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2018 Practical Innovation Award Winner: ENGINUITY

Posted on July 25, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

As the vision for the Health IT Expo came into view, we realized how valuable it was for the Health IT Expo community to learn about and share practical innovations that were happening in healthcare IT. As part of that effort, we announced the 2018 Practical Innovation Awards. Being the first year, we only had a short time to promote it and get the word out about it. With that said, we’re extremely pleased with the practical innovations that the 2018 Practical Innovation Award Winner has brought to the healthcare IT community and we’re excited to share those with you.

So, without further ado, we’re excited to announce the 2018 Practical Innovation Award Winner is ENGINUITY run by Kelly Del Gaudio, Principal Consultant, Galen Healthcare Solutions and was implemented at Freeman Health System, Valley Health System, and Canton – Potsdam Hospital System. This is a well-deserved honor for Kelly Del Gaudio and the team that worked on this project. Congratulations!

While awards and recognition are great, they don’t mean much if we don’t share the details of the practical innovations that won the award. In order to share more details about ENGINUITY (originally named Project Claire[IT]), we thought an interview with Kelly Del Gaudio would be a great way to share what they accomplished and hopefully help to spread their experiences, insights, and innovations.

Tell us about Project Claire[IT].  How was it started and who was involved?

Project Claire[IT] was what we originally called ENGINUITY. It was a project in honor and memory of my friend and Rule writing mentor at MEDITECH, Claire Riemer. Claire was the original pioneer of the MEDITECH rules engine and led the Clinical Content group there for many years.

The idea for this project started about a few months after I came on as the Principal Consultant for MEDITECH at Galen Healthcare Solutions. Since I had a lot of experience with the MEDITECH Rules engine from people like Claire, and working on a Clinical Optimization Performance Team during my 10 years at the “Tech”, I decided to host a free “Rule Writing 101” webinar that would give users a basic understanding of the MEDITECH Rules engine and offer tips and tricks on how to write some basic rules. We were surprised when we saw the signup list the day of the webinar (which ended up being our highest attended to date), and soon after, the flood gates opened with questions from MEDITECH users asking for help with Rules they’ve been stuck on for weeks, months and sometimes years!

Many of the questions we received were similar (people needing help with calculations, VTE compliance, Problem List Management etc) so we thought maybe we could streamline the process and write the complex rules that everyone seems to need for them; or as we call it: Doing their NerdyWork. Galen was no stranger to this as we have been successful in creating and delivering a similar solution to our Allscripts clients called eCalcs.

I knew I had the unique skill set to write the Rules that these customers needed, but not being a nurse or clinician by trade (although I can occasionally fake it til’ I make it) I knew I needed their help to understand exactly what their frustrations were from both a clinical and IT perspective. The only logical conclusion was to host a focus group, and so our first Galen Focus Group: Operation NerdyWork was born.

Operation NerdyWork was a group of nine MEDITECH hospitals all running MEDITECH’s 6.x/6.1 or higher platform. They represented various areas of the country, from cities to rural/remote, from large Health Systems to small Critical Access satellites. It seems that no matter how big (or small) your IT staff was, the Rules Engine was a bit of a black box for everyone.

Here is our elite nine:

  • Catholic Health Initiatives
  • Salinas Valley Medical Center
  • Randolph Hospital
  • Uvalde Memorial Medical Center
  • Freeman Health System
  • Canton-Potsdam Hospital
  • Peterson Reginal Medical Center
  • Calvert Memorial Hospital
  • Parkview Medical Center

These groups offered their time on Thursdays during the winter of 2016 and provided us with valuable insights into the world of a MEDITECH doctor, nurse, care provider, or pharmacist. From their list of frustrations, we got to work building better, rule driven workflows that will save time, reduce clicks, increase compliance and patient safely and present users with much needed clinical decision support.

We decided to call our platform ENGINUITY because we use the MEDITECH Rules Engine to code a lot of our custom content. It’s also a derivative of the word ingenuity which is the quality of being inventive, clever, resourceful; thinking outside of the box. We pride ourselves on coming up with really clever ways to achieve something that may otherwise be “Working as Designed”. ENGINUITY continues to be crowdsourced and we receive suggestions every day from users of our content. MEDITECH customers drive the future direction of this product because hey, they’re the one that have to use it right?

