Archive for the 'Meaningful Use' Category

Syndromic Surveillance


Syndromic surveillance is a method of collecting and using clinical data for the early detection of potential disease outbreaks. For Meaningful Use Stage 2, there are several scenarios in which Eligible Providers (EP) can meet the Syndromic Surveillance Menu Set measure.  Each of those scenarios can be grouped into one of two categories:

Syndromic Surveillance is Available in your State

The first scenario occurs when an EP has been submitting information using an ONC certified EHR prior to the EP’s MU Stage 2 attestation, and continues to submit during the reporting period.  At this point in time, very few EPs fall into this category, but for those who do, no changes are necessary.

The next scenario happens when an EP registers intent with the state within 60 days of the reporting period and achieves ongoing submission of data for the reporting period.

Syndromic Surveillance is not Currently Available in your State

For many states Syndromic Surveillance is not yet up and running, so ongoing submissions are not an option for meeting the measure.  In this scenario CMS requires you to register intent with your state within 60 days of the start of your reporting period. Once you’ve registered, intent your organization will need to engage in the required validation and testing, or wait for your state to approach you about validation and testing process.

The key to this measure is to register intent within 60 days of your EP’s reporting period.  For 2015 that would be March 1st, so make sure to mark that date on your calendar.





Patient Reminders


Sending patient reminders based upon clinically relevant data is now a core measure for Meaningful Use Stage 2.  The required threshold is 10% of unique patients that have been seen by an eligible provider at least twice in the past 24 months.

Initially, the best approach is to generate several general patient lists based upon specific conditions to gauge where your providers stand in terms of meeting that 10% threshold.  From there, you could slowly make the queries more specific to narrow the population down near 10%.

Since this is based upon the patients’ preferred communication methods, we recommend not defining too broad of a patient population.  Your organization will be responsible for calling your patients and for printing and mailing these reminder letters, both which can be costly and time consuming.  This serves as all the more motivation to encourage patients to enroll and use your patient portal.

A qualifier for this measure requires that the reminder be for follow up or preventive care that the patient is not already scheduled to receive.  For example, it would not be acceptable to send patients reminders about an annual visit that had been previously scheduled, though sending a reminder to schedule an annual mammogram or get a yearly flu shot does count towards the numerator.  If your organization needs any help generating queries or defining patient populations to help you meet this measure, the staff at Galen can gladly assist you.

Failure to Address Advancements Electronic Healthcare May Affect Patient Safety

Safety Image

With advancements in technology and improvements in functionality comes an increased risk in patient safety.  Systems are continuously being upgraded and configured to address the latest improvements.  With each change there is potential for unexpected glitches, causing the system to possibly behave incorrectly or differently than previously utilized by its users.  New workflows may be required within the organization and existing ones may need to be re-visited.  This can lead to data being entered incorrectly or not captured at all.  One recent case involved an Ebola patient being released when quarantine was required, potentially exposing other patients and individuals upon release.  Upgrades to software versions may display risks in a different manner and become confusing to the individual entering data.  Unfortunately, this can jeopardize patient safety.

Electronic healthcare has been a growing business and vendors are continuously offering new applications and add-ons.  They are created and offered for different EHR systems and may or may not work as intended with each new upgrade. There are many vendors and products in the industry which causes an unfortunate problem where many disparate systems are unable to communicate with one another.

It becomes more important to ensure each organization is prepared for roll-outs with careful planning.  Strategies need to be in place to prepare for these changes.  Training should be created, detailed, and documented to ensure end-users are trained on newer versions, as well as being trained on each new application and feature that will be used.  This applies to current employees and new-hires.

Researchers evaluated 100 closed safety investigations reported between August 2009 and May 2013 to the Informatics Patient Safety Office of the Veterans Health Administration. Among the findings, 74 events resulted from unsafe technology, such as system failures, computer glitches, false alarms or “hidden dependencies,” a term for what happens when a change in one part of a system inadvertently leads to key changes in another part. Another 25 events involved unsafe use of technology such as an input error or a misinterpretation of a display.

Universally, organizations have devised aggressive timelines to implement new systems and features in order to meet federal requirements for meaningful-use goals.  Unfortunately, this may lead to improper planning, testing and training.  Patient safety becomes compromised in these situations and puts healthcare networks at risk for penalties.  SAFER Guides is a recommended list of various implementation and monitoring resources.

See Modern Healthcare “Complicated, confusing EHRs pose serious patient safety threats”

See HealthIT.Gov for additional information and resources.

