Patient Centered Medical Homes: A New Model for EHR Maximization

Posted in HIT, Uncategorized on May 31, 2013 by Matthew Levy

A growing problem in healthcare today is a shortage of providers available to offer primary care solutions to patients. Most students have extensive debt upon completing their medical education, and the idea of entering a low-paying field that might cause them to spend more of their professional career in debt. The percentage of medical school graduates who opt for some sort of specialist training, either as part of their residency or with a fellowship after completing an internal medicine residency is too high to sustain an acceptable level of access for patients to quality primary care.

The non-profit group National Committee for Quality Assurance has set out a series of criteria for measuring the success of a medical home model in place. One of the fundamental criteria set out is a quality EHR system to guide the interactions and interchange of information, which is among the things that EHR systems were designed to take advantage of. The interactions required to make this model work are central to the features of an EHR, from both quick and more advanced communication to tracking of results and tests amongst multiple providers. Additionally, it allows analytical models within a population. Data from the system can be used to track all sorts of achievements, measuring care levels and seeing which patients have not reached certain levels of care. This makes it easier to manage care, not as isolated encounters, but with the focus on a patients ongoing health and outcome.

It could be argued that the advantages of an EHR, while useful in all systems, are best suited for a Medical Home model. While the popularity of the medical home model is still reasonably new, the ideas behind it are not. Not only has the concept been around since 1967, but it is driven by basic concepts, not limited to many of the requirements set forth as part of Meaningful Use. Whether the model will stick as a common method for managing care is yet to be seen, but the tools are there to make it work, and like many ideas for change, all it will take is people willing to make the effort.

Further Reading:

HHS: What is PCMH

Allscripts case study on the use of PCMH

Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality

State of the EHR World

Posted in Uncategorized on May 28, 2013 by Matthew Levy

Last month, the Office of the National Coordinator for Health IT (ONC) released a report showing off the incredible growth in Health IT that has occurred in recent years, especially since the introduction of the HITECH act and the implementation of Meaningful Use requirements. The report breaks down increased hospital and provider participation, as well as the adoption of technology and shows off how the economic benefits of the program are working as they were designed.

As of March 2013, more than 85% of hospitals were registered for ONC’s EHR incentive program and most of these have attested to meaningfully using their EHR technology. Small practices, with only a few providers and no regular link to a hospital, are harder to drive towards change, in part because they have more control over their own business and because the advantages are usually limited to Meaningful use incentives and whatever benefits their personally gain from the EHR they choose.  And still, 73 % of eligible professionals are registered for incentives and already over half have received a payment.  In addition, a recent HHS report observed that in the period since before HITECH was passed in 2008, the number of providers using advanced EHR technology has increased dramatically from 17 percent before HITECH to over 50 percent today. These two numbers are above the goals set out by HHS before the project began.

The area in which we see the most impressive gains are in the number of providers that are not only making the effort to use EHR technology to attest for meaningful use, but using an advanced system that has advanced features beyond stage 1 of meaningful use, including several features, such as electronic notes and imaging results, that are central requirements as part of stage 2. Forty percent of providers, up from 17% in 2008, are using such a system.

There is still a long way to go in this process. But it is clear, as more hospitals, providers, and other healthcare institutions adopt more advanced technology, that the incentives offered through HITECH have helped to do what the mere availability of advanced technology hasn’t been able to do and encourage more and more providers to embrace, or at least consider, this technology.  The advantages of using EHR technology to keep and enhance medical records have been well noted, both here and elsewhere, and it is good to see that, even if some nudging is required, that those most affected by these advantages are starting to notice.

Further Reading:

Infographic: A Record of Health Information Technology

HHS Reports Providers’ Use of Health IT Doubles Since 2012

Let’s Talk Telehealth!

Posted in HIT on May 16, 2013 by mfisher527

What is telehealth? Healthcare services provided over the web, text, video and remote interacting between patient and their Provider.

