The Office of Electronic Health Record Modernization at the U.S. Department of Veterans is looking for a few good men or women to help ensure its landmark Cerner EHR implementation is rolled out with clinical integrity – and optimal interoperability with the Department of Defense.

The department is seeking candidates – who will be based in St. Louis, Seattle and Washington, D.C. – to be Deputy Chief Medical Officers for the massive $10 billion rollout, and it seems to be focused especially on how the system built over the next decade will sync with the DoD's own Cerner project, MHS-Genesis.

WHY IT MATTERS
VA sees deputy CMOs as key leaders to "execute informatics strategy and closely coordinate with DoD peers," according to a blog post. They'll be tasked with helping manage the annual budget for the project and ensuring the provision of top-quality care for some 9 million veterans.

The department is looking for physician leaders who are "broadly familiar with clinical treatment modalities, administrative and clinical support systems and multifaceted healthcare delivery systems," and says leadership skills, communication, clinical know-how and experience in IT and informatics – as well as an understanding of larger healthcare policy – will be key.

In addition, VA is looking candidates who are able to share "best practices, processes, structures and policies" with DoD to enable lasting improvements in the way both departments use EHRs; oversee the change management and training to ensure clinical end users are comfortable with the new workflows; work with other VA leadership to implement changes as needed and "manage and monitor budgets and productivity improvements."

THE LARGER TREND
This past spring, an array of major challenges with the DoD's EHR modernization came to light, with many IT, training and workflow hiccups reportedly causing inaccurate prescriptions, misdirected patient referrals and other complaints that clinicians said could put patient safety at risk. One oversight report slammed MHS Genesis for its "poor system usability" and "insufficient training."

The VA appears to be trying to forstall similar problems here by bulking up its own clinical leadership, making hires for several key locales – and ensuring they have the skills to guide leadership, IT staff and clinicians toward a smoother implementation.

Part of the DoD's challenges seemed to stem from the fact that its "original change management and training structure focused a little too much on how to use the system and not enough on how the workflow will differ from legacy," explained Stacy Cummings, program executive officer for Defense Healthcare Management Systems, in a podcast with Cerner.

Both the VA and Cerner seem intent on not repeating the DoD's mistakes.

"Cerner and the agency are committed to applying commercial best practices, as well as any lessons learned from our DoD experience, to the VA’s Electronic Health Record Modernization program," said Travis Dalton, president of Cerner Government Services, in an update this past October. "The VA has unique challenges and it’s critical that end-users and stakeholders are engaged throughout the implementation process."

ON THE RECORD
"OEHRM is setting a new standard in the development of electronic health records and in the seamless sharing of patient data between VA and DoD," said Darren Sherrard, associate director of recruitment and marketing at the U.S. Department of Veterans Affairs. "OEHRM leaders will be at the forefront of this transformation, which promises to drive better clinical outcomes by giving providers a fuller picture of Veterans’ medical histories."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication. 

Health systems invested in electronic health records to drive patient care improvements, increase efficiencies, reduce lengths of payment cycles and allow for prospective and retrospective reporting without manual intervention.

Some, not all, of those anticipated benefits have been realized. In many cases, expected clinical efficiencies are not being experienced, and often satisfaction is deteriorating. Many providers are spending significant time searching for clinical data, constructing orders with the necessary diagnostic evidence, documenting the patient story to inform the care team, and responding to patient/colleague communications outside of clinic hours.

Some in healthcare have even blamed the EHR for exponentially increasing the physician burnout epidemic.

"The promise and hype of EHRs, for many organizations, has failed to materialize," said Dr. Greta Branford, associate CMIO for ambulatory care and assistant professor of internal medicine/pediatrics at Michigan Medicine.

"Despite the sizable investment in implementing these EHRs, most organizations have allowed a reduction and/or overall embargo on the very resources that should be dedicated to working shoulder-to-shoulder with providers to enable continuous improvement, resolve issues, enhance skills and build tools to drive efficiencies," she said.

Many caregivers are experiencing a training desert after initial go-live and/or new hire onboarding, she added. For them, training is delivered in a self-service format, assuming caregivers have the time to read and apply well-intentioned e-mails, tip sheets and pre-recorded online learnings, she said.

"The program should consist of multiple and diverse educational offerings delivered by dedicated trainers fluent in physician workflows who work in partnership with identified physician champions."

Dr. Greta Branford, Michigan Medicine

"Instead, it’s pivotal for organizations to institute an ongoing program that promotes a state of continuous improvement, keeping pace with new functionality so end-user needs can better support efficiency, optimized patient care, and provider and patient satisfaction," said Branford.

"The program should consist of multiple and diverse educational offerings delivered by dedicated trainers fluent in physician workflows who work in partnership with identified physician champions," she explained, offering some examples of what she sees as an effective training portfolio:

• Physician onboarding: Educate new physicians on EHR functionality, using workflow-based curricula;
• Three-month boost: At the three-month mark for new physicians, refresh EHR functionality knowledge, personalize key workflows and correct misunderstandings/ineffective use;
• E-learnings on new features: Provide training on EHR system enhancements, which occur on a regular basis several months per year;
• Home for dinner: Customize the EHR tools to support improved clinical workflows; relearn some basics;
• 1:1 physician coaching: Improve provider usability for targeted areas of improvement and establish lifelines between provider champions and faculty;
• Training bursts: Include as a regular agenda item on department meetings to highlight new tools and workflows;
• Clinic sprints: Deploy a "power team" of workflow and EHR experts to improve specific focus areas of operations.

EHRs in general are capable of much personalization, but they are so complex that caregivers have no idea what features exist; furthermore, they have no time or energy to learn or to do the personalization, Branford said.

"From my personal experience, with this comes a feeling of just clicking boxes and disconnection from the patient and loss of a sense of purpose," she explained. "On any given day, we physicians must click boxes to record history and then click a box stating we have reviewed it, order labs and studies and order referrals, and medications."

Physicians also need to track pain, depression and anxiety scores, how people learn best, how they want to be contacted, and whether the patient vapes or uses tobacco, alcohol or drugs. Physicians must enquire about food security, isolation, transportation, health knowledge, among other things.

"While all of these things are intended to provide risk stratification and a richer understanding of the patient, and ultimately better care, the patient is left wondering when we will ask them why they came in for the visit," she said. "The doctor is left wondering if this is why they went to medical school."

A comprehensive program can ensure personalization does occur as well as improvements in efficiency and satisfaction, addressing the aforementioned concerns, she added.

While everyone is enamored with the cutting-edge IT, AI, and the shiny objects of tomorrow, focusing on realizing the true value of EHR investments is critical to advancing to the next generation care model, addressing growing financial pressures, and improving operational efficiency and effectiveness, Branford insisted.

