR adoption is through the roof at every level (although, I think they’d like it higher in the ambulatory space). This can’t be argued. The $36 billion in EHR incentive money got healthcare on board with EHR software.

If EHR use is your measure of success, then the HITECH act was a success. However, the goal of the HITECH act wasn’t just EHR adoption. If it was, then we wouldn’t have meaningful use. The goal was for doctors to adopt an EHR and then meaningfully use it. Of course, the jury is still out on whether doctors will follow through on meaningful use stage 2. I’m personally predicting a major fall out from those who attested to MU stage 1 and those that choose to sit out MU stage 2. Certainly Dr. Desalvo argues that this won’t be the case.

Either way, let’s assume that the majority of doctors do attest to meaningful use stage 2. Should we call the HITECH act a success? More pointedly, does meaningful use produce the results we want?

As someone who follows the EHR industry day in and day out, I think the jury’s still out on this. I’ve said many times that I fear the EHR incentive money might have incentivized doctors to adopt the wrong EHR software. The current and future EHR switching will likely prove this out. Although, we’ll see if organizations can get it right the second time.

However, choosing the right EHR is only half of the battle. Even the best tool used inappropriately won’t yield the desired results. There’s a strong case to make that meaningful use forces a doctor to use an EHR inappropriately. Every person at ONC calls this blasphemous and every doctor is likely to agree that meaningful use causes more work and does little to improve care.

I recently heard someone argue that they had “no sympathy for doctors having to accurately, legibly, and cohesively document what is happening.” I think it’s a real challenge to say that meaningful use equates the more accurate, legible, and cohesive documentation. In fact, many of the meaningful use hoops serve to make the documentation more illegible and difficult to read. Not to mention the issue of making the physician less efficient and therefore more likely to cut corners.

In this post, I’m not trying to make the case for or against EHR software. I’ve done a whole series on the benefits of EHR and so I believe that they can provide an amazing benefit to healthcare when implemented properly. My point with this post is that if our government is going to spend $36 billion on EHR software, then I wish they’d spend a little more time making sure that it’s not only implemented, but implemented well.

If they did this, then maybe we could call the HITECH act a real success. As it stands now, we’re using the only metrics we have available: EHR incentive spent and meaningful use attestation. I’d suggest there’s so much more value (both gained and lost) in an EHR implementation than either of those two things measures.

How about we track ways EHR use reduced costs, improved patient care, and saved lives? Maybe they don’t want to track that data because if they do, they won’t like the results. What would they do with meaningful use if they found out it raised costs, hurt patient care and did nothing to save lives? Would anyone want to make the case for why meaningful use should be scraped for something better? I wouldn’t want to as the new ONC chair either.

ONC Offers Guidance on EHR Safety

Posted on January 17, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

ONCHIT has released a new set of guidelines and tools designed to help providers make safer use of EMRs and related technology. ONCHIT calls the set of nine toolkits SAFER, or Safety Assurance Factors for EHR Resilience. (Access the toolkit here.)

According to Healthcare IT News, the SAFER tools include checklists and recommended practices designed to optimize EHR safety.  ONC officials say that this suite follows up on, and forms an important part of, the Health IT Patient Safety Action and Surveillance Plan released by HHS this past July.

The toolkits, which include self-assessment checklists, practice worksheets and recommended practices, include the following topics:

  • High-priority practices
  • Organizational responsibilities
  • Patient identification
  • CPOE and decision support
  • Test results review and follow-up
  • Clinician communication
  • Contingency planning
  • System interfaces
  • System configuration

According to officials, the SAFER guides complement existing health IT safety tools already developed by ONC and the Agency for Healthcare Research and Quality.

The idea behind these guides, it seems, is to bring evidence-based practices to an area which is still evolving rapidly. As things stand, EHR use and workflow development is subject to a lot of guessing, especially as to what pathways work best in getting providers to use EHRs most effectively and safely.

All that being said, hospital executives are eyebrow deep in operational and IT issues related to their EHR, and may be simply too overwhelmed to shift their work processes to adopt these evidence-based tools.  It will be interesting to see, in other words, whether the industry considers these guidelines to be “nice to have” or necessary.