What are the benefits of telehealth? Easier access to healthcare and decreased cost for starters! Everyone is busy these days…convenience is what we are all seeking. Most people have been in the position of wanting to schedule a visit with their Healthcare Provider, but simply do not have the time. People in rural areas have little access to convenient healthcare options. With telehealth, they have easier access to proper care. This is ideal if they need a visit with a specialist. If all we had to do was get on our computers to have a healthcare related visit, wouldn’t we be more apt to make that appointment?

Quality of care is the main concern of Healthcare Providers. With telehealth patients can be closely monitored. Patients can transmit blood pressure results, glucose readings, protime results and other in-home tests they perform on a regular basis.

The Veteran’s Association is offering some amazing services via telehealth. These include speech pathology appointments, mental health visits, surgery consults, visits with their family practitioner for medication refills/changes and much more. The VA is making it easy and affordable for our veteran’s to receive the care they need. Read more here http://www.telehealth.va.gov/real-time/index.asp

Many facilities are offering 24/7 web based services. Internet Medical Clinics is based in Texas and offers their patients to “consult with their healthcare providers, receive laboratory services, medications, diagnostic testing, and more. Online access to the Virtual Healthcare Delivery System for appointment requests, prescription refills, “virtual” consultations with healthcare providers, and online medical records”. UC Davis Children’s Hospital has provided telemedicine consultations to over 5,500 children in California. They also offer  specialty services, rural telehealth care, teleradiology and acute care.

Of course the concept of telehealth requires up-to-date technology and training. Thanks to the FCC “The Healthcare Connect Fund” was created. This fund will help cover the costs of equipment, broadband internet, research, education and may even help cover the cost of facilities if it is the most cost-effective option. The annual cap is 4 million dollars.  Facts and criteria can be found here http://www.fcc.gov/document/healthcare-connect-fund-fact-sheet

Will online healthcare be the wave of the future? Time will tell if it is cost-effective and being used properly.

Healthcare Apps: Useful, Unreliable, or Gimmicky

Posted in Uncategorized on May 7, 2013 by Matthew Levy

One current development in Health IT aside from the areas of EHR implementation and the effort to adjust practice to meet and attest to Meaningful Use is through new applications designed to better the world of healthcare, from both the view of the provider and the patient. While the term “app” is frequently used to refer to applications running on smartphones or tablets such as the iPad, in this case, it can also refer to pieces of software, both web-based and otherwise, that can be used in concert with the Electronic Health Record. More recently, certain systems have been modified with the idea that these apps can be integrated with the EHR so that the provider need not go separate places to handle the needs that come up within the day to day routine of the practice. But a major question that comes up now is the value of these applications. Are they really all that useful, safe to use, and do they add real value to the world of healthcare?

There are many different healthcare applications that serve a wide variety of purposes. This encompasses items such as reference materials for providers, physician directories for patients and software that can be used to dictate quick chart notes into your phone.  The greatest advantage to these applications is the ability for the provider to think or work on a patients record while away from the computer. Perhaps one of the biggest concerns raised by providers about the new EHR-centric method of practice is how it takes away from face to face time with the patient. Unless the computer is in the room with the patient, they cannot quickly jot down a few notes, and for providers who are not adept at quickly addressing an issue on the computer, this can draw out an appointment. There are also apps that can aid patients who wish to know more about their own healthcare, helping them to quickly look up certain symptoms and find area providers that treat the symptoms they have. As EHR’s grow, more of these systems can be linked to this type of app, allowing integrated contact and scheduling efforts.

While the use of certain applications can benefit all stakeholders in the healthcare environment there are some critical questions. On April 30, Politico.com held a forum in which several experts in the field of health information technology, including ONC head Farzad Mostashari, discussed these and other issues. A major question that was raised was how reliable is the information provided in easily available healthcare apps? All medical devices that enter the marketplace require approval by the FDA before they can be sold or provided to patients. But is any piece of software a medical device?

