Archive for the tag 'Meaningful Use'

Meaningful Use Stage 2: Hesitation could be costly

We often expect something we experienced before to be not as hard the second time around.     We are encouraged by software companies to not to think about MU2 until after we get the latest compliant version of the software installed in our system.       There are promises that if we have the software in place on day one of reporting that we will be able to attest.

Yet,  Meaningful Use Stage 2 has the potential to be the perfect storm.    

I have been on many calls and talked with other Meaningful Use SMEs (Subject Matter Experts) that are not just helping their clients through configuration, but working at warp speed both bailing the water and battening the hatches.   We can do it, we are great at it…but the frustrating thing is that we don’t have to let it get to this point.

Meaningful Use Stage 2 has a broader and deeper scope than Stage 1.       Many measures that at first glance look the same as last time around are actually much more specific in ways that affect how you organize your data and workflow – Computerized Provider Order Entry is a great example of this.   In Stage One, Providers just needed to be placing orders electronically, 90% of our clients were doing this so we were good.   In Stage 2 it becomes more specific about the types of orders and will be reporting a percentage for Medications, Labs and Imaging orders.     This means that we need to review those dictionaries and ensure that all Labs and Imaging orders are in the correct parent class and that there is nothing extraneous there that might alter our numbers.

“We’re not going to talk about MU2 until after the upgrade”    I have heard this from clients as well as software reps, and it’s maybe the most dangerous attitude that anyone on the team could present.    We are at a stage in this process that every Organization should have a Meaningful Use SME that they can call when implementing anything new and just ask “Is there anything I am missing here, what should I be thinking about in regards to MU?”

For MU Stage 2 specifically, we know that there is work to be done that is not dependent on the latest and greatest version of the software.   Dictionary updates, cleaning up the referring provider dictionary,  LOINC & SNOMED updates, identifying & thinking through the gaps between the present day workflow and future state workflow are among the items that can be done well in advance.

Most importantly, don’t rely on software timelines to drive your project.    MU2 work should start a full three months prior to the quarter that you want to attest, regardless of infrastructure timelines.     If you are planning on reporting in Q3 of this year, you should be looking at all of the measures and reporting requirements now.    If you are planning on reporting in Q4, then you should start your review no later than July first. If you doubt the need to start reviewing and configuring now, take a close look at the measure for closing the referral loop.  That should get you and your staff motivated to begin as early as possible.


HIE is here to stay

Galen Healthcare Solutions announced its strategic partnership with Orion Health in a past January article. Since then, Galen has been heavily involved in the recent boom of Health Information Exchange (HIE). What’s an HIE? In a nutshell, HIE is the “secure health data exchange between two or more authorized and consenting trading partners” (HIE Implications in Meaningful Use Stage 1 Requirements). On one end is the data supplier; on the other end is the data receiver. A third party – in this case, Orion Health – facilitates the data transfer to ensure quality control and necessary HL7 specifications.

I’ve spent the past few months working with two promininent HIE projects: hundreds of hospitals in each state sending demographic information, clinical documents, laboratory results, radiology reports, and immunizations to the state’s data repository. Providers from those hospitals are then able to access a portal that can display a patient’s full medical history from multiple hospitals on one profile.

Engaging in an HIE is one way for a hospital to meet Stage 1 Meaningful Use objectives. HIE engagement will only grow in the future as Stage 2 and Stage 3 Meaningful Use requirements are initiated. At its core, Meaningful Use is using EHR technology to promote patient engagement, care coordination, and health security. A breakdown of the 3 stages are as follows:

An important criteria for Stage 2 is that providers who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria to continue collecting government incentives. As eligible providers move into the next phase of meaningful EHR utilization, we can expect the trend of HIE to continue, with increased attention on advanced clinical procedures.

The Benefits of a Shared Community Record

Why would an independent practice or community clinic benefit from sharing an electronic record system with a larger organization? After all, they often view these organizations as their competition. They are private clinics for a reason. They want to make their own decisions. They want the flexibility of staffing who they want in what roles they deem appropriate. They want to keep their patient lists private. They value their independence.
So, just what are the benefits for a community clinic to join the EHR of the larger healthcare organization?