What have been the practical benefits of this project?

Practical Innovation is all about solutions that can be implemented now that bring value to an organization. We think we are doing just that.

By streamlining the lengthy design process that many of these rules take to write and creating a plug and play solution that has been tested, validated, and thoroughly researched, we can confidently help hospitals achieve optimal compliance, increased patient and provider satisfaction, EMR confidence, realize revenue gains and so much more. If you wanted to implement some of these complex tools outside of ENGINUITY, not only would you need at least one full time dedicated FTE on these projects, but that person would need to have an advanced Rule writing skill set which is not easy to find. You would also need to keep those people on staff to troubleshoot Rules that are subject to change during much needed updates or future workflow changes.

I actually spoke with a client at last year’s MUSE conference who told me that their resident “Rules” person was about to retire so they stopped optimizing their system because she was the only one who could support it. I used this anecdote the next day at our official launch presentation and realized that this was more common than I thought. Rules are complex and there are a lot of unknowns but they are far and away the most efficient way to optimize the your MEDITECH system which is why everyone should have them!

ENGINUITY makes these options an affordable reality for many organizations that simply don’t have the time, capital or resources. The Galen team supports all of our content post-implementation, so our clients can worry about daily system support and education.  ENGINUITY customers also determine “what’s next” in our dev cycle and are always receiving the fruit of our development efforts keeping their system optimized, refreshed and functional for years to come.

What were the keys to success with this project? 

I attribute the success of this project to 5 main things.

  1. First, having a deep understanding of the technical underpinnings of the MEDITECH Rules Engine is crucial to the success of ENGINUITY. I have always been fascinated with trying to figure out this puzzle and I continue to learn more about it daily. For me, it’s fun; for most, its frustrating. Thank you Claire Riemer, Ginny Jacques and Nancy McGowan for teaching me this craft.
  2. Second, having the support of the Galen Healthcare Solutions team. They let me run with this idea to design, develop and mass deliver content to clients who need it and they’ve fully supported it through its infancy to now. We are KLAS ranked and on Modern HealthCare’s Best Places to Work for a reason and I know working at Galen was one of the best decisions I have ever made. I firmly believe that autonomy, support and confidence is really what helps innovation to thrive.
  3. Third, our focus group. They are the ones who brought the ideas to the table and got the ball rolling. Thank you Operation NerdyWork!
  4. Fourth, our ENGINUITY clients who push us and challenge us with new puzzles every day. Their challenges (though sometimes daunting) make us better in the long run.
  5. Finally, getting the word out in major healthcare IT publications! Having published articles that recognize our unique approach to customer collaboration and feature our MU3: Measure 3 content really help to spread the word about what we’re doing.

How does this project impact patients?

We put a lot of effort in the design process of a workflow to make it easy for the doctor/user to use. Many of our tools are “single-click” meaning that as soon as I “click” on something (a query or order) then the algorithm will “fetch” necessary data and bring that to the providers attention immediately. We can suggest, require, suppress or automate responses based on preexisting information which makes ENGINUITY very patient centric. This added clinical decision support is embedded directly into the MEDITECH system (not 3rd party) which significantly increases the confidence that users have in the messages they are receiving. We can then use a combination of hard stops, soft stops, alerts and audit trails to increase patient safety across the board.

We’re currently working on a case study of before and after Implementation of our VTE Compliance protocol, which was designed using the AHRQ’s Best Practice recommendations for VTE Prophylaxis compliance. It is estimated at increasing organizational compliance to over 90% which will significantly impact the lives of many surgical inpatients.

I also worked with some of our product development folks from our VitalCenter Online Archival team to create a way to have Rules evaluate patient Problems and drive care off the Problem List. From my research, this is not just a MEDITECH problem, (pun intended) but it spans across all EMRs leaving most Problem Lists “static”. We are changing that for our MEDITECH clients by driving and automating care off the Problem List making it a truly “dynamic” list.

You call the effort “Operation NerdyWork”.  What’s been your experience getting “nerds” together to collaborate on a solution like this?