Meaningful Use Stage 2 Extension, MU Stage 3 Delay and New 2015 EHR Edition Certification Proposed

Posted on December 6, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The big news of the week just came out of CMS at 4 PM EST on a Friday. Feels like they’re trying to bury the news story, but maybe it was just the way the timing worked out. Either way, there’s no way anyone who lives in the EHR and meaningful use would miss the announcement (not to mention I’ve already seen it posted on every major health IT news site). CMS is proposing an extension of meaningful use stage 2 another year through 2016 and so that means a delay in meaningful use stage 3 until 2017.

Here’s how Robert Tagalicod, Director, Office of E-Health Standards and Services, CMS and Jacob Reider, MD, Acting National Coordinator for Health Information Technology, ONC described the change in meaningful use timeline:

Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.

Meaningful Use Stage 2 and 3
This shouldn’t come as a surprise to many. In fact, we’d been discussing the possible meaningful use stage 2 extension in the comments of my post: ICD-10 will be delayed. We thought meaningful use delay was possible, and now it’s happened.

I do like that this delay gives CMS and ONC more breathing room to know what to include in meaningful use stage 3. Plus, maybe they’ll get the MU Stage 3 certification requirements out in plenty of time for EHR vendors to be able to update their software.

One thing that is really interesting about this delay is that meaningful use stage 3 won’t go into effect until after the Medicare EHR incentive money is over. The Medicare EHR incentive money is only scheduled to be paid through 2016. Medicaid wasn’t implementing MU stage 3 until year 6, so I expect there’s no change there. While you won’t have to show MU stage 3 for Medicare EHR incentive money, you will have to attest to meaningful use stage 3 in 2017 if you want to avoid the EHR penalties (Payment Adjustments if you prefer CMS’ terminology). In 2017, those EHR penalties will be at 3%.

Many have called for a delay to meaningful use stage 2 as well, but that didn’t happen today.

2015 Edition EHR Certification
The other part of the CMS announcement is the 2015 Edition EHR certification. They propose having an additional 2015 EHR certification that sounds like it would amount to an update to the 2014 edition. The 2015 edition would fix any issues with the 2014 edition and update any changes to interoperability standards. Sounds like an EHR certification patch.

The catch is that EHR vendors that are 2014 Edition EHR certified wouldn’t have to do 2015 Edition. This is good since we don’t need software vendors having to certify again (as much as certifying bodies would love the new revenue). Although, I won’t be surprised if most EHR vendors take the new standards in the 2015 edition and update their software to those standards. Let’s just hope that if they choose to do so, it doesn’t kill their 2014 Edition EHR certification. We should all be using the latest and greatest standards. Even more important, we need to all be on the same standard.

What do you think of the announcement? I look forward to hearing your thoughts in the comments.

See Also:
HIMSS Response – HIMSS Supports Stage 2 Extension
CHIME Response – Meaningful Use Timeline Shift Does Not Afford Flexibility in 2014

TURF: An EHR Usability Assessment Tool

Posted on October 22, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Carl Bergman from EHR Selector.

To paraphrase Mark Twain, everyone talks about EHR usability, but no one does anything about it, at least until now. Led by Dr. Jiajie Zhang, the University of Texas Health Science Center at Houston’s National Center for Cognitive Informatics and Decision Making (NCCD) has developed several tools for measuring usability.

Now, Zhang’s team at NCCD has put several EHR usability tools into a Windows based app, TURF, an acronym for Task, User, Representation, Function. Funding for the project comes from ONC’s Strategic Health IT Advanced Research initiative.

TURF’s Tools. TURF has two major tools, Heuristic Evaluation and User Testing:

  • Tool One. Heuristic Evaluation: Expert Screen Capture and Markup. This tool takes EHR screen snapshots and let you compare them to usability standards. You can markup the screen and document the problem.
    Turf Expert Markup Tool - Showing Problem and Documentation
    For example, you can note if the error is minor, moderate, major or catastrophic. The system has a review function, so others can look at your markup and comment. The system also compiles your edits and can generate various statistics.

