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An EHR optimization that actually wins over physicians?

EHR optimization – Baystate Health takes aim at click fatigue with mobile-optimized workflow tool.

Like all healthcare CIOs, Joel Vengco, chief information officer at Springfield, Massachusetts-based Baystate Health, has no shortage of pressing projects competing for his attention for EHR optimization.

Whether it’s working to drive operational efficiencies across the $2.5 billion health system, improving the usability of an array of applications for clinical end users, spearheading community engagement and patient outreach for population health management or working on analytics and “knowledge management,” it all make for a busy workday.

That’s all in addition to the imperative of constant innovation: Beyond just being Baystate’s CIO, Vengco is the founder of TechSpring, an innovation center based at the health system where IT vendors are given secure access to real patient data to speed the development of new technologies.

“So there are lots of things to focus on as a CIO – notwithstanding all the security issues we’ve got to focus on too,” he said.

But even with so much going across Baystate – five hospitals, an academic medical center, 90 medical groups, a health plan with about 250,000 members, “a Next Gen ACO that we manage, and we’re getting into a Medicaid ACO” – Vengco has generally felt pretty on top of things.

Except, until recently, with one important initiative.

“The big project we’ve still yet to quite crack the nut on is: How do you optimize the EHR? How do you optimize the workflow for a clinician?” he said.

Work for providers, on a day-to-day basis, just gets more burdensome, said Vengco. “They’ve got to document, they’ve got to bill – and then they have to see the patient at some point. And then that 15-minute visit becomes a 20- or 30-minute visit because you’re doing all this other work.”

So Vengco posed a tall task to his IT team: Optimize the electronic health record and improve workflow for Baystate’s clinicians. But do it, crucially, in a way where the clinicians take to the new approach voluntarily, because it works better for them, rather than having to be told to do so.

“That was the challenge,” he said. “To leverage our current legacy EHR, Cerner, but then really enhance it without ripping and replacing it.”

For help, he turned to Palo Alto, California-based Praxify, whose recently unveiled MIRA app can augment existing EHRs, integrating with legacy systems to improve workflow.

Touted as being designed by and for physicians, the app offers capabilities such as “glanceable” interfaces that can surface key patient data for faster documentation and review, and dictation tools that enable voice-activated order entry.

The app gives clinicians the “data and the functionality they need within one or two touches or clicks,” said Vengco. “In our case, it’s more of a mobile design, using the heuristics of swiping and all the mobile capabilities you’re using in your day to day life.”

To Praxify, he also had some clear instructions: “We can’t spend two years doing this, we can’t spend millions of dollars putting you guys on top of Cerner. That doesn’t create value. What creates value is doing it in three to five months and actually getting adoption by the providers without me mandating use,” said Vengco.

“That challenge, happy to say, has been met,” he said.

Praxify connects with Cerner, using APIs, in just two or three months, he said. “Now we’re going full force with a production deployment to our health system. And some of the preliminary feedback is that providers, who are some of the hardest customers, are saying they definitely want to use this,” he said.

“We had a hospitalist, probably one of the most vocal critics of our EHR, initially said she wasn’t going to use Praxify,” said Vengco. “She said it was just another technology burden.”

Not long after trying it, she returned to the CIO with glowing reviews. “She said, ‘This is amazing. It’s incredible.'”

Across Baystate, “we’ve seen efficiencies of, on average, 40 percent if you compare it to the way the EHR was previously being used,” said Vengco. “They love the fact that they can get it on any mobile device. They love that, instead of taking five or seven or 10 clicks, it’s a swipe, or a touch. It’s efficient and fast. They love the design of it. They love that they can dictate.”

Because it connects directly to the EHR, there’s no concern about a loss of data. “And the design is intuitive enough that we don’t have to do five or seven hours of training  – it’s a 20-minute discussion and they’re off and running,” he said.

The point, said Vengo, is that “I want them to adopt it themselves. If I give it to them and it goes viral, and they take to it, that means it’s intuitive, it’s optimized, and that makes me happy because the providers are happy.”

