Implementation of electronic health records is considered a national priority in this era of healthcare reform. However if EHRs are not implemented correctly they can be painful.
EHRs that are not implemented effectively can affect productivity and revenue. The extra documentation requirements and intricate workflows create distance between physicians and their patients. Physicians have reported that they spend too much time on EHRs and that they don’t get enough time to interact with their patients. But physicians often communicate that spending time on EHRs is crucial to creating a trusted set of structured data that can guide their business. Every click that providers make creates important data points that can be used to inform the efficient delivery of their practice.
Every EHR saves a large amount of data inside it regarding patient health, effectiveness of treatments, system efficiency and provider tendencies. Despite the extra time and effort that is dedicated to electronic documentation, many practices and physicians do not make full use of this precious data set that they have produced.
If a practice can get its EHR adoption right they can make a number of positive results, some of which are mentioned below:
By overcoming the difficulties providers can see more patients and will be able to generate more billed revenue using its existing staff. Furthermore, if a provider is using its EHR efficiently then the improved documentation produces billing at higher rates, combined with increased patient flow. This represents significant potential revenue.
Quick Cash Flow
Many of the practices work on revenue cycle management, but few make it flawless. With increased charge accuracy and reduced time for denials, there will be an increase in the yield with timely reimbursements by the payers.
Add to the list of known certainties: death, taxes, and the need to lower the cost of healthcare.
Neither HIPAA standards nor encryption were created with the purpose of lowering the cost of healthcare, but neither was penicillin originally purposed as an antibiotic. Both welcome side effects in the world of medicine.
Cloud Computing and Healthcare
Healthcare and medical companies are migrating to cloud computing in record numbers. The cloud offers flexibility and scalability to manage ever-growing databases of patient records. At the same time, it offers mobility to enable care providers to access patient information remotely and shareability to share data with colleagues, specialists, and labs. The cloud, perhaps most importantly, enables cost reduction on several levels.
It eliminates the need healthcare organization have to purchase, maintain, upgrade, and replace costly computing equipment and staff.
It saves costs of multiple providers running multiple tests by enabling them to share and track the results.
It saves time and money by enabling paperless transmission of prescriptions and insurance claims. It also increases the accuracy of reimbursement coding.
Now, HIPAA omnibus and the American Recovery and Reinvestment Act (ARRA) requirements stipulate everyone in the healthcare industry begin migrating patient records and other data to cloud computing. Essentially, by 2015, all medical professionals with access to patient records must utilize electronic medical and health records (EMR and EHR), or face penalties.
Guest post by Brandee Norris, assistant professor healthcare administration and management school of business and technology, Trevecca Nazarene University.
The health information technology (HIT) industry is on the verge of a dramatic dawning. As more healthcare organizations transition to paperless systems and to meaningful use of a certified electronic health record (EHR), the need to ensure the safety and integrity of healthcare data and to eliminate the risk of health IT breaches increases. In the past five years, the Department of Health and Human Services reported more than 800 breaches of healthcare patient data, breaches that affected more than 30 million patients. Breaches in electronic healthcare data cause serious negative outcomes for patients, stakeholders, and organizations—both public and private—and result in millions of dollars in fines and losses.
As the use of HIT systems increases within the healthcare industry, hospitals and providers of private practices are seeking effective methods to enhance data storage and streamline access to patient information without jeopardizing the privacy of the data. A possible solution to this problem is the transference of protected health information from a local system’s network to a cloud-based electronic medical records (EMR) service. Cloud computing may be categorized as private or public. Based on HIPAA regulations, professionals in the healthcare industry continue to dispute the legitimacy of public cloud computing and compliance with specific requirements of the HIPAA.
Contrary to provisions mandated by HIPAA, cloud-based platforms could accommodate the growing needs of healthcare organizations and provide flexibility to adapt to frequent changes, while providing significant cost savings. The primary objectives of using any variation of a cloud-based program are efficient leveraging of healthcare information, enhancement of patient experience, versatility for providers, and improved clinical outcomes. Cloud-based programs permit 24-hour patient access to electronic records.
Consumers in the 21st century prefer convenient methods to access healthcare services and manage personal information. Consequently, healthcare organizations have adopted patient-centered models to deliver health care and increase provider-patient communication. In addition, cloud-based platforms can facilitate the use of mobile devices, such as smartphones and iPads, allowing patients and providers to access health software applications. The number of healthcare consumers using smartphones to access health information soared from more than 60 million to more than70 million in the last two years. Anderson projects an estimated 20 percent annual increase of software application sales during the next five years.