Operation NerdyWork was all about bringing a diverse group of people together with some commonalities (trades, users of MEDITECH) and working together toward a common goal. Listening to each other’s pain points and sometimes even solving each other’s problems without my help at all (which was really fun to see). Everyone brought a unique voice to the table. As innovators, the best we can do is shut up and listen, hear what people want and develop what they need.

What practical advice would you give health IT professionals that will help them be more successful in their work?

Find something you’re good at, something you’re passionate about, something that keeps you up at night but also helps you rest easy knowing you could be a part of the solution. When you’ve found it then surround yourself with supportive people and get busy on the Nerdywork.

A big Congratulations to the 2018 Practical Innovation Award Winner: ENGINUITY

Physician Burnout, a Healthcare Issue Unique to Our Healthcare Providers

Posted on May 25, 2018 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.

I Can’t Get No Satisfaction…but I try, and I try, and I try, and I try – Rolling Stones

Justin CampbellIn a 2018 Medscape survey exploring the professional satisfaction of providers, 42 percent of 15,000 survey respondents reported feeling burnt out with their jobs, up from an overall rate of 40 percent in 2017. In recent years, physician burnout has become a serious industry issue, with national policy discussions ensuing on how to best combat the problem. Researchers have drawn correlations between physician burnout and higher medical error rates, lower overall quality of care, and increased clinical staff turnover. Year after year, the underlying drivers of dissatisfaction have remained consistent: overwhelming charting requirement, long work hours, and cumbersome EHRs.

As health IT leaders, one question we should be asking ourselves is how we can best apply our EHR expertise to help reduce physician burnout. To answer this question, let us look to the doctors we aim to help. When physicians are at the bedside, they analyze a patient’s condition and formulate a care plan accordingly. They look to diagnostic test results, review trended vitals, pain scores, and nursing assessments, and consult with specialists in a massive data gathering exercise all aimed at quantifying the problem and crafting a treatment plan.

Providers are telling us there is a problem, and they are consistently identifying the primary underlying causes. IT department leaders have a direct influence over many of the drivers of physician burnout, so it is time for us to dig into the details, measure the problem, and craft a treatment plan. How do we measure and manage physician burnout?

There’s Gold In Those EHR Audit Logs

The Office of the National Coordinator’s EHR Certification Requirements mandate that all certified EHRs be capable of generating an audit log detailing all user activity, stored in a database alongside user credentials and a date and time stamp. At first glance, these unassuming audit logs appear to provide little actionable insight, but buried in the data there is value. When audit logs are compiled across several months, data analysts will quickly see that they have a rich dataset that can be sliced and diced to expose the EHR navigation and module utilization trends of key physician populations.

Analyzing patterns within EHR audit logs will allow savvy data analysts to determine the average length of time providers spend working in the EHR. This information can be calculated at the individual level or aggregated across all providers.

Source: Galen Healthcare Solutions

Knowing how long providers are spending on administrative tasks in the EHR is valuable information for a number of reasons. First and foremost, this information can be used as a benchmark to measure the impact of future software updates or optimization projects. Any significant changes to provider workflow should be retrospectively reviewed to understand how it impacts the average time providers spend in the EHR. First, do no harm.

Analyzing user activity logs at the individual level also helps identify highly efficient EHR users within each specialty. The EHR workflow patterns of these EHR champions can be modeled. Peers can be educated on how to adjust their own workflows to mirror specialty-specific champions, reducing their own daily EHR burden. These “quick win” workflow adjustments are changes that can be adopted by clinical staff immediately, before extensive EHR optimization efforts are undertaken.

Audit log analysis can also highlight which EHR modules providers spend the most time in. In most cases, updating user preferences and optimizing the information displayed on EHR screens can expedite chart navigation. Simplified documentation templates and macros training can expedite the documentation process. A library of evidence-based order sets and targeted clinical decision support algorithms can minimize time spent entering orders.

Analyzing utilization trends at the EHR module level exposes the workflow tasks that are consuming a disproportionate amount of provider time.

Don’t. Stop. There.

EHR audit log analysis can reveal how much time providers are spending in the EHR, and where specifically they are spending that time. It can identify physician champions, and highlight those that are struggling. Audit log analysis can be used to measure EHR-induced physician burnout and support system-wide optimization efforts aimed at improving satisfaction.