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Digital health tools ‘dramatically transforming’ care experience

Digital health tools: a new study found that patients of all ages, with Baby Boomers leading the charge, are interested in accessing medical records online and tapping into portals to book appointment, pay bills, and refill prescriptions.

By Jack McCarthy

Nearly 75 percent of patients expressed a high level of interest in accessing their electronic medical records via digital tools, according to new research, and 33 percent indicated that EHRs have already changed their experience for the better.

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EHR notification overload costs doctors

EHR notifications – Primary care doctors are subject to twice as many notifications as specialists, researchers found, but both are facing information overload.

By Jack McCarthy

“Information overload is of concern because new types of notifications and ‘FYI’ (for your information) messages can be easily created in the EHR (vs in a paper-based system),” the researchers wrote in the Journal of the American Medical Association  Internal Medicine.

Making the workload harder to endure, reading and processing these messages is uncompensated in an environment of reduced reimbursements for office-based care, according to the study.

Physicians are receiving these increasing amounts of notifications in EHR-based inboxes such as Epic’s In-Basket and General Electric Centricity’s Documents. The messages include test results, responses to referrals, requests for medication refills, and messages from physicians and other healthcare professionals.

The system is crying out for change the researchers wrote. “Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed.”

What’s more, optimistic predictions that EHRs would improve patient care through better doctor-patient communications have not ubiquitously materialized.

“Unfortunately, we are far from this promise and now also grapple with the unintended consequences of EHRs,” Joseph Ross, MD wrote in an editorial accompanying the research.

In fact, electronic “paperwork” has burdened doctors and reduced the time for patient care.

Ross advocated that inbox notification capabilities be periodically reviewed to be sure EHRs are working in the best interests of patient care and not creating an unnecessary burden on physicians.

In addition, doctors should be reimbursed for time spent reviewing EHR notifications.

“Although many of these notifications are in the service of patients,” Ross wrote, “we need to be sure that physicians’ reimbursement, particularly for primary care physicians, is taking into account the full time needed to manage patients’ care.”

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HIMSS16 – Frustrations linger around EHR

HIMSS16 – Experts say healthcare providers need to turn up the pressure on tech vendors to create more intuitive products.

By Mike Miliard, March 10, 2016

HIMSS16 – Electronic health record usability might not have been the hottest topic at HIMSS16 this past week – our polling shows big data and interoperability tied for that honor, with privacy/security just nudging population health for the second spot – but it was certainly top of mind for many.

The multi-day User Experience HIMSS16 Forum, for instance, explored the human factor and design choices that can directly impact the use and efficacy of health information technology, examining UX from the perspective of physicians, nurses, patients, vendors and more. Sessions gave voice to end-user frustrations, looked to tear down the barriers to innovation and tracked the clinical and financial return that can be gained from improved software interfaces.

In a provocative prime-time speech, meanwhile, Acting CMS Administrator Andy Slavitt threw down the gauntlet: “I’m certainly not bashful about what we need to do better, and I’m not going to be bashful here, even in the face of some very good reasons for optimism, about ways we need to take our game up across the board.”

The health IT industry has done very well in the years since the HITECH Act, said Slavitt. “But we’re still at the stage where technology often hurts rather than helps physicians providing better care.”

To bolster his case, he rattled off a series of actual quotes from frustrated clinicians. One complained that in his EHR, “to order aspirin takes eight clicks; to order full-strength aspirin takes 16.”

Slavitt said at HIMSS16, CMS is newly committed to taking a “user-centered approach to designing policy.” He asked vendors to do the same, with a similar spirit of empathy: “Step back and look at what you don’t think is working, and make it better.”

In recognizing that health IT still “often hurts rather than helps physicians,” Acting CMS Administrator Andy Slavitt said at HIMSS16 that the agency is newly committed to taking a “user-centered approach to designing policy.” He asked vendors to do the same, with a similar spirit of empathy: “Step back and look at what you don’t think is working, and make it better.”

