Category Archives: EHR

Electronic Health Record technology and software

Google Health could drive EHRs

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With two large players, Microsoft and Google, entering the health IT marketplace, it would make sense that the two would drive standards for information exchange between applications and their PHR systems.

Microsoft and Google are notorious for innovation and driving development towards their own ends yet neither seems too vocal on electronic health records and the inevitable leap in innovation the industry will experience over the next five years.

Both Microsoft and Google have electronic health portals for use by patients to create and store a patient health record (PHR) yet neither has been very vocal to drive interoperability and consistent formatting. For an industry we literally entrust our lives to, patient records have the least governance for standardization.

It makes sense that the national health exchange would dictate standards for formatting to both share doctor driven EHRs and patient driven PHRs, but with the states gaining control of the backbone of data exchange, it seems unlikely that all 50 states will agree upon a standard format. Where does the industry turn? HITSP? HHS? Industry leaders?

In the past, the health care industry seems happy to invent their own cryptic standards such as HL7, but with the aggressive time table for implementation it seems fruitless to spend time reinventing the wheel. There are many options available, but why not use XML? With XML accelerators available on the market to process large quantities of data, a structure easy to customize and modify as requirements change, and the perfect way for disparate software platforms to communicate to each other. It seems XML would be a perfect solution for vendors to use to export data from practice to national health data exchange and then again to PHR systems for the patient to view their data. XML data exporters can be effectively optimized for speed, security and integrity.

Close to any modifications and upgrades to the health IT infrastructure in use within the United States must always be the security of the patient’s health information. HIPAA security requirements are weak at the best of times, but generally are open for any knowledgeable hacker to obtain from the average health care provider. It is imperative to treat the security of patient health information with the care we treat our financial information.

EHR: Saving Health Care Industry $$

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One of the main purposes for many of the new regulations in the HITECH Act and the push to increase technology utilization within the health care industry is to save money. If implementation of an EHR increases the amount of time to see a patient, is it saving money? What is the real ROI for the average provider post implementation?

My argument is by no means to stop the push for EHR and other technology improvements to the health care industry. My argument is the current players simply do not have the right EHR system to do the job. The majority of systems do not improve workflow or increase efficiency within an office. These systems definitely improve quality of care and decrease the possibility for human error, but do they actually save time and increase the doctor’s ability to perform timely and cost effective health care.

Technology generally improves a person’s quality of life. User interface design is big business. Other software developers focus on ease of use, number of clicks, user intuitive screen design. Business intelligence, finance, security and other very high tech industries have very efficient and easy to use systems. Health care does not. Health care is 10 years behind the curve.

Where is the EHR system that will anticipate the user’s actions based on previous click and role? Where is the EHR system that reduces the number of clicks compared to a comparable system by half? Where is the EHR that allows a physician to double the number of patients they see?



HITECH Act pushes high-tech development?

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Why has the health industry historically been so quick to resist movements to jump into the electronic age? Cost barriers? Implementation headaches? Lack of usable solutions? Perhaps all of these items have contributed to the slow adoption of technology within the smaller practices but the software industry has not been helpful in reducing the barriers to entry and educating the end user.

A few weeks ago I was sitting in a seminar hosted by a major health care software development company and listened to a client testimony tell the full room to simply accept that the process of implementing an EHR should be painful and slow for six to eight months. Appalled would be an understatement for my reaction to this testimony but unfortunately it seems to be a consensus for most health care professionals when you start talking about EHR and practice management solutions. This is the fault of the software industry. It is completely unacceptable for a end user to believe that implementation of technology will impede not improve their operations.

My background in software development is not rooted in health care technology but most of my clients would have called security and had me escorted out of the building if I told them my software package was going to be painful to install and not improve business processes post implementation. It is time for the reformation of the health care software industry and impose the standards and requirements the rest of the software development world has apparently been using for years.

More importantly than simply catching up to status quo, I believe that the HITECH stimulus funding will push health care software development to push features and functions beyond the expectations of the end user. Why should the application simply store data? The application should be intuitive and interactive. If ever the software industry had a market for bleeding edge features and functionality, the health care industry is it.

Speech recognition is still very costly for rich functionality. Many EHR systems that offer speech recognition charge $100,000 or more to integrate the module and training the system for each user is yet still another costly burden. Health care IT has an opportunity to push speech recognition to the edge and reduce implementation costs while increasing effectiveness.

Moreover, IT should improve practice management operations and profit margins. Patient evaluations should move more quickly allowing doctors to see more patients without sacrificing care. Systems should automatically notify practice managers when patients are due for checkups or tests based on treatment, diagnosis and lifestyle. Prescription management should have guesswork removed. Systems should auto-interface with other provider records and pharmacy records to aggregate all prescribed medications for a patient so health care providers are better informed.