Beyond this, EHRs offer a wealth of additional datasets that can help highlight inefficiencies in clinical workflows. Traditional health IT data analytics typically aims to uncover problems in care quality or revenue cycle management, but analysis focused on EHR workflow improvement is just as noble an effort, and one providers have long been seeking.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement & data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and Gold sponsor of Health IT Expo. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on TwitterFacebook and LinkedIn.

 

HIMSS17: Health IT Staff, Budgets Growing

Posted on March 1, 2017 I Written By

Anne Zieger 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.

A new study announced last week at the HIMSS17 event concludes that demand for health IT staff continues to grow as employers expand their budgets. Not surprisingly, given this growth, the healthcare employers are having trouble recruiting enough IT staffers to meet their growing needs.

Results from the HIMSS Leadership and Workforce Survey reflect responses from 368 U.S. health IT leaders made between November 2016 and early January 2017. Fifty-six of respondents from vendors and consulting firms were in executive management, as compared with 41% of providers.

The survey concluded that the majority of health IT respondents have positions they’d like to fill, including 61% of health IT vendors/consultants and 43% of providers who responded. Only 32% of vendor/consultant organizations and 38% or providers said they were fully staffed, HIMSS said. We’ve seen this challenge from many of the healthcare IT companies which post their jobs on Healthcare IT Central.

Demand for IT recruits grew last year, as well. Researchers found that 61% of vendors/consultants responding and 42% of providers responding saw IT staffing increases over the past year, and that the majority of respondents in both groups expect to increase their IT staffing levels or at least hold them steady next year.

Of course, someone has to pay for these new team members. HIMSS researchers found that IT budgets were continuing to rise over time. Roughly nine out of ten vendors/consultants and 56% of providers said they expected to see increases in their IT budgets this year.

As often happens, however, vendors and consultants and providers seem to have different HIT priorities. While vendors seem to be addressing new technology issues, providers are still focused on how to manage their existing EMR infrastructure investments, HIMSS said.

That being said, the survey found, health IT stakeholders have many overlapping concerns, including privacy and security, population health, care coordination and improving the culture of care.

One of the key insights from this study – that vendors/consultants and providers have different views on the importance of enhancing existing EMRs – is borne out by another study released at the HIMSS event.

The study, which was backed by voice recognition software vendor Nuance Communications, found that providers are broadly interested in implementing new technologies that enhance their EMR, especially computer-assisted physician documentation, mobility and speech recognition tools.

However, when asked to be specific about which tools interested them, they were less enthusiastic, with 44% showing an interest in mobility tools, 38% computer-assisted physician documentation and 25% speech recognition. Documentation tools that enhanced existing functions were especially popular, with 54% of respondents expecting to see them support a reduction in denied claims, 52% improved performance under bundled payments, 38% reduced readmissions and 38% better physician time management which improves patient flow.

This survey also found that the most popular strategy for enhancing physician satisfaction with health IT tools was providing clinician training and education (chosen by 82%). Since their EMR is probably their biggest IT investment, my guess is that the training will focus there. And that suggests that EMRs are still the center of their universe, doesn’t it?

Health IT Jobs Data Yields A Few Surprises

Posted on February 25, 2016 I Written By

Anne Zieger 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.

After taking a look at a pre-release copy of a new report chronicling trends in the healthcare IT staffing world (The full report will be released during HIMSS), I’ve realized that many of my assumptions about the health IT workforce are wrong.  The report, from specialist technology recruitment firm Greythorn, offers a useful look at just who makes up the healthcare IT workforce and how they prefer to work, but just as importantly, how health organizations are treating them.

To collect its data, the recruiting company surveyed 430 U.S. IT professionals over Q4 2015. Greythorn focused on factors that define the healthcare pro’s work experience, including the demographics of the HIT workforce, length of tenure, hours in a typical work week, career motivation and reward/bonus trends.

More than one item in the report surprised me. For example, despite last year’s ups and downs, 84% of respondents reported feeling optimistic or extremely optimistic about healthcare IT, up from 78% the previous year.

