Report Tracks Demand for Consultants To Help With Health IT Adoption

Nearly 70% of health care providers expect to hire a professional services firm to help them achieve “meaningful use” of electronic health records, according to a new report from research firm KLAS, Healthcare IT News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.

Report Findings

For the report, KLAS researchers interviewed 118 health care providers (Monegain, Healthcare IT News, 5/18). They found that integrated delivery networks had the highest need for external expertise, with 90% reporting plans to collaborate with consulting firms (Guerra, InformationWeek, 5/20).

Trend Toward Specific Tasks

Researchers noted that many health care providers already have achieved some level of health IT adoption and now are seeking to hire smaller groups to complete specific tasks.

Mike Smith — report author and KLAS general manager of financial and services research — said many health care organizations hire consultants to help bolster physician adoption of clinical information systems (InformationWeek, 5/20).

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HHS to study patient perceptions of EHRs

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health IT is seeking patient perceptions of the delivery of healthcare through the use of an EHR.

“Health IT experts agree that HITECH stimulus funds are likely to improve how physicians practice medicine for Medicare and Medicaid beneficiaries and, ultimately, for advancing patient-centered medical care for all Americans. However, there is an evidence gap about patients’ preferences and perceptions of delivery of health care services by providers who have adopted EHR systems in their practices,” the HHS’ May 14 notice in the Federal Register stated.

According to the notice, the goal of the proposed Patient Perceptions of EHR study is to help policymakers understand how primary care practices’ use of EHRs affects consumers’ satisfaction with:

* Their medical care,
* Communication with their doctor
* Coordination of care.

“The research questions for the proposed study are motivated by a concern that patients may have negative experiences as practices begin to use EHRs,” the agency wrote.

HHS plans to survey 840 patients about their opinion of their medical care when their primary care physicians use EHRs, according to the notice, which can be read here.

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Speakers at Boston Conference Highlight Health IT Opportunities

On Thursday, National Coordinator for Health IT David Blumenthal discussed national progress on health IT adoption during a speech at a conference hosted by the Massachusetts Health Data Consortium, Computerworld reports.

Blumenthal highlighted the grants his office is distributing for health IT education and training at regional extension centers. He said federal investment in health IT training could help create between 45,000 and 50,000 jobs over the next five years.

Blumenthal also discussed how federal officials plan to investigate safety issues associated with electronic health records. He said the Office of the National Coordinator for Health IT will prioritize patient safety goals as it works to promote EHR adoption nationwide.

According to Blumenthal, over the next year ONC will focus on:

* Finalizing “meaningful use” regulations for EHRs;
* Helping hospitals and health care providers adopt standards that align with the National Health Information Network; and
* Implementing the “beacon community” grant program to support regional health IT infrastructure and data exchanges (Mearian, Computerworld, 4/30).

Blumenthal said ONC will announce the awards for the beacon community program “very, very soon” (Monegain, Healthcare IT News, 4/30).

Governor Discusses Massachusetts’ Experience

Also during the conference, Massachusetts Gov. Deval Patrick (D) discussed how health IT initiatives have played out in his state, which requires most residents to obtain a minimum level of health coverage (Computerworld, 4/30).

Patrick said that:

* 45% of Massachusetts physicians have adopted EHRs;
* 50% of state physicians use computerized physician order entry systems; and
* Massachusetts leads the country in electronic prescribing (Healthcare IT News, 4/30).

The governor also said that his state could face challenges in connecting health care providers through health information exchange networks (Computerworld, 4/30).

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EHR Use Thought To Help Boost Adoption of Telehealth Initiatives

Growing adoption of electronic health records is expected to complement and boost the use of telehealth initiatives across the country, InformationWeek reports.

Health care organizations are planning to deploy telehealth programs to increase access:

* To certain specialists;
* For patients with conditions that prevent them from traveling; and
* During patient transport, since some conditions require treatment while patients are in transit.

Greater use of EHRs will provide remote specialists with more detailed data about patients. Digital medical images, ranging from picture-archiving systems to digital cameras, also can provide more information to providers.

InformationWeek described several telehealth initiatives, including:

* The use of telemedicine gear — including videos and digital stethoscopes — to help physicians treat pediatric patients in transit to hospitals in the area in and around Cincinnati, Ohio;
* Telestroke, an application that links hospitals without stroke specialists to specialists at other hospitals; and
* An effort to offer telehealth services to employees on-site at company facilities (Kolbasuk McGee, InformationWeek, 4/27).

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NIST Begins Rolling Out EHR Performance Testing Program

By Rich Silverman

There are hundreds and hundreds of Electronic Health Record software packages in the marketplace that claim to be capable of allowing you to establish meaningful use, but how do you know if those claims are true? So far there has not been an impartial, independent way to determine the truthfulness of a vendor’s claims.

