The Brookdale University Hospital and Medical Center is one of New York’s most innovative hospitals on the forefront of health IT. As one of Brooklyn’s largest voluntary nonprofit teaching hospitals with 530 inpatient beds and a regional tertiary care center, Brookdale provides general and specialized inpatient care to hundreds of thousands of people every year. In addition, the medical center provides 24-hour emergency services, numerous outpatient programs, and long-term specialty care. Brookdale is one of Brooklyn’s largest, and most experienced full-service emergency departments and a regionally recognized Level I Trauma Center that receives more than 100,000 visits a year.
Brookdale University Hospital and Medical Center has come to rely on two main resources to seamlessly and securely access patient data and medical history.
Brooklyn Health Information Exchange (BHIX) is a Regional Health Information Organization (RHIO) devoted to developing, deploying, operating and promoting innovative uses of health information technology to facilitate patient-centric care in Brooklyn and surrounding areas. BHIX was established in 2007 as a community-driven collaboration between providers and payers interested in improving patient care across healthcare settings.
RHIOs, such as BHIX, maintain medical records that are continually updated by participating healthcare providers, who can then access the accumulated data with a patient’s consent.
As one of the largest and busiest full-service emergency departments in Brooklyn and a regionally recognized Level I Trauma Center with more than 100,000 visits a year, Brookdale University Hospital and Medical Center has a demonstrable need to instantly and securely access accurate patient data from a multitude of sources. In an emergency situation, access to critical patient data such as medical history, medication usage, and allergies can often make the difference between life and death.
One of the greatest sources of information that depicts the changes in health IT trends across the industry landscape is from Michael Lake, healthcare technology strategist. Through his monthly reports on the state of health technology, published by his company Circle Square, he provides succinct highlights from throughout the last month. Possibly, what’s best about these reports is that they cover such a diverse segment of the ecosphere.
For example, in one of his most recent reports, the focus was the EHR vendor sphere, cloud EHRs and their importance to independent practices, the use of faxes in hospitals, vendor news and transactions and practice portal insight, among other news.
According to his most recent report, cloud-based EHRs with integrated billing are quickly becoming a key to a practice’s future success as an independent practice. In his report, he cites Black Book as ranking solutions that seamlessly integrate electronic health records (EHR), revenue cycle management (RCM) and practice management (PM). Kareo tops on the list, per KLAS.
However, most practices feel that billing and collections systems and processes need upgrading (87%) and more than 40 percent (42%) are considering an upgrade to RCM software in in the next year . Most practices (71%) are considering a combo of new software and outsourcing services for improvement.
It is no surprise many hospitals and eligible professionals are “heads down” on meaningful use Stage 2 preparations. EHR upgrades, evaluating performance against increased thresholds for carry-over objectives from Stage 1, and delving into the technical, procedural and workflow complexities of many new objectives has caught many providers off guard, particularly those for whom meeting Stage 1 was a relatively easy goal.
Two very challenging areas for Stage 2 for most eligible hospitals (EHs) and eligible professionals (EPs) are the objective “Summary of Care Record at Transitions of Care (ToC)” and those that relate to Public Health reporting.
For these objectives, it is not necessarily the performance thresholds that present the challenge, rather the EHR functional requirements, the requirements-behind-the-requirements, or the workflows that are the cause of consternation. These objectives and their unique challenges are described below:
Summary of Care Record at Transitions of Care (ToC).
This objective is challenging on two fronts. First, the population and generation of the Summary of Care Record (the “Record”), and second, the actual transmission of that document at transitions of care to intended recipients.
All change faces resistance, and the adoption of technology in healthcare is no different. Advocates speak of the advantages to quicker information access, paperless offices and speed of care. On the other side of the spectrum, technology laggards point to the physical and theoretical technology barriers during a patient exam, a perceived loss of nuance in capturing data and data security issues.
Today’s medical students are debunking the debating by adopting a modern medical approach that merges technology and a focus on patients. Coined as “patient-centric care,” future physicians are encouraging patients to be engaged in their care and live a healthy lifestyle with the aid of technology.
This fresh and engaging method of healthcare delivery, known as patient-centered care, revolves around three key approaches: shared decision-making, a care-team approach and adherence support.
Shared decision-making involves creating a more active discussion between clinicians and patients. This not only develops a mutual sense of trust and information sharing, but also leads to better outcomes. If a patient feels that the physician is speaking with him versus at him then they will be more willing to share information and widen the gateway of communication. Furthermore, the impression of physicians being the sole and final authority has been challenged by the pervasive availability of health information (accurate or not) on the Internet.
