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  • OIG Fraud Warnings

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Patient Health Information Data Processing and Storage

US Patent Publication – Who Owns Your Medical Info?

By staff reporters

******

Physician Call for Overhaul of EHRs

Harris Poll of Doctors

[By staff reporters]

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Conclusion: Your thoughts are appreciated.

Product DetailsProduct DetailsProduct Details

***

The Doctor Will “SEE” You Now!

OR … Not!

[By staff reporters]

A Medical Office Exam – FROM THIS EMR VISIT!

Your privacy is not protected.

We  use Electronic Health Records.

paper

[Courtesy Dr. DK Pruitt]

A Medical Office Exam – TO THIS PMR VISIT!

***

Assessment

Beware – No medical specialty is immune! Which office visit style do you prefer? Are we “Back to the Future?”

Conclusion

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“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

Product Details

***

An EHR State of Mind [video]

Two Rap Videos

[By staff reporters]

Can you believe these videos are two years old?

***

https://youtu.be/gaLi0ak5D-o

https://www.youtube.com/watch?v=3TveJLAi_y4

Conclusion

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Product DetailsProduct Details

EHRs = Opine “YES” or “NO”

EHRs = Opine “YES” or “NO”

A Binary Verbal Opinion Poll

OR

What grade would you give the state of EHR in 2018 on a national basis with physicians and hospitals, and are there aspects that have fallen well short of your past expectations of where we would be today?”

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TELL US WHAT YOU THINK?

On “Fancy-Smancy” EMRs, IT and Cyber Security, etc.

EMRs – Providers Need to Prepare for Virulent Ransomware in 2018

[By staff reporters]

Ransomware emerged as a significant threat on the worldwide stage in 2017, but new variants will challenge healthcare providers well into 2018, with some versions of new malware not even needing a network to distribute themselves throughout an organization. Previous variants of ransomware, particularly the WannaCry attack in May, showed the ability to self-propagate and spread across a network and onto other networks via the Internet.

Educating a healthcare’s organization workforce on cyberattacks is necessary, but it’s not enough to bring them up to speed on phishing and other threats. Practices need to harden their own email systems; for example, Matt Sherman, a malware outbreak specialist at Symantec, advises using secure email systems as a best practice along with two-factor authentication software. Email systems should scan links contained in incoming messages, and they should enable automatic image loading in messages.

Source: Joseph Goedert, adapted from Health Data Management [12/28/17]

***Courtesy: FunnyBones

Conclusion

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***

Update on EHR Rankings

Top Vendors

By http://www.MCOL.com and KLAS

******

Conclusion

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Contact: MarcinkoAdvisors@msn.com

***

Dental EHRs are Coming to an End?

Dental EHRs are Coming to an End

By Darrell Pruitt DDS


The reckless third-party push for adoption of increasingly dangerous dental EHR systems is the most harmful scam in the history of dentistry.

But it’s almost over, Doc. Equifax was hacked.

“If a company like Equifax can make significant investments, have every incentive to keep the most sensitive kind of information secure, but still experience a breach … it stands to reason that our playbook needs a revision,”

Josh Mayfield: [Platform Specialist at Firemon Immediate Insight]. (See: “Equifax, U.S. consumers alike will struggle to overcome massive hack” By Tim Johnson for Mcclatchy, September 8, 2017).

Http://www.mcclatchydc.com/news/nation-world/national/national-security/article172078982.html

Why should anyone assume electronic dental records are any more secure than Equifax records?

Not only do digital health records subject Americans to increasing risk of medical identity theft – which can be lethal – but they are increasingly more expensive than paper dental records.

What’s more, electronic dental records offer dental patients NO TANGIBLE BENEFITS:  When is the last time you witnessed a practice advertise the benefits of digital records? On the other hand, you may have also noticed the appearance of paper files in the backgrounds of promotional photos.

A decade ago, I tried to persuade American Dental Association leadership to consider de-identification of dentists’ primary dental records. After all, if identities are unavailable, they simply cannot be stolen. ADA leadership summarily discarded the idea in favor of full disk encryption – which dentists summarily rejected in favor of luck …. And so here we are, Doc. “First, do no harm.”

