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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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EMR – Canadian MDs Can Improve Patient Care With it

EMR, MarketWire – Opportunity for Primary Care Physicians to Fully Embrace EMR Functionalities

EMR (Electronic medical records) among Canadian primary care physicians continues to grow, but the use of advanced functions that support improved patient care varies, according to the Commonwealth Fund’s 2015 International Health Policy Survey of Primary Care Physicians.

Initial survey results released in December 2015 revealed that EMR use among Canadian primary care physicians tripled in the past nine years (73 per cent versus 23 per cent). New analysis released today includes provincial EMR adoption rates, benefits being realized and advanced use patterns.

“In a relatively short period of time, the rate of EMR adoption and use in Canada has reached strong levels,” explained Lynne Zucker, Vice President, Canada Health Infoway. “What we see in the Commonwealth Fund survey results is that here and globally there is opportunity to further advanced EMR use to fully realize the benefits to patients and the health care system.”

Most provinces saw growth in EMR use since the previous survey in 2012. Alberta, British Columbia and Ontario continue to have the highest adoption rates in Canada. Quebec, Manitoba and Saskatchewan experienced the highest increases in EMR uptake by primary care physicians since 2012.

Physicians with EMRs report the ability to better manage their patients’ care compared to physicians operating without an EMR:

  • 79 per cent of physicians with EMRs report that they are able to generate a computerized list of patients by diagnosis compared to 20 per cent without an EMR
  • 70 per cent can generate a list of all medications taken by an individual patient compared to 17 per cent without an EMR
  • 62 per cent are able to produce a list of patients overdue for tests or preventative care compared to those without an EMR at 11 per cent

Canadian primary care physicians using EMRs are more likely to use some functionalities that support patient care and less likely to use others, when compared to the 10 country average from the Commonwealth Fund survey. For instance:

  • They are more likely to:
    • Receive and review data on patients who received recommended preventive care (41 per cent versus 36 per cent internationally)
    • Receive reminders for guideline-based interventions and/or screening tests (34 per cent versus 30 per cent)
  • They are less likely to:
    • Receive alerts and reminders for potential problems with medication doses or interactions (55 per cent versus 76 per cent internationally)
    • Track all laboratory tests ordered until results reach clinicians (34 per cent versus 51 per cent)
    • Send reminders to patients for regular preventive or follow-up care (22 per cent versus 48 per cent)

Additionally, the survey also highlighted two areas of digital health that present significant opportunities to provide further value to Canadians:

  • Information exchange: 19 per cent of primary care physicians say they can electronically exchange patient clincial summaries with doctors outside of their practice
  • Consumer services: 15 per cent of primary care physicians say they offer patients the option to email them about medical questions or concerns and 11 per cent offer patients the means to request an appointment or referral online

Canada Health Infoway (Infoway) co-invested with most of the provinces and territories in Canada to encourage EMR use in community-based physicians’ offices. Many EMR systems are also connected to electronic health record (EHR) systems outside the practice, which provides access to valuable clinical information, such as lab results, medication information, or hospital discharge reports. As of September 30, 2015, over 19,000 community-based physicians and/or nurse practitioners are benefitting from Infoway EMR investments.

Additional Canadian Commonwealth Fund survey data may be viewed in the Canadian Institute for Health Information (CIHI)’s new report How Canada Compares: Results from the Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians Report.

About The Commonwealth Fund Survey

The Commonwealth Fund’s 2015 International Health Policy Survey of Primary Care Doctors findings are based on responses from primary care physicians in 10 countries, including 2,284 Canadian physicians. The survey was conducted between March and June 2015.

The Commonwealth Fund provided core funding with co-funding from the following organizations: Bureau of Health Information; Health Quality Ontario; the Canadian Institutes of Health Research; the Canadian Institute for Health Information; Canada Health Infoway; le Commissaire à la santé et au bien-être du Québec; la Haute Autorité de Santé; the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés; BQS Institute for Quality and Patient Safety; the German Federal Ministry of Health; the Dutch Ministry of Health, Welfare and Sport; the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen; the Norwegian Knowledge Centre for the Health Services; the Swedish Ministry of Health and Social Affairs; the Swiss Federal Office of Public Health; and The Health Foundation.

About Canada Health Infoway

Infoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government.

Attachment Available

For more information:
Dan Strasbourg
Director, Media Relations
Canada Health Infoway
Tel: (416) 595-3424

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Office 2016 – 3 data privacy features

Microsoft Office 2016 and Windows 10 coming on the heels. The new productivity and collaboration suite brings security features specifically for healthcare entities

Those were mostly lost amid most of the trade press and mainstream media coverage, which largely focused on the new collaboration functionalities. That makes sense given the new Office’s overarching themes as collaboration, productivity, and security.

While there are collaboration and productivity enhancements for health entities, healthcare CIOs and CISOs might be most interested in the privacy features.

Here are three of those:

1. PHI recognition: Outlook can now recognize protected health information in an attachment and warn the user before sending to avoid the common mishap of PHI landing in the inbox of someone who should not receive it. And different permissions can be set to stop some users from even sending PHI at all.