CIOs in healthcare face the constant challenge of doing more with less. Most are being asked to dramatically cut costs while continually tackling an ambitious list of responsibilities, including maintaining their organizations’ ability to demonstrate meaningful use, making the transition to ICD-10, sharing information through healthcare information exchanges (HIEs) and maintaining stringent patient privacy and HIPAA compliance programs.
Three key and often overlooked elements can help to address these tasks: document scanning, clinical language understanding and integration standards. Mastery of this electronic health record (EHR) trifecta can significantly simplify the healthcare CIO’s challenge.
Electronic health record adoption levels are steadily increasing, but ongoing interoperability issues result in high volumes of paper-based communications between providers. In fact, a survey conducted by the Bipartisan Policy Center in Washington, D.C., found that 71 percent of physicians identified lack of EHR interoperability and exchange infrastructure as major barriers to HIE.
Kareo, a company I have come to quietly respect (the company does not sponsor this site in any way) issued the following graphic (something else I have come to really like). I’m a visual person and there’s often no better way to convey complicated information like that found in health IT and I find the following graphic filled with much telling information, and seems to beg whether small practices are served well by EHRs.
This graphic seems to speak to a bigger picture of what’s going on currently in the space. This information tells the story of how it is becoming more difficult to maintain autonomy in private practice, but not impossible. With technology, small practices can thrive. But, is there enough focus on the small practices for technology to make the difference Kareo says it can?
Kareo has skin in this game, after all, and makes its position clear: “The solution is technology, and not just one piece of software but a fully-integrated seamless package of solutions from a single vendor … most physician practices know that to remain independent they will have to make changes.
“The willingness to change is important because success may rely on seeing your practice as a business and carefully considering and evaluating your bottom line. While many physicians in practices with five providers or fewer are still hesitant to adopt an EHR, the potential benefits are indisputable.”
Guest post byJason Thomas, CIO and IT director of Green Clinic Health System, and Dell Software solutions user.
Across the healthcare landscape, organizations are expected be in complete compliance with all security and privacy policies on all devices – even personal devices brought in by doctors, nurses, clinicians and administrators.
Being compliant involves many things, including training staff, revising business agreements, modifying policies, staying up-to-date on the newest technologies and updating notices of privacy practices as new regulations go into effect – such as the HIPAA Omnibus Final Rule.
While most of the industry’s current compliance strategies are focused on maintaining privacy and protecting patient data, the more recent addition of bring-your-own-device (BYOD) brings a whole new level of complexity into the compliancy equation.
David Willis, vice president and distinguished analyst at Gartner, recently stated, “BYOD strategies are the most radical change to the economics and the culture of client computing in business in decades.” He added that the benefits of BYOD include creating new mobile workforce opportunities, increasing employee satisfaction and reducing or avoiding costs.
Might healthcare learn a thing or two from research firm Gartner’s top strategic technology trends? Fresh off the Gartner Symposium/ITxpo 2013 held in Orlando where tens of thousands of IT executives gathered, Forbes magazine offers up the following from the research giant:
Mobile Device Diversity and Management
“Gartner suggests that now through 2018, a variety of devices, user contexts and interaction paradigms will make ‘everything everywhere’ strategies unachievable. The unintended consequence of bring your own device (BYOD) programs has been to render much more complex (by two or three times, Gartner estimates) the size of the mobile workforce, straining both the information technology and the finance organizations. It is recommended that companies better define expectations for employee-owned hardware to balance flexibility with confidentiality and privacy requirements.”
Even the world of healthcare will not miss out on MDM as workforces become more mobile. In addition to infrastructure needs, practices will need BYOD policy and MDM solutions to help them protect and manage their data.
Like the adaption and implementation of every new and innovative technology, it takes time to get used to it. Therefore, with electronic health records, being ready for change is key.
Previously, physicians were comfortable with a paper-based system because its usage had been a norm since and before they started studying medicine. The way they had to learn and adopt to a working environment when they started practicing, they will have to do the same with innovative technologies such as EHRs, built to make their lives easier.
In the initial stages, EHR documentation is likely to be cumbersome as physicians familiarize themselves with the new system.
ONC’s HealthIT.gov published the following graphic aimed directly at consumers, expanding on its education strategy. For those that live in health IT, much of the information included here has been seen multiple times. Perhaps there is little new here.
However, there are a few nuggets that I personally find of interest that are worth sharing. According to the the feds, “between 2001 and 2011, the number of doctors using an EHR system grew about 57 percent, making it easier for you and all of your doctors to coordinate your care, and often reducing the chance of medical errors.”
Now that studies have suggested that about 66 percent of the population would switch to a doctor using an EHR versus one not using one, we’re going to see this stat is every piece of collateral in support of the effort; in fact, that same story has been reported here at this twice (this makes the third time). That detail is included here, too, as we would expect.