IT Practice Consulting – Health IT Report –

November 2017

“Healthcare Experts Weigh In

On Interoperability, EHR Advancement”

 

Introduction

The American Health Information Management Association (AHIMA) called on the nation’s leading healthcare and health IT professionals in a recent article analyzing the known benefits and consequences of EHR systems. Author Lisa A. Eramo, MA endorses the dialogue as “a status check on health IT adoption and standardization efforts” in relation to the advancement of patient-centric, quality care. The article also boasts the insider perspectives of headline industry experts such as John D. Halamka, MD, MS, Chief Information Officer at Beth Israel Deaconess Medical Center, and Vice President and Chief Health Transformation Officer at IBM Watson Health, Paul Tang, MD. These experts examine recurring issues and milestones in the past ten years of rapid health IT implementation, specifically within the “meaningful use” EHR Incentive Program. Moreover, they highlight three significant hurdles for the future of health IT: bolstering interoperability, reestablishing a “business case,” and preventing information blocking.

Read the entire report here: Health IT Time Out: Where is the US Healthcare System on Interoperability and a Quality Strategy?

 

Meaningful Use and Interoperability

The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals (EPs) and hospitals who adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology  to stimulate the adoption, and subsequent “meaningful use,” of digitized health information. Despite the initiative’s objective success, – Eramo reports that 96 percent of hospitals and 78 percent of office-based physicians currently possess a certified EHR – the lasting effects of sweeping EHR implementation has left some experts torn. John D. Halamka, MD, MS praises meaningful use for its advancement of immunization registries and coordinated care amongst physicians: “You could argue that no other industry has automated so quickly.” Conversely, Paul Tang, MD advises that current federal incentives lack the “value-based payment reform” necessary to promote true interoperability between medical practices. Although Eramo notes that interoperability was always a key aspect of the original  provisions, it remains a key goal of EHR development in upcoming years.  

Read more about the ONC’s interoperable guidelines here: ONC Report, Proposed Interoperability Standards Measurement

 

Providing a “Business Case”

Nicole Miller, MS, RHIA, president of Miller and Miller Associates in Lockport, NY, reports that the advancement of EHR technologies is dependent on continuing to provide a “business case” for medical professionals nationwide. Miller asserts that federal incentives were indisputably the momentum behind EHR implementation, but encourages the medical community to emphasize the non-financial benefits in the future. Similarly, Eramo notes that more established physicians simply don’t recognize the improvements that EHRs make to patient-quality care and health data analytics, which undermines the success of these systems. For example, EHR systems are proven to decrease misdiagnosis, prevent opioid abuse, and personalize preventive care.   Furthermore, Tang posits that healthcare professionals will receive even more informational return on investments (ROIs) as EHRs increase coordinated care.  

Read more on EHR technology and preventative care here: Studies Show that EHR Technology Leads to Improvements in Patient Care

 

Preventing Information Blocking

In the article, Eramo asks readers to redefine the concept of “successful” health IT adoption by moving away from quantitative measurements and towards intangible, interoperable milestones. Mark E. Frisse, MD, MS, MBA, professor in the Department of Biomedical Informatics at Vanderbilt University Medical Center, echoes this sentiment: “It’s time to move away from the EHR as the center of the universe and focus on the broader system of care.” Moreover, the participating experts unanimously identify information blocking – intentionally preventing the “access, exchange, or use of electronic health information” – as a significant hurdle to health IT development. Eramo includes a collaborated list of recommendations, published in “Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative,” to demonstrate the leading theories for preventing both intentional and unintentional data hoarding. Key ideas include crafting federal regulation information-sharing standards; de-incentivizing redundant, ineffective EHR systems; and providing clinical guidelines for appropriate conduct.

Read more about expert-recommended interoperability standards here: Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative

 

Final Thoughts

Adjusting and maintaining EHR systems can become daunting tasks for smaller healthcare practices and independent physicians, especially as the industry shifts focus towards data-sharing practices and away from basic adoption. The New York eHealth Collaborative (NYeC) teams up with medical professionals statewide to navigate the federal incentives and regulations surrounding their health IT options. Furthermore, IT Practice Consulting (ITPC) assists with clients’ personalized optimization needs, with everything from HIPAA compliance preparations to ambulatory care evaluations.

Contact ITPC today and speak to a representative about optimizing your health IT systems!