Also, some of the demographics data caught me off guard:

  • 59% of respondents were female, while only 41% were male. I couldn’t dig up a stat on the overall makeup of the US HIT workforce, but my best guess is that it’s still male-dominated. So this was of note.
  • Also, 52% of respondents were between 43 and 60 years old, though another 24% of respondents were 25 to 34 years old. On level it makes sense, as health IT work takes specialized expertise that doesn’t come overnight, but it bucks the general IT image as a haven for young hopefuls.
  • I was also surprised to learn that only 40% of respondents were employed full time,  On the other hand, given that consultants and contractors can earn 50% to 100% more than full-timers (Greythorn’s data), it’s actually a pretty logical development.
  • Greythorn found that 43% of respondents were working 41 to 45 per week, not bad for a demanding professional position. On the other hand, 21% report working 46 to 50 hours, and 10% more than 60 hours.

The report also served up some interesting data regarding HIT hiring and staff headcount:

  • 39% of respondents said that they expected to increase headcount, perhaps signalling a move away from implementing big projects largely with contractors. On the other hand, 24% reported that they expected to cut headcount, so I could be off base.
  • On the flip side, only 9% said that they expected to see significant headcount losses, with 33% asserting that headcount would probably remain the same.

When it came to technical specializations, the results were fairly predictable. When asked which EMR system they knew best:

  • 55% of respondents named Epic
  • 19% named Cerner
  • 5% named Meditech
  • 3% named Allscripts and McKesson
  • 14% cited “other”

Finally, given that many of the survey respondents seem to cluster at the high end of experience levels, I was intrigued to note the wide spread in salaries, which ranged from less than $50K per year to to more than $160K. Some of the most interesting numbers, included the following:

  • 20% reported earning $50K to $69,999
  • 21% were earning $100K to $119,999
  • 6% reported earning more than $160K

To my way of thinking, it doesn’t make sense that 53% of  health IT pros  — many of whom reported being fairly senior, were making less than $100K per year.

Sure, health organizations’ budgets are stretched thin. But skimping on IT pay is likely to have a negative impact on recruitment and retention. As we cruise into 2016, let’s keep an eye on this problem. I doubt junior- to mid-level salaries will attract the hard-core HIT veterans needed to transform health IT over the coming years.

Note: Healthcare Scene helped promote this survey and Greythorn pays to post its healthcare IT jobs to our healthcare IT job board.

For Health IT Opportunities, Look to the Chaos

Posted on October 9, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Sunnie Southern, founder and CEO of Viable Synergy, spends her days pushing for health IT innovation. Her firm provides products and consulting services for commercialization and community engagement. One of its best-known projects is Innov8 for Health, a Cincinnati-based tech accelerator. Southern, a registered dietitian who started her firm in 2010, talked about her work and about EMRs — as they are and as they could be.

Sunnie Southern

What does Viable Synergy do?

Viable Synergy specializes in commercializing assets that transform health. It offers consulting services and proprietary products that support the development and deployment of innovative health solutions from concept to customer. This year and next, Viable Synergy is focused on the institutional market by helping hospitals and provider organizations to generate new (non-clinical) revenue from currently available assets.

You are part of the Health Data Consortium. What is that?

The Health Data Consortium is a collaboration among government, non-profit and private sector organizations working to foster the availability and innovative use of data to improve health and health care.

Viable Synergy leads the Ohio Affiliate of the Health Data Consortium through our Innov8 for Health program. HDC Affiliates host events and build local networks of groups including startups, entrepreneurs, health companies, universities, government agencies and other innovators to create an ecosystem around using open data to improve health outcomes for individuals and communities.

Do you think EMRs are reaching their potential in improving health?

We are at the very beginning of a new era of leveraging technology to improve health and care and reduce costs. EHRs are an essential component of gaining access to health data to make better decisions.

What is missing from the equation?

Time. We need time to bring the plans to fruition to increase engagement and activation.

The essential elements are in place:

  • Standards that provide direction on necessary features and now interoperability/accessibility (MU2)
  • Incentives to increase purchase, implementation and meaningful use
  • Awareness within the health care community and beyond about the importance of ensuring that providers and patients have access to the critical information they need to make informed decisions

What goals do you think we should be prioritizing in health IT right now?