"Using the system to a provider’s best advantage is really what will make most of the difference on a broad scale," she said. "When we spend time to listen to the providers, their requests for system changes and the opportunities for improving workflows, it helps. They feel heard, and we can start tailoring training and personalization efforts to what they need and deliver it in the way in which they prefer to learn."

"Addressing the stressors of provider burnout is imperative for all health systems," Branford stated. "There are several components contributing to overall burnout: technology, care models, leadership and engagement structures. Progress must be parallel-tracked across all these causal components."

The EHR is a contributor, and investigating how to improve usability with the EHR is an essential step, she said. Factor in the voice of the caregiver through surveys, interviews and focus groups to determine the primary drivers, she added. Then develop a roadmap and plan to address the top drivers, she said.

"Usability is likely to come to the top of the list," she said. "If so, build a program supported with the resources and programs that will meet provider needs, on their terms, to drive year-over-year continuous improvement.

By factoring in the voice of the provider, she explained, an organization is best equipped to connect physicians with resources and programs that meet their needs, on their terms, to drive year-over-year continuous improvement for this significant EHR investment.

Branford will share more insights at HIMSS19 in a session titled "Burnout: How EHR Usability Improves Efficiency & Satisfaction." It’s scheduled for Thursday, February 14, from 2:30-3:30 p.m. in room W304E.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

A new report this month from the Bipartisan Policy Center explores the reasons for – and remedies to – the fact that mental and behavioral health data are so poorly integrated with clinical information in electronic health records.

WHY IT MATTERS
Some 45 million Americans have some form of mental illness, the Bipartisan Policy Center points out, and there's been an increase in deaths due to substance abuse and suicide in recent years. The ongoing opioid crisis is only exacerbating the challenges associated with getting patients the healthcare they need.

A decades-old federal statute known as 42 CFR Part 2 aimed to protect patient privacy by keeping substance use disorder separate from clinical records. It was well-meaning, but the rule prevents physicians from getting a complete view of their patients.

Add to this the fact that mental and behavioral health providers were left out of the federal EHR Incentive Program that spurred uptake of EHRs at hospitals and practices a decade ago.

There are numerous other hurdles too, related to insurance, administrative barriers, workforce challenges and more.

The new report aims to "identify barriers to integration caused by federal policy, to identify policy options to mitigate or remove those barriers, and, through policy changes, to advance evidence-based treatment for mental health in the United States."

Among its suggestions: Congress should enable use of HITECH funding to incentivize uptake of EHRs for mental and behavioral health provides, and HHS should clarify rules around HIPAA and data sharing.

"A major integration barrier in a coordinated care setting is the inability to easily share patient information between providers," researchers from the Bipartisan Policy Center write. "Providers are allowed to share information only with elaborate contractual agreements, which creates barriers for care coordination, an essential component of successful integration."

Another major barrier is the "lack of information sharing, spurred by privacy concerns, which has limited the adoption of electronic health records by mental health and SUD providers."

While the HITECH Act earmarked "billions of dollars in subsidies for medical providers to purchase and maintain electronic health records," it didn't make those incentives available to mental health and substance abuse disorder providers. As a result, "while the adoption of electronic health records has increased among other healthcare providers and entities, adoption by mental health and SUD providers has lagged."

THE LARGER TREND
As long ago as 2011, leaders on Capitol Hill such as Sen. Sheldon Whitehouse, D-Rhode Island, were looking to remedy HITECH's oversight of behavioral health providers and extend eligibility for meaningful use money their way.

More recently, both the House and the Senate have supported bipartisan bills designed to incentivize adoption of EHRs by psychologists, psychiatric hospitals, community mental health centers and others.

"Electronic records help doctors and other providers make better decisions about their patients’ care," said Whitehouse in a May 2018 statement touting the senate passage of a newer bill, his Improving Access to Behavioral Health Information Technology Act. "Americans who receive substance abuse and mental health treatment should benefit from that technology, too."

ON THE RECORD
"The history and structure of the mental health system has resulted in payment and policy silos and a host of agencies and providers that, while committed to quality care for people with mental illness, have significant interest in changes to the status quo," wrote researchers in the report.

"Integration of services financed at the federal level will require collaboration among traditional mental health providers, public health departments, states, health plans, and federal government agencies that have not traditionally been required to work together and may not have aligned interests.

"In addition to political and jurisdictional concerns associated with some of the options, many will require increased federal spending. BPC has typically sought to identify savings or additional revenues to avoid policies that add to the federal deficit. This will need to be considered as policymakers weigh options."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication. 

Comments closed Jan. 28 on the Office of the National Coordinator for Health IT’s (ONC) draft recommendation to make electronic health records (EHRs) more user friendly with support over the recommendations and a host of cautions that included going slow with changes and creating panels to help oversee them.

WHY IT MATTERS

The comments come a day after Pew Charitable Trusts urged ONC to focus on patient safety in EHRs, pediatric one in particular. 

ONC and the Centers for Medicare & Medicaid Services (CMS) incorporated stakeholder feedback into a draft strategy they released Nov. 28, that included proposals to reducing the time and effort it takes for physicians to enter data into an EHR; reducing the effort and time it takes to meet regulatory reporting requirements, and; helping to improve the overall ease of using EHRs.

AMIA and other groups responded with a variety of requests that included:

Fix the root cause

CentriHealth, a subsidiary of UnitedHealth Group, called ONC’s draft strategy “noteworthy and commendable,” but said it only addresses the symptoms. “The root cause is the lack of a useful and usable system that supports overall individual care in a complex, diverse health care economy,” CentriHealth said. “In the absence of such a system, the administrative functions have filled this ‘system of care vacuum’ leading to the problems identified.”

How to relieve this? CentriHealth said, “ensure we have the systems for individual care that meet the needs of contemporary medicine and practice. Until then the problems identified will persist and the approaches proposed in the ONC Draft Strategy will be at best damage limitation.”

Streamline requirements for substance use disorder records

The Partnership to Amend 42 CFR Part 2 called for new guidance to align Part 2 (a measure that deals with the federal confidentiality of substance use disorder patient records) with HIPAA, to allow for the transmission of Part 2 records without written consent for treatment, payment, and healthcare operations. The group says Part 2 is an “outdated regulation” and limits the use and disclosure of patients’ substance use records from certain substance use treatment programs.

Currently, patients must submit written consent prior to the disclosure of their substance use disorder record. “Obtaining multiple consents from the patient is burdensome and creates barriers to whole-person, integrated approaches to care, which are part of our current health care framework,” the Partnership said.