Healthcare providers have suggested that significant benefits could occur for patients using mobile software applications to monitor their health status. Currently, numerous types of health software applications exist that are free or obtainable at a reasonable fee. Last year, healthcare providers used health software applications for obtaining diagnostic test results, sending alerts for patients to self- medicate, track and monitor levels of chronic pain, and store vital signs and emergency contact information. Consumers should be aware that a compatible operating system and adequate storage space are required to download health software applications to a mobile device.
Guest post by Keith Boyce, vice president of business development, RxOffice.
The recent postponement of the implementation of ICD-10 is nothing but good news. Moving the deadline to next year gives providers an opportunity to conduct further research and select the software that is compliant and the least disruptive of their existing processes while keeping the best interest of the patient in mind.
ICD-10 was the first step by the Obama administration’s healthcare plan, Obamacare, which revealed the need for a universal software platform that could work in all medical areas. Some professionals say the ICD-10 and other requirements of the new healthcare plan will cause physicians to spend more time on paper work and less time with patient care. If that is the case, healthcare providers will need a system that will cut down on the amount of time needed for paperwork. With the extension in ICD-10’s implementation, now is the time to make decision about keep or modifying current systems or investing in new ones.
The new regulations proposed through Obamacare will have more of an effect on small to mid-size healthcare providers and the IT companies that cater to them. Larger IT firms are not affected as much because their clients are the hospitals and large research clinics that do not have to adhere to the requirements of ICD-10. This means that these firms are less likely to understand and provide compliant software to smaller, special medical centers, such as diabetes, mental health and podiatry to name a few.
Healthcare providers should look for systems with the following characteristics:
Tina Greene, Senior Regulatory Affairs Consultant, Casualty Solutions Group, Regulatory Affairs and Compliance at Mitchell International.
The Administrative Simplification provisions of the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) include requirements that national standards for electronic health care transactions be established. These standards were adopted to improve the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data interchange in health care.
In the final rule, it’s recognized that:
“Non-HIPAA entities such as workers’ compensation programs and property and casualty insurance accept electronic healthcare transactions from providers, however, the Congress did not include these programs in the definition of a health plan under section 1171 of the Act.
The statutory definition of a health plan does not specifically include workers’ compensation programs, property and casualty programs, or disability insurance programs, and, consequently, we are not requiring them to comply with the standards. However, to the extent that these programs perform healthcare claims processing activities using an electronic standard, it would benefit these programs and their healthcare providers to use the standard we adopt.”
“Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice.” Federal Register 65:160 (17 August 2000) p. 50319.
In an effort to realize the effectiveness of electronic data interchange, some states have adopted regulations requiring electronic healthcare transactions for billing and payment. Early implementers of EDI for workers’ compensation in various states identified issues such as payer ID (claim administrator identification), claim filing indicator code and claim number, and worked with stakeholders to find resolutions. These issues have since been addressed in industry standards.
Guest post by Lea Chatham, content marketing manager, Kareo.
In the recent Physicians Practice Technology Survey, sponsored by Kareo, there are two trends that bode well. First, the majority of practices surveyed were independent, and second, there were more positives about EHRs than negatives. It looks like things are finally heading in the right direction.
Ongoing EHR Concerns Linger
That isn’t to say that practices don’t continue to have concerns, however. Nearly 20 percent of those surveyed still don’t have an EHR. The barriers? Implementation, interoperability and cost. And implementation of EHRs is cited as the top technology challenge for practices.
“The transition to an EHR can be hard, especially when practices choose the wrong system the first time and have to go through the process twice,” explains Laurie Morgan, senior partner at Capko and Morgan, a practice management consulting firm. “So it is really important to make the right choice. What we have seen is that the practices that have been on a good system for while do see the value and the workflow benefits. It just takes some time.”
On the flip side though, 57 percent are happy with their choice of vendor, which may mean that we will start to see a slowdown in EHR switching, giving providers a chance to focus on patient care and building their practices. In addition, more than 40 percent say they have seen a return on investment, and even more cite an improvement in efficiency.
For those who are unhappy with their EHR, this is a clear sign that better technology is out there. It is a matter of making sure to choose the right one and implement it correctly. “There are several steps practices can take to make sure they get the right EHR at the right price,” says Tom Giannulli, MD, MS, chief medical information officer at Kareo. “These days most of the affordable cloud-based EHRs will have the basic features so it often comes down to a few special needs and the implementation and training. To help improve satisfaction with the EHR it is really important to take advantage of all training and support and invest the time to get familiar with the system.”