    • Administration. To work with groups, the system has several preset admin template forms and a template editor. The furnished templates cover these areas:
      • Demographics
      • Expert Review
      • Performance Evaluation, and
      • System Usability. This form asks 10 questions about the EHR, such as:
        • I think I would like to use the system frequently,
        • I thought there was too much inconsistency in this system,
    • Standards. The system uses the National Institute of Standards and Technology’s (NIST) EHR usability protocol, NISTIR 7804. You may also add your own rules to the system. (Also, see EMRandEHR.com, June 14, 2012.)
    • EHR Sections. Using the NIST protocol, the system’s review areas are:
      • Clinical Decision
      • Clinical Information Reconciliation
      • Drug-drug, drug-allergy interactions
      • Electronic Medical Administration
      • ePrescribing
      • Med – Allergies
      • Medications list
      • Order Entry
      • User defined
  • Tool Two. Live Session Testing. TURF’s user test tool sits on top of an EHR and recording each movement. TURF’s designers have created a system that not only tracks use, but also adds these major functions:
    • User Sessions. TURF captures live screens, keystrokes, mouse clicks and can record a user’s verbal comments in an audio file.
    • Administration. The tool is designed for testing by groups of users as well as individuals. It captures user demographics, consent forms, non disclosures, etc. All of these can be tailored.
    •  Testing for Specifics. TURF allows managers to test for specific problems. For example, you can see how users eprescribe, or create continuity of care documents.
    • Comparing Steps. Managers can set up an optimum selection path or define the steps for a task and then compare these with user actions.
    • Reporting. TURF builds in several counting and statistical analysis tools such as one way ANOVA.

  • Running TURF. TURF isn’t your basic run and gun app. I downloaded it and then tried to duff my way through, as I would do with most new programs. It was a no go. Before you can use it, you need to spend some time setting it up. This applies to both its tools.

    Fortunately, TURF has about 30 YouTube tutorials. Each covers a single topic such as Setup for Electronic Data Capture and runs a minute or so. Here’s what they cover:
    Turf Tutorials Screen
  • Hands On. Installing TURF was straightforward with one exception. If you don’t have Microsoft’s .Net Framework 4.5 installed, put it up before you install TURF. Otherwise, the install stops for your to do it. TURF will also want the Codex that it uses for recordings installed, but the install deals with that.

    TURF is a Windows program, so I ran it in a virtual Win 7 session on my iMac. Given the environment, I kept the test simple. I ran TURF on top of a web based EHR and had it track my adding an antibiotic to a patient’s meds. TURF stayed out of the way, recording in the background.

    Here’s how TURF captured my session:
    Turf Playback Screen
    The left side screen played back my actions click for click. It let me run the screen at various speeds or stop it to add notes. The right screen lists each move’s attributes. You can mark any notable actions and document them for review by others. You can save your sessions for comparisons.

I found TURF to be a versatile, robust tool for EHR usability analysis. Its seeming complexity masks an ability to work in various settings and tackle hosts of problems.

If you aren’t happy with your EHR’s interface, TURF gives a remarkable tool to show what’s wrong and what you want. Indeed, with some adaptation you could use TURF to analyze almost any program’s usability. Not bad for a freebie.

Eyes Wide Shut – Is This Meaningful Use?

Posted on September 25, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Again and again, I find myself expounding upon the need to differentiate between the “letter of the law” and the “spirit of the law” of Meaningful Use Stage 2. I believe whole-heartedly in the transformative power of health IT, and support the future vision of the Meaningful Use objectives of patient empowerment and nationwide standards for records transmission and interoperability. The spirit of the “law” is a revolutionary movement towards a technology-enabled, patient-centric healthcare system, where clinical data can be shared and consumed instantly, whenever patient desires or requires it.

The letter of the “law” is daunting, and its implementation could be seen as not only counter-revolutionary, but detrimental to the very patient population it is designed to engage and empower.

Consider this acute care scenario:

You’re a hospital healthcare provider, discharging a patient, in compliance with the patient-specific education and Summary of Care measures. You log in to your EMR, complete the discharge instructions in the correlated workflow, print the discharge summary and any condition-specific educational information for the patient, revisit their room to insure that they can review the instructions and ask any questions, and you’re on to assessing the condition of the next patient in need of care. Right?