Earlier this month, the National Institute for Standards and Technology (NIST) rolled out the first part of its testing infrastructure, created in conjunction with the Department of Health and Human Services (HHS), vendors, implementers, standards organizations and certification bodies. The American Recovery and Reinvestment Act of 2009 (ARRA) designated NIST as the agency responsible for determining if EHRs meet HHS standards for functionality, interoperability and technical benchmarks.

According to Bettijoyce Lide, NIST’s senior advisor, program coordinator for Health IT, speaking to Information Week Magazine, the goal is to establish a health IT infrastructure that provides a high level of security to American’s electronic medical records. “New test methods, along with testing infrastructure, certification, security and usability help ensure that the health information of Americans is exchanged safely, securely, reliably, and only to appropriate sources,” she said.

NIST created the test procedures and infrastructure based on the Interim Final Requirements (IFR) published by HHS on January 13th of this year. If those requirements change, NIST says it will change its test procedures accordingly. Plans call for tests to be rolled out in four waves.

Fifteen test drafts have been rolled out so far, each keyed to a specific requirement as spelled out in the IFR. As an example, test criteria 170.302(b) relates to maintaining an up-to-date problem list, a key meaningful use requirement. The test will determine if the program will “enable a user to electronically record, modify, and retrieve a patient’s problem list for longitudinal care in accordance with (1),the standard specified in §170.205(a)(2)(i)(A), or, (2) at a minimum, the version of the standard specified in §170.205(a)(2)(i)(B).”

Other tests will evaluate a product’s ability to maintain allergy and medication lists, calculate body mass index (BMI) and track among history. Additional tests will be rolled out over the coming weeks.

To keep stakeholders informed about the full extent of NIST’s activities in the health care certification arena, NIST has set up a special website with links to all of its major activities: infrastructure creation, test methods, conformance testing, and testing and support. The overall program can be used by vendors to determine if their products will meet standards before it submits them for certification, and will be used by approved certification bodies to test those product offerings.

This NIST program puts into place one of the final pieces of the certification puzzle. It will enable you to determine if a product which claims to be certified will actually perform the functions it says it can perform, because it has been tested and proven to meet the standards set forth by the HITECH Act and the definition of meaningful use.

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Proposed EHR Certification Program Won’t Inhibit Innovation, Says Blumenthal

By Andrea Kraynak

Is your EHR meaningful use-compliant? Healthcare providers may soon be able to find out for sure.

HHS released a proposed rule Tuesday for establishing certification programs for health information technology. The proposed rule describes the creation of a certification program for EHRs, as mandated by the HITECH Act.

EHR certification is designed to “give purchasers and users of EHR technology assurances that the technology and products have the necessary functionality and security to help meet meaningful use criteria,” according to a press release from the Office of the National Coordinator (ONC) for Health Information Technology.

When writing the interim final rule on standards and certification criteria for EHRs, the ONC strived to balance competing agendas, David Blumenthal, MD, MPP, the national coordinator for health information technology, said today at the Healthcare Information and Management Systems Society (HIMSS) 2010 Annual Conference and Exhibition in Atlanta.

For example, it tries to balance the need for uniform standards against the need for interoperability and innovation and the need for an efficient way to exchange information versus patients’ rights to privacy. The agency tried to allow for flexibility, to meet providers “where they are,” and not inhibit “critical innovation,” he said.

Similar to the multi-stage approach proposed for the EHR meaningful use incentive program, the proposed establishment of an EHR certification process would also occur in various phases.

* The first phase would be a temporary certification process whereby the National Coordinator would approve organizations to test and certify EHRs.
* The eventual permanent program would transfer testing and certification fully to private sector organizations and separate the two functions.

The separation of those two functions is an important aspect, Blumenthal said. It allows certification of not only completed EHRs, but also of individual modules, a move designed to allow architectural innovation.

The proposed permanent program also has requirements for accreditation and addresses the potential certification of health information technology (HIT) other than complete EHRs and EHR modules.

HHS anticipates issuing separate final rules for each of the two programs.

The multi-phase system is designed to enable eligible professionals and hospitals to implement certified EHRs in time to qualify for the initial set of meaningful use incentives, which are set to begin as early as October for hospitals, and January 1, 2011 for eligible professionals.

The phased method is a sound way for HHS to work within the regulatory timelines put in place by the HITECH Act, says Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal of HIPAA Boot Camp in Casa Grande, AZ. “It’s an ambitious program, so this approach works well.”