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Dental EHR vendors simply will not survive transparency without fundamental changes in how patients’ welfare is guarded – which will further increase their cost and liability.

The future is obvious, yet I am the only dentist in the nation openly warning of the inevitable collapse of the electronic dental record industry. Unlike physicians, who treat four to five times as many patients a day and depend on quick interoperability with other physicians, dentists can safely return to paper. They won’t like the inconvenience of carbon paper, but following the Equifax breach of almost half of the nation’s consumers – virtually every one of them mad as hell – dentists will have no choice. Ehrs have become too costly.

Assessment

This week, a dentist on Facebook who tried but failed to defend the censorship habits of a popular dental consultant said I was on a “one-man crusade.” I don’t think he meant it in the good way. I ask you to remember that remark for future reference.

Conclusion

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***

 

Health Information Technology [EMR] Update

2014 to 2017

 

 

 

 

 

 

By D. Kellus Pruitt DDS

Three years ago

“When Patients Fear EHR – When patients believe paper medical records are safer and more private than electronic ones, their health can suffer. Many members of the public mistakenly believe electronic health records (ehrs) are less secure than paper files. Magnified by misinformation and political distortion of facts, an unnecessary fear has taken root in the minds of many consumers — often with serious consequences.” 

-Mansur Hasib

Cybersecurity Professional – Author and Speaker in commentary for informationweek, July 28, 2014

Http://www.informationweek.com/healthcare/electronic-health-records/when-patients-fear-ehr/a/d-id/1297519

This week 

“Doctors claim medical records system puts patient safety at risk – PROBLEMS with Queensland Health’s electronic medical record system are angering health workers, with fed-up senior doctors circulating a document slamming the technology and those in charge of it.”

-Kara Vickery and Janelle Miles – The Courier-Mail, July 25, 2017.

Http://www.couriermail.com.au/news/queensland/doctors-claim-medical-records-system-puts-patient-safety-at-risk/news-story/dc18cb388552eb4d179629c298a28408

“300,000 records breached in ransomware attack on Pennsylvania health system – The breach on Women’s Health Care Group of Pennsylvania was discovered in May, but hackers had unauthorized access to the system as early as January.”

-Jessica Davis – Health Care IT News, July 26, 2017

Http://www.healthcareitnews.com/news/300000-records-breached-ransomware-attack-pennsylvania-health-system

“HIPAA Data Breaches, Cyber Attacks Reported by 47% of Orgs – KPMG found that there was a 10 percentage point increase in reported HIPAA data breaches or cyber attacks from 2015 to 2017.”

-Elizabeth Snell – Health IT Security, July 27, 2017

Https://healthitsecurity.com/news/hipaa-data-breaches-cyber-attacks-reported-by-47-of-orgs

“Doctors frustrated that electronic records steal time from patients – Dr. Rebekah Gardner has to make a choice each time she sees a patient in her Rhode Island office: she can scroll computer screens and click boxes, or she can focus on the patient and take home the computer work.”

-Ronnie Cohen – Reuters, July 28, 2017

Http://www.reuters.com/article/us-health-records-electronics-iduskbn1ad2gt

“Plastic Surgery Associates data breach: Patients’ records, payment card details possibly compromised – The company said it discovered that some of its systems were infected with ransomware in February.”

-Hyacinth Mascarenhas – International Business Times, July 29, 2017

Http://www.ibtimes.co.uk/plastic-surgery-associates-data-breach-patients-records-payment-card-details-possibly-compromised-1632555

Conclusion

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***

EHRs, ADA Leaders and Conflict of Interest

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A decade later ….?


By D. Kellus Pruitt DDS

In July 2007, Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, testified before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry.