IT Practice Consulting – Health IT Report –

October 2017

“Face-to-face Clinician Care 

Doubles EHR Participation”

Introduction

 

A new study from SelectHub – a technology evaluation program based out of Denver, Colorado – suggests that the majority of clinicians and patients actually view EHR systems positively. Public discourse surrounding EHR use has polarized the medical community, with some critical research revealing increased rates of physician burnout in relation to EHR time management. Other studies indicate that health information technology invaluably benefits clinicians through its potential for early detection of hereditary illnesses and opioid addictions. Similarly, the SelectHub findings erred on the side of EHR optimization, with a survey of 1,007 patients and 107 healthcare professionals revealing overwhelmingly positive reactions towards EHR productivity, accessibility, and effectiveness. Overall, this most recent investigation of practical EHR applications gave detailed insight into the divide in public opinions, including the assertion that patients who are properly coached on information management are twice as likely to participate in patient portals.

 

Read more on SelectHub’s groundbreaking research here: Patient and Professional Perspectives: A Sentiment Analysis of Electronic Health Records (EHRs)

 

The Clinician’s Perspective

 

SelectHub’s clinician participants currently report the highest recorded approval ratings of health information technology, with “86 percent of medical professionals felt an EHR system made that job easier.” Moreover, the professional responses delved into fairly overlooked components of EHR usability, including time management techniques and demographic factors.

 

For instance, while 81 percent of the healthcare providers agreed that EHR implementation increased “general workplace productivity,” the average participant only saved an hour daily with electronic, versus manual, reporting. However, SelectHub determined that “those [medical professionals] who frequently used the EHR system were more likely to see its benefits than those who seldom used the system.”

 

Moreover, the study’s demographic perspective suggests that healthcare providers are less divided on EHR management than previously believed. Specialists, administrative staff, and laboratory researchers fully (100 percent) supported their EHR systems, while physician assistants followed with the lowest approval rating, at 73 percent. Clinicians’ opinions were more varied depending on the type of healthcare employer (hospital, urgent care, etc.), but SelectHub concluded that age was wholly insignificant in determining positive reviews.

 

Read more on clinician reviews of EHR technologies here: Nationwide Survey: Physician Views on EHRs Remain Mixed and Complex

 

The Patient Perspective

For the patient participants, the SelectHub questionnaire focused on overall opinions, accessibility of EHR systems, and frequency of use. Although “patients had a slightly lower overall positive sentiment at 80.1 percent (positive and very positive)” than their associated health care professionals (87 percent), the study indicates that patients strongly value the opportunity to review their personal records. According to the official report, of those surveyed, “64 percent of patients felt it was very important or moderately important to have access to electronic health records.”

 

Moreover, SelectHub compared qualitative reviews of doctor-patient interactions with the positive sentiment rates to evaluate how hands-on training might improve EHR application. Patients rated their clinicians on EHR demonstrations and explanations, which was then cross-examined against their reported usage rates. Mostly notably, those patients whose doctors “explained [EHRs] well” logged twice as much activity on the systems than those whose doctors “explained poorly.”

 

Final Thoughts

 

In the eight years since the Health Information Technology for Economic and Clinical Health Act (HITECH) began promoting EHR adoption, the medical community has remained largely torn over the complexities and cons of the technologies. Fortunately, SelectHub reports that “87 percent of office-based physicians use an EMR/EHR system,” indicating that the EHR debate has matured from resisting implementation to maximizing efficiency. Indeed, non-profit organizations like the New York eHealth Collaborative (NYeC) offer roadmaps and training programs to help medical professionals participate in federal benefit programs for exceptional EHR management. At IT Practice Consulting (ITPC), information technology experts guide healthcare professionals through EHR internal affairs, with a focus on streamlining administrative tasks, fortifying security, and increasing patient participation.  

Contact ITPC today and double your patient portal participation rate!

IT Practice Consulting – Health IT Report –

September 2017

 

“AMA Calls For EHR Overhaul, Drafts Priority Framework”

 

Introduction

 

New research from the University of Wisconsin and the American Medical Association (AMA) indicates that primary care physicians (PCPs) dedicate over half of their workday to electronic health records (EHRs). Originally published in the Annals of Family Medicine, “the retrospective cohort study of 142 family medicine physicians” collected over 118 million EHR event logs, or records of system access, to analyze the time allocation and frequency of electronic tasks. Researchers determined that family physicians completed over six hours of EHR activities each day, nearly two-thirds of which were “delegatable” clerical tasks that coincided with job dissatisfaction and physician burnout. In a public statement, AMA President David Barbe, MD said the findings reflected physicians’ existing concerns that “data entry tasks associated with EHR systems are significantly cutting into available time for physicians to engage with patients.” The AMA endorsed similar conclusions in a recent press release, in which the organization condemned a culture of “poorly designed and implemented” health information technology and offered a comprehensive framework for EHR reprioritization.