Interoperability, integration and convergence. There are so many places that providers and patients must go to access critical information that it is difficult to get a complete picture of a patient’s history or a physician’s patient population. I hope that we will begin to see tools that allow for data to be aggregated from multiple sources and provided in an easily consumable fashion. We’ll also need the appropriate regulations to secure and support the aggregation.

What’s the most exciting thing you see happening in health IT at the moment?

The whole system is being turned inside out and upside down. Everyone across the health care continuum is focusing on how to perform their role better. Innovative solutions are popping up everywhere. The chaos is creating massive opportunities. We really have a chance to make a difference. I believe it is the best time ever to be an entrepreneur in health care. So glad to be a part of it!

Eyes Wide Shut – Teaching to the Meaningful Use Stage 2 Test

Posted on September 30, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She 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.

According to Twitter analytics, one of my more engaging tweets recently stated that Meaningful Use is stifling innovation by requiring that health IT vendors and healthcare providers employ very specific tactics to capture and report on clinical data capture and interoperability standards compliance – ostensibly to engage and empower the patient, and improve coordination of care between providers. Of course, I said it much more succinctly than that. In effect, conforming to the Meaningful Use Stage 2 attestation measures is akin to “teaching to the test”:

Here’s a real-world example of what it means to “teach to the test” of Meaningful Use. In order to qualify for CMS incentive dollars, Meaningful Use Stage 2 Year 1 patient engagement measures must be met, with auditable data captured, in a 90-day contiguous period in 2014. An eligible provider (EP) must demonstrate that 50% of all patients with encounters during that time period have online access to their clinical summary within 4 days of the data becoming available to the provider. 5% of those patients must access the clinical information within the 90 days, and 5% of those patients must leverage secure messaging to communicate relevant health information with the provider. Finally, the MU-certified EMR must proffer patient-specific education materials for 10% of the patients seen during that time.

What I believe the ONC had in mind when they crafted these measures: engaged patients who will log in to their portal after each encounter, review the findings and lab results to assess their own progress and outcomes, read or listen to the condition-specific educational materials provided that resonate with them, and ask more meaningful questions of their providers as a result of this new-found, data-enabled empowerment. That is why they categorize these measures as “patient engagement”, right?

Wrong. This is what “patient engagement” looks like, from the EMR implementation, Meaningful Use-consultant, EP business process standpoint.

First, establish the bare minimum thresholds for meeting the measures. If the EP saw 1000 patients during the same 3-month period the previous year, your denominator is 1000; calculate the numerator for each measure based on that. So, we need 500 patients to have access to their clinical data online; 50 patients must access their information; 50 patients must communicate with their provider via secure messaging; 100 patient encounters must prompt specific educational opportunities.

To meet the 500 patients with online access to their clinical data, patient portal software is preloaded with patient demographic accounts, based on the registration data already available in the EMR. An enrollment request is emailed to the patient or authorized representative (assuming an email address is available in their demographic information). The EMR captures the event of sending this email, which contains the information about how to enroll and access the patient’s medical records via the portal. This measure is met, without the patient acknowledging the portal’s existing, and without any direct communication between provider and patient.

The medical records view and secure messaging measures can be met simultaneously, in a matter of days, by planning to add a few extra minutes to each encounter for 50 patients’ worth of appointments. The EMR has already triggered an email with portal enrollment information to each of the patients in the waiting room on a given day. As the medical assistant (MA) is taking vital stats, she asks whether the patient has enrolled in the portal. It’s likely the patient has not; the MA hands the patient a tablet and has him log in to his email, and walks him through the portal enrollment and initial login process. Once logged in, the MA directs the patient to click the link to view his medical record. That click is recorded, and the “view” measure is met; whether a CCD or C-CCD is actually displayed is irrelevant to the attestation data capture.

Having demonstrated how a patient can view his record, the MA then asks the patient to go into the portal’s message center, to send a test communication to the provider. The patient completes the required fields, and the MA prompts him with a generic health-related question to type into the body of the message. Once the patient hits “Send”, the event is recorded, and the “secure messaging” measure is met.