‘Dissatisfaction with EHRs has been immense’

The rigors of federal policy requirements, combined with the suboptimal UX of many EHR products has left doctors and nurses feeling less like clinicians and more like clerks, said one chief medical information officer at HIMSS16. Ceaseless data entry is bad enough. But even worse when done through a clunky or dated user interface.

“Dissatisfaction with EHRs has been immense,” said George Gellert, MD, associate system CMIO at CHRISTUS Health. “Understandably, physicians are looking for release.”

Increasingly, many of them are finding it by using unlicensed medical scribes, who often have minimal training, as data-entry workarounds. If that poses obvious patient safety risks, it also hinders the progress of EHR product improvement, he argued.

“If you insert a scribe permanently between the physician and the EHR, and the physician totally disengages from using the EHR, you are going to have a significant deceleration of technological advancement because there’s no market pressure,” said Gellert at HIMSS16.

As problematic as UX often still is, many IT vendors have made big design and usability improvements in recent years, as a direct result of pointed and specific clinical feedback – including at CHRISTUS, where docs and nurses now enjoy an updated EHR made better thanks to the health system’s commitment to capture “every single physician complaint” and relay them to its vendor.

Market pressure works, said Gellert, and a rising sub-industry of scribes could be counterproductive as doctors’ dissatisfaction comes to a boil.

At least scribes still engage with technology, in contrast with one New York Times item that garnered a bit of attention in health IT circles this past December. “In Age of Digital Records, Paper Still Carries Weight,” was the headline.

The good news? We’ve come a long way in a short time: “In 2009, fewer than 10 percent of hospitals had any kind of electronic medical records,” wrote Abigail Zuger, MD. “By 2014, 75 percent had at least a basic system.”

The bad news? That “rushing” has led to some severely problematic products that often have care providers gnashing their teeth in frustration. Or, sometimes, making use of workarounds that defeat the purpose of well-meaning federal policies such as the Affordable Care Act and meaningful use.

“Paper has become our lingua franca, our fallback and standby,” wrote Zuger. “In our new digital universe, we have peculiarly seen a retro explosion of paper. We may no longer write paper prescriptions, but we fax or hand-deliver paper versions of our electronic dealings routinely now. When you don’t know what electronic language the receiver speaks (and you never do) you go with paper.”

While her primary complaint was about systems’ lack of interoperability, it’s a safe bet that she and many of her colleagues would add poor usability to their list of EHR gripes.

That dissatisfaction is getting worse, not better. A study published this summer by the American Medical Association and the American College of Physicians found that physicians are more frustrated with EHRs than they were five years ago.

Forty-two percent of respondents said their EHR system’s ability to improve efficiency was “difficult or very difficult.” Some 72 percent said the same about its ability to decrease workload.

We saw similar feedback in HIMSS16 Healthcare IT News’ first-ever EHR Satisfaction Survey this past fall. In addition to numerical scores, we also asked for anecdotal feedback from more than 400 people who took the poll. Opinions such as “not very intuitive,” “cumbersome” and “too many clicks” cropped up over and over again.

‘Limited in their understanding of people’In his landmark book, The Design of Everyday Things, Don Norman, director of The Design Lab at University of California San Diego wrote:

“The reasons for the deficiencies in human-machine interaction are numerous. Some come from the limitations of today’s technology. Some come from self-imposed restrictions by the designers, often to hold down cost. But most of the problems come from a complete lack of understanding of the design principles necessary for effective human-machine interaction, Why this deficiency? Because much of the design is done by engineers who are experts in technology but limited in their understanding of people.”

Of course, in healthcare IT there are other challenges. EHR vendors would probably love to have all their products look as sleek and intuitive as the latest iOS release. But they also have to ensure they check all the boxes to comply with certification criteria from the Office of the National Coordinator – all 560 detailed pages of the 2015 Edition.