Every day, physicians send and receive clinical information to and from patients, nurses, care managers, pharmacy technicians, specialty clinics and other physicians. These communications occur through a wide range of modes—including smart phones, pagers, CPOE, emails, texts and even messaging features within electronic medical records. Patient health information (PHI) is constantly exchanged through these messages, and to avoid a HIPAA violation, which can cost millions of dollars plus a hit to reputation, practices must make sure proper security features are in place.
Especially for physicians in smaller practices who are already strapped for time and resources, a HIPAA violation could leave their practice in a precarious situation. In fact, according to a recent study by the Ponemon Institute, the average cost of HIPPA breaches from 2010 through 2012 was $2.4 million per organization. To meet evolving guidelines around the quality of care, increase efficiency and potentially avoid financial penalties in the years to come, physicians must address communications security holistically.
The final HIPAA ruling requires physicians look at their entire risk management process, and not just specific technologies, which is why “HIPAA-compliant” text messaging isn’t yet possible. While texts are commonly sent between two individuals via their mobile phones, the “communication universe” into which a text enters is actually much bigger. This universe also includes creating electronic PHI (ePHI) and sending messages—in text and voice modalities—from mobile carrier web sites, paging applications, call centers, answering services and hospital switchboards.
The law stipulates that a covered entity – i.e. a physician, medical group practice, hospital or health system – must perform a formal risk assessment; develop and implement and effective risk management strategy based upon the findings in that risk assessment; implement the strategy using sound policies and procedures; and monitor its risk on an ongoing basis. These regulations apply to physicians creating, transmitting and receiving PHI in any electronic form.
While there is no “one-size-fits-all” approach, medical practices can take the following steps to improve the security of their communications:
Chris Fox, CEO of Avantas, discusses how he and his firm help physicians improve their operational performance; healthcare staffing; the need for addressing operational efficiencies across a health system without following some traditional approaches — like layoffs; and market trends that continue to perplex, yet offer opportunity for growth and development.
Avantas started as a group within Alegent Creighton Health more than a decade ago with the goal of optimizing its workforce across the health system. Its efforts were so successful that it became a separate company and began offering its expertise to the entire industry.
In 2007 Avantas developed a healthcare scheduling software, Smart Square, as no other solution on the market offered the flexibility and customization necessary to fully automate our strategies and provide a transparent view of staffing, scheduling, and productivity at the enterprise level.
Avantas executives provide thought leadership in healthcare labor management.
What keeps your passion for this mission, and the organization, alive? Tell me more about what excites you about your work and why you love what you do?
Very simply, if we are successful as a company it is because we have helped our clients – healthcare providers – improve their operational, clinical, and financial performance. Stronger healthcare providers means more services, more community outreach, basically, better, more affordable healthcare for everyone. It’s pretty easy to be passionate about that.
What draws you to healthcare? Did you seek out the sector when you began your career?
I’ve worked in software development and innovation for more than 15 years within a number of industries. It’s a funny story, but I actually got involved in healthcare because of a chance seat assignment on an airplane almost 10 years ago. I was seated next to Lorane Kinney, Avantas’ co-founder. We got to talking about Avantas and what she was trying to build there. Hearing Lorane’s passion for the company and the need to automate a new approach to labor optimization in healthcare was very inspiring. I knew I wanted to be a part of it, and I knew I could play a big role in bringing Lorane’s vision to fruition. Avantas has a compelling story and big aspirations. As Avantas’ CEO, I, like Lorane, seek out individuals who are passionate about the vision we have for the industry and want to be part of that change.
Tell me more about the evolution of Avantas, from where you started to where you’ve come today? Where are you headed and why?
Avantas started as a group within what is today Alegent Creighton Health more than a decade ago with the goal of leveraging economies of scale and standardizing its labor proactively across its then five Omaha hospitals. Our purpose was to develop and implement strategies that would leverage the system’s care staff, both proactively and in the moment to cost effectively adjust to the natural rise and fall in patient volume. Our efforts were so successful we became a separate company in 2001 and began offering our workforce management expertise to the entire industry via consulting. In 2006 Avantas conducted an RFP to find a scheduling solution we could use within our client base to automate the labor strategies we had developed. After we were unable to identify an appropriate solution we developed our own healthcare-specific enterprise scheduling solution, Smart Square. Now Smart Square is being utilized in more than 200 facilities across the country. Our strategies and technology solutions are packaged in a comprehensive methodology called HELM, which stands for healthcare enterprise labor management. HELM takes a step-by-step approach at restructuring an organization’s labor management strategy by first right-sizing its staffing sources, standardizing policies, and implementing best practices. Next we automate those policies with Smart Square. We also work with our clients to develop centralized methods of managing staffing resources as well as helping them build out the necessary layers of contingency staff, enabling them to cost effectively adjust to constantly changing patient demand. We help our clients implement these strategies across their systems: inpatient, ancillary and outpatient areas, like medical group practice sites.