For all patients, whether portal-users or not, a new process begins when the MA finishes, the provider enters the room and begins her evaluation of each of the 100 patients required to meet the education measure. As the patient talks, the provider is clicking through EMR workflow screens, recording the encounter data. The EMR occasionally prompts with a dialogue box indicating educational materials are available for patients with this diagnosis code, or this lab result. Each dialogue box prompt is recorded by the EMR; the “patient-specific education” measure is met, whether the provider acts on the prompt and discusses or distributes the educational information or not.

To put it simply: the patient never has to log in to a portal to meet the 50% online availability requirement, they don’t have to actually view their records to meet the 5% view requirement, they don’t have to have an actual message exchange with their provider to meet the 5% communication requirement, and they don’t have to receive any tailored materials to meet the 10% education requirement. Once those clicks have been recorded, the actions never have to be repeated; meaningful and ongoing patient engagement is not needed to meet the attestation requirements and receive the incentive dollars.

In a previous post, I introduced my interpretation of the difference between the spirit and letter of the Meaningful Use “law”. By teaching to the test, we’re addressing the letter of the law, only, in its narrowest interpretation. When will we incent vendors and providers to go above and beyond and find ways to truly engage patients in meaningful ways, empowering them with accurate, timely data access and tools to analyze it?

Are State Health Agencies Ready for Meaningful Use Stage 2?

Posted on September 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

As part of its public health objectives, Meaningful Use 2 requires doctors and hospitals to report sizable amounts of information.

The idea is that when significant patterns are forming — an outbreak of a certain disease, for example, or a peculiar cluster of symptoms — they’ll be apparent right away.

But someone has to be in position to receive the data.

The responsibility falls to local and public health departments. Agencies around the country should, theoretically, be preparing for the immunization records, laboratory results and other information they’ll soon be getting.

Just how many will be ready, though, remains to be seen. Many cash-strapped departments lack the IT infrastructure for what’s being asked of them — and the money allocated by the government hasn’t amounted to much, according to a 2012 American Journal of Public Health article by Drs. Leslie Lenert and David Sundwall.

In fact, the authors wrote, the federal effort “has created unfunded mandates that worsen financial strains” on health departments.

There’s a caveat, though: The mandates aren’t really mandates.

“Nothing compels them to do it” except the desire to do the right thing, said Frieda du Toit, owner of Lakeside, Calif.-based Advanced Business Software. “Some directors are interested, some are not. The lack of money is the main thing.”

In our recent interview, du Toit, whose company specializes in information management solutions for health departments, added: “One customer asked me: ‘Am I going to be punished in any way, form or fashion if I don’t support the efforts of my hospitals and care providers?”

Her firm’s Web-based Public Health Information Management System serves cities and counties throughout the United States, including in California, Texas and Connecticut.

The federal government’s goal is for public health agencies to be involved in four administrative tasks to support MU2, according to the Stage 2 Meaningful Use Public Health Reporting Task Force. The task force is a collaboration between the U.S. Centers for Disease Control and Prevention, nonprofit public health associations and public health practitioners.

The first step is to take place before the start of MU2 — that’s Oct. 1, 2013, for hospitals and Jan. 1, 2014, for individual providers.

The tasks:

  • Declaration of readiness. Public health agencies tell the Centers for Medicare & Medicaid Services what public health initiatives they can support.
  • Registration of intent. Hospitals and providers notify public health agencies in writing what objectives they seek to meet.
  • On-boarding. Medical providers work with health departments work to achieve ongoing Meaningful Use data submission.
  • Acknowledgement. Public health agencies inform providers that reportable data has been received.

For doctors and other eligible professionals, MU2 calls for ongoing submission of electronic data for immunizations. Hospitals are to submit not only immunizations but also reportable laboratory results and syndromic surveillance data.

Health care providers whose local public health departments lack the resources to support MU2 are exempt from the reporting requirements.

In Meaningful Use Stage 3, which health IT journalist Neil Versel wrote is likely to begin in 2017, “electronic health records systems with new capabilities, such as the ability to work with public health alerting systems and on-screen ‘buttons’ for submitting case reports to public health, are envisioned,” according to Lenert and Sundwall.