“I know some people inside big EMR companies who want to do excellent design, but in an organization that’s owned by IT, it’s difficult for even a design advocate to have their voice heard and affect the process,” Amy Cueva, co-founder of the design-centric Health Experience Refactored conference, told Healthcare IT News in 2013.

Meaningful use spurred uptake, of course, but that doesn’t necessarily mean the end-users are looking at EHRs with joy in their hearts.

“You don’t have to pay people to use Facebook or Google or their iPhone,” Cueva said. “They use it because it’s valuable and meaningful and it gives them something they can’t get anywhere else.” In many cases there was too much of a rush to get hospitals online – to the point where many were “just sort of throwing software out there,” she said.

That’s changing, thankfully, as more and more efforts are being made industry-wide to make EHRs easier to use and perhaps a bit better-looking. One of those ONC certification criteria, after all, is that vendors employ a user-centered design process when developing their tools, and report the results of usability testing.

A recent study published in the Journal of the American Medical Informatics Association took a look at UCD processes at 11 unnamed vendors, seeking to understand the challenges and opportunities for better design practices.

“Our analysis demonstrates a diverse range of vendors’ UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD,” wrote AMIA officials – noting that the latter category might refer, say, to the mistaken belief that responding to end-users’ requests and complaints qualifies as user-centered design.

“Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization,” according to AMIA.

Dishearteningly, the researchers found some respondents still didn’t see the business case for investing in UCD processes. It even found that some smaller EHR vendors didn’t even have any usability experts on their staff.

But there’s evidence that many are moving in the right direction. In December, for instance, the EHR Association and American College of Physicians joined forces for a workshop to discuss ways to improve EHR usability – enlisting clinicians, developers and usability experts to explore ways to improve the experience.

“The workshop also included a ‘design-a-whirl’ where the group rotated through examples of different techniques for obtaining and validating clinician feedback during the development process, which was an important opportunity for the attending clinicians to learn more about the software development life cycle,” according to a brief in Politico.

Meanwhile, a recent report looking at EHR usability and clinical decision support called upon AHRQ research to explore ways improved health IT interfaces  – websites, apps, dashboards  – can lead to better patient care.

It’s “promising that electronic health records and clinical decision support tools are rapidly being implemented in hospitals and clinics nationwide,” wrote Thomas McGinn, MD, chair of medicine at Hofstra North Shore-LIJ School of Medicine, in the study’s introduction.

But implementing EHR and CDS into clinical workflow “continues to be challenging,” he added. Poor integration runs the risk of “substantially reducing adoption and use.”

Lately, there has been some movement toward thinking a bit more closely about the clinical users of these technologies. 

”It is believed that thoughtful systems engineering approaches, including consideration of user experience and improvements in user interface, can greatly improve the ability of CDS tools to reach their potential to improve quality of care and patient outcomes,” wrote McGinn.

Exploring topics such as UX and system redesign, EHR-based visualization tools and integration patient-reported data, the multi-part study aims to spur some rethinking about the ways EHR decision support is presented to clinicians.

“We are at the very early stages of the science of usability,” wrote McGinn. “Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice.”

IT Idea

“The reasons for the deficiencies in human-machine interaction are numerous,” writes design guru Don Norman. One of the biggest, he says, is that “much of the design is done by engineers who are experts in technology but limited in their understanding of people.”

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telehealth, mobile,cloud

Mobile and Cloud capabilities are driving change

Mobile and Cloud among top EHR trends to watch in 2016, consultant says, By Jessica Davis, Associate Editor

Mobile and Cloud solutions in the market for electronic health records, is predicted to be worth about $35.2 billion by 2019, the steady rise of data has increased the need to strengthen the software to make data more accessible, reduce errors and increase the ease of use.

“You have two driving forces – demand and technological capabilities,” Cathy Reisenwitz, a researcher with software firm Capterra, told Healthcare IT News.