No one will argue that there are not benefits to EHRs (electronic health records). They eliminate paper, enable providers to track data efficiently over a period of time, create a clearinghouse of patient health information in one place, just to name a few. Some argue EHRs improve the overall quality of patient care and business management. However, with so many EHRs on the market, hospitals and doctors’ offices face the daunting task of selecting the right system. Like the general population, most healthcare professionals’ exposure to technology has been limited to that of a consumer, making the selection of the right EHR system a process out of their comfort zone. Then getting trained on how to efficiently use the system while maintaining a high level of patient care comes into play. This has proven to be frustrating, ineffective and possibly dangerous in extreme cases when information is incorrect and/or cannot be accessed. This situation has put healthcare providers in a challenging position, to say the least.
Since 2009 when the federal government rolled out the $30 billion American Recovery and Reinvestment Act as an incentive program for the healthcare industry to go digital with its records, the landscape has changed. One of the first things that happened was the huge influx of technology vendors who decided to make their foray into the healthcare space. Unfortunately, most of these companies did not understand how the industry operated, no pun intended. In fact, the average vendor just launched its first product to the industry in the last year so that does not provide a lot of industry longevity/credibility. Many vendors were focused on getting the peace of $30 billion pie at the cost of their client not getting what the system they needed. Established technology vendors, who shifted their focus on solving the industry’s problems, were outnumbered by the new players who entered the market chasing government grants. The availability of these grants actually created an EHR technology bubble in very short period of time. To make matter worse, well-intended government rules only focused on the end users’ ability to implement technology correctly instead of the technology producers.
With the overwhelming amount of information out there about EHR technology and the providers, healthcare professionals must do thorough due diligence to find the best system that fits their needs. This will take both a time and resource commitment. Let’s look using a metaphor that most people understand or at least have had some experience with, dating. The same principles used in dating can apply when selecting the right EHR technology. Here are four simple rules that can help any healthcare provider make a good business decision when looking for an EHR solution.
MobileSmith is an online app development platform, enabling hospitals and health organizations to create custom, native apps, across iPhone, Android and iPad devices, without any coding required.
We have a platform that allows a marketing department with no development experience to create custom, native mobile apps. With us, any hospital can enhance their patient engagement strategy, without coding, and without the cost of hiring developers.
The earliest foundations of the company that would become MobileSmith, were laid in 1993. Back then, the company, known as SmartOnline, sold software to assist small businesses. SmartOnline became one of the early pioneers of the SaaS (Software as a Service) model that we use today. The company worked to adapt to the constantly changing technology. In 2010, the company hired Bob Dieterle as senior VP and general manager. He advocated and orchestrated a complete overhaul of the company services, and focused the company, instead, on the budding industry of mobile applications. The company wanted to deliver organizations a means to quickly create and manage apps to connect to their consumers, without having to rely heavily on an IT department. Working to that end, the MobileSmith online platform was developed, and in July 2013, the overhaul was complete, as the company rebranded itself as MobileSmith Inc. and has since focused entirely on delivering quality and cost-effective mobile apps to organizations.
Market Opportunity and Strategy
There are several app development platforms out there, such as Appcelerator or Kony. These platforms still require a programmer or developer to write code for the apps. Our platform requires no coding whatsoever. A designer or marketer can easily come to us and use our platform to design, prototype, build and deploy an app. While we have clients from a variety of fields, healthcare providers have found our platform particularly useful. With healthcare IT departments swamped with EHR implementation and marketing desperately trying to enhance patient engagement options, our platform has been able to fill their needs without placing any further burden on their IT, and avoiding the higher labor cost of developers. As only 35 percent of healthcare providers offer mobile apps, according to the HIMSS Analytics Survey, there is a clear need in the healthcare industry for our platform, and several organizations have found us to be an excellent means of enhancing their patient engagement via mobile apps.