His testimony is featured in an official document titled:

“Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007

http://www.ncvhs.hhs.gov/070731p08.pdf

Here are the ADA’s 11 selling points which Dr. Ahlstrom presented to HHS in support of electronic dental records:

  1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.
  2. Vendors will be able to supply low-cost software solutions to physicians/dentists who support standards-based electronic data interchange. Costs associated with mailing, faxing and telephoning will decrease.
  3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.
  4. Dentists will have a more complete data set of the patient they are treating, enabling better care.
  5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.
  6. Consumer documents will be more uniform and easier to read.
  7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.
  8. Patients will save postage and telephone costs incurred in claims follow-up.
  9. Patients will have the ability to see what is contained in their medical and dental records and who has accessed them. Patient records will be adequately protected through organizational policies and technical security controls.
  10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.
  11. Consumer correspondence with insurers about problems with claims will be reduced.

Not one of Ahlstrom’s 11 promises has been fulfilled. None …. Total failure!

A decade later, it has become clear that the nation was misled by ambitious leaders of the American Dental Association who have since enjoyed power and/or profit from members’ misinformed adoption of digital records.

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 In my opinion, the grandest deception in the history of dentistry is clearly a result of a secretive not-for-profit corporation’s conflict of interest. This very important business lesson would have been lost to history if I hadn’t been documenting the true progress of EHRs in dentistry.

I (alone?) recognized very early that paperless was doomed simply because the needs of dentists and their patients was secondary to implementation of third-parties’ half-baked, selfish ideas. And I got spanked for that by the same ADA leadership behind Ahlstrom’s tainted testimony to Congress.

My ADA membership was suspended, and I still have not been told why. All the President of the Texas Dental Association would tell me is, “You know what you did.”

Assessment 

To this day, dental EHRs are both increasingly less secure than paper dental records as well as increasingly more expensive. What’s more, they offer no tangible benefits for the patients. ADA leadership failed my profession.

Transparency is accountability.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

HITECH: A politically-correct Scam?

Update on HITECH

By Kellus Pruitt DDS

“How bad science can lead to bad science journalism — and bad policy – This is what happens when news organizations don’t catch lousy studies.”

By Stephen Soumerai and Ross Koppel for The Washington Post, June 7, 2017/

Https://www.washingtonpost.com/posteverything/wp/2017/06/07/how-bad-science-can-lead-to-bad-science-journalism-and-bad-policy/?Utm_term=.631e0a2d022c#comments

Soumerai and Koppel:  “As researchers who focus on health care, we see news coverage of badly designed studies constantly. And we’re concerned that breathless reporting on bad science can result in costly, ineffective and even harmful national policies.”

You mean like HITECH?

Since the HITECH Act was passed in 2009, it has been well-documented that not only were the premises of the law fiction, but the law itself has always favored healthcare stakeholders like Cerner at the expense of patients and their doctors – the healthcare principals.

The grandest blunder in medical history gained traction in 1999 with an Institute of Medicine (IOM) report titled, “To Err is Human,” which promises that EHRs should have already saved 100,000 lives a year … Not even close. Not unlike the dangerous research bias described in Soumerai and Koppel’s article that was posted recently, several researchers have also pointed out that the studies cited in the IOM report did not show that people were dying from medical errors that health information technology could detect or correct.

The questionable IOM report was followed in 2005 by a tainted RAND Corporation report which promised savings of $77 billion annually… Wrong again!

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untitled

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Shortly after the report was published, rumors quickly spread that the data for the study were cherry-picked by those with software to sell. By 2011, the passage of time revealed that RAND had clearly made a vendor-friendly mistake, forcing RAND to disown their study – but not before its optimistic conclusion was instrumental in the successful passage of the HITECH Act in 2009 (two years after Minnesota lawmakers had already passed the doomed EHR mandate based on the same tainted RAND results).

Political Fiat

Then presidential candidate Hillary Clinton was only one of many lawmakers to quote the RAND study. Almost everyone the nation was suckered in. Ultimately, it was revealed that the study’s vendor-friendly conclusion was largely financed by software giant Cerner, who continues to profit from years of misinformation.

(See: “In 2nd Look, Few Savings From Digital Records,” by Reed Abelson and Julie Creswell, New York Times, Jan. 10, 2013).

Http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html

In fact, it was announced last Monday that Cerner, which is responsible for the most dishonest research in the history of health information technology, has been awarded the Department of Veterans Affairs contract for the VA’s next-generation electronic health records system.

