Introducing an electronic medical records system into the practice helps the physicians and staff provide more efficient health care by making medical records more accessible to all health care team members. It also brings some risks. In this two-part article, CAP Risk Management and Patient Safety identifies 10 areas of risk exposure and provides some brief recommendations in each area.
Diagnostic Testing
Tracking of laboratory and diagnostic orders and results is more efficient and timely when all orders are processed through the EMR with a bi-directional interface. If possible, also set up to receive all results back through the system. If fax or paper reports are received, scan and index reports into the system the same day. The EHR system may also be used as a “tickler file” for verification of orders and paper reports. Physicians should see all diagnostic testing whether normal or abnormal.
As a patient, I sat in the exam room awaiting the results of my labs and tests. From my perspective, there was a great deal on the line – my personal health and possibly my longevity.
I sat alone — waiting for the nurse to come in to begin the initial check-in phase — taking in the sterile room, its beach-themed art and the blank flat-screen monitor near me on the counter.
After several minutes alone, pondering my fate and driving myself further into a place of stress, the nurse finally entered the room.
We exchanged pleasantries. Hellos and how are yous.
With that, she turned from her back to me, keyed in a few strokes and began to enter data into the practice’s EHR.
The ability of consumers and healthcare providers to access information and streamline processes using mobile devices is having a profound impact on healthcare.
For the first time this year, sales of smartphones are expected to surpass sales of traditional cell phones. More than 800 million smartphones are expected to be sold worldwide in 2013, according to Canalys. In addition, IDC predicts that more than 170 million tablets will be sold this year, surpassing laptop sales.
All these mobile devices in the hands of consumers means that the mobile app market will continue its torrid pace, and this is true in healthcare too. The market for mobile healthcare apps is expected to reach $400 million by 2016, according to ABI Research.
With the consumerization of healthcare, both doctors and hospitals have a vested interest in delivering an experience that will build patient loyalty. At the same time, new healthcare laws also are putting patients in a position of being more responsible for their own care. Healthcare providers who give patients the tools they need to simplify information and make informed choices will build stronger and longer relationships with patients. Mobile apps will be the heart of these tools.
Kal Patel, COO of Meditab Software, speaks about innovation in health IT, reactions from physicians and caregivers about the continuous changes in health IT, trends affecting the industry, where we are going and how we are going to get there and the qualities he thinks makes for a health IT leader.
What’s your daily motivation and what makes for innovation currently in the HIT market?
I am motivated by innovation, focusing on creating a product that’s in a league its own, not only for usability, but for the highest and best use, providing each practice the most customized solution for their specialty needs. We don’t subscribe to the notion that one size fits all.
Since the dawn of meaningful use, questions have swirled about how the money, the incentives, are being spent by those who receive them. In fact, it’s a question I’ve asked several colleagues, practicing physicians and healthcare leaders.
The answer typically depends on the person giving it. As such, no two answers are ever really the same, but there are some general responses offered.
The most common, from my perspective have something to do with responses such as “work to ensure better patient care,” “take steps to be more efficient” and “better meet our goals.”
The report suggests that 16 percent of surveyed U.S. doctors say that patients should be able to update some demographic information in their EHR and 5 percent say that patients should not have the ability to update any demographic data.
“Sixty-seven percent of surveyed U.S. doctors say that patients should be able to update all family history information in their EHR, while 21 percent say that patients should be able update some family history data and 12 percent say that patients should not have the ability to update any family history information,” according to the study.
Twenty-five percent of surveyed U.S. doctors say that patients should be able to update all of their laboratory test results in their EHR, while 28 percent say that patients should be able to update some lab test results and 47 percent say that patients should not have the ability to update any lab test data.
On behalf of Accenture, Harris Interactive conducted the online survey of 500 U.S. physicians between November 2012 and December 2012.
This is an interesting topic that seems to have many foes and fans, and I can see the perspective from each side. On one hand, allowing access to a personal record may allow for breeches of information, HIPAA violations and may create a slippery slope to a movement for patients to have full editorial access to their records. Obviously, doing so creates more many more problems than it solves.
The benefits to such a move – allowing patients to input their demographic data into their personal health record – may lead to greater patient engagement, which seems to be healthcare’s sticky wicket, and it may help practices struggling with being overwhelmed administratively to streamline some of their intake and the management of their information and “pass along the cost,” so to say.
It seems as new solutions come to pass and as we as an industry seek ways to moderate, streamline and create new efficiencies, questions such as the one raised by this survey will be asked more and more. As the questions become more well circulated and discussed, the issues they address will move toward the acceptable and standard practice as they gain ground within the society we have created.
As such, though there may be initial resistance, like all cultures built to change, what was once unacceptable will become standard practice.
Given the issue raised by these questions, I wonder what level of change we’ll see in regard to this in the near term. My hunch is that in an effort to include more people in the process, to streamline and to offload some of the administrative responsibility, we’ll see tactics such as these be incorporated more often, and more “power” given to the patients.
I wonder what your thoughts are on this subject, and what your perspectives are. Do you agree with the survey results? Should patients be allowed to change any of the data in their records or does it make sense to include them in the administrative management of the record?
In light of recent reports that nearly 220,000 hospitals, office-based physicians and other eligible professionals have received more than $12 billion in federal incentive payments, I thought I’d highlight the top questions as featured on CMS.gov’s FAQ section.
But, a little perspective first. According to Modern Healthcare, to this point, 3,757 hospitals, or 75 percent of the 5,011 U.S. hospitals that are eligible to receive federal funds under the program, have received an EHR incentive payment.
Also, “215,500 physicians and other EPs, or 41 percent, of the 527,200 total physicians and other professionals deemed eligible to participate, have been paid. Some 85 percent of hospitals and 70 percent of physicians/EPs are registered under the programs, the CMS reports.”
