Archive for the tag 'Meaningful Use'

Are Medical Scribes For You?

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A role gaining popularity in the ever growing electronic healthcare industry is the medical scribe.  Scribes perform the data entry in the EHR so that the doctor can focus on the patient. They’re clerical in nature, don’t communicate directly with patients, and don’t perform clinical procedures or administer medications.  We’ll examine the pros and cons of using medical scribes in today’s dynamic healthcare field.

These positions are very competitive to obtain, which ensures that only strong candidates are selected.  They’re typically filled by pre-med students pursuing a career in healthcare, often during a gap year, as the idea of real provider-patient interactions appeals to many.  Observing providers as they diagnose and treat patients is an invaluable real-world learning opportunity that can’t be paralleled in a classroom.

 

PROS:

Refocus attention on the patient: Scribes manage the majority of the data entry for the physician, affording the provider the freedom to listen attentively and focus on the patient’s needs.  In one example, “An American Journal of Emergency Medicine study found that emergency physicians spent 43% of their time entering data into a computer, compared to only 28% of their time spent talking to patients

Real-time documentation: While the physician examines the patient, a scribe can enter all relevant findings in real-time.  The result is more comprehensive and accurate documentation with fewer incomplete notes for the physician to circle back to at the end of the day.

Reduced Visit Durations: By minimizing the physician-computer interaction during the actual patient encounter, the time required to document a patient visit is significantly shortened.  This leads to decreased patient wait times and ultimately, increased patient and physician satisfaction.

Increased Revenues: Along those lines, practices stand to see potential long-term revenue improvement on two fronts:

  1. They can schedule a higher volume of daily appointments since patient visits are shortened, while maintaining high levels of accuracy and face-to-face interactions
  2. From a billing aspect, claims submissions should be more efficient since the documentation is completed in a quicker and more accurate fashion. This is especially important with the ICD-10 cutover less than 2 months out, but also very beneficial for incentivized programs.

Provide adaptability for incentive programs: Practices and physicians are constantly challenged with new regulations, and it is imperative that proper documentation accompanies each visit.  Scribes can alleviate some of the stresses by expediting the documentation process for initiatives such as Meaningful Use or PCMH, and capturing the added details required by the move to ICD-10.

 

CONS:

Provider Responsibility: Regardless of how a visit is documented, the provider is liable for their notes, and is required to review all scribed documents for accuracy before signing off.

Loss of alerts and decision support functions: Providers will not see the alerts and decision support prompts if they are not personally navigating through the EHR.

Initial Investment: Scribes may increase revenue over time, however the initial investment shouldn’t be overlooked.  The additional compensation is an obvious consideration to account for, but using scribes also requires a workflow overhaul which may disrupt daily throughput (as any workflow change might).

Learning Curves: Other costs to consider are the associated learning curves.  Scribes require training in multiple areas – the application, HIPAA, medical terminology, etc. – and the adjustment periods between the providers and scribes could hinder workflow efficiency.  Practices must factor all of this, including the high turnover rate of pre-med students heading off to medical school, in their evaluation process.

Big Data: The need for structured, reportable data is greater now than ever before as pay-for-performance initiatives that leverage EHR reports are taking off.  Moving forward, it’s not only important that a patient visit gets documented, it’s also important how it gets documented. As part of the initial onboarding, organizations must train their scribes to document in the appropriate fashion to ensure their providers get the full credit for each patient encounter

Patient Comfort Level: Patients may not be comfortable with other non-clinical personnel in the exam room, which could lead to them being less open about relevant healthcare information.  Sensitive or embarrassing conversations necessary for accurate diagnosis and treatment may be omitted in certain scenarios.

 

There are definitely lots of discussion points when considering medical scribes. The cost/revenue analysis will differ at each practice. Patient and physician satisfaction are likely to improve, but at the cost of alert and decision support functions.