For many years, EHRs have been “aimed at satisfying regulators, not just what clinicians want or need,” she said. That’s changing, though, as developers work more to make health records more appealing to end users on both sides of the doctor/patient relationship. Better mobile interfaces, for instance, are “clearly desired by patients and physicians.”

Reisenwitz laid out four EHR and other health IT trends the industry can expect to see in 2016.

1. EHRs are moving toward the cloud. Start-up costs for EHRs can prove burdensome for some institutions, while cloud-based tools offer minimal start-up costs and can make better use of providers’ current resources. The cloud also enables better continuity of care and easier software updates. In the coming year, more and more EHRs will offer cloud services.

2. EHRs will improve the patient portal experience. Though patient portal usage got off to a slow start, it’s been steadily gaining momentum. More providers will both offer and promote patient portals. Some may even have patients use the portals during office visits to begin getting their data into the system. And patients will start to see their value.

3. Telemedicine will finally find its stride. The telemedicine market is forecasted to exceed $30 billion in the next five years, as providers increasingly see the need to reach seniors and patients in rural areas. The mass adoption of wearables will promote telemedicine, as well, especially when patients are willing to share device data with providers.

4. EHRs are going mobile. More and more providers want to provide medical care from their smartphones, and more patients want to access data through mobile devices. To accommodate this need, EHRs will will offer better mobile design and functionality. Scheduling and patient chart updates will align with prescribing functions on mobile devices, as well.

Providers will need to overcome some hurdles for these trends to take hold, Reisenwitz said, noting that, at the moment, “there’s a huge space where the data isn’t able to be fully utilized, as it’s unstructured or poorly structured; therefore not easily accessed nor interoperable.”

The other big EHR challenge is cybersecurity, she added, stoking fears that are preventing even wider acceptance of mobile and cloud platforms.

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hospital predictions

Healthcare predictions – IDC releases top 10

HealthCare IT News and top 10 predictions, Nov 2015

There has never been a more exciting time to be in healthcare IT and its predictions. There has never been a more pivotal and stressful time to be in healthcare IT. IDC’s latest healthcare IT predictions illustrate this and could not ring more true. U.S. healthcare spending as a percentage of GDP is almost double that of any other nation putting continued legislative focus on reforming the system and IT is truly in the driver’s seat.

These predictions highlight the multitude of transformational innovations that will help us get to much needed efficiencies through proactive personalized care, intelligence driven protocols, machine to machine learning and scaling to deliver care outside provider settings.

IDC FutureScape: Worldwide Healthcare 2016 Predictions

1.      Downward pressure of the healthcare economy will increase risk based contracting to 50% of provider payments by 2017 resulting in premium increases in the 2% to 3% range.

2.      By 2018 industry cloud creation will be the top market entry strategy for tech providers and industrial companies, as leaders of IT and industry domain unite to tear down traditional barriers to entry.

3.      By 2018 physicians will use cognitive solutions to identify the most effective treatment for 50% of complex cancer patients resulting in a 10% reduction in mortality and 10% in cost.

4.      By 2017, surgeons will use computer assisted or robotic surgery techniques to assist in planning, simulating and performing 50% of the most complex surgeries.

5.      One out of the three individuals will have their healthcare records compromised by cyberattacks in 2016.

6.      By 2018, due to more frequent drug launches, pharma adoption of global launch sequence optimization solutions will grow by 50%, saving the industry billions in potential lost revenue.

7.      By 2018, 80% of customer/patient service interaction will make use of IoT and bid data to improve quality, value and timeliness. Virtual care will become routine by 2018.

8.      By 2018, 30% of WW healthcare systems will employ real time cognitive analysis to provide personalized care leveraging patient’s clinical data, directly supported by clinical outcomes and RWE data.

9.      Reluctantly, through 2017 healthcare IT services buyers will consolidate IT services spending in the hands of the 5-10 largest service providers for each sub-vertical at double industry growth rates.