So, back to the original story: CMS.gov’s Frequently Asked Questions and the answers. If you’re not aware of the resource, it serves a broad base audience with a smattering of questions and responses. For example, there a variety of topics including billing, e-health, data navigation, EHR incentive programs, well, you get the point.
Here’s a short list of some questions and their answers:
How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be made? For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximately eight to 12 weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. Payments will be held until the EP meets the threshold in allowed charges for the calendar year ($24,000 in the EP’s first year) in order to maximize the amount of the EHR incentive payment they receive. Medicare EHR incentive payments are based on 75 percent of the estimated allowed charges for covered professional services furnished by the EP during the entire calendar year. If the EP has not met the threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March of the following year (allowing two months after the end of the calendar year for all pending claims to be processed).
What is CMS? The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program. Provides information for health professionals, regional governments, and consumers. Additional information regarding CMS and it’s programs is available at http://www.cms.hhs.gov/.
When eligible professionals work at more than one clinical site of practice, are they required to use data from all sites of practice to support their demonstration of meaningful use and the minimum patient volume thresholds for the Medicaid EHR Incentive Program? CMS considers these two separate, but related issues. Meaningful use: Any eligible professional demonstrating meaningful use must have at least 50% of their of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology capable of meeting all of the meaningful use objectives. Therefore, States should collect information on meaningful users’ practice locations in order to validate this requirement in an audit.
How do physicians join or leave a group? If both the physician and the group are already enrolled with the same carrier, the physician and the group together are required to complete a CMS 855R showing the date the physician joined the group and reassigned benefits to the group. If a physician leaves a group, the physician or the group should complete the CMS 855R, showing the date the physician left the group. When leaving the group, the CMS 855R does not need to be signed by both the physician and the group. If either the physician or the group have not enrolled with the carrier, they must first complete the appropriate CMS 855 for either an individual (CMS 855I) or group (CMS 855B) before the reassignment can be effective.
With the annual HIMSS conference once again over, now is as good as any time to look back and pontificate on what the experience brought. For this piece, I once again reached out the readers of this site for their insight for their perspective, who are, after all, those benefiting from the show and its sessions.
It should be noted that I asked for pros and cons of the show, and I received mostly positive feedback, which doesn’t surprise me. However, don’t take that to mean this is a positive puff piece. On the contrary, I am trying to offer a fair and balance response from attendees that HIMSS leadership can use to plan future conferences.
Obviously, as each of us has been told at one time or another, criticism – good or bad – helps us grow, change and expand. With that, I welcome your comments, positive or negative about the show. Perhaps as a collective, we can help lead our community forward in a manner that’s most beneficial to all it stakeholders.
Without further ado, here are the comments from our colleagues about their reactions to HIMSS13.
Peter Ransome, vice president sales and marketing, Westbrook Technologies, Inc.
Pros: HIMSS was once again a tremendously successful event. Westbrook came away with new resellers, customers and partners. We had a great opportunity to network, learn and meet other vendors. Our team found great value in the keynotes and educational sessions and especially Farzad Mostashari’s final day keynote. Today, healthcare reform is focused on meaningful outcomes and disease management. The next wave of reform will put more emphasis on the value of preventive medicine. There are still a lot of error-prone paper processes that negatively affect the quality of patient care — even in a healthcare organization that has implemented a leading EHR system. We’ve found that more technology doesn’t necessarily result in better care. With more than 1,000 EHR vendors competing for the same healthcare dollars, consolidation is inevitable. It will be interesting to see how HIMSS changes in 2014 and how the industry is affected by rapidly accelerating acquisition activity.
Cons: (Apparently, the show was so good, Ransome listed no cons.)
Bill Fera, MD, principle, healthcare advisory practice of Ernst & Young
Pros: HIMSS has become an extremely valuable venue for gaining real-world examples of how organizations are advancing strategies to better utilize data for the improvement of patient care. Having so many industry influencers in one forum really makes HIMSS stand out — what I take away from networking and informal conversations can be just as useful as what’s formally presented in the sessions.
Cons: The challenge with HIMSS is the sheer volume of everything. The overload of information can become a distraction if you don’t allocate your time in advance and stay focused on what you want to accomplish.
Pros: HIMSS is well-organized and it had a great location this year in relations to access to airport and hotels. Additionally, education tracks were comprehensive and interesting, and there is a good assortment of attendees (institution and title).
Cons: At HIMSS, there’s not enough opportunity for partner networking. HIMSS should have a new/upcoming technology track (not just big vendors pitching products) and there should be better management of keynotes as managing overflow was challenging.
Christopher Ellis, director, Vree Health
Pros: There was clear industry movement toward technology integration and interoperability – this is a very positive step forward and something that was spoken to more than acted upon, until now. More consistently usable, structured data will open many avenues for leveraging data for better quality of care. Coming from this meeting, I am energized to see that many of the speakers emphasized that while technology is a great enabler, solutions must begin and end with the patient in mind. Providers and vendors that emphasize patient engagement, across varying levels of patient technology literacy, are positioning themselves well. The HIMSS conference was an excellent forum to survey different approaches to solving the same problems, including coordination of care, assessing health risk and patient engagement. Organizations that have a deep and long-standing heritage in healthcare clearly hit the mark on approaching these in ways that are reflective of provider operational flow.
Cons: Bring your walking shoes next year.
Thanks for all of your candid feedback, guys. I know HIMSS was considered a success this year, but there’s always room for improvement and growth, and it’s nice to be able to report such positive feedback for all in attendance.
If you have something to add, please leave a comment below. Thanks!