Our recommendation before even considering medical scribes is to assess your EHR and note module to ensure they are optimally configured for your providers’ use and for all requirements (e.g. ICD-10, Meaningful Use, P4P initiatives).  We are all familiar with the additional work required of providers to document and order within the EHR, but often these efforts can be greatly reduced by streamlining the EHR’s configuration, especially the note forms, for ease of use.  At the same time, an optimization can improve the documentation and data required for ICD-10, Meaningful Use, and other initiatives. Under pressure to first implement EHRs and then to conform to Meaningful Use, many organizations have not had the time to perform such an assessment. Once your EHR, especially the notes, is optimized, you may find that fewer providers actually require a scribe.  For additional information and an example of an assessment, you can check out Galen’s complimentary Assessment & Gap Analysis for ICD-10.

Whatever decision you ultimately make, we always encourage our clients to define metrics and implement a pilot group before proceeding.  Determine what is important to your organization.  Maybe the focus is increased revenue, provider productivity, staff and patient satisfaction, accurate and timely documentation, or a combination of the above.  Either way, goals need to be established and measured to be able to track success.  Piloting a program on a small scale prior to enterprise-wide implementation could prove very insightful.  Changes in a practice are always difficult, so it’s important to research and obtain the necessary information ahead of any decision making.  For more information on medical scribes, EHR assessment & optimization, or Galen’s implementation methodology, feel free to contact us.

 

References:

http://www.ajemjournal.com/article/S0735-6757(13)00405-1/abstract

http://www.fortherecordmag.com/archives/0115p10.shtml

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049807.hcsp?dDocName=bok1_049807

 

Top 10 Recent Quotes on Healthcare Interoperability

Much print has been dedicated to interoperability over the past several months. At issue is whether the government (ONC) should attempt to solve healthcare interoperability or continue the course and let the market solve it (or perhaps some in between). We will be discussing this issue with our partners at our annual GPAC event next week in Boston. To prime the discussion – and as part of our interoperability blog series – we present the top 10 recent quotes on the issue:

  1. Interoperability may not have gotten enough attention in the early days of Meaningful Use’s electronic health records (EHR) gold rush, but it’s now taking center stage as healthcare providers, government agencies, vendors, and committees consider how to support the exchange of data easily and securely. It’s very easy to point fingers at folks. People underestimate how challenging this work is,” Sawyer told InformationWeek. “I think the vendors are being cautious before spending lots of research and development money before a standard is more clearly defined.

    -Alison Diana, Information Week, “Healthcare Interoperability: Who’s The Tortoise?”

  1. If Big Data is the new oil in healthcare, clinical business intelligence is the refinery.

    -Brendan Fitzgerald, HIMSS Analytics, “Infographic: The future of clinical & business intelligence in healthcare”

  1. Congress doesn’t think that the marketplace has created the interoperability it thought it was mandating in the HITECH Act. The right question is: How do we ensure that patients, clinicians and caregivers all have read and write access to a patient’s longitudinal health record in real time? More generically, how do we ensure that the right information gets to the right person at the right time?

    -Flow Health Blog, “Beyond Interoperability”

  1. “information blocking” – I believe this concept is like the Loch Ness Monster, often described but rarely seen.   As written, the information blocking language will result in some vendors lobbying in new political forums (Federal Trade Commission and Inspector General) to investigate every instance where they are getting beaten in the market by other vendors.  The criteria are not objective and will be unenforceable except in the most egregious cases, which none of us have ever experienced. We are in a time of great turmoil in healthcare IT policy making.   We have the CMS and ONC Notices of Proposed Rulemaking for Meaningful Use Stage 3, both of which need to be radically pared down.   We have the Burgess Bill which attempts to fix interoperability with the blunt instrument of legislation.  Most importantly we have the 21st Century Cures Act, which few want to publicly criticize.   I’m happy to serve as the lightening rod for this discussion, pointing out the assumptions that are unlikely to be helpful and most likely to be hurtful

    -John Halamka, Life as a Healthcare CIO Blog, “21st Century Cures Act”

  1. The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connected health IT system, are we getting our 28 billion dollars’ worth?