Providers should remember that anything is possible with software. Be vocal with your requests and ideas and drive development. Write letters to your congressman and women and to HHS. http://www.hhs.gov/feedback.html


Medicare Stimulus Calculator

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Please complete the following 5 questions to calculate your Medicare stimulus incentive payments.
Number of MDs in the practice
Average # of Patients/MD/Day
# of paitents that are Medicare
Avg. submitted allowable per medicare patient
Working days per year
Stimulus payments per physician using Medicare incentives
2011 2012 2013 2014 2015 Total
Stimulus payments per practice using Medicare incentives
2011 2012 2013 2014 2015 Total



What does Meaningful Use mean?

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One of the more confusing requirements for stimulus funding under the HITECH Act is the definition of “meaningful use.”  The goal of this requirement is to encourage not inly implementation of an EHR, but utilization as well.  Understanding how meaningful use is defined is important when determining your stimulus incentives for implementation of an EHR system.  This is the first in a series of many documents to begin helping the physician understand “meaningful use” requirements and insuring stimulus funds will not be denied.

As of today, meaningful use is still very broadly defined and has a ways to go before a clear understanding emerges.  The initial broad scope requirements outlined in the HITECH Act have undergone a 1st iteration by the Health IT Policy Committee and this iteration is simply a recommendation of the definition for meaningful use.  On July 16, 2009, a second iteration will be released before CMS begins work on the final requirements for compliance with meaningful use.

It is important to not disregard initial iterations of the meaningful use definition.  The 2011 deadline to have an EHR system in place and demonstrating meaningful use is just around the corner.  Implementation and training will likely need to occur before the start of 2011 to qualify for the first incentive payments available to health care providers.  Most likely a certain % of patients will be

Look for a breakdown of the 2nd iteration of the meaningful use definition on this site after the July 16th release date and expect a final publication by CMS before the end of September 2009.

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Benefits an EHR Should Provide

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Benefits of EHR For Small Practices

When looking for an EHR system to implement for a small practice with less than 20 providers, there are key factors everyone should weight before choosing an application.  Although there will be new requirements out in late 2009 for all software developers to comply with, providers can begin searching for an EHR solution now.

  • Key benefits of an EHR system should:
  • Improve clinical process or work flow efficiency
  • Increase quality of care
  • Improve clinical documentation to support appropriate billing service levels
  • Share patient information among other health care providers
  • Reduce opportunity for medical errors
  • Provide remote access to patient records
  • Improve clinical data capture
  • Contain or reduce health care delivery costs
  • Meet the requirements of new standards set forth in late 2009 (not available yet)
  • Facilitate clinical decision support

A checklist to begin your evaluation of EHR systems might include the following items:

  • Administrative/management reporting
  • Audit trails
  • Claims processing
  • Clinical documentation
  • Clinically driven billing
  • Coding support
  • Contract management
  • Decision support
  • Outcomes management
  • Patient access
  • Patient disease registry
  • Patient education
  • Physician order entry
  • Referral tracking
  • Registration eligibility referral
  • Scheduling
  • Specialty clinical software
  • Speech-based capabilities
  • Supports simultaneous users
  • Supports wireless
  • Touch screen
  • Transcription
  • Utilization management
  • Web-based
  • Web-enabled
  • Work group tools

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HITECH Act Basics

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With the introduction of the HITECH Act in early 2009, there is a plethora of information and misinformation surfacing for providers.  This article is a simple breakdown of the HITECH Act and what it means to healthcare providers as of today.  It is important to note that few absolutes have been defined by governing organizations including the method of dispersal.

The HITECH Act is part of the American Recovery & Reinvestment Act signed by President Obama on February 17, 2009.  It includes $36 Billion in funds available to physicians and healthcare providers for implementation AND USE of an EHR system that is certified by the standards to be set forth near the end of 2009.

Funding is available for physicians and in rural areas some physician’s assistants and nurse practitioners who have Medicare and Medicaid billings.  Practitioners have two options, incentives through Medicare or Medicaid but not both.

Medicare incentives are based on a percentage of Medicare billings up to $44,000 over five years starting in 2011.  Physicians in a health provider shortage area will be eligible for a 10% increase.

Medicaid incentives are for physicians who see more than 30% of patients paying with Medicaid (20% for pediatricians) and are eligible for up to $64,000 over five years with the majority of the payment during the first year, $35,000, and $10,000 over the next 4 years.

The HITECH Act declares that physicians must not only implement an EHR system, but demonstrate “meaningful use.”  Within the Act, meaningful use is defined in three ways:
-    User of a certified product complete with ePrescribing capability as determined appropriate by the Secretary of HHS
-    The EHR technology is connected for the electronic exchange of PHI
-    Complies with submission of reports on clinical quality measures
It is important to note that the standards for certification have not been released yet so no system is currently certified.  Additionally, it is expected that meaningful use will be more clearly defined in the upcoming months as more documentation is released by CMS.

Key Milestones
-    September 2009: CMS releases process for obtaining incentives
-    December 2009: Standards for certification should be released
-    2011: First payments from HITECH will be issued
-    2014: Demonstration of meaningful use required or penalties begin

In short, the HITECH Act is like many new legislation and requires additional definition by the regulatory and oversight organizations within the government that will distribute funding and enforce policy.  While this act will benefit most physicians financially over the next 5 years tremendously, it is important to stay updated regularly on new mandates and interpretations of the law.

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