Measure the pace of changes

Based on the collective perspectives and experiences of its 35-member companies who serve the majority of hospitals and ambulatory care providers using EHRs across the U.S., the Electronic Health Records Association believes that ONC should use a “measured pace” for introducing change.

“This will be important to successfully updating the systems and workflows, which have been used for many years,” the association said. EHR clinical documentation is embedded with algorithms for clinical care reimbursement needs. “As with all changes that are introduced to health information and technology, especially those that impact clinical workflows, clinicians and clinical support staff need time to learn about the changes and adapt to using new, less prescriptive approaches,” the group said.

Decouple clinical documentation from billing, regulatory, and administrative compliance requirements

In a Jan. 29 announcement, the American Medical Informatics Association (AMIA) “strongly supports” ONC’s proposed strategy to decouple clinical from billing documentation to reduce burden on clinicians. However, AMIA warned, “the core challenge and dominant threat” to this strategy is that “most EHRs are designed to support transaction-based, fee-for-service (FFS) billing requirements and business processes for regulatory/administrative compliance, rather than reflect clinical observation and treatment.”

To make the decoupling work, the federal government, developers, providers, and payers will all have to agree to the decoupling, AMIA aded, “with the expectation that documentation will be used downstream for clinical decision support and quality/performance reporting as a biproduct of care delivery.”

ON THE RECORD

AMIA CEO Douglas Fridsma, MD, in the group’s comment letter: “Rather than be the focal point of a clinical visit, technology should be invisible to our clinicians’ workflows. Our regulatory and policy approaches need a paradigm shift so that our informatics tools can realize their potential to heal healthcare.”

Pew tells ONC that it's time to emphasize safety in pediatric EHR usability efforts

Common usability challenges can also contribute to medical errors, the organization said.

By Diana Manos

January 28, 2019

02:04 PM

ONC needs to incorporate safety into the usability of EHR reporting and prioritize safety in new certification requirements for EHRs used in pediatric care, according to Ben Moscovitch, project director of health information technology for the Pew Charitable Trusts, in a Jan. 28 comment letter to Donald Rucker, MD, National Coordinator for Health IT.

Pew’s response follows ONC’s request for comments on its Nov. 28 draft report, “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs,” which proposes making EHRs easier for clinicians to use while at the same time easier to meet regulatory requirements.

The ONC proposal was mandated under the 21st Century Cures Act.

WHY IT MATTERS

In the report, ONC highlights two key challenges with EHRs, namely, poor system usability and ineffective data exchange.

“These same challenges can also introduce patient safety problems and hinder the coordination of care,” wrote Ben Moscovitch, project director of health information technology for the Pew Charitable Trusts. “ONC, through several policies under development, can take steps to address these challenges.”

The Pew Charitable Trusts, a non-profit research and policy organization, has a number of initiatives focused on improving the quality and safety of patient care. The organization also works on facilitating the development of new medical products and reducing costs. Last April, Pew released a report on how to make EHRs easier and safer to use.

THE LARGER TREND

Moscovitch pointed out that usability challenges can arise from the implementation, customization, layout, use, and maintenance of an EHR system.

“These same factors can also contribute to medical errors — such as patients receiving the wrong dose of a drug,” he noted.

Moscovitch explained there are two provisions in the Cures Act that ONC could use to ease EHR burdens on clinicians and improve safety.

One: develop a reporting program to collect data on a variety of EHR-related functions, including system usability. “Given the intersection of usability and medical errors, ONC should ensure that some of these usability-related criteria focus on safety,” Moscovitch added.

Two: issue regulations that establish a voluntary certification program for EHRs used in the care of children. EHRs designed for use with adults can overlook differences in the care of children — such as growth patterns — and introduce the opportunity for error, he says.

In the report, ONC said APIs can be used to improve interoperability, but Moscovitch said, “only if the interfaces are effectively implemented.” 

ON THE RECORD

“Forthcoming regulations from ONC on EHRs used in the care of children and the development of a new reporting program offer opportunities to enhance usability — which would simultaneously reduce burden and improve safety,” Moscovitch added. 

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

An implementation plan for a nationally consistent Electronic Oral Health Record (EOHR) will be presented to the country’s 20 district health board (DHB) chief executives by the middle of this year.

Professional services organisation TAS is leading the implementation on behalf of the DHBs after recently signing a contract with the Ministry of Health.

Chair of the EOHR programme board Robin Whyman is clinical director oral health at Hawkes Bay DHB.

He says the programme started around 2015–16 because staff operating oral health services recognised that, while nearly all DHBs are using the same clinical system, differences in local implementations mean they are unable to get nationally consistent information out of it.

“When trying to get information for a national picture of what’s going on in oral health and around service quality improvements, we were struggling to compare things and be confident we were interpreting things in the same way,” he added.

All but two small DHBs are using Titanium Solutions and the remaining are paper based. A number of Māori health providers contracted to the DHBs are also using the software.

The Titanium system contains critical information about the status of patients and treatments provided to nearly all children up to the age of 12 and some adults.

However, each DHB has made its own decisions with the vendor, resulting in boards being on different versions of the software and two slightly different code sets for treatments being used.

A Request for Proposal for a national EOHR system was released in November 2016, but the EOHR Programme Board recommended not to award a contract. Instead the programme team is working with Titanium to make improvements and move towards a nationally consistent system.

“One of the early pieces of work is to work with the sector to allow a nationally agreed code set for the system,” Whyman says.

“By having a consistent coding set and interpretation we believe we will start to have conversations about quality improvement, looking at outcomes of treatment and oral health status and how that’s linked to interventions put in place.”

He hopes to have a national coding set in place and in use by mid-2019.

Whyman says the board is also looking to develop regional groupings of DHBs using the same instance of the software. These will evolve over the next couple of years.

“Part of the work of TAS is to work with the sector on the best way to do that,” he says.

An implementation plan that’s “achievable within the resources of the DHBs” will be presented to the 20 DHB chief executives by the middle of this year for approval, he says.

A TAS statement says a nationally consistent EOHR is expected to help improve New Zealanders’ oral health through improved capture and quality of oral health information.

It says the programme of work underway will see DHBs implementing consistent business, system and information management processes. It will also enable DHBs to benefit from national economies of scale and achieve efficiency benefits.

This article first appeared on eHealthNews.nz.

Meditech and Nuance announced that they are partnering to combine voice tech and electronic health records.

Specifically, the companies will integrate Meditech’s Expanse EHR with Dragon’s Medical Virtual Assistant to enable clinicians to perform clinical and administrative tasks with voice activation.

WHY IT MATTERS

Physicians have been more and more frustrated with the time it takes to wade through their EHRs to meet regulatory and reimbursement requirements, losing valuable time with their patients. Now two companies have come up with something that should ease a little of the strain.