How many times did you have to close the “patient-specific education” suggestion windows that popped up, alerting you to available materials for download, keyed off diagnosis codes or lab results?

How many minutes did you spend looking for the HISP address of the patient’s cardiologist, so you could transmit the Summary of Care document to them via the Direct module of your EMR? How many clicks did you have to use to FIND the Direct module in your EMR? And how many minutes did you spend cursing the ONC for requiring Direct for Summary of Care transmission for 10% of your discharged patient population when the cardiologist’s address was rejected by the Direct module, giving you a message that the receiver is not DirectTrust-accredited?

How much time did the discharge process take you before your facility decided to attest to Meaningful Use Stage 2? How much time does it take you now?
Consider this ambulatory care scenario:

You’re support staff for a general practitioner, who is deploying a patient portal in support of patient engagement measures. At check-in (or check-out), you provide the patients with the URL for enrollment and access, give them information on the benefits of having their medical records available electronically, encourage them to communicate electronically with their provider with questions or concerns, and you send them on their empowered and engaged way.

How many minutes did you spend validating each portal account owner’s identity once their enrollment request came? How many minutes did you spend validating the relationship of the portal account owner to each of the patients he/she requests to associate with the account? How did you document the due diligence done to insure no medical records are improperly released per HIPAA and other federal guidelines, as in the case of custodial disputes, behavioral health patients, or emancipated minors?

How many minutes did you spend walking patients through the enrollment, login, medical records view, and secure message functions? How much time did you spend answering questions from patients about the portal, rather than the health concerns that prompted the visit?

How much time did the check-out process take before your GP decided to attest to Meaningful Use Stage 2? How much time does it take you now?

In both of these scenarios, did you or the patient see any measurable difference in care as a result of the EMR’s new functionality?

Now, consider the aggregate of these scenarios over an entire day – dozens of encounters, dozens of clicks, dozens of minutes spent engaging the EMR to record requisite “clicks” for attestation numerator reporting, rather than engaging the patient.

Is this meaningful use of a healthcare provider’s time and energy? Is this meaningful use of health IT, meeting very specific targets to obtain finite objectives rather than enabling innovation and deriving best practice long-term solutions?

Is this what the ONC intended?

Model Notice of Privacy Practices (NPP) Released by OCR and ONC

Posted on September 20, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The HIPAA Omnibus Rule compliance date is on Monday. Are you ready?

I’m sure the answer for most organizations is NO!

In fact, the real question that I hear most organizations asking is what they need to do to be compliant with the new HIPAA omnibus regulations. One of my more popular video interviews was on the subject of HIPAA Omnibus with Rita Bowen from HealthPort. That might be one place to start.

OCR and ONC recently released some model HIPAA Notice of Privacy Practice forms to help with compliance. Why they are just releasing them a week before organizations are suppose to be compliant is a little puzzling to me. Hopefully your organization is well ahead of the game on this, but you could still compare your Notice of Privacy Practices with the model forms they released.

David Harlow from the Health Blawg wrote the following about the model forms:

I was disappointed, however, with one of the examples given in the model NPP:
*You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
*We will say “yes” to all reasonable requests.

Telephone and snail mail are nice, but many patients would prefer to be in contact with their health care providers via text message or email. Both modes of communication are permitted under HIPAA wth the patient’s consent (which may be expressed by simply emailing or texting a provider), but if the NPP doesn’t alert patients to that right, then many will never be aware of it.

As I heard voiced at a healthcare billing conference yesterday, “You have to be HIPAA omnibus compliant on Monday. I’m not saying you should spend your whole weekend making sure you’re in compliance. The HIPAA auditors won’t be knocking your door on Monday, but you better become compliant pretty quickly if you’re not already.”

ONC Cartoon with Homage to Farzad

Posted on August 9, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, someone who calls themselves HIT Sprite sent me a cartoon that looks at ONC dealing with the recently announced departure of Farzad Mostashari. You might not get the cartoon if you don’t know Farzad and ONC well, but for those who live, eat, breathe and sleep health IT, I think you’ll enjoy it.