    -HealthBlawg “Locked Down or Blocked Up? ONC Report on Health Information Blocking”

  1. The bill abolishes theHealth IT Standards Committee and proposes to have the work of developing interoperability standards contracted out though usual procurement channels, and reviewed and approved by NIST and the Secretary ofHHS in addition to ONC. It also requires attestations by EHR vendors as to their products’ compliance with the interoperability standard, and it calls for the creation of a federal website that will have full transparent pricing for every certified EHR (and its components and interfaces) 

    -David Harlow, JD MPH, Principal, The Harlow Group LLC, “Whither Interoperability”

  1. The U.S. healthcare stakeholders include patients and individual physicians. Unfortunately, these two stakeholder groups are seldom represented in technical standards organizations and, more importantly, have almost no purchasing power when it comes to electronic health records or health information technology. This contributes to the slow rate of progress and has created significant frustration among both patients and physicians. The beauty of patient-driven interoperability is that ancillary infrastructure is helpful but not mandatory. As with auto-pay transactions with your bank, directory services are not required and certificate authorities are already in place. Certification tests would still be needed but the the Internet provides ample examples of open tests and self-asserted certification that would bypass most of the delays associated with legacy methods.

    -Adrian Gropper, MD, The Health Care Blog, “Patient-Driven Interoperability”

  1. I believe that the sufficient conditions for interoperability include the following:
    *A business process must exist for which standardization is needed. As Arien Malec put it recently, ‘SDOs don’t create standards de novo. They standardize working practices.’
    *A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation.
    *A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose. The business purpose may include satisfying regulatory requirements, or meeting market pressures, or both.
    *A ‘network architecture’ must be defined that provides for the identity, trust, and security frameworks necessary for data sharing in the complex world of healthcare.
    *A ‘business architecture’ must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur.
    *A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed.
    *And almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard.

    -John Halamka, Life as a Healthcare CIO Blog, “Standards Alone are not the Answer for Interoperability”

  1. Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay

    Anne Zieger, EMR & EHR, “HHS’ $30B Interoperability Mistake”

  1. This is one of the most public and noteworthy conversations that has taken place on the issue of patient identification. It’s time that Congress recognize the inability to accurately identify patients is fundamentally a patient safety issue.

    Leslie Krigstein, CHIME Interim Vice President of Public Policy,  EMR & EHR News Blog,  “Patient ID Highlighted as Barrier to Interoperability during Senate HELP Hearing”

 

Allscripts Analytics Platform – Do You Have the Latest News?

AAP

As Meaningful Use, PQRS, and CPCI have developed over the past few years, so have their reporting capabilities.  The race to achieve MU-required goals as well as a pattern of late-in-the-year Final Rule updates from Congress have required vendors to rapidly update reporting algorithms.  For Allscripts, what began as the Stimulus Reporting Portal with v11.2.3 migrated to the more robust Allscripts Analytics Portal (AAP) in v11.4.1.

In keeping with the ever-changing landscape, AAP 15.2 was deployed to Production on June 9, 2015.  There are the usual logic changes, however at a higher number than seen in the past.  In fact, there were enough significant issues during UAT testing that this update was delayed for several few weeks.  This latest version brings numerous logic, value set, and even workflow changes – 21 pages of calculation changes to be exact!   Whenever there is an update to the AAP, every organization’s data will be recalculated, and this can take several days for the process to finish.  As of the date of this publication, Allscripts is expecting this process to be completed by the end of the week.  Remember that the dropdown for the 2015 reports will be unavailable until the data has reprocessed.

A major change to note is in workflow NQF 0028- Preventative Care and Screening for Tobacco User:  Screening and Cessation.  In 2014, physicians were credited if counseling was entered as an order, but for 2015, the order must also be in a “completed” status to count in the calculation.  The numerous updated measures will have a new section in the configuration document called “Changes from 2014 to 2015”.  The specific measures affected can be found here with helpful hyperlinks.

With the combination of increasing alternative payment model adoption and the impending code set change to ICD-10, it stands to reason that audits will increase.  It is has become increasingly important to not only have accurate reporting in place, but to also develop the contextual connection to that information.