Meditech said the virtual assistant can “understand, analyze, and respond to human language,” and offers voice-driven workflows.

THE LARGER TREND

Toward the end of last year, 2018 was declared the year of the voice tech pilot, foretelling much more innovative work in the realm is on tap for 2019.

Solutions that bring AI into the mix to ease strain on physicians will be welcome.

Comments closed Jan. 28 on the Office of the National Coordinator for Health IT's draft recommendation to make electronic health records more user friendly, we reported on Wednesday.

And even dating back to early 2017, intrepid providers were running proofs-of-concept and pilot programs that offered a glimpse of how they are reshaping the patient experience.

ON THE RECORD

“Clinicians want technology that is easy to use and that gives them more time back in their day to spend with the patients they care for," said Nuance Senior Vice President Peter Durlach.

Meditech physician consultant Dr. Howard LeWine added: “When I am rounding, I regularly need to quickly access information in the chart and submit orders on the fly. By using Nuance's Virtual Assistant, I can ask for the chart information, such as last EKG or colonoscopy report, and order tests and medications without interrupting my interaction with the patient.”

The two companies will demonstrate the new technology at Meditech booth #3921 and Nuance booth #3345 at HIMSS 2019, Orlando, Florida, Feb. 11-15. 

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

Chicago's Rush University has been earned the HIMSS Davies Award Of Excellence for its work using health IT to treat veterans with post-traumatic stress disorder, more commonly known as PTSD.

The provider organization recognized that approximately 23 percent of U.S. veterans who served in Afghanistan and Iraq suffer from PTSD. Despite the availability of effective evidence-based treatments for PTSD, research has suggested that less than 20 percent of these veterans actually receive these interventions, HIMSS reported.

Furthermore, of the veterans who receive evidence-based PTSD treatments, close to 40 percent do not complete them and therefore do not receive adequate therapeutic doses. Consequently, it is important to identify ways to increase access to evidence-based PTSD treatments and to help veterans stay engaged in treatment so that they can complete their course of therapy, HIMSS said.

To address these critical needs, the "Road Home Program: Center for Veterans and Their Families" at Rush University Medical Center developed an intensive treatment program for veterans with PTSD. The three-week-long program offers a combination of evidence-based PTSD treatments and adjunctive services. Rush is one of the first health systems in the country to offer intensive PTSD treatment, so it was important to ensure that this novel PTSD treatment delivery method was effective, HIMSS explained.

Innovating with clinical data

The Road Home Program worked to address veterans not receiving adequate amounts of therapy by systematically capturing clinical data, including but not limited to PTSD and depression symptom severity at various time points.

This was performed while using existing technology available through the electronic medical records and survey tools. All data capture tools were designed with input from clinicians, researchers and system administrators to ensure that the collection of program data could be completed in short amounts of time to minimize any potential burden on clinicians. Moreover, the systems were designed so that captured data could be easily extracted and analyzed to assist with program evaluation, HIMSS said.

As a result, the Road Home Program was able to improve access to evidence-based treatments for veterans with PTSD. Ongoing, data-driven program evaluation led to continuous improvements in program effectiveness.

According to research published by Road Home clinicians, clinical outcomes from the three-week-long intensive program demonstrate that the intensive program is highly effective and that participation in the program leads to large reductions in PTSD symptoms. In addition, program completion rates are much higher (91.5 percent) compared to standard outpatient PTSD treatment. Veterans also report very high satisfaction with the program and would recommend it to their veteran peers, HIMSS reported.

The organization was able to standardize the Road Home Program data-capture system and share it with other academic medical centers who offer similar programs for veterans with PTSD. As a result, PTSD programs and clinical outcomes can be directly compared to ensure that the veterans served receive the highest quality care possible, HIMSS explained.

Since it first began to offer intensive treatment services in 2015, the Road Home Program has closely tracked clinical outcomes and patient satisfaction through custom flowsheets in the electronic medical records and external survey tools. By continuously analyzing its program-based data – such as veterans' PTSD symptom improvement over the course of the program and at short, medium and long-term follow-up time points – the Road Home Program has been able to make changes to further increase effectiveness, HIMSS said.

The Davies Award

The HIMSS Davies Award of Excellence recognizes outstanding achievement of organizations that have used health information technology to substantially improve patient outcomes and value. The HIMSS Davies Award of Excellence is the pinnacle of the HIMSS Value Recognition Program and highlights organizations promoting health information and technology-enabled improvements in patient and business outcomes through sharing evidence-driven best practices on implementation strategies, workflow design, change management and patient engagement.

"Rush is proud to receive the HIMSS Davies Award of Excellence, as striving for excellence is the bedrock of everything we do at Rush," said Dr. Larry Goodman, CEO of Rush University Medical Center and the Rush System. "While this award symbolizes information technology achievement and expertise, we are especially proud that it also reflects the collective efforts by clinical, operational, and business teams to drive technology-enabled improvements for our patients."

Rush University will be recognized during HIMSS19, February 11-15 in Orlando, Florida.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

For the ninth year in a row, Epic earned the top score for Overall Software Suite in the annual Best in KLAS 2019 Software & Services report.

The Verona, Wisconsin-based health IT giant also scored top marks in the Overall Physician Practice Vendor category, and was best-rated in nine segments, while also winning category leader awards in two others.

In other major categories, Impact Advisors was named the top Overall IT Services Firm. It also won top marks for HIT Enterprise Implementation Leadership and was also the winner in the Clinical Optimization cate. Premier, meanwhile, earned the award of top Overall Healthcare Management Consulting Firm.

Best in KLAS is an annual survey from the Orem, Utah advisory firm, based on the 2,500 or so interviews it conducts with providers and payers each month. On an annual basis, that feedback represents the opinions of clinicians and other healthcare decision-makers  from more than 4,500 hospitals and 2,500 outpatient clinics.