  • Continuity of patient care. Physicians have access to the patient’s history at the click of a mouse. The physician knows the patient’s history from experience; decisions and new information can be integrated from a whole-patient perspective efficiently without extensive investigation or record review.
  • Transparency of data. Clinical data can be shared freely while keeping finances and scheduling completely separate and private.
  • Improved referral process. The referral process is made more efficient and the results turn-around is much faster and more consistent.
  • Better communications between patients and providers. There are fewer chances for errors and “missed” communications, both provider-to-provider and provider-to-patient.
  • Centralized system maintenance and troubleshooting. Community providers benefit from sharing technical resources of the host organization, including support and upgrades.
  • More affordable cost option. Community physicians and hospitals can have all the benefits of a shared record, often at a lower cost than implementing a free-standing EHR.
  • Benefit from lessons learned from a completed implementation. The larger organization does all the work after having had a successful implementation. They have picked a meaningful use (MU) approved vendor, efficient and meaningful workflows have been tested and proven, and quality reports are already created and readily available. This avoids the risks and time consumed by starting from scratch.
  • Government financial incentives are theirs to keep. Meaningful Use dollars are their own.

Ultimately, joining a program such as Epic’s Community Connect gives these practices the access to share medical records with the larger organization in an easy, proven and affordable manner. Private clinics and community hospitals can maintain their independence while their access to a shared medical record contributes to better, safer patient care.

Integration Client Success Story: NMDOH -> NMSIIS Immunization Interface

Galen’s expertise and sound approach allowed our organization to achieve integration with the state registry. Their flexibility and ingenuity in facilitating necessary customizations combined with their wealth of knowledge with regard to standards was invaluable to the project. We highly recommend partnering with Galen in integration initiatives.
-Irene Vold, NMDOH BEHR Program Manager

Many health care providers are required by law to send their immunization records to the state registry. An immunization interface can assist healthcare providers with completing this task. Sometimes a standard immunization interface can work effectively, other times customization is needed. A client of Galen recently implemented an immunization interface to send their immunizations from their EHR to the state registry, NMSIIS (New Mexico Statewide Immunization Information System). This particular implementation required customization as the state registry only accepted weekly batch files and also required customization to scrub and filter transactions which did not meet requirements as outlined in the specification.

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Let My Data Go!

I recently had a nice chat with a colleague analyzing HIT industry trends for Kalorama Information. Kalorama does industry research for the medical and life sciences for many of the major news and consulting organizations. I got in touch with her specifically because of Kalorama’s analysis on EHRs in 2012 which was used by Bloomberg Government for their (very expensive) EHR industry analysis for provider and vendors. She found that in 2012 one of the most immediate challenges for providers was implementing EHR systems that meet meaningful use standards. She also found that vendors were having trouble with interoperability and usability.

Fast forward to 2013; a lot has changed. Epic has grown to dominate many markets. Allscripts has a new CEO and a few new toys to play with. eClinicalWorks has become a force to be reckoned with in the small practice space. However, the challenges the providers are facing have changed. My colleague and I talked for a while about various organizations we each have worked with and came to the same conclusion: providers are now having trouble with interoperability and conversions of data.

2013 Priorities

The majority of physician offices have implemented EHRs, but they must now communicate with other entities such as HIEs and ACOs. With the increase in mergers and acquisitions, we are also seeing an increased demand for conversions from one system to another. These problems involve a thorough understanding of the underlying data structure as well as a solid foundation in interoperability standards such as LOINC, HL7, SNOMED, and CDA. The vendors have the expertise to work on the problems for their products, but they are not enthusiastic about helping clients switch off their platform. Selling the EHR has been the primary goal for vendors in the past, not technical support that moves a client away from their product. Vendors are under the assumption that if they make switching off their product difficult, then clients will be less likely to undertake the conversion or integration with a product that is not part of the vendor’s family of products. While this is definitely true for disgruntled clients, it only makes it frustrating for clients who do not have a choice in the products they work with. This reality has led to some very important questions.

Where is an organization to go when their own vendor is not supporting their efforts? How do organizations extract meaningful data from such complicated or cloud based databases? How can we become self-sufficient in managing our data? How does an organization meet new institutional and government requirements? Galen can help clients with these challenges, but vendors need to help by making products that play nice with others.

At the end of our conversation my colleague and I simultaneously came to the same conclusion: “Organizations feel like their data is being held hostage!

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