ONC Cartoon 1
ONC Cartoon 2
ONC Cartoon 3

While not completely accurate, Farzad’s quirks have grown almost as large as his efforts to change healthcare. Will Farzad be better remembered for his bowtie or his work to move healthcare IT forward?

Can Healthcare “Step on a Scale” Today?

Posted on August 1, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the Healthcare Forum, Dr. Farzad Mostashari posited an important question: Can healthcare step on a scale today?  Embedded in this question is the idea that healthcare should have a simple way to measure the quality of care it provides.  Dr. Mostashari suggested that most practices today can’t step on the proverbial scale.  However, the technology is now available for us to measure and track how well we are doing at providing care.

The problem with stepping on the scale is that the feedback it provides can often be difficult to accept.  Our normal first response to stepping on the scale is to exclaim, “this scale must be broken.”  Dr. Mostashari suggested that “There isn’t a healthcare provider in the world who doesn’t think they’re doing better than they are.”  This isn’t a condemnation of the healthcare providers, but a simple reality of our own self evaluations.  The way to solve this reality distortion is to provide trusted data which illustrates the realities of the situation.

This proverbial “scale” isn’t some high level concept, but is part of a major shift that’s happening in healthcare measurement and payment.  Dr. Mostashari said that “Reimbursement will be tied to how well we manage a population.  People will have to answer, ‘How am I doing?'”  This shift in payment models is happening quickly and healthcare IT will be the tool that measures our progress in key healthcare quality measures.  We must have the courage to step on the scale and face the reality of our baseline metrics.  We must set goals and take action to improve our performance.

The unique promise of technology is that it can make things better.  One of the core beliefs of Dr. Mostashari and his predecessor, Dr. Blumenthal, is the equation:  man + computer > man

Dr. Mostashari offered some high level ways that technology can help to improve healthcare.  He said, “What we need isn’t necessarily big data in the sky.  We need small data in every interaction we have.  We need to learn from the healthcare interactions and learn from what we’re doing.”  What a drastically different view of health data than what we often see in the market today.  We are collecting a lot of data, but are we using that data in ways that will improve care?  This is the promise of technology in healthcare.

Another way technology could be used to improve healthcare was described as learning as we deliver care.  Think about putting together an A/B trial for emails or letters sent to patients who need to return back to the office.  We can take these care experiences and learn from them.  Our hospital CEOs know what our length of stay is to multiple decimal points, but does our CEO really know what population health management will do for our workflows?

Healthcare is no longer an individual sport.   Healthcare is now a team sport that will require interoperability of healthcare data.  The purpose of clinical notes are no longer short notes for myself or long notes for the CMS auditors, but are data to be used to improve care.

Healthcare improvement needs to happen across the spectrum.  This includes improvement at the community, practice and personal level.  The shared values of health IT are that healthcare can be better, data is the key to making it better, and an optimism that the future will be better than today.  As Dr. Mostashari concluded, “We can use information and tomorrow will be better, faster, and cheaper than today.”

Check out the full Healthcare Forum presentation by Dr. Farzad Mostashari embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Missed Patient Portal Changes to MU Stage 1

Posted on July 8, 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s fun to have this post on Monday since we did a few years of Meaningful Use Monday posts. This actually comes from a regular reader of EMR and HIPAA who works at an EHR vendor. He wanted to point out a change to meaningful use stage 1 that they’d missed. I expect there are likely others that might have missed this change as well.

Practices attesting stage 1 in 2014 for their year one or two must have the Patient Portal. ONC made a change and made the menu item Core for this in Stage 1. We thought it was stage 2 only. I reached out to a dozen or so REC consultants we work with and more than half of them had missed this point also.

CMS replaced the Stage 1 objectives for providing electronic copies of (CORE) and electronic access to health information (MENU) with the objective to provide patients the ability to view, download, or transmit their health information.

This means that any provider attesting to Stage 1 MU in 2014 (either Year 1 or Year 2) must attest to the objective: “Provide patients ability to view download and transmit their health information.” This will be a CORE measure and will require the portal.

More information is available on page 3 of this
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

Looks like we’re going to have more patient portals in place really soon. Is your organization ready with a patient portal to meet this meaningful use measure?