 

 

Read the entire AMA report in the Annals of Family Medicine: Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

 

AMA on “Tethered to the EHR,” Methodology and Conclusions

 

According to the official report, university researchers analyzed the Epic systems of 142 primary care physicians in southern Wisconsin to determine a correlation between “EHR time allocation and usage patterns” and physician burnout rates. The study examined three years of Epic event logs, “automated tracking features that monitor the accessing and performance of the EHR interface,” to compare the frequencies of indirect (asynchronous) and face-to-face (synchronous) activities in family care practices. Researchers concluded that participating physicians spent half of their viable work hours – equivalent to 6 hours a day – completing any of the trackable Epic event log activities, including patient documentation, order entry, billing and coding, and system security.  Simply put, “primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care.”

 

Established EHR critics, including the American Medical Association (AMA) and the American Medical Group Association (AMGA), responded to the findings with demands for an industry-wide reevaluation of the benefits, usability, and long-term goals of current health information technologies. Notably, the AMA results echoed a 2016 study of family medicine, internal medicine, cardiology, and orthopedic practitioners, which also concluded that physician EHR exercises accounted for twice dedicated workload of doctor-patient interactions. The authors further speculated that the growing market of EHR implementation, and subsequent decrease in time allocations for direct patient care, contributes to observed physician “work–life imbalance, dissatisfaction, and a burnout rate exceeding 50%.” In summary, University of Wisconsin and AMA professionals advised family care practices to delegate burdensome administrative tasks to support staff and encourage face-to-face patient communications.

 

Read more AMA research for EHR implementation here: Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

 

 

AMA on “Types and Click Tasks,” EHR Priority Framework

 

On September 11th, the American Medical Association (AMA) issued a conciliatory statement regarding the future of healthcare information technology, titled “Type & Click Tasks Drain Half the Primary Care Workday.” The controversial report claimed that the “AMA shares physicians’ frustration” stemming from failed EHR systems, which disrupt effective workflows and offer incomplete performance evaluations.

AMA President David Barbe, MD raised his own concerns over mounting evidence that EHR initiatives can damage patient engagement: “Poorly-designed and implemented EHRs have physicians suffering from a growing sense that they are neglecting their patients and working more outside of clinic hours as they try to keep up with an overload of type-and-click tasks.”

Fortunately, the AMA also provided a tentative framework for the reconfiguration and prioritization of EHR policies; the main components reflect the organization’s strong emphasis on physician-centric strategies:

 

• Enhance physicians’ ability to provide high-quality patient care
• Support team-based care
• Promote care coordination
• Offer product modularity and configurability
• Reduce cognitive workload
• Promote data liquidity
• Facilitate digital and mobile patient engagement
• Expedite user input into product design and post-implementation feedback

Read the executive summary for the AMA EHR Priority Framework here: Improving Care: Priorities to Improve Electronic Health Record Usability

 

Final Thoughts

 

After years of leading public discourse on EHR implementation and incentive programs, the AMA claims that it “recognizes the potential value of electronic health records” and acknowledges the significant role of information technology in preventative healthcare. Clinicians seeking to balance EHR initiatives with distinguished patient care can participate in STEPS Forward, an “ambitious online practice transformation series [the AMA] launched last year that offers modules to help physicians learn their risk factors for burnout…and reignite professional fulfillment.” Similarly, the New York eHealth Collaborative (NYeC) spearheads the Statewide Health Information Network for New York (SHIN-NY) program to install and maintain secure EHR infrastructures for qualified entities statewide.

Health information technology professionals are vital to the advancement of patient-focused healthcare and can offer insider perspectives on the complex world of coordinated care, interoperable standards, and Meaningful Use performance audits. Contact IT Practice Consulting (ITPC) today to receive a comprehensive EHR evaluation and advice tailored to your organization’s needs!

IT Practice Consulting – Health IT Report –

August 2017

“CMS Finalizes 2018 Meaningful Use Rule,

Relaxes Reporting Requirements”

 

Introduction

 

Nearly half a year after the Centers for Medicare & Medicaid Services (CMS) issued its 2018 Meaningful Use Proposal – FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule – and a community-wide Request for Information, the CMS has delivered its concluding revisions to 2017-2018 reporting period. According to the CMS press release, “The final rule relieves regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility, and innovation in the delivery of care.” Most notably, eligible hospitals and critical access hospitals (CAHs) participating in EHR Incentive Programs will only need to demonstrate a continuous 90-day attestation period in 2018, compared to a previously mandated full calendar year. However, while the majority of the finalized revisions have been praised by leading members of the medical community as responsive to industry advisement, the CMS determined that revision inquiries for Meaningful Use objectives and measures, audits, and the Merit-Based Incentive Payment System (MIPS) were beyond the scope of its final ruling. Overall, healthcare professionals should implement any of the significant changes to the CMS 2017-2018 Final Rule and prepare any additional estimations for the October 1, 2017 application deadline.