As an example, in the past we have discussed apps such as one that helps people track calorie counts and exercise. But how are we to know that the calorie data provided by the application are accurate? If a provider uses an app as reference for how to prescribe a specific drug and the data is unreliable, any resulting errors are on him. This is why we count on government approval for other methods. But apps for phones or tablets are so easy to produce and distribute that it has become difficult for the government to keep track of them all.

A good app, used in concert with other available technologies, can be a powerful too, both to providers and patients in dealing with complex healthcare-related issues. But in deciding to use an app, one is trusting it to be reliable and safe to use. Without a massive, expensive, time consuming overhaul of the apps process, the government cannot possibly authorize everything that is out there. Therefore, the crowd sourcing method of reviewing applications, combined with the effort of healthcare organizations and EHR and practice management program developers to pick and promote the best and most reliable applications will have to suffice for the time being. The abilities of these technologies mean that there is a place out there for the good apps, but users and the government need to pay attention, because the difference between a great app and an unreliable one is often limited to the quality of information it provides.

 

Further Reading:

Politco “Tech Intersection: The Future of Health Care” 

Sample Apps

Cache Programming 101

Posted in Uncategorized on April 26, 2013 by mfisher527
EHR Evolution is offering a course on Cache Programming!

This 5 day course will develop an object-oriented database from organizing the data (building classes) to accessing it (writing methods to operate SQL queries and printing the results). It will cover relationships between data, storage of large objects (X-rays, MRIs), printing reports and the trade-offs made in storing data in different configurations. It will also cover MUMPS vs. ObjectScript coding and the advantages and usages of each. This is a hands-on course where each student will not only study the advantages of different approaches but will also build a fully functioning object-oriented database.

MUMPS is the basic language used in many applications world-wide.  It sits under 85% of the healthcare databases in the US.  It is also used by the Dutch healthcare system.  In addition, it is used in the financial industry, among other places.  One example is TDAmeritrade.

The MUMPS databases will not go away and there will always be a need to support them.  The future of programming involves many applications accessing each other.  This is where Cache objects become especially important.  If you have a MUMPS database and want to build an object-oriented front-end (Java, say, or .NET), you need to build objects that can access the data and send it to the front-end in an object-oriented format.

For your convenience this course will be offered via E-Learning and in person. Interested? Please fill out this form for more information!

EHR in the Cloud! Is it Right For You?

Posted in HIT on April 17, 2013 by mfisher527

Among the more popular advancements in technology in recent years has been the promotion of a style known as “cloud computing.” Developments such as Apple’s iCloud, Google Apps and Microsoft Office were designed to take advantage of the on the go atmosphere of today. Workers and students alike have migrated to a world in which they might need information or data at any time and being away from home or the office is not a reasonable excuse. Cloud computing offers users storage and access to their information, including contacts, calendars, e-mail. The result is a lack of need to store these items on a home computer, which allows them to be quickly accessed from another computer or a smartphone or tablet. It provides two major abilities: to quickly access necessary information while away from home, and eliminating the need to undergo a time wasting data transfer when acquiring new equipment.

It comes as little surprise, then, that Healthcare organizations are getting in on this trend. EHR’s such as AthenaHealth, Practice Fusion, and e-MDs exist as cloud based systems. This means that practices and providers do not need to host servers or storage units in the office to run all the necessary programs and store all records, both old and new. At the same time, providers can access their EHR from anywhere, and all it can require is quickly signing on from any web browser, meaning all doctors can complete their work at home if they need to, or quickly respond to a task, review a lab, or authorize a prescription, even if they happen to be away for the day.