10.    2016 will see 3rd platform acute care HIS and EHR begin to come to market and early adopters will get started on digital transformation in 2017 – 2019.

Healthcare is beginning to harness and integrate previously untapped intelligence. There will soon be a tsunami of medical innovation driven by distilling intelligence from mass digitized PHI and the pressure for providers to deliver, and get paid on, quality outcomes. Improving patient care and creating better quality of life is what it is all about and for IT to be such an integral part of this evolution is what makes it such and exciting, albeit stressful, time to be in healthcare IT.

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congress interoperability

Interoperability – Docs send Congress meaningful SOS

HealthCare IT News, Interoperability in Healthcare, November 6, 2015

The rallying cry about interoperability to do something about the meaningful use program is getting louder and more insistent.

Earlier this week, the American Medical Association and 111 medical societies sent please to Congress urging a reprieve – or at the very least, a “refocus” of Stage 3 of the program, they write.

“We are writing to express our strong concerns with the decision by the Administration to move ahead with implementation of Stage 3 of the Meaningful Use program despite the widespread failure of Stage 2,” they state in their Nov. 2 letter to Majority Leader Mitch McConnell and Minority Leader Harry Reid.

Interoperability should be front and center now, they say.

“We believe that the success of the program hinges on a laser-like focus on promoting interoperability and allowing innovation to flourish as vendors respond to the demands of physicians and hospitals rather than the current system where vendors must meet the ill-informed check-the-box requirements of the current program,” leaders of the medical organizations write.

They claim the Administration has not responded to this need and instead has chosen to perpetuate the current failed program through the release of Stage 3 Meaningful Use.

“It is unrealistic to expect that doing the same thing over and over again will result in a different outcome,” they write. “We believe, therefore, that it is time for Congress to act to refocus the Meaningful Use program on the goal of achieving a truly interoperable system of electronic health records that will support, rather than hinder, the delivery of high quality care.”

In their letter to House Majority Leader Paul Ryan and Minority Leader Nancy Pelosi, they write: “Congressional action to refocus this program is urgently needed before physicians, frustrated by the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements, abandon the program.”

In a move that surprised many healthcare providers – both in hospitals and in physician practices – CMS released the final rules for both Stage 2 and Stage 3 in one fell swoop October 6.

In the months leading up to the reveal of the final rules, many stakeholders continued to hope for a delay of Stage 3 requirements.

By the time 600 or so CIOs met for CHIME’s Annual Fall Forum in Orlando in mid October, the rules were out – and CIOs Pamela McNutt and Liz Johnson were prepared to analyze and advise.

They were specific about their Stage 3 concerns:

  • Requires 365-day reporting
  • Increased thresholds on troublesome measures
    – Patient Engagement Threshold – 10%, includes use of APIs
    – Requires inclusion of patient-generated data or from non-clinical settings
    – Transitions of Care Threshold increased
    – Establishes six public health reporting measures, requires bi-directional exchange with immunization registries
  • Actions to meet measures must be electronic – paper-based methods will not suffice (e.g. summary of care and patient education)
  • 2015 Edition of CEHRT required for Stage 3 reporting
  • Vendor and Provider readiness
  • CQM’s can be reported by attestation through 2017, electronic submission required starting in 2018

There still remains an opportunity to comment on the rules through December 15.

“It is your right and duty to comment,” Johnson told a packed room one of CHIME forum’s sunrise sessions in Orlando.

*American Medical Association (AMA)
Centers for Medicare & Medicaid Services (CMS)
College of Healthcare Information Management Executives (CHIME)

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No EHR ? Paper records create dangerous voids in care coordination

HealthCare IT News – Many patients are growing increasingly impatient with the progress their doctors are making in adopting digital tools (such as EHR).

They’re exasperated by the demands placed on them to be responsible for mounds of paperwork.

There’s more at stake than just agitating your patients with paperwork, of course.