Here are some of the top software, services and medical equipment leaders for 2019:

Acute Care EMR (Large Hospital / IDN)
Epic EpicCare Inpatient EMR

Ambulatory EMR (11-75 Physicians)
Epic EpicCare Ambulatory EMR

Ambulatory EMR (More than 75 Physicians)
EpicCare Ambulatory EMR

Cardiology
Watson Health Imaging Merge Cardio

Care Management Solutions
Casenet TruCare

Claims & Clearinghouse
Waystar Clearinghouse

Community HIS
athenahealth athenaOne for Hospitals & Health Systems

Enterprise Resource Planning
Workday HCM, Financial Management and Supply Chain

Health Information Exchange
Epic Care Everywhere

Healthcare Business Intelligence & Analytics
Dimensional Insight Diver Platform

Home Health
Thornberry NDoc

Laboratory (Large Hospital / IDN)
Epic Beaker

Long-Term Care
MatrixCare

PACS (Large Hospital / IDN)
Sectra PACS

Patient Access
DCS Global Patient Access

Patient Accounting & Patient Management (Large Hospital / IDN)
Epic Resolute Hospital Billing

Patient Portals
Epic MyChart

Payer Claims & Administration Platforms
Conduent MediTrac (Health Solutions Plus)

Payer Quality Analytics
MedInsight Platform

Population Health
HealthEC Population Health Management Suite

Practice Management (11-75 Physicians)
NextGen Healthcare NextGen Enterprise PM

Practice Management (More than 75 Physicians)
Epic Resolute/Prelude/Cadence Ambulatory

Small Practice Ambulatory EMR/PM (10 or fewer Physicians)
Aprima EHR/PM

Speech Recognition: Front-End EMR
M*Modal Fluency Direct

Virtual Care Platforms
InTouch Health Telehealth Network

VNA Image Archive
Carestream Vue Archive

Application Hosting
Epic (Clinicals & Financials)

Cybersecurity Advisory Services
Meditology Services

Extended Business Office
HRG

Financial Improvement Consulting
PwC

Healthcare Management Consulting
Premier

HIT Advisory Services
Optimum Healthcare IT

HIT Enterprise Implementation Leadership
Impact Advisors

HIT Implementation Support & Staffing
Galen Healthcare

Partial IT Outsourcing
ROI Healthcare Solutions

Revenue Cycle Outsourcing
Navigant

Strategy, Growth, & Consolidation Consulting
Premier

Technical Services
Navin, Haffty & Associates

Value-Based Care Consulting
Deloitte Consulting

Value-Based Care Managed Services
Arcadia.io

Worksite Health Services
Activate Healthcare

Automated Dispensing Cabinets
Omnicell OmniRx

Smart Pumps
ICU Medical Plum 360

ON THE RECORD
"Best in KLAS is about raising the bar for healthcare technology," Adam Gale, president of KLAS, said in a statement about the new report. "It's providers and payers demanding better performance, usability and interoperability. Ultimately, Best in KLAS is about giving providers and payers the tools they need to facilitate superior care and improved outcomes."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication.

Two New York health information exchanges, HealthlinkNY and HealtheConnections, announced plans to merge. The deal follows a September announcement the two made, to accelerate their mutual goal to deliver improved resources to their regions.

WHY IT MATTERS

Combined, the new HIE will increase usage and adoption of health information exchange across New York, said Staci Romeo, executive director of HealthlinkNY.

Romeo noted that the two organizations are the only New York State HIEs that support the Department of Health’s Population Health Improvement agenda through regional collaborative efforts, and the merger will strengthen this.

THE LARGER TREND

Though some have doubted their viability, state and regional HIEs have said not to count them out just yet. Even as EHR vendor-driven networks gain maturity and scope, older and more traditional health information exchanges still have a lot of critical value to bring to the table, said John Kansky, president and CEO of Indiana Health Information Exchange, one of the HIEs that is still standing and self-sufficient.

"If you go looking for the people that have the last mile wired or have the data available – and in some cases have it in normalized, curated repositories, ready to be exchanged – it's the HIEs," Kansky said.

With the advancement of the Commonwell – Carequality interoperability connection, HIEs have moved from the limelight they once held.

ON THE RECORD

Rob Hack, president and CEO of HealtheConnections said the combined HIEs will leverage best practices and team skills from both to create a stronger organization.

“Together, we have an opportunity to deliver valued services that enable improvement and efficiencies in health and healthcare delivery,” Hack said.  

The new larger HIE will span 26 counties, bringing together 4,100 participating providers in 1,800 locations in the Central and Southern Tier regions of New York, with 4,600 participating providers and 1,000 locations in the Upper and Lower Hudson Valley. 

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

Iatric Systems, which itself was acquired by Harris Healthcare this past summer, has announced that it is purchasing Haystack Informatics, whose behavioral analytics offerings aim to help providers ensure patient privacy and optimize operations.

WHY IT MATTERS
Iatric's wide suite of offerings – security, interoperability, EHR optimization, medical device integration and more – are mostly geared toward helping hospitals and health systems make the most of their existing technology infrastructure.

With the addition of Haystack Informatics, a digital health startup spun off from Children's Hospital of Philadelphia, aims to add to the tools available to help healthcare providers maximize the value of their other IT investments.

Haystack's technology monitors activity log data from hospitals' electronic health records, analyzing how they're used, identifying anomalous activity patterns and spotlighting areas where the EHR can be better optimized.

Toward the aim of better privacy and security, the technology can make use of artificial intelligence to detect variations across the system, enabling threats to be detected and breaches prevented. The tech will help improve Iatric's existing privacy monitoring too, Iatric Systems Security Audit Manager, officials say.

THE LARGER TREND
Harris Healthcare announced its acquisition of Iatric Systems in August 2018, and has been running it as an independent business since then, with continued goal of developing and acquiring technology that helps hospitals be more efficient and effective.

This acquisition of Haystack signals a recognition of the value of AI and behavioral analytics to help spot anomalies that, if tackled, could lead to more efficient care processes and safer patient data.

As Dr. David Asch, executive director of Penn Medicine's Center for Health Care Innovation told Healthcare IT News a year ago: "The key promise of behavioral economics is that we're irrational in highly predictable ways."

That's in part why, for instance, Penn Medicine is pursuing a multi-year initiative to innovate its EHR for the 21st Century, focusing intently on behavioral design.

ON THE RECORD
"We look forward to bringing our advances in behavioral analytics to Iatric Systems customers in order to enhance patient privacy and improve operational performance throughout the health system,” said Adrian Talapan, co-founder and CEO of Haystack Informatics, in a statement.

Iatric Executive Vice President Frank Fortner added: "Haystack’s user centered design and advances in behavioral analytics will not only enhance our patient privacy monitoring solutions, but it will also allow us to extend our platform into new areas of behavioral insights."

Terms of the deal were not disclosed.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication.

Electronic health record developer eMDs is acquiring Aprima Medical Software for an undisclosed sum. The addition of Aprima, which develops EHR, practice management and revenue cycle management technology, will help eMDs better serve its 63,000 provider customers worldwide, the company said.

WHY IT MATTERS
Both companies had independently worked on modernizing their product lines before this deal came together, eMDs points out, which will help when it comes to integrating the technologies and expanding them across their combined client bases.

"Together, we can service a broad range of specialties and meet the evolving needs of our client partners," said eMDs CEO Derek Pickell in a statement.