It sounds too good to be true, and in some cases it is. While downside is probably too strong, there are some concerns that keep cloud-based EHRs from being the obvious solution. Foremost, because of the ease of access, these systems need to strongly address security. HIPAA is a major concern. If a provider can easily access  their EHR from any computer, what is to keep them from accidentally leaving it open when others use the same computer? Luckily most cloud-based EHR’s use bank level security in ensuring that patient records stay secure. The other major concern is one of storage. While the biggest advantage to a cloud system is that storage is off site, and offices are not required to buy expensive new equipment, which makes it a good investment for a small practice with a limited number of providers. But in the case of larger practices and hospital systems, sometimes the amount of data needed to be stored in the form of past patient records and images are very large. So the organization needs to determine that the system they are considering does not have a either a limit to storage space or the potential for higher usage fees for practices that need more data space.

If a practice determines that a cloud-based EHR is both secure and cost effective given the size of their practice and their data needs, they should consider cloud-based technology. It is easier to implement, easier to set up access for all providers, and easier to share information. Whether ones system is cloud or server based, it is proper implementation and motivated use which will best allow the provider to reap the benefits.

Further Reading:

“5 Advantages of A Cloud-Based EHR for Small Practices”

AthenaHealth

PracticeFusion

EHR Evolution Supports the Leukemia and Lymphoma Society!

Posted in Uncategorized on April 16, 2013 by mfisher527

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The Leukemia & Lymphoma Society’s Team in Training will participate in a century bike ride, June 2nd in Fletcher, North Carolina—cycling 100 miles in 9 hours. TNT (Team in Training) is an organization dedicated to helping those involved in these events, focusing on raising money to support leukemia and lymphoma research as well as training for the event itself. TNT started in 1988, and over 25 years has helped to raise more than 1.3 billion for life saving cancer research therapies! It is the largest endurance sports training program in the world, and provides participants with the experience of a lifetime!

EHR Evolution is a proud sponsor of the Leukemia and Lymphoma Society sponsoring our own Clinical Consultant, Charity Davis, a TNT participant. Each year Charity volunteers her time to raise awareness of blood cancers for the Leukemia and Lymphoma Society through this Team in Training program. Each week she will put in hours on the bike to prepare for the 100-mile ride that lies ahead, as a team they fight to beat the battle of blood cancers for those affected and to find a cure!

Did you know an estimated 1,596,679 people in the United States are living with, or are in remission from, leukemia, Hodgkin lymphoma, NHL or myeloma? Every 4 minutes, someone is newly diagnosed with a blood cancer. Every 10 minutes, another child or adult is expected to die from a blood-related cancer. In 1960, the 5 year survival rate for children with the most common form of leukemia was just 4%– TODAY, it is 85%– Lets make it 100%!

If you would like to help fight blood cancer and give to Charity, please follow this link! www.runcharityrun.com

Read more about Team in Training here http://www.teamintraining.org/

Read more about this specific event here http://fletcherflyer.com/team-in-training/

You can make a difference with us!

You can make a difference with us!image (1)

Blue Button…it’s Heading Your Way!

Posted in Uncategorized on April 4, 2013 by mfisher527

Every healthcare entity is required by law to allow patients access to their own health information. Previously it wasn’t as simple as utilizing  the “Blue Button” tool to electronically transmit records. Paper copies were harder to get a hold of, especially if the patient relocated or saw multiple physicians. Blue Button is giving patients all over the country easy access to their own medical records.

Currently Blue Button is available to Medicare beneficiaries, veterans and service members.  In August 2010, President Obama released news that Veterans could soon use a tool called “Blue Button” to access their medical history. The Department of Veteran Affairs launched Blue Button in October 2010 (around the same time Meaningful Use went into effect).

Slowly but surely other companies are getting on board and offering Blue Button, United Healthcare  and Aetna are among them.  United Healthcare anticipates 26 million patients will have access to “Blue Button” by the end of 2013. Blue Button users can view or print records in PDF and text formats, or even save to a thumb-drive.

With easier access, patient’s are more apt to be involved in their care, keeping track of their medical history and be “in the know” when it comes to preventative care. Patients, ask your healthcare provider if they offer “Blue Button”.

Healthcare Provider’s, if you don’t offer it, what are you waiting for? Licensing is no longer required to use the “Blue Button” logo and brand. You just need to follow these guidelines, put out by the U.S. Department of Health and Human Services.