Assessment

Dishonesty wins.

Conclusion

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***

 

A Clever Rap Anthem About Electronic Health Records

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On EHRs

A Re-Post Report by Jaan Sidorov

***

broken PC

Clever Rap Anthem About Electronic Health Records

Assessment

ZDoggMD makes some good points, slips in a sly reference about one EHR provider and salutes another.

Ten years that have passed since he wrote this article, and we still have a way to go.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

Identity Management in Health Care

Join Our Mailing List

By http://www.MCOL.com

Importance in Health Care

***

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

Announcing the Philosophic Medical Records Revolution

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Enter the Revolution

DEM blue

By David Edward Marcinko MBBS MBA CMP®

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

To understand the MR revolution that has occurred the past decade , place yourself for a moment in the position of third-party payer.

You want to know if Dr. Brown actually gave the care for which he is submitting a bill.  You want to know if that care was needed.  You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?

Of course not!  You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a CAT scan on the patient at the imaging center.  What you can do is review the medical record that underlies the bill for services rendered from Dr. Blue.

Most of all, you can require the doctor to certify that the care was actually rendered and was indicated.  You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made [Stark Laws].  You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate that point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart.  As far as the patient was concerned, everything was correct and beneficial to the patient.  As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.  Shall we change it back to the way it was?  That is not going to happen.

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Instead, practitioners must adjust their attitudes to the present function of patient records. They must document as required under pain of punishment for failure to do so.  That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal.  They are also aware of the fact that full documentation can be provided without a reality underlying it.

“Fine, you want documentation?  I’ll give you documentation!”

Some have given in to the temptation of “cookbook” entries in their charts, or canned computer software programs, EHR [electronic medical record] templates, listing all the examinations they should have done, all the findings which should be there to justify further treatment; embedded “billing engines” not with-standing. We have personally seen records of physical examinations which record a patient’s ankle pulses as “equal and bounding bilaterally” when the patient had only one leg; hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

***

EMRs

***

Whether electronic medical records (EMR) will really be helpful, in the future, is still not known.

In fact, according to Ed Pullen MD, a board certified family physician practicing in Puyallup WA, electronic health records are defined primarily as repositories of patient data [much like paper records].

But, in the era of meaningful use [MU], patient-centered medical homes, and Accountable Care Organizations [ACOs], mere patient data repositories are not sufficient to meet the complex care support needs of clinical professionals. These complaints arise because EHR systems are being used as clinical care support systems, which means they should enhance the productivity of clinical professionals and support their information needs, not hinder them [personal communication, and DrPullen.com]. 

Conclusion

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 Harvard Medical School

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Yale University

HEALTH PLAN BEHIND NEW HOSPITAL RANSOM-WARE INCIDENTS

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HEALTH PLAN BEHIND NEW HOSPITAL RANSOM-WARE INCIDENTS

by Derrick Smithsonian for HealthTurnup

Hospitals downloaded ransomware with their electronic payment from a plan that demanded discounts for out of network services
ON THE HEELS OF a highly-publicized ransomware attack experienced by a southern California hospital, HealthTurnup has learned a number of additional hospitals have been victims of a “copycat” hospital ransomware campaign that has been orchestrated by a health plan seeking reductions in their out-of-network payments.

According to sources, the new hospital ransomware incidents all involve malware downloaded when accepting electronic payment from the plan for out of network services, that locks the hospital’s information system by encrypting virtually all files, until a ransom is returned equal to a percentage discount of the previously paid out of network charges.

Sources indicate that the FBI cut short an investigation of the incidents after determining there was proper disclosure provided in the health plan’s electronic payment page, that accepting download of payment of full charges for the out of network services would also provide “download of a suite of complimentary payment adjustment software.”

“Who reads the legal fine print in the tiny font that accompanies those electronic payment download pages provided by the plans?” a representative for one of the impacted hospitals complained. “And the galling thing is, the health plan demanded their discount refund in bitcoins. We’re still issuing refunds with paper checks. Do you know what a pain it is to manually adjust one transaction to bitcoins?”