 

Read the fact sheet for the CMS Final Rule here: Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1677-F)

 

EHR Incentive Programs for 2017-2018

 

According to the CMS Final Rule fact sheet, eligible hospital, critical access hospitals (CAHs), and eligible professionals that “adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified EHR technology (CEHRT)” are viable candidates for federal incentive programs. In order to increase participation rates among these demographics, the CMS has finalized its decision to accept applicants who can demonstrate that their non-compliance with EHR regulations stems from the decertification of their EHR technology under ONC’s Health IT Certification Program. The CMS also issued an exception for the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based EPs by redefining an ASC as “those who furnishes 75 percent or more of their covered professional services in an ASC.” Finally, feedback from stakeholders about the complexity of EHR transition processes resulted in the CMS revision to allow “2014 Edition CEHRT, 2015 Edition CEHRT, or a combination of 2014 Edition and 2015 Edition CEHRT, for an EHR reporting period in 2018.” The American Hospital Association (AHA) was the first of many to release a statement praising the CMS for “allowing hospitals and critical access hospitals to report meaningful use modified Stage 2 in 2018, as well as implementation of a 90-day meaningful use reporting period in fiscal year 2018.”

 

Uncompensated Care Payments

 

Another prominent adjustment to federal assistance programs saw the CMS estimating its Medicare Uncompensated Care Payments stipends at $6.8 billion in 2018, nearly a $800 million increase from its 2017 allocations. Medicare disproportionate share hospitals are the primary beneficiaries of this federal initiative, with reimbursements delivered based on their relative share of uncompensated care; these debts often stem from uninsured patients that are unable to pay for the cost of care. The CMS reports that the additional capital was calculated after reviewing data from its National Health Expenditure Account, including updated estimations of the percentage of uncompensated care in participating care centers. “This final rule will help provide flexibility for acute and long-term care hospitals as they care for Medicare’s sickest patients,” said CMS Administrator Seema Verma in a statement. “Burden reduction and payment rate increases for acute care hospitals and long-term care hospitals will help ensure those suffering from severe injuries and illnesses have access to the care they need.”

 

Read the entire 2018 Final Rule CMS press release here: CMS Finalizes 2018 Payment and Policy Updates for Medicare Hospital Admissions

 

Hospital Readmissions Reduction Program

 

The 2018 Final Rule report also focused on the completion of the preliminary stages to the CMS Hospital Readmissions Reduction Program socioeconomic adjustment approach, as mandated by the 21st Century Cures Act. Previously, penalties for excessive readmission rates disproportionately punished the smallest hospitals dually eligible for Medicare and full-benefit Medicaid due to comparisons to wide-spread industry averages. However, the CMS will now implement a five-level “peer group” methodology to distribute penalties based on stratified median ratios; this revision aims to mitigate the unfair penalization of modestly-funded care centers. Blair Childs, Premier, Inc.’s senior vice president of public affairs in Charlotte, NC, commended the CMS on finalizing the changes, noting that the “CMS is taking needed steps to fairly assess hospital performance.” Industry leaders seem unanimous in their approval of the program revisions, but anticipate more research into refining readmissions rates by “race/ethnicity, income, education, and marital status” in the coming years.

 

Read Premier, Inc.’s entire statement on the Readmission Reduction Program here: Premier Statement on House Ways and Means Committee approval of H.R. 5273, The Helping Hospitals Improve Patient Care Act

 

Finals Thoughts

 

Although industry responses to the CMS 2017-2018 Final Rule completion have been overwhelming positive, medical professionals are encouraged to remain diligent and prepared for future revisions. Many of the minor revisions to the CMS Proposed Final Rule are under constant market review, including the 1.2 percent bump in IPPS payments through the Hospital Inpatient Quality Reporting (IQR) Program, and won’t officially commence until the beginning of the 2018 calendar year, leaving time for re-estimation. Still, with the October 1st application date looming for most eligible healthcare centers, practitioners need to construct a personalized roadmap for their 2017-2018 reports that take advantage of incentives opportunities while satisfying regulation. The New York eHealth Collaborative (NYeC) supports the development of functional and effective electronic health systems statewide by offering participants comprehensive policies and standards to optimize health information technology. Moreover, IT Practice Consulting (ITPC) calls on decades of experience in healthcare technology implementation to benefit medical professionals and local communities alike with fully-optimized EHR programs.