The combined company will be headquartered in Austin, Texas, with other locations in the U.S. and India. Pickell will lead it, while Aprima CEO Michael Nissenbaum will serve in an advisory role during the integration.

THE LARGER TREND
The acquisition of Aprima comes the same week as the company was scored the highest rated EHR/PM platform for small ambulatory practices (10 physicians or fewer) in the 2019 Best of KLAS awards.

"It's a nice high note as we look forward to the brand we have built growing exponentially and offering even more value to providers now that Aprima has been acquired by another market leader in this space, eMDs," said Nissenbaum in a statement.

Together the two companies will work to address the unique specific needs of practicing physicians – not least the ongoing challenges that could physician burnout, which is getting more and more attention as EHRs are increasingly eyed as major culprits and the stakes of the looming public health crisis become apparent.

Aprima quoted one of its customers, Mark Hinman, MD, who said the technology helps him "stay ahead of a lot of the rigors associated with practicing today, and certainly burnout-wise, I don't have the problems that a lot of physicians experience."

ON THE RECORD
"The unique combination of our technologies and services prepares us to offer the most powerful and comprehensive portfolio of solutions available – and that means greater impact, increased productivity, and less operational burden for healthcare providers," said Pickell. "Our bottom line is about facilitating the best patient outcomes, and together our companies clear the path for providers to do their best work while enhancing their financial strength."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication.

With HIMSS19 just days away, EHR giant Cerner has a lot on its mind. And its executives at the global health IT conclave are going to be focused on a variety of trends affecting EHRs and much more.

“Healthcare is a fast-paced industry defined by dramatic shifts in regulations, technology, care delivery and patient-physician interactions,” said John Peterzalek, chief client officer at Cerner. “At HIMSS19, we’re showcasing how our solutions integrate and help solve challenges and identify opportunities not only for today, but for the future.”

To that end, Cerner will be discussing trends including population health, seamless care and others, with an eye how those trends will transform the industry into the future.

“At HIMSS19, we’ll highlight the shifts from retrospective analytics to predictive analytics, a health system chart to a longitudinal record and plan, and population health to personalized health,” Peterzalek commented. “We also will focus on the future of healthcare through partnerships, improving national and local public healthcare, and continuing our mission to provide seamless care across the globe.”

The complexity required to move patients through a health system exceed those of any other industry – and the stakes are very high, Peterzalek remarked.

“Providers today are tasked with the challenge of managing the supply and demand equation, having to assess patients’ needs with available resources and staff without real-time or predictive capabilities to assist,” he said. “In order to perform and plan with excellence, healthcare organizations should embed real-time and predictive capabilities into operationally aware clinical workflows, which deliver action back into these workflows.”

"As we continue to rapidly scale innovation, open and interoperable systems will reach the full potential and benefits of these advancements."

John Peterzalek, Cerner

There are a variety of factors in the healthcare arena today that are pushing these trends along. In addition to digital transformation, pop health, patient experience, and the Silver Tsunami among those.

“We know that in order to improve, healthcare organizations need to be able to manage populations one person at a time,” Peterzalek said. “We’re focused on supporting our clients with a platform, solutions and services that meet their needs, no matter if they are just starting their population health journey or looking for new innovations.”

Another big trend is interoperability, which continues to play an important role in the future of healthcare. The sense of urgency in advancing open, interoperable systems and technologies is high while the industry makes strides with open data standards.

“Last year, we saw a leap toward nationwide interoperability with the connection of two of the largest interoperability communities — CommonWell Health Alliance and Carequality,” Peterzalek stated.

But as Cerner evaluates what comes next, Peterzalek said technology and healthcare companies will fight alongside each other in the push for interoperability, providing fresh perspectives and additional resources. This push is ultimately focused on the consumer and their experience to achieve better health outcomes throughout their lifetime, he added.

“As the industry continues to embrace advanced interoperability strategies, the volume of exchanged information will scale, making it critical to have the right data infrastructure to create actionable results,” he said.

Peterzalek noted that the healthcare landscape is changing.

“Our accomplishments in the now – such as the digitization of healthcare, an increase in patient-centered care and the promotion of evidence-based medicine – are the foundation for the future,” he said.

Everyone must do their part to help reach this future state – by encouraging other organizations to join efforts to promote interoperability across the industry, he added.

“As we continue to rapidly scale innovation, open and interoperable systems will reach the full potential and benefits of these advancements,” he concluded. “Improving the care delivered while reducing costs for both patients and healthcare organizations is not an easy undertaking. We all need to work side by side to make this next era of healthcare possible.”

Cerner will be in booth 2941.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

The Global Alliance for Genomics and Health has chosen seven genomic data initiatives from around the world as new Driver Projects for 2019 – projects where researches will work together develop and pilo standards for the sharing genomic and other health data.

Those projects are:

• Human Heredity and Health in Africa
• GEnome Medical alliance Japan
• European Joint Programme on Rare Diseases
• Swiss Personalised Health Network
• EUCANCan
• EpiShare
• Autism Sharing Initiative

GA4GH officials said they were chosen according to three criteria: global representation, scientific merit and their capacity to contribute in-kind resources to GA4GH development efforts.

WHY IT MATTERS
GA4GH, formed in 2013, is an international, nonprofit alliance of more than 500 organizations representing patient advocacy, life sciences, IT and others. With the goal of boosting the potential of precision medicine, members of the alliance work together to build frameworks and develop standards to enable the "responsible, voluntary, and secure sharing of genomic and health-related data."

The group has also developed a five-year plan drive uptake of those standards and frameworks for sharing of clinical-grade data by 2022. These new international driver projects will help the alliance make progress on that goal.

GA4GH also announced that it will expand its work with ELIXIR, a European infrastructure for the management of life science data. The partnership between the two groups will help build capacity in around cloud computing, as well authorization and authentication capabilities, officials said.

“Together, the new projects significantly expand GA4GH’s global representation, strengthening our collaborations across Africa and Europe, as well as in Japan, and adding connections in 31 countries for a total global reach across more than 100 countries worldwide," said GA4GH CEO Peter Goodhand in a statement.

"Several of the new projects are diverse international collaborations to share data and knowledge across national borders," added GA4GH Vice Chair Heidi Rehm, of Harvard and MIT's Broad Institute. "Collectively, these global Driver Projects bring together resources from 94 countries around the world."

THE LARGER TREND
The promise of precision medicine is immense, but its success depends on overcoming some fundamental challenges that have many different root causes, including: the willingness of patients to share their own data, the IT challenges associated with managing voluminous and highly-specific genomic information, the security implications of sharing it among researchers and providers. Efforts such as these and many others are critical to plowing a path forward for personalized care, in the U.S. and around the world.