2. Smart Attachments: This feature gives users the option of sending a link in lieu of heavy documents that consume a lot of memory. The reason that matters: When clinicians send a link via OneDrive for Business, the security mechanism authenticates the user and Exchange can track whether a recipient even clicked on that link – which could help account for what happens should data be sent to unintended recipients.

3. Encryption, single sign-on and authentication: This is kind of a threefer, admittedly. They are connected enough to group together. In addition to Office, Microsoft injected encryption into Office 365 services, so now both documents and emails are encrypted, while Windows Hello serves as a single sign-on capability and Windows Passport is now being used by third-party apps, such as Allscripts EMR, for facial recognition.

Office 2016 comes on the heels of Windows 10, which also brought new features specifically for healthcare.

Those include the ability to “snap together” different applications so clinicians can view an EMR alongside, say, a home health app, business intelligence tools for visualizing care data, mapping techniques for population health, as well as care management and information sharing functions

Windows 10, Office 2016 and the forthcoming Windows 10 Mobile are the foundation of the company’s “One Windows” strategy — to enable healthcare organizations to sync apps and data across smartphones, PCs, tablets and a wide range of medical and IoT devices.

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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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How one hospital boosted care transitions

From HealtCare IT News

Taps DataMotion to build Web portal
February 27, 2015

Faced with the imperative of sharing patient information when patients moved from the hospital to a nursing home, the technology leaders at Hackensack University Medical Center learned that the facilities they would be sending information to had no way to receive it electronically.

It might not seem that important to some – “just an email, just an attachment,” Hackensack UMC Chief Information Officer Shafiq Rab, MD, told Healthcare IT News, “But when your life is at stake, and when that information is critical for the person that’s going to be taking care of you, and it’s you, it becomes very important.”

It was also critical to get it resolved. Patient safety was paramount, Rab said. Also, direct and secure messaging is required by Stage 2 meaningful use, and the medical center would start its reporting on the requirements on July 1.

Hackensack UMC is a 775-bed facility that employs 7,600 people, including 1,600 physicians. It has an Epic EHR, and all nursing facilities associated with the medical center use EpicCare Link to provide web-based patient information to authorized healthcare providers.

For long-term care facilities not part of the medical center – there are seven of them – there was no way to connect to the portal and no other way to transfer patient information electronically in a secure way.

“These organizations did not have Direct addresses, accessible to them,” Mike Fitzpatrick, enterprise project manager at Hackensack, said. Hackensack UMC launched a search for a vendor with a Web portal or some type of tool that the medical center would provide at no cost to the facilities.

How difficult or easy the portal would be to use, the implementation plan and the services the vendor could provide were top of mind for Fitzpatrick.

After reviewing offerings from several health information services providers, or HISPs, Hackensack UMC tapped DataMotion to get the job done.

Shafiq Rab, MDDataMotion seemed best aligned with Hackensack UMCs tenets, Rab said.

“The people we talked to at DataMotion seemed to also care about patients first and business later,” he explained.

The job was done within three weeks of launching the project – and in time for the medical center to meet a July 1 deadline to start the reporting required to attest to meaningful use Stage 2, Fitzpatrick said.

“It was a very quick and effective process that DataMotion provided,” he said.

“In Hackensack’s case, they’re very IT savvy,” said Bob Janacek, founder and CTO of DataMotion. “They’ve implemented Epic. They have a very smart technology staff, so they have the capability to implement the technology to benefit their workflows and such. They’re ahead of their broader community, though, of referral partners, their community of care.”

To address that, DataMotion set up a Web portal that makes it possible for the long-term care facilities to receive patient records and view the attachments that are not readable in their native form. They are able to read these documents and also they are able to reply and send a message back into the medical center’s Epic system.

Bob JanacekThe portal is easy to use – similar to webmail, such as Yahoo! or Outlook, Janacek said.

Before using Direct, whenever a patient transferred to another facility, the discharge documents were printed out and were either faxed or given to the patient to hand to the next provider, according to a DataMotion case study of the project. This manual process sometimes resulted in patient transitions taking longer than desired, and often depended on the patient remembering to deliver the documents to the new provider. Automating the process is not only expected to improve the quality of care patients receive after discharge, but also decreases the time it takes to complete the transition.”

To Rab, quality of patient care is paramount.

“It’s not about the success of Hackensack, and it’s not about the success of DataMotion,” Rab said. “It’s not the success about Direct messages and that we got to meaningful use Stage 2 and the money. It’s not about that. I think the message in all of this is that different tools that different people are using make the lives of patients and the care coordination better so that we make our people healthier, quality of life better and at the same time decrease the cost of care.

“Healthcare needs urgent work,” he added. “As fast as we finish this conundrum, then we can get to the second and third layer of healthcare. That is using information and then analyzing it – what is the most appropriate way to decrease the cost of healthcare and how to maximize the benefit for the patient.

“Let the world know that those people who don’t have these things, they are waiting for it. They really want this information, and it’s our moral and ethical duty to provide it to them.”

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October 10, 2015 / Posted by / How one hospital boosted care transitions