 

e6030530904385_56389b1f258f2

Assessment

http://www.BusinessofMedicalPractice.com

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***

EHR Meaningful Use Rules Finalized

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The CMS Modifications

[By staff reporters]

Source: Joseph Goedert, Health Data Management [10/7/15]
***
Centers for Medicare and Medicaid Services
***
The Centers for Medicare and Medicaid Services has issued a 752-page final rule covering three components of the electronic health records meaningful use program. The rule finalizes modifications to Stages 1 and 2; the 2015 edition of electronic health records certification criteria; and Stage 3 of meaningful use.
Modifications
Under the modifications to Stages 1 and 2, eligible professionals have 10 meaningful use objectives, down from 18 previously. In Stage 3, there are 8 objectives for eligible professionals and hospitals, and more than 60 percent of measures require interoperability.
Assessment
The entire rule is available here.
***
MD with eHR
***
Conclusion
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EHRs in the News – GAG!

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A Recent Round-Up

1-darrellpruitt[By D. Kellus Pruitt DDS]

“Feds push forward with controversial health rule – The Obama administration is moving ahead with controversial new rules that require doctors to switch to electronic health records or face fees, resisting calls from both parties to delay implementation.”

By Sarah Ferris for The Hill, October 6, 2015

http://thehill.com/policy/healthcare/256120-feds-push-forward-with-controversial-health-it-rule?utm_content=buffer9cd4b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

“The Gag Clause is Killing Us – Doctors are barred from discussing safety glitches in software…  And what if doctors — your doctor — is unable to make problems with EHR programs public, due to a so-called ‘gag clause’ written into the contract with the software company, which forbids sharing and publishing, in any form, of potentially dangerous flaws in the IT systems? This is already happening.”

By Deirdre Reilly for HealthZette, October 6, 2015

http://www.lifezette.com/healthzette/gag-clause-is-killing-us/

 “Hackers target Australian health sector, selling records for A$1,000 – Hackers are targeting the Australian health sector, with fully populated digital health records sold on the black market for up to A$1,000 each [$720 US].”

By Beverley Head for ComputerWeekly.com, October 7, 2015

http://www.computerweekly.com/news/4500254986/Hackers-target-Australian-health-sector-selling-records-for-A1000 

 “Electronic health records software often written without doctors’ input – The reason why many doctors find electronic health records (EHR) difficult to use might be that the software wasn’t properly tested, researchers suggests.”

By Kathryn Doyle for Reuters, October 7, 2015

http://www.reuters.com/article/2015/10/07/us-health-software-ehr-idUSKCN0S11OY20151007

 “EHRs provide long-term savings, convenience.”

(no byline), American Dental Association, ADA News, December 6, 2013

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

 ***EHR

***

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs

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***

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR, HIT AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

Product DetailsProduct Details

[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

***

Got a Beef With Your EHR?

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So – Go Tell the Feds; Already!

[Staff reporters]

Are you a doctor or medical provider unhappy with your electronic health records system, or unable to share health data because of the actions of other organizations?

Or, are you a healthcare consumer who can’t access your EHRs? The feds want to hear from you.

The Office of the National Coordinator for Health Information Technology has a new online complaint website, healthit.gov/healthitcomplaints. It is the first formal complaint process that ONC has had throughout the journey to EHR meaningful use.

***

Source: Joseph Goedert, Health Data Management [9/18/15]

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  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

***

Can the EHR Save Private Practice?

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OR … Can Private Practitioners Save the EHR? 

By http://www.Kareo.com

***

Kareo EHR Savior

Click to access Kareo_Private_Practice_EHR_Infographic.pdf

[Click Link to Enlarge and Expand]

***

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  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs

Assessment

Has the “tide-turned”, and physician sentiment changed, since creation of this info-graphic?

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UNDERSTANDING MEDICAL PRACTICE CYBER SECURITY RISKS

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Mitigations for the Digital Health Era

Shahid N. Shah MS

[By Shahid N. Shah MS]

There has been a tremendous explosion of information technology (IT) in healthcare caused by billions of dollars of government incentives for usage of digital healthcare tools.