Because HHS made such a conscious effort to solicit input from so many different parties and such a wide variety of stakeholders, it injected an element of practicality into the rule, according to Ruelas. In addition, the rule takes care to consider the evolving meaningful use criteria and how the adoption of future criteria may affect the certification status of EHR systems or modules, he says.

One element of the program the healthcare community is likely to find particularly helpful is the proposed master “certified HIT products list” that the ONC plans to have publicly available on its Web site.

“This ONC master list will help folks accurately identify genuinely certified products that may help meet their needs, such as in achieving meaningful use,” says Ruelas.

The ONC expects it will add additional features to the Web site over time, such as interactive functions that would allow providers to review combinations of certified EHR modules to verify that they would comprise a certified EHR technology.

Interested parties will have 30 days after the proposed rule’s publication in the Federal Register to comment on the proposed temporary program, and 60 days to comment on the proposed permanent program. You can submit comments electronically at www.regulations.gov.

Blumenthal made it clear that HIT leaders must step forward to provide feedback for the proposed rules; throughout the document, there are questions directed at HIT leaders and requests for feedback. “We want you to continue to be leaders and we will follow your lead,” he said.

With the release of the proposed rule, the focus now shifts from policy to the process of implementation, said Blumenthal, who expects the release of the three related EHR meaningful use final rules later this spring. His soon-to-be expanded office will now begin working on the next iteration of meaningful use.

“That is a huge job. We are going to have to grow considerably to make that happen,” he said.

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A New Study: Easing the Adoption and Use of Electronic Health Records in Small Practices

A new study identifies lessons learned by organizations that help small physician practices adopt and use electronic health records (EHRs).

The authors surveyed 29 initiatives that help smaller medical practices adopt and use EHR technology, including some regional extension centers. They obtained information from program leaders, Web sites, and published reports.

Key Findings

* Current programs providing health IT assistance form one-on-one relationships with practice clinicians and staff to overcome implementation barriers—such as lack of technical expertise, isolation, and practice disruption—and to increase odds of successful practice transformation.
* Practice consultants need direct experience with small practices, the technical expertise to manage relationships with vendors, knowledge of software implementation, and know-how around work-flow change and quality improvement methods. Program leaders warned of a shortage of such individuals and remain concerned about finding sufficient qualified staff.
* A significant barrier to successful implementation and use of health IT is underestimating the effort and upheaval that accompany implementation.
* Most assistance programs can provide only limited help with selecting software and hardware, yet this is a critical decision for practices.
* Practice redesign and quality improvement methods are integral to using health IT to its full capabilities. Program leaders stressed addressing practice redesign prior to, or simultaneously with, health IT implementation.

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EHR Early Adopter Offers Advice for Providers Vetting New Technologies

By Andrea Kraynak,

Upcoming EHR meaningful use subsidies may give many hospitals the additional incentive necessary to push toward a largely paperless existence.

Some facilities may be adopting their first electronic systems at this time. Others currently operating in a hybrid environment are likely looking to increase their EHR technologies to meet soon-to-be-finalized meaningful use measures.

Of course, cost is always a part of the conversation when vetting potential new technologies. Many providers may also want to insist on purchasing certified EHR technologies so they are eligible for incentives. But many other less obvious points warrant consideration when selecting potential EHR technologies, says Deborah S. Fernandez, RHIA, corporate services manager for New York-Presbyterian Hospital in New York City, who has been working with various EHR systems and technologies since the late 1990s.

First of all, as much as possible, HIM should be a part of the team that considers various EHR technologies. HIM staff can offer a unique perspective on what the new technology needs to be able to accomplish. For example, HIM staff members may be able to determine whether the potential technology will capture documentation in a way that meets legal requirements.

“It’s terrible to make an investment like that and not have a full handle on everything [the system needs to do],” Fernandez says.

And don’t forget about your record reproduction needs. Consider the various healthcare reform initiatives aimed at saving government dollars. It all translates into more audits for hospitals, says Fernandez. And that means reproducing your records for auditors.

“My facility is going to be receiving recovery audit contractor requests,” she says. “That’s a lot of printing.”

For example, consider how systems print hard copies of your data. Some systems print information in the form of unwieldy spreadsheets instead of more consolidated narratives.

“Some systems are very nice and neat, but some of them are horrific,” Fernandez says. “Some of these systems will print thousands of pages.”

In addition to printing hard copies, don’t forget to look at the ease with which potential systems can reproduce electronic copies of information, Fernandez says. Many auditors may soon begin to accept electronic versions of medical records, if they don’t already.

But the electronic versions can be equally unwieldy; some systems produce huge files, she says. When considering various technologies, consider how easy it will be to save the data in the systems on a CD or DVD, for example.