Indeed, some 30 percent of patients need to physically bring test results, X-rays, or health records from one doctor’s office to another. What’s more, 54 percent indicated that they frequently or always sign paper forms while 28 percent continue to write details of their medical history on paper forms.

Based on those findings in Surescripts’ Connected Care and the Patient Experience report, for which researchers surveyed more than 1,000 adults, it should come as no surprise that nearly 66 percent of respondents are only somewhat confident, if at all, that they would be granted access to their own medical information within 24 hours.

“Dangerous voids in health information sharing can easily be solved through the use of digital communications and technology,” Surescripts CEO Tom Skelton said in a prepared statement. “Patients take notice and are ready for a change.”

The dangerous void? That would be the 55 percent of survey participants who said that when they visit doctors, their medical history tends to be missing or incomplete, with approximately half of patients noting that their doctor is not aware of what prescriptions they are taking, allergies they might have, existing medical conditions, recent surgeries, hospitalizations or visits with other physicians.

“A more digitally-connected doctor would make millions of patients breathe a sigh of relief,” the survey said. And it is becoming a key consideration when choosing a physician.

If evaluating two comparable doctors, more than half of patients would select a doctor that let them fill out paperwork online before a visit (51 percent), receive test results online (48 percent), store medical records electronically (46 percent), or schedule appointments online (44 percent).

“As an industry, we need to come together to connect the nation’s healthcare system,” Skelton added, “to enhance the patient experience while improving quality and lowering the cost of care.”

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OIG to CMS: Make EHR fraud prevention efforts a priority

[HealthCare IT News] The Office of Inspector General is once again calling out CMS for failing to adequately address fraud vulnerabilities in electronic health records. Despite submitting recommendations back in 2013, a new OIG report underscored that the agency is still dragging its feet with implementing EHR fraud safeguards.

Part of the Office of Inspector General’s role is to audit and evaluate HHS processes and procedures and put forth recommendations based on deficiencies or abuses identified. Turns out, a lot of these recommendations are ignored, disagreed upon or unimplemented, according to OIG’s new Compendium of Unimplemented Recommendations report. And EHR fraud is on that list.

“HHS must do more to ensure that all hospitals’ EHRs contain safeguards and that hospitals use them to protect against electronically enabled healthcare fraud,” OIG officials wrote in the report.

Specifically, audit logs should actually be operational when an EHR is available. And CMS should also develop concrete guidelines around the use of copy-and-paste functions in an electronic health record. According to OIG data, most hospitals using EHRs had RTI International audit functions in place, but they were significantly underutilized. What’s more, only some 25 percent of hospitals even had policies in place regarding copy-and-paste functions.

These recommendations have come up repeatedly in recent OIG reports, and despite CMS officials agreeing with the outlined recommendations, the agency is still not making it enough of a priority.

In a January 2014 report, OIG also called out CMS for failing to make EHR fraud a priority. Specifically, OIG said, the CMS neglected to provide adequate guidance to its contractors tasked with identifying said EHR fraud, citing the fact that the majority of these contractors reviewed paper records in the same manner they reviewed EHRs, disregarding the differences. Moreover, only three out of 18 Medicare contractors were found to have used EHR audit data in their review process.

When it came to identifying copy-and-paste usage or over documentation, many contractors reported they were unable to do so. Considering some 74 percent to 90 percent of physicians use the copy/paste feature daily, according to a recent AHIMA report, the implications are significant.

As Diana Warner, director of HIM practice excellence at AHIMA, recounted back at the October 2013 MGMA conference, that dueto copy-and-paste usage, they had a patient at her previous medical practice who went from having a family history of breast cancer to having a history of breast cancer. The error was caught by the insurance company, which thought the patient had lied, was poised to change her healthcare coverage. “We had to work for months to get that cleared up with the insurance company so her coverage would not be dropped,” Warner said. “We had to then find all the records that it got copy and pasted into” incorrectly and then track down the locations the data was sent to.

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October 9, 2015 / Posted by / OIG to CMS: Make EHR fraud prevention efforts a priority