Recommendations:

  • Subscribe to the AAP Blog to automatically receive email updates
  • Run and validate reports regularly
  • Always export reports to excel and save them! This is important for audits, but perhaps even more important for validation testing processes.
  • Keep careful records of what a report represents for the organization. A detail as simple as a specific consistent naming convention helps delineate changes, and creates a defensible audit position.
  • Keep a calendar or diary of the changes applied, not only for audit purposes, but also for ease of knowledge transfer between team members. For example documentation should include Plan of Correction Actions taken for workflow changes and confirmation of changes to existing configurations.

The healthcare atmosphere requires careful balancing between the many competing objectives of healthcare reform.  If you have further questions or feel your organization could use the strategic insight and proven solutions that Galen Healthcare Solutions offers, don’t hesitate to contact us at sales@galenhealthcare.com.

Resources:

Allscripts Analytics Platform Documentation: https://clientconnect.allscripts.com/community/toolbox/doc

Allscripts Advisory Blogs:  https://clientconnect.allscripts.com/docs/DOC-33108age

Allscripts Changes 2014 – 2015 Announcement: https://clientconnect.allscripts.com/docs/DOC-19659

Successfully Attest for Meaningful Use While Simultaneously Converting to a New EHR

MU Conversion2

With seemingly everyone trying to consolidate and take advantage of economies of scale, some of the biggest trends in today’s dynamic healthcare landscape are conversions and mergers.  Is your organization making the move to a new EHR?  Is your group entertaining the idea of acquiring another hospital or outpatient facility?  Outside of the business-related articles that will directly impact an organization during an acquisition, there are many other important items to take into account that may fly under the radar.

One of which is Meaningful Use, and the ability to effectively manage both the conversion from a Legacy system to your new Target EHR, and your physicians’ MU successful attestations.  We find it wise to consider the following prior to kicking off a project:

  • Are there resources in place and are they experienced?
  • Is the conversion team skilled enough to populate all necessary fields with the appropriate information for MU reporting?
  • Are there configuration experts available from both EHRs who can collaborate and communicate effectively about the MU requirements?
  • Is the project manager experienced with other conversions and does he/she understand the caveats that come with MU reporting?

Although Meaningful Use is tapering down, don’t leave any of that money on the table!  To learn more about how to manage an EHR conversion and MU attestations simultaneously, join us for a free webcast this Friday, June 19.  Having facilitated many EHR conversions, Galen is uniquely positioned to partner with healthcare organizations who are about to engage in such an undertaking.  We have the system analysts, MU resources, and technically savvy specialists to give the proper recommendations and project leadership that will provide your organization with a leg up in keeping things on track.  Managing multiple projects is always a difficult task, but with enough foresight and preparation, you can position your organization for success, despite the interdependent project timelines.

#HIMSS15: On Being Human

purple clover

After attending HIMSS, everyone asks “What was the *biggest* theme this year?”  But this blog is not about that.  This blog is about the murmurs.  The soft undercurrent of a theme running through the speaker sessions, the social media streams, and conversations preceding and following the event.  I don’t know if I would have even made the connections if I had been there in person, with the noise of the floor, the long line for Starbucks, and the ever-attractive bling from the vendors.

But quietly sitting in my home office, I listened.  I listened to the live online sessions and the recorded sessions, I read the blogs and engaged on twitter….and as I did, I started to hear it.  Like the Whos down in Whoville calling out from their speck, the more I listened the louder it became.  “Be Human” people said.  “Be real.”

The first murmur may have been from Mary P. Griskewicz, MS, FHIMSS, HIMSS Senior Director in her blog A portal is not patient engagement in which she states “true patient engagement requires providers to listen to and make the patient part of the process.  It also requires patients to actively participate in the care process, have access to and, the ability to inform their health data and, partner with their care providers for patient engagement to be successful.”

