Archive for the Uncategorized Category

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

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, 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 Evolution Supports the Leukemia and Lymphoma Society!

Posted in Uncategorized on April 16, 2013 by mfisher527


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!

Read more about Team in Training here

Read more about this specific event here

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, to access Blue Button

More Barriers to Patient Engagement

Posted in Uncategorized on February 27, 2013 by Matthew Levy

In attempting to address the barriers to increasing and expanding the ways patients can get involved in their own healthcare, we need to realize that some of these barriers are not just expansions of communication problems that can exist no matter where the healthcare exchange is taking place, but rather as a result of the way healthcare has changed. In this case, we move outside of the patient-provider realm and into the administration elements that drive healthcare. For the purposes of this discussion, administration can include just about any group or factor outside of the provider and clinical staff, including hospital administrators, as well as IT factors such as the EHR.

There are two groups that stand to benefit the most from a system like the ones that are being proposed by the ONC. These are patients, who can see improved health services, and hospitals, who can cut costs and improve services. This is obviously the major reason to pursue these efforts. Unfortunately, it is not that easy. The type of patient who is likely to benefit most from an advanced role in their own healthcare is one with more medical issues. Frequently, this represents both the elderly and more economically deprived who, not coincidentally, are the least likely to be both computer literate enough to handle their new tasks or even have the appropriate computer equipment.

Hospital administrators and payers also need to ensure that their providers are given the proper incentives and training to take part. The fundamental difficulty in implementing a new EHR is training all of the new users and convincing them to ditch old workflows in favor of a system that they may not find easier. In this case, we have heard a great deal from providers who are unhappy with the EHR that has been forced upon them, and likely aren’t interested in exploring the new features, capabilities, or benefits available to them. In addition, many healthcare organizations do not always pass on all the serious economic benefits of change to their employees; meaning change for change’s sake is the only encouragement.

Ultimately, the need for a system of greater patient engagement is like a microcosm of the structure it finds itself within. Like those who both promote change as it comes with EHR use, there is evidence that these changes are important and can be useful both in terms of improving patient health, improving the healthcare system as a whole, and provider a greater business model that can provide economic benefits. In addition, many providers who are given the proper guidance, training and support to switch to a new system

At the same time however, this is a change that requires a great deal of change in methods and basic practices. For a group of people who won’t necessarily see the benefits to this change right away, this change might be a difficult one to embrace.

Further Reading:

Patient Engagement:

Barriers: Providers and Patients

Posted in Uncategorized on February 22, 2013 by Matthew Levy

There are many reasons why the healthcare system might never reach the potentials being presented by ONC experts and proponents of advancing the doctor-patient relationship to a new level. There are barriers, both large and small, that exist throughout the field, amongst all relationships. Provider-patient is the oldest relationship in healthcare. As long as there have been doctors, they have had patients to treat. This history brings with it an entrenched relationship and some rigidly defined roles. This might include providers who are simply not interested in doing more than is required in the exam room to address their patients’ questions and concerns.

If this was the only limitation, we could work on breaking the barrier by providing hospitals proper levels of training and support to encourage a more open patient provider relationship. The difficulties, however, go deeper than this. Some of the greatest issues, even during an on-site appointment, are communication barriers. Studies have shown that Americans have a lower than average level of literacy when it comes to healthcare. This means they cannot fully interpret information given to them to make proper health care decisions. The only health literacy study done on a national level has shown that 12% of patients are proficient in completing the tasks we consider essential to understanding and acting on healthcare knowledge given to them.

In addition, on the other side, providers frequently do not realize their patient cannot understand. Often they ask the patient a “any questions?” instead of trying to truly ascertain comprehension. People of all classes are reluctant to do anything that they think might expose them as being less intelligent, and what does this more than admitting you do not understand what someone is saying to you? Now imagine the difference between the previous scenario happening in the doctor’s office, where a well-trained provider might be able to see or ask if the patient understands what has just been said, and a remote exchange, or an occurrence like the patient reading highly technical results. This is exactly the type of barrier that might make a patient prefer to avoid an online encounter.