ON THE RECORD
"Initially a community of like-minded individuals and organizations committed to federated genomic data sharing, GA4GH is now an indispensable, globally representative standards organization," explained David Altshuler, chief scientific officer at Vertex Pharmaceuticals and founding chair of GA4GH, in a statement. "The new Driver Projects join a community that is building the standards and frameworks that will guide the field for years to come."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS Media publication.

At HIMSS19, Medicomp Systems will be debuting a new module in its Quippe Clinical Solution suite that focuses on maximizing Medicare Advantage reimbursement with automated risk adjustment factor scoring and hierarchical condition category documentation.

"For providers participating in Medicare Advantage plans, the correct calculation of a patient's risk adjustment factor is essential to ensure accurate reimbursement," said Dr. Jay Anders, chief medical officer at Medicomp Systems.

"However, calculating risk and prospective cost of care is not only important for treating patients covered with Medicare Advantage plans, but rather for any provider participating in risk-bearing value-based payment programs," he said.

Leaving money on the table

Traditionally, providers have lacked automated tools to ensure they are accurately and fully documenting all of the information required for proper risk adjustment factor scoring, Anders explained. This means they could be leaving money on the table, he said.

"Our new technology helps clinicians identify at the point of care any conditions that are not fully documented or accurately coded to ensure maximum reimbursement," he said.

With the new technology, provider organizations also will have access to dashboards and reports based on structured information that enables them to proactively identify potential gaps that need to be addressed in coding or documentation, which is essential for any value-based care program, including Medicare Advantage plans.

"They will also have new tools to more accurately forecast expected reimbursement," Anders said. "Payers could also use this technology to streamline their documentation review and risk adjustment factor scoring processes."

Trends to discuss at HIMSS19

Medicomp sees a couple of trends as very important at HIMSS19 and beyond and will be focusing on them at the conference.

"At HIMSS19, we will likely hear a lot about artificial intelligence, machine learning, blockchain and other exciting trends – but all of these innovations are putting the cart before the horse, to put it mildly," Anders said. "To draw quality conclusions from AI queries, you first need data that's in a codified and structured format, but as much as 80 percent of the patient information within EHRs is stored as free-text and not mapped to data standards."

In addition, the majority of enterprises are not able to clean and standardize the huge amounts of clinical data created over the last couple of decades as EHR adoption has grown, he added.

"That's why the most important trend at HIMSS19 we will be talking with attendees about is the importance of delivering ready-access to reliable, standardized and structured data to physicians at the point of care," he said. "Without such information to power AI or machine learning engines, that technology is simply not going to work."

Adding new functionality to EHRs

Along those lines, another trend Medicomp expects to focus on at HIMSS19 is making EHRs more usable through expanding the availability of third-party applications so that both clinicians and administrative staff can add new functionality to address their needs.

"Rather than stacking unrelated tech on top of tech, healthcare technology and EHRs need to operate as more of an ecosystem," Anders said. "Some EHR vendors have been hesitant to open their systems. In some cases, that's due to an understandable fear of loss of control or the misguided perception that their developers understand physician workflows better than physicians."

"The most important trend at HIMSS19 we will be talking with attendees about is the importance of delivering ready-access to reliable, standardized and structured data to physicians at the point of care."

Dr. Jay Anders, Medicomp Systems

In other cases, it's concern over missed potential revenue opportunities, he added. If the industry ever wants physicians to fully embrace EHRs as a productivity-enhancing tool that makes it simpler to deliver quality patient care, this mindset must change to one of transparency and collaboration, he said.

If asked at HIMSS19 what advice he would give healthcare CIOs when it comes to these and other health IT trends, Anders said that regarding any technology that promises to deliver actionable, clinically relevant information to physicians at the point of care, he urges CIOs to demand to see the technology in action.

Can tech with buzz deliver?

"Many buzzed-about technologies that will be discussed at HIMSS19 are far from maturity and have yet to deliver any tangible results at hospitals or health systems," he said. "What's worse, they may compromise clinician productivity, or even more troubling, compromise patient care."

Instead, he said, CIOs' priority should be to seek proven, widely implemented technology that intelligently identifies and interprets the disorganized and complex arrays of medical information from multiple sources to support providers in their goal to deliver better care.

The technology should then convert that data into structured, actionable formats and present the relevant elements for each patient encounter, he said. Finally, CIOs need to see in person how the solution delivers this filtered, high-value information as part of the physician's workflow in the 10 minutes or less they have with the patient in the exam room, he concluded.

Medicomp Systems will be in booth 3901 at HIMSS19.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

Provider productivity can make or break a healthcare organization. And for good reason: as noted in studies published in the Annals of Family Medicine and Annals of Internal Medicine, physicians spend hours and hours interacting with the EHR – time that could be better spent elsewhere.^1,2 Much has been made of the effects of EHR documentation on provider satisfaction and burnout. But it also has significant impact on provider workflow and productivity. The time spent interacting with the EHR could be better allocated to increasing the number of patients seen or lengthening appointments for more challenging medical cases. Over time, those efficiencies can help healthcare organizations improve patient outcomes – and their bottom lines. The productivity situation only worsens when a healthcare organization migrates to a new EHR platform.

“You may as well just bomb productivity for the first few months after any migration component,” says Cathie Biga, RN, president and CEO of Cardiovascular Management of Illinois. “So much depends on how your migration is done. But even with a strong plan in place, you can end up with reduced clinic hours for weeks, even months, after a migration in order to facilitate providers finding the data they need and getting used to the new system.”

Lorren Pettit, vice president of HIMSS, agrees. “EHRs were developed to aid in productivity,” he says. “Ironically, they often present a barrier to physician workflow. And when you add in a migration, it can really be disruptive. It creates inefficiencies for the physician, of course. And that impacts the organization financially. It’s important that organizations take steps, from the beginning, to make sure those productivity speed bumps are minimized.”

Levels of impact
There are many reasons why an organization may need to migrate to a new EHR platform. Pettit says it may involve a merger and acquisition situation, or an organization simply needing a more sophisticated system to help with their documentation, reporting and analytics needs.

“EHR migrations are common,” he said. “But they can be quite a source of frustration for clinicians. Important clinical information may not easily move from one system to another. Clinicians have to spend extra time searching for information or re-documenting it. They may not know the system that well. It adds up to an even bigger drain on productivity.”

More to the point, these “speed bumps” can impact organizations clinically, operationally and financially. Pettit says that, operationally speaking, ensuring patients are seen at their designated times requires clinicians to be very regimented during appointments. When clinical data from the legacy system isn’t where it’s supposed to be in the new EHR, it makes it much more difficult.