Now, if you stand in the middle of the exhibit hall floor, you would think that this is a conference just about technology.  What I heard was a little different.  What I heard calling out from that speck was “Well actually, this is about people.  This is about health.”

Luke Webster, MD talked about changing the role of the C-suite CMIO from one that reviews and approves technology to one where the C-Suite is “Focusing on the people, the process and the change more than the technology.”  In the same session, Pam Arlotto said the CHIO is a strategy position “Redesigning care around what a patient needs, not around technology.”

At this point, I was starting my own Amen corner in my office.  This was good stuff.  These are board tables that I want to sit at and the conversations I want to be involved in.  This is going to be what changes healthcare: being human.

I was watching the twitter feed of the #HITMC (Health IT Marketing Chat) live meetup where John Lynn was quoted as saying “Be worth following.  Be human.  People want to follow humans.”  This is true not just in the arena of social media, but in organizations as well.  If you walk into any healthcare organization and say “this is the proven methodology and this is how I am doing it” without taking the time to understand the organization you are walking into, your plan is destined to fail.

Linda Stotsky tweeted “#PatientData #patientengagement is about #human interactions – not about #MeaningfulUse check boxes #IHeartHIT bc #patients matter #HIMSS15

In my consulting life, I hear providers talk about the computer in the room as a huge barrier.  It sits between them and their patient, diverting their focus from the patient to the monitor.  It looms large in their minds and it affects their ability to connect with their patient…and to be human.

first portable computer

I think back to visiting my father at work when I was a kid (this will date me), and I can remember these enormous IBM mainframes with tape.  They were writing all their information to tape, and my Dad was so proud of those massive machines.  The reporters were wary when green screen computers replaced their typewriters.  In his lifetime he watched the newspaper business go from an offset ink printing system with metal plates to fully computerized layout and publishing. It was a dramatic technological change to take the newspaper digital – and it wasn’t easy.  Dad loved the smell of the ink and the characters on the composing room floor, and even as he rode the wave of change, he was also sad to see parts of it go.  He used to jokingly call his job title the “Director in charge of new fun stuff” and he would bring home technological marvels to test at the kitchen table, like a portable computer that must have weighed 30 lbs.  Luckily for the newspaper, their “Director in charge of new fun stuff” was a newspaper man.  He had worked every job in small town papers and he never forgot that these were tools to get the job done.  He loved technology, but it had to have the right utility, be introduced at the right time, and keep in partnership with the people who would be using it in order to be successful.

Technology is changing at such a rapid pace in not just healthcare but in our lives, that it seems almost radical to say “Be human.”  We have daily conversations in my household about the amount of time family members (myself included) spend on devices vs. spend outside, and now we even have devices to encourage us to be outside and active.  My kids come home and ask how many steps I have taken and how many followers I have on twitter.  I have to occasionally take stock, think about my priorities, and make sure I throw the football around in the yard or go on a hike in the woods.

The same is true in healthcare today.  Things are changing so rapidly, we are capable of so much – we can map a human genome, we can not only create an electronic record, but we have teams that can then take that record and convert it to another software platform or upload it to an HIE.  We have wearables and Bluetooth connections and hotspots.

Sometimes, the fancy toys and new fun stuff can be so all-consuming like that trade show floor that we can lose sight of the goal.  The goal is health.  The goal is supporting our providers and their teams in providing excellent healthcare.  The goal is tools that enhance the delivery of care and increase our medical knowledge.  The goal is not for technology to be a real or perceived barrier between provider and patient, but to be a supportive aspect of their relationship.

The most basic part of being human is being present and listening.  This has an extreme amount of value, especially in times of dramatic change and situations that call for collaboration.  We need to be nimble, but we also need to be thoughtful, attentive, and make sure we are delivering the right solutions at the right time.

This is also part of why I am so glad to be in HealthIT and to be working for a company like Galen Healthcare.  We do for sure have fun cool stuff, and I will be the first to tell you about our products and services.  We are also a company and a team that knows the value of being human.  Of meeting our clients where they are, listening, and using our expertise in conjunction with their vision to turn the corner to where they want to be.

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