To learn more about your electronic health technology opportunities, contact ITPC today.

IT Practice Consulting – Health IT Report –

July 2017

“Study Discloses Top Reasons

Patients Value EHR Management”

 

Introduction

After nearly a decade of controversial discourse, the movement towards electronic health records (EHR) management has centered on interoperability, or the improvement of patient-focused care through open communication between primary, emergency, and coordinated-care medical professionals. Although leading healthcare experts have questioned the security of electronic data sharing, given its prevalent use of vulnerable technologies (smartphones, cloud storage, etc.), a new study of 260 patients provides evidence that access to reliable health information increases patient engagement and satisfaction. The Beth Israel Deaconess Medical Center, which collaborated with health information technology advocate OpenNotes, reports that an aggregate 98 percent of its participants rated EHR technology as “valuable” after partaking in a patient portal that digitized doctors’ real-time notes during appointments. Lead author Macda Gerard, an OpenNotes research assistant, expressed frustration with the slow progress of actualized “patient-centered” technologies among the medical community, noting that, “We’ve heard very little about what matters to the patients themselves, perhaps because information sharing has been largely one-way and passive.” Fortunately, Gerard’s survey successfully ranked which attributes were most desired in portal EHR technology, using keywords for the open-end question bank to match patient experiences and critiques.

 

Read the entire report in the Journal of Medical Internet Research: What Patients Value About Reading Visit Notes: A Qualitative Inquiry of Patient Experiences With Their Health Information

 

Ability to Confirm Instructions, Prepare for Next Steps

Researchers with The Beth Israel Deaconess Medical Center and OpenNotes confirm that an industry-wide focus on the bottom line of healthcare services, instead of preventative care, directly influences patients’ perspectives of “rushed” or confusing appointments. One respondent claimed that a common “white coat syndrome” caused problematic recall of issues discussed with the doctor; others added that access to their healthcare instructions removed the “overwhelming” burden of correctly remembering the details of appointments where they were “not feeling well or were too overwhelmed.” These findings also indicate that this portal technology comes with the fiscal benefits of decreasing redundant treatments or superfluous testing.

Read more on EHRs mitigating redundant procedures here: Studies Show that EHR Technology Leads to Improvements in Patient Care

 

Quick Access to Information and Results

According to the report, patients were overwhelmingly positive about the immediate accessibility of test results and additional physician observations, which one participant found particularly valuable because “they provide context” for complicated medical issues. “The records [laboratory results] show the numbers,” one respondent recorded, “but the notes provide the interpretation in regards to my personal health status.” In the information age of WebMD and countless healthcare blogs, patients benefit from direct, concise communication with their primary physicians and any other supporting professional.

 

Confirmation of Positive Relationships

Noted as “Positive Emotions” in the report’s results, researchers have also concluded that patients who read personalized notes on an EHR portal had greater levels of respect and satisfaction with their doctors and staff. In one positive response, the patient reported that, “I like reading my notes because they keep me uplifted.” Studies show that public consumers considered medicine to be a “highly ethical” in nature, but the amount of Americans that “have great confidence” (read: trust) in their primary care physicians dropped to 34 percent by 2012. Therefore, the validation produced through attention-to-detail methodologies and meticulous note taking during appointments may in turn ensure communicative patient-physician relationships for participating practitioners.

Read more on public perspectives of U.S. Medicine and trust: Public Trust in Physicians — U.S. Medicine in International Perspective

 

Reliable Information Sharing for Care Partners

Undoubtedly just as vital as the medical professionals in a patient’s life, and equally deserving of transparent communication, are the long-term care partners (CPs) that support vulnerable or disabled individuals in their medical decisions. Portal usage under the The Beth Israel Deaconess Medical Center and OpenNotes EHR research survey established multi-device platforms to encourage participation of CPs in the education of patients’ medications or treatment plans. “Reading the notes can only make me come to my appointments better prepared,” one patient wrote, “and help my team understand what issues are important to me and what I need them to hear.”

 

Final Thoughts

Meaningful Use and other federal incentive programs may assist in the preliminary implementation and reorganization of EHRs, but in an era of rapid technological growth, there are always more improvements and updates available for existing systems. While the New York eHealth Collaborative (NYeC) provides countless security and assessment services to local health communities statewide, it also guides first-time users through trending EHR modifications in its public resource blogs and newsletters. Moreover, a brainstorming session with IT Practice Consulting (ITPC) offers a comprehensive health information technology education and tips, including optimizing patient portals to actualize the practices of a patient-centered organization.

To make your move towards patient-centered, reliable EHR management, contact ITPC today.