“Getting off schedule has a domino effect,” he said. “It leads to patients waiting to be seen. It leads to patients being frustrated with the organization and reporting unsatisfactory patient experiences. And, taken together, these things have a residual effect on patient compliance. Patients are less likely to listen to the provider and manage their conditions. So you see reduced patient outcomes. There really are a lot of downstream effects – unexpected downstream effects – when providers can’t manage their workflows and they really can affect all levels of an organization.”

Minimizing speed bumps, maximizing productivity

Biga said that some of these downstream effects can be mitigated with proper planning. Healthcare organizations that take the time to create a comprehensive migration plan, complete with quality auditing and manual abstraction, may be at a better advantage.

“Manual data abstraction has absolutely proven to be an efficient and cost-effective way to help minimize disruptions,” she said. “It’s indispensable to have that so that your conversions are better and the impact to productivity is minimized.”

She noted that, with a good plan and manual abstraction services in place, her organization was able to return to business as usual after only a single week of reduced clinic hours. Pettit added that it also takes the burdens off providers – before, during and after an EHR migration.

“When you outsource the abstraction to a professional who actually knows what they are doing, they can help to reduce inefficiencies and, ultimately, minimize the impact to your organization,” he said. “It can help minimize errors, increase patient safety and improve provider productivity. And those are all good things for healthcare.”

Resources

1. Sinsky, C. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine. 6 December 2016. http://annals.org/aim/article-abstract/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties

2. Arndt BG et al. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Annals of Family Medicine. September/October 2017. http://www.annfammed.org/content/15/5/419.full

Effective software depends on user feedback, with developers rely on a culture of open communication to learn more about bugs and usability issues. That goes electronic health records too, and MedStar Health is showing, not telling, how they could.

The MedStar Health National Center for Human Factors in Healthcare, in partnership with the American Medical Association, has launched a new advocacy website, EHRSeeWhatWeMean.org, to highlight for vendors some of the the usability challenges clinicians grapple with every day.

On the website, MedStar hosts a series of videos showing how poor UX can present various risks to patient safety and can hinder quality of care.

It also decries the gag clauses, often contained in contracts between EHR vendors and their healthcare system customers, that can prevent healthcare providers from openly discussing workflow challenges and proposing solutions.

WHY IT MATTERS
"EHRs have introduced new kinds of risks to the safety and quality of care, due to serious challenges with EHR usability, or the effectiveness and efficiency of using the technology," according to the website. "These well documented issues can lead to clinician burnout and errors that directly impact patient safety."

MedStar said that by showing various videos of EHRs in action – and all the workflow, data entry and user interface challenges they can pose – will be a key step in  "improving EHR design, development, and implementation to eliminate known patient safety risks and make them easier to use."

When users are prevented from sharing their problems with other users, researchers and developers, MedStar argues that EHR efficiency and patient safety are affected. Poor EHR design is leading cause of physician burnout and when technology does not integrate seamlessly into a clinical workflow, it can cause dangerous lapses in communication or the wrong information to be delivered to the doctor.

At stake is a battle between EHR developer’s right to keeping proprietary information secret and the clinician and patient’s need for an open and speedy process to document and share issues.

"For example, a confusing visual display of medications could lead to a clinician ordering the wrong medication," Or an automatic refresh of the screen that reorders a patient list could result in the clinician selecting the wrong record to view,” MedStar notes on its website.

THE LARGER TREND
Buggy EHRs, or ones with poor usability, can lead to any number of issues– from the wrong medication being prescribed to a mixup in patient records. Burnout is widespread among users who have to spend significant amounts of time battling with difficult software. In many cases, the EHR was touted as a revolutionary way to improve productivity and deliver better outcomes but in reality satisfaction with the tools are rapidly deteriorating.

Sharing data about everything from treatments to EHR bugs is frequently listed as one of the most crucial places the healthcare industry needs to make advances in. Gag orders between developers and providers are not the only thing standing in the way of improving EHRs but greatly complicate the process of refining the tools every physician must now use over time.

ON THE RECORD
In a separate statement, the American Medical Informatics Association pledged its support of the MedStar and AMA campaign, which calls for vendors, providers, policymakers and patients to work together to address these critical usability issues.

"We have a fractured and loosely connected system to understand when health IT negatively impacts patient care, how such harms could have been avoided, and what changes to usability, design, and implementation are necessary to mitigate such shortcomings in the future," said AMIA President and CEO Douglas Fridsma in a statement.

"This inability to understand how health IT impacts safety across settings of care is why AMIA supports the establishment of a national public/private center, or collaborative, on health IT safety meant to convene, analyze and disseminate information to improve the safety and safe use of health IT."

Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
Twitter: @BenzoHarris.

As the industry moves beyond mere EHR adoption and meaningful use, small practices of 10 physicians or fewer told researchers that they want their EMRs to do more than just meet regulatory requirements, a new KLAS report on small physician practices finds. But first, they want the basics to just work better. That means tailoring usability for them and improving customer service.

WHY IT MATTERS

Over the past year, small physician practices have varied greatly on what they think of their EMR vendors — some by as much as 10 percentage points. KLAS discovered, however that all-in-all, small physician practices want their EMR and practice management vendors to figure out how to meet unique needs for functionality, usability, and vendor support and guidance — before they do anything else for them.

The KLAS study, titled “Small Practice, Ambulatory EMR/PM, 2019,” also found that practices want ease of use and better customer service as some of their top priorities.

When it comes to this issue, there is a vast disconnect between vendors and these small physician groups, the study found. Only five percent of the practices named new technology as their top priority, while 75 percent of vendors see providing new technology as the top priority.  

THE LARGER TREND

As part of this research, KLAS interviewed representatives from AdvancedMD, Allscripts, Aprima, athenahealth, Azalea Health, CareCloud, Cerner, CureMD, eMDs, Greenway Health, Kareo, NextGen Healthcare, Quest Diagnostics, and Virence Health (GE Healthcare) to determine how well the vendors were aligned with the small practices’ needs and what is driving dissatisfaction among small groups.

Most vendors named usability as one of their top three priorities.

The physician call for better usability coincides with a greater industry trend in that direction. Comments closed Jan. 28 on the Office of the National Coordinator for Health IT's draft recommendation to make electronic health records more user friendly, with support over the recommendations and a host of cautions that included going slowly with changes and creating panels to help oversee them.

ON THE RECORD

“The most important attribute is product functionality because we need the product to do what it is supposed to do,” said a practice manager in the KLAS study. “That is what the doctors live off of every day, so the options and the functionality have to be there for the doctors to carry on with their day. The next most important thing is the ease of use because physicians want the system to be easy. They want fewer clicks.” 

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com