And be sure to talk to vendors about how their technologies will interface with those you already have in place. Many providers will adopt different specialized systems for different areas of the hospital. This isn’t necessarily bad, Fernandez says, because the technologies are designed to do different things. But at the same time, you don’t want staff members to have to sign on to five separate systems to view information on a patient.

You’ll probably need to push systems into working together for information to be available in this way, she says. Do yourself a favor and consider upfront whether technologies will be able to talk to each other.

“The idea that clinicians can view something in a single system might not sound like such a big deal, but it is,” Fernandez says. “You want it to seem to the end user that you have only one system instead of a dozen.”

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10 Steps to Selecting the Right EHR Solution For Your Practice

By Reda Chouffani

As many medical practices shift gears toward a paperless environment, it’s clear to many they must first investigate what potential incentives will be available to them if they participated in the Stimulus healthcare information technology HITECH. Additionally they will need to identify which product would be the most cost effective and offers the highest return on investment.

In selecting an EHR, most healthcare organizations face conflicting reports on products they are evaluating, some of which can be based on lack of proper product implementations. Others failed products that did not fit the practice’s workflow. As an example; by knowing how to select an EHR product, and examining how some of the previewed products compare, the medical practice will be able to properly identify its need and which products can successfully meet its challenges.

Practices have had plenty of time to make paper charts work for them since the early 20s, when the US saw the spike in private group practices grow. This provided ample time to perfect the efficiency of using paper based workflows. While several software vendors come with a promise of a new world where no paper exists and practice’s revenues increase, it would be very naïve for any Practice Administrator to take their word for it.

Today’s technology is fully capable of automating and streamlining many clinical workflows, as long as it is the right solution with the right planning and readiness.

To avoid being just another statistic in the failed world of EHR, there are a few critical objectives that should be met to ensure a thorough assessment, smart selection and careful planning for an EHR selection.

The following are the ten steps that can help you during your EHR selection stage:

1. What are Your SMART EHR Goals?

It is critical to define what the practice’s EHR goals are. This will enable the practice to ensure that providers, practice administrators and other stakeholders are on the same page. Document the top 10 goals everyone needs this EHR to accomplish.

The goals can be further divided into financial and or operational objectives. Each goal must document using the S.M.A.R.T. methodology (Specific Measurable Attainable Realistic Time Bound). By doing so, everyone will have a clear understanding of what to gain and expect from the adoption of an EHR system.

2. Current State Analysis

Since every practice differs in workflows, you will need to consider that there are different EHR’s. We recommend that all major workflows must be reviewed, and establish which can be automated and streamlined through an EHR and which will require additional resources to properly document electronically.

Example:

• Physician completes visit, and marks on the encounter
• Physician writes a prescription for some medication
• Patient takes the paper encounter and gives it to Check-out staff
• Check-out staff enters data in the billing system
• Check-out staff collects the co-pay / balance.
• Patient gets receipt and takes the prescription to the pharmacy

Future State Analysis:

• Patient pays at the time they come in for any balance or co-pay requirement
• Physician completes visit electronically and selects the procedures performed
• Physician creates an electronic prescription for the patient and submits it online
• Patient leaves the practice without one piece of paper
• Patient picks up their medication at the local pharmacy

3. Define What Devices You Are Planning on Utilizing

During this assessment phase, it is critical to identify the proper set of devices, interfaces and hardware that you will need as part of your paperless endeavors. There are several aspects to identify so you have a clear understanding of the complete scope of the project:

• Does the current Ultrasound machine allow you to submit studies electronically? If yes, how much for licensing from the vendor?
• Does the Dexa machine support imaging export? How much is the cost for that?
• Are insurance card scanners needed? Are they double sided?
• How many high speed scanners are required?
• Are the providers going to need tablets or plain laptops?
• Do you need wireless set up at the practice?
• Are the lab interfaces included in the EHR package or is the lab company willing to pay for them?
• Do you need signature pads to eliminate form printing?
• Does the transcription company support interfacing with EHR?
• Does your router allow for remote connectivity, and do you have redundancy on the connection?

4. Create a Comprehensive Vendor Questionnaire

This should include questions about company history and certifications.

Currently, there is no finalized decision on certification body for the ARRA, financial viability, business agreement, system cost, post-implementation maintenance costs, system functionality, system technology and most importantly references.

Some examples are:

• What is the cost per physician?
• Total cost of ownership, yearly fees, support costs and upgrades
• Can you design and modify the current system templates?
• Is your system true client/server or it is web based?
• How many installations do you have that are current?
• Is support local or outsourced overseas?
• Is your product a certified product (certification body to be determined)? If not, do you plan on it?
• Can your product interface with another PMS application?