Clinical Quality Measures

Clinical Quality Measures


Clinical Quality measures are metrics introduced by CMS to improve patient health, patient care, and lower costs. Currently there are 29 CQMs which fall under six domains:

  1. Patient and Family Engagement
  2. Patient Safety
  3. Care Coordination
  4. Population/Public Health
  5. Efficient Use of Healthcare Resources
  6. Clinical Process/Effectiveness

Eligible professionals are required to report on nine CQMs that fall under three of the six defined domains. In addition Meaningful Use requires that Clinical Decision Support interventions are applied to four of those Clinical Quality Measures.

As a result simply identifying which domains, CQMs, and CDS your organization will be using for your eligible professionals can be a time complicated process. Now factor in the configuration, LOINC codes, SNOMED codes, CPT codes, training, etc. and it can start to become overwhelming.

That’s where Galen can help.  At Galen we can start by helping with the identification of which CQMs  are most appropriate for you EPs. Once CQMs have been selected we can assist with configuration and workflow training. Finally we can assist in the quality assurance of your reports to ensure that your organization is receiving the most accurate data possible. If your organization has any questions regarding CQMs for your EPs please contact us and we would be happy to assist.

Patient Portals: 3 Hot-Button Items

As we start the fourth quarter, we enter the final 3-month reporting period for Meaningful Use (MU) Stage 2 in 2014.  Many healthcare organizations will be working feverishly this quarter to ensure that their eligible providers (and supporting staff) are performing all of the necessary tasks in order to successfully attest to MU Stage 2 in 2014.  Stage 2 has three core objectives that require patients to interact with their health information and communicate with their provider electronically.  All three of these objectives can be satisfied by the use of a patient portal.

Recently, Galen Healthcare forged a partnership with MedfusionTM to help expand their portfolio of EHR’s that integrate with the MedfusionTM Patient Portal.  This project got me thinking about some of the bigger picture issues with patient portals.

Organizational Benefits.  By now, most healthcare organizations have selected a patient portal allowing them to achieve the MU objectives.  While MU was likely the driver for many providers to implement patient portals in their organization, there are many other reasons to integrate a patient portal with the organization’s EHR solution.  Secure communications between providers and patients, appointment requests, prescription renewal requests, and automated delivery of visit summaries are a few examples of office workflows that can be made more efficient when using a patient portal, freeing up time for office staff.  What are the next wave of patient portal features that will help optimize the healthcare organization?  Will e-visits gain traction amongst providers, patients, and payers?  Is there a place in the patient portal for e-visits and will they benefit the healthcare organization?

Patient Adoption.  Not only does the patient portal provide many benefits for the healthcare organization and its staff, but patients also benefit from the features and functionalities added by the portal.  Patient portals provide patients with innovative functionalities that are not only new and exciting (smart phone apps, cloud services, etc.), but also provide services that yield streamlined and improved healthcare outcomes.  And while a patient portal can reduce the amount of effort required of the patient to get the needed healthcare, and even result in healthier patient care, portal adoption is still a big struggle.  How can adoption be increased?  Most of the burden falls on the organization to get the message out to their patients to join in many different ways, but can patient portal vendors create a user-interface that is simple to use while also including trendy and exciting features (possibly including some element of gamification) to attract younger generations, enhance the patient experience, and motivate individuals to live healthier lives?

EHR-Tethered Patient Portals.  Does the tight relationship between EHR vendors and patient portals reduce the adoption of patient portals by patients?  Each vendor has their own patient portal solution, creating the need for patients to possibly maintain multiple portal accounts.  As much as providers don’t want to be required to login to multiple applications to see a patient’s full clinical record, a patient doesn’t want to have to login to multiple portals in order to see their full health record.  Much like HIE was the next step for getting data out of EHR silos, what is next for providing patients with a way to combine their data across multiple portal “silos?”  Is the best solution to tether patient portals to HIE’s, which already aggregate data across multiple providers in a community, rather than EHR’s?  There are definitely some design costs associated with this type of solution, but is it more sustainable and desirable in the long-term?

Patient portals have been developed and deployed for many years, but the adoption still seems relatively low.  Meaningful Use Stage 2 is trying to increase their usage, but there need to be more benefits (for both the healthcare organization and the patient) in order to sustain and augment their utilization.

Feel free to provide your thoughts and comments, including your own experiences, on patient portals below.  What current features are most useful?  What features are still needed?  What is the future of patient portals?

Next Page »