Veterans and service members, click here to access Blue Button

Medicare beneficiaries, https://www.mymedicare.gov/ to access Blue Button

http://bluebuttondata.org/

EHR Interoperability

Posted in HIT on April 1, 2013 by mfisher527

What does “interoperability” mean?  ” The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiable, when and where needed.”

http://www.ehealthinitiative.org/

Electronic Healthcare Records are not a one size fits all. With the variety of healthcare facilities, it is a given that each EHR option is not created equally. EHR interoperability is a work in progress. With that being said, the goal is for them all to be able to communicate with each other, making healthcare for the patient and the providers much more efficient, safe and transitional. Exchange of documents between EHR’s is also a big part of meaningful use stage 2. Several states have started to mandate EHR Interoperability.

Cerner, McKesson, Allscripts, Athenahealth, Greenway and RelayHealth, a McKesson subsidiary make up about 40% of the EHR market. These vendors announced the launch of CommonWell Health Alliance at a recent conference (HIMSS). Allscripts signed on last minute, while EPIC has yet to jump on board. The goal of the alliance is to make sharing data a possibility and to enable  interoperability.

EHR/HIE Interoperability Work Group  includes 19 EHR suppliers, as well as  18 vendors of health information exchange software. Similar concept as CommonWell Health Alliance, only smaller EHR systems. Their goal is to have interfaces between EHRs and HIEs be compatible.

What are the advantages to EHR interoperability? There is no wait time for transferring charts between specialties, up-to-date information will be easily accessible.  Avoiding keying information in manually or scanning it in will save valuable time and money. Patient care and safety will greatly increase with EHR interoperability.

Why are there so many challenges with EHR interoperability?  Technical barriers, time and the expense of setting up interfaces are the major  challenges.

Seeking New Benefits within an EHR

Posted in HIT on April 1, 2013 by Matthew Levy

It is known that screening for colon polyps with colonoscopy can decrease the rate of colon cancer, the second leading cause of cancer death in both men and women. And yet, many people are never appropriately screened. This was highlighted by the recent “Love your Butt” campaign designed to encourage people to be screened.  While putting “Love your Patooty” signs in the metro is one attempt to increase screening rates, a recent article published in the Annals of Internal Medicine described a more focused approach using EHR’s to identify candidates for focused interventions. The study observed 4 methods for tracking this approach, each adding one additional element to the care provided. These included a “usual care” control group, an EHR-based addition that automated reminders and selected the patients that needed mailings sent, a further group that received mailings plus “assisted” telephone calls from an MA to follow up and schedule screenings, and a final group that received “navigated” assistance from an RN to help them with more complicated decision making.

The results of this study were interesting. On top of the “usual care” group, patients in the EHR-automated group were twice as likely to be current for CRC screenings within 2 years. The more advanced groups received notable steps up from there, but not as impressive as the automated group. This can be very useful. It shows that a system set up to fully automate the process, with the EHR handling everything except requiring staff to put messages out with regular mail. If the office wants to go further, it can, through phone calls and expert advice.

EHR’s have been criticized for being expensive and time consuming, but in this study, the ability to use structured data to identify patients who were eligible for, but had not yet received, colonoscopy allowed the investigators to target just these people for more aggressive, and ultimately often successful, interventions. The fact that the vast majority of the task could be done without provider oversight is more interesting. This same type of structured data and related processes could also be used to identify other groups of patients such as those who need vaccines or other tests. A good system can be set up to allow providers to easily check both the dates and results of screening but also prompt users if screening is overdue. Structured data can also be used to identify patients who have received prescriptions which might have had warnings issued, such as the recent one regarding Ambien in women. These types of uses for an EHR are just beginning to be investigated and utilized and everyone should look forward to seeing more such investigations.

Further Readings:

“’Love Your Butt’ Ads Try To Conquer Colonoscopy Fears”

Study Abstract