But, IT systems face threats with significant adverse impacts on institutional assets, patients, and partners if sensitive data is ever compromised. Every health enterprise is required to confidentiality, integrity and availability of its information assets (this is called “information assurance” or IA). Confidentiality means private or confidential information must not be disclosed to unauthorized persons. Integrity means that the information can be changed only in an authorized manner so as to maintain the correctness of the information. Availability defines the characteristic that information systems work as intended and all services are available to its users whenever necessary.

It is well known that healthcare organizations face and have been mitigating many risks such as investment risk, budgetary risk, program management risk, safety risk, and inventory risk for many years. What’s new in the last decade or so is that organizations must now manage information assurance risks related to operating its information systems because information systems. IT is now just as a critical an asset as most other infrastructure managed by health systems. It is important that information security risks are given the same or more importance and priority as given to other organizational risks.

As health records move from paper native to digital native, it’s vital that organizations have information risk management programs and security procedures that woven into the culture of the organization. For this to happen, basic requirements of information security must be defined and implemented as part of both the operational and management processes. A framework that provides guidance on how to perform these activities, and the co-ordination required between these activities is needed.

***

hacker

[Black Hat Medical Hacker]

***

INTRODUCTION

The Risk Management Framework (RMF), supported by the National Institute of Standards and Technology (NIST) provides this framework. The NIST 800 series publications provide a structured approach to achieve risk management. It provides broad guidance and not necessarily all the prescriptions, which means it can be tailored to meet the organization’s specific needs and providing the flexibility needed for the different organizations. Using the NIST RMF helps organizations with risk management not only in a repeatable manner, but also with greater efficiency and effectiveness. Healthcare information assurance is complex and without a framework that takes into account a broad risk management approach, it is difficult to consider all the intricacies involved.

The NIST Risk Management Framework consists of a six step process designed to guide organizations in managing the risks in their information systems.

The various steps as defined in the NIST specifications are the following:

  • Categorize the information system and the information processed, stored, and transmitted by that system based on an impact analysis.
  • Select an initial set of baseline security controls for the information system based on the security categorization; tailoring and supplementing the security control baseline as needed based on an organizational assessment of risk and local conditions
  • Implement the security controls and describe how the controls are employed within the information system and its environment of operation.
  • Assess the security controls using appropriate assessment procedures to determine the extent to which the controls are implemented correctly, operating as intended, and producing the desired outcome with respect to meeting the security requirements for the system.
  • Authorize information system operation based on a determination of the risk to organizational operations and assets, individuals, other organizations, and the Nation resulting from the operation of the information system and the decision that this risk is acceptable.
  • Monitor the security controls in the information system on an ongoing basis including assessing control effectiveness, documenting changes to the system or its environment of operation, conducting security impact analyses of the associated changes, and reporting the security state of the system to designated organizational officials.

All information systems process, store and transmit information. What is the possible impact if a worst case scenario occurs that causes endangers this information? A structured way to find out the potential impact on the confidentiality, integrity and availability of information can be done through the first step of NIST RMP, the categorization of information systems.

***

keyboard

[Triple Redundant Passwords and Encryption]

***

The NIST SP 800-60 [1, 2, 3 4] provides such guidance. The potential impact is assigned qualitative values – low, moderate, or high. Based on these impact levels for each of the information type contained in the system, the high water mark level is calculated, that helps in selecting the appropriate controls in the subsequent steps.

Organizations need to mitigate risks adequately by selecting an appropriate set of controls that would work effectively. In the selection of security controls step, the set of controls are chosen based on the categorization of the information system, the high water mark and the goals of the organizations.

These baseline controls are selected from NIST SP 800-53 [5] specification, one of three sets of baseline controls, corresponding to low, moderate, high impact rating of the information system. These baseline controls can be modified to meet specific business needs and organization goals. These tailored controls can be supplemented with additional controls, if needed, to meet unique organizational policies and environment factors and its security requirements and its risk appetite. The minimum assurance requirements need to be specified here.

All the activities necessary for having the selected controls in place, is done in the implementation of security controls step. The implementation of the selected security controls will have an impact on the organization risks and its effects. NIST SP 800-70 [6, 7] can be