5. Narrow Down the Vendor List

Creating a list of vendors based on product specialty, reputation, and references will help you tremendously. This list should consist of 3 to 5 vendors at most.

There are several web sites such as KLAS that will provide you with some additional reviews of software packages that are available, and may further assist you in narrowing down your list.

6. Request System Demonstrations

During this stage, it is highly recommended that the practice provide the implementation and project manager with a number of scenarios. These workflows should be performed during the demonstration.

Examples can be:

• Documenting review of systems and adding family history
• Documenting initial prenatal visit
• Documenting requesting/scheduling and post surgery notes
• Documenting colonoscopy procedure and viewing clinical imaging

7. Request References From Vendors of Practices Such as Yours

At this step, a list of practices using the product that you can contact would be advisable. This would shed some light on several components.

Questions to ask are:

• How long before the practice was seeing the same volume of patients?
• What specific items do the providers see as value with this package?
• What items does your clinical staff say is slowing them down?
• How would you rate the company support?
• Has this impacted your billing cycle?

There are several questions you should ask, but the main focus is to be specific. Get facts which will help you determine whether or not this package is a good investment.

8. Review the Business Case

Whether the vendor provides you with a strong business case to justify the investment you are about to embark on or you take it upon yourself to create a financial analysis, it is a must to have some financial measurements such as return of investment (ROI), total cost of ownership (TCO), net present value (NPV) and discounted cash flows (DCF). This will enable you to have a clear understanding on whether this solution will pay for itself or drain your practice of income during these difficult economic times.

Some of the items to review are:

Soft ROI: This is the element of your business that will have soft savings. For example: First begin to perform time and motion studies. This is where you measure the time it takes for the physicians to document a visit, prescribe or record the diagnosis and procedures on the encounter. Then measure the time it will take for the same activity but with the EHR package (s) you are evaluating. The difference in time gained will be one of the practice’s soft ROI.

Hard ROI: This can be associated with the cost savings from eliminating things like paper charts, folders, material, filling cabinets, and space leased for storing paper charts, transcription costs and such.

Risk Mitigation: The final section will cover the risks of using such a product. It is clear that by digitizing paper charts, practices reduce the risk on misplacing or losing patient charts. With the proper backups in place, a healthcare organization can rest assured that no matter what, the patient charts are protected. In addition, some of the prescription modules enable drug interaction and allergy alerts. This reduces the patient’s health risks dramatically.

9. Visit Local or Remote Client’s Site

Being exposed to a live site using the product(s) you are evaluating is key. This can help you get candid feedback, and will demonstrate how it is being utilized.

10. Decision Time

When you have considered your goals and challenges, what to resolve and what products to select, reviewed their existing install and had everyone on the same page, it’s time to evaluate your findings and use the attached checklist to assess which of the products will fit your need.

As the market and healthcare regulatory changes continue to affect medical organizations, executives are under pressure to reduce IT costs, automate current processes and increase revenue. Some of the changes can also determine if current implemented EHR will be a source of incentives or penalties.

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Survey: Many Non-EHR Users Plan To Purchase Systems Within 2 Years

Fifty-eight percent of physicians who currently do not use electronic health records say they plan to introduce new systems in the next two years, according to a survey released Tuesday at the Healthcare Information and Management Systems Society’s 2010 conference, HealthLeaders Media reports.

For the study, Accenture’s Innovation Center for Health and Institute for Health & Public Service Value and Harris Interactive surveyed 1,000 physicians in practices with fewer than 10 practitioners.

Of the survey respondents, 15% were currently using EHRs and 85% were not.

Of the respondents younger than age 55, 80% said that they plan to purchase EHR systems within two years (Johnson, HealthLeaders Media, 3/2).

Motivations for EHR Purchasing

When asked about major factors driving EHR adoption:

• 61% cited federal penalties for non-adoption; and
• 51% cited federal incentive payments (Mearian, Computerworld, 3/2).

The survey also found that 75% of non-users said they would be interested in purchasing an EHR system from a local hospital if the facility partially subsidized the purchase. Most non-users expect a hospital or health network to subsidize about 50% of the cost for an EHR system.

EHR Expectations

The survey also found that physicians have high expectations for EHR systems. According to the survey:

• 67% expect EHRs to improve billing and other administrative processes;
• 62% expect EHRs to make it easier to order and view imaging and test results;
• 59% expect EHRs to facilitate medication management;
• 55% expect EHRs to boost care coordination with other clinicians; and
• 51% expect EHRs to improve patient care (HealthLeaders Media, 3/2).

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