In response to this problem, the Institute of Medicine has suggested that organizations become “health-literate organizations” that is organizations that attempt to present information at all times in a way to help patients with low health literacy understand and use information about their health. This means, for one thing, applying a “universal precautions” approach to health literacy: assuming that low health literacy may exist in all health systems or provider- patient interactions.

The issue as it currently exists is similar to what we see quite frequently throughout Health IT. It is difficult to break out of the everyday routine that has become very easy for healthcare workers. Embracing a new system is difficult, even with the knowledge that it will improve care and make for a better business.  It will require proper support and training for doctors, administrators and patients to break through the inertia.

Further Reading:

Health Affairs: “A Health Literate Care Model”

Institute of Medicine: “Ten Attributes  of Health Literate Health Care Organizations”

Barriers to Patient Engagement

Posted in Uncategorized on February 21, 2013 by Matthew Levy

The EHR effort, and patient engagement initiatives in particular, are meant to transform healthcare in a meaningful way. But the concept is not new. While there are different degrees of patient interaction, for example, several hospitals have made efforts to offer patients electronic access to their own records as well as personal electronic communication with their provider. And people have observed that patients with greater involvement in their own healthcare are, on the whole, healthier.  However, as we have pointed out, despite these efforts at larger organizations to create a patient engagement system, the goals set out under Meaningful Use require very little achievement. A larger effort must be made throughout the healthcare system in order to push further patient engagement.

This raises an important question. If so many elements of the healthcare process are interested in pushing patient engagement, what are the barriers to moving forward? To begin to find an answer to this question, we can explore the interconnecting elements that make up the healthcare system. They can be loosely categorized into three: Providers, Patients, and Administrators. Administrators does not just include people running a hospital, but also the people responsible for creating and selecting Electronic Health Records, as well as government elements and those that control the purse strings.

Former surgeon general C. Everett Koop once observed, “Drugs don’t work in patients who don’t take them.” This can apply here as well. If we cannot get patients engaged, we cannot fully reap the benefits of the EHR. Each participant within the healthcare field, as well as relationships and interactions between them, can potentially have its own barriers to moving forward. In the next few posts, we will address some of these barriers.

How Government is Driving Patient Engagement

Posted in Uncategorized on February 19, 2013 by Matthew Levy

As discussed both here and elsewhere, as Meaningful Use goes forward, increasing levels of patient engagement are required.  The latest issue of the journal Health Affairs is dedicated entirely to the idea of promoting patient engagement throughout healthcare. Unsurprisingly, the recent efforts to promote greater use of technology and Electronic Health Records come into play. One article is written by members of the Office of Consumer eHealth, part of the Office of the National Coordinator for Health Information Technology (ONC). They discuss their understanding of why this engagement is important and where we are now.

They then turn to the current federal strategy for increasing consumer engagement with e-health. A major focus is the “Three A’s” strategy developed by the ONC to fulfill its goal to empower people to improve their health and health care through health information technology. The three parts of the strategy are to increase patients’ Access to their health information; to enable consumers to take Action with that information; and to shift Attitudes so that patients and providers think and act as partners in managing health and health care using health information technology.

The implementation of each of these is just starting, but several things are clear: Access alone, even if it were universal which it will never be, is insufficient and that success in this area requires a partnership between patients/providers/government/EHR providers and others in a way that is unique in health care. A “cultural shift” is required on the part of patients and providers. For example, they say  “patients need to feel comfortable requesting electronic access to their health records, asking providers questions, sharing their own health knowledge, and weighing in on treatment options. “ Successful implementation in this area requires acknowledging barriers that may exist at many levels and trying to study and reduce them. This work is just beginning. Going forward, we must address these barriers to a world of greater patient engagement in healthcare.