The authors noted: “Public health departments will be required not just to upgrade their systems once, but also to keep up with evolving changes in the clinical care system” prompted by the regulations.

They proposed cloud computing as a better way. Shared systems and remote hosting, Lenert and Sundwall suggested, could get the work done efficiently and affordably, albeit at a cost to individual jurisdictions’ autonomy.

As EMR adoption grows, it would be a shame not to take advantage of the opportunities for public health. The entire health IT effort being pushed by the federal government is, after all, geared toward improving the health of populations.

Without money for the job, though, public health agencies’ ability to support Meaningful Use will likely always be limited. It looks like a good time to think about committing significant funds, embracing cloud-based solutions or both.

Disaster Planning and HIPAA

Posted on November 20, 2012 I Written By

Anne Zieger 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.

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.

Major EMR Vendor Consolidation On The Verge

Posted on June 14, 2012 I Written By

Anne Zieger 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.

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?

Tricorder Devices, REC Numbers, and EHR Photo IDs: This Week in HealthCare Scene

Posted on June 10, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

John’s Note: As regular readers know, I usually reserve the Sunday post to do a Twitter round up. The Sunday post on EMR and EHR has been a Healthcare Scene round up post written by Katie. I decided to mix things up a little bit. Each week I’ll swap which site does the Twitter round up and which site does the Around Healthcare Scene.

If all of this is confusing, don’t worry. Just subscribe to the emails for EMR and HIPAA & EMR and EHR and you’ll be all set. Now sit back and enjoy a look around the Healthcare Scene network.

EMR and EHR
The Shift From Expensive Technology to Cost Saving Technology

For years, medical technology came with a hefty price tag. While many of these investments were a miracle worker of sorts, it left hospitals and medical practices with a large bill. Fortunately, in recent years, the technology being released, such as EHR, are trying to make health care less expensive. While it is up for debate if software like EHR really is less expensive, there is a definite shift in the costs of medical technology.

Photo IDs as Part of the Patient Record — Flashy Trend or Future of Medicine?

Unfortunately, errors do occur in hospitals. However, putting photos on a patient record may help prevent some of these problems. Children’s Hospital in Colorado is currently trying this out. The number of mistaken orders dropped from 12 in 2010 to 3 in 2010 since the hospital started using photo IDs. So the question is, are photo IDs worth the time and effort?

Hospital EMR and EHR
Make Consumers Want Their PHR

More PHRs seem to be popping up, but are any of them really convincing people to use them? Anne Zeigler doesn’t think she. In this post, she lists several different ideas on how to get people “excited” about PHRs with tips such as good marketing and rewarding the user. If companies want consumers to use their PHR, many things should be taken into consideration.

EMR Thoughts

REC Numbers for REACH (Minnesota and North Dakota Doctors)

REACH is a nonprofit federal Health Information Technology Regional Extension Center that aims to help hospitals and medical practices through Minnesota and North Dakota implement EHR or optimize the current system. It had many goals in mind when it started, and recently, many of these goals have been met or surpassed. REACH serves 4,749 priority primary care providers across these two states.

EHR and EMR Videos

Dr. Eric Hartz’s EHR Story from the 2012 HIMSS Conference

At the recent HIMSS Conference, Dr. Eric Hartz shared his thoughts on EHR. He discussed the benefits of EHRs and gave tips on participating in incentive programs. He also talked about how to use EHR across a number of different hospitals.

Smart Phone Health Care

Is the Tricorder Device a Reality?

Is that rash on your child something serious, or nothing to worry about? Or is that fever from a UTI? Scanadu, a tricorder-like device, supposedly will use social media to help make healthcare more immediate and accessible. The machine will allow people to take a picture or sample of something worrisome, and immediately find out what action needs to be taken. The world of social medicine is quickly expanding, and a tricorder is becoming an actual possibility.

Pajamas Created to Monitor an Infant’s Vital Stats, Sends Mobile Alerts

Wearable monitors are popping up throughout the health care world. The latest? Pajamas for an infant to wear. It monitors an infant’s vital stats and sends mobile alerts to the parents. Great idea, or just another gimmick to sell to paranoid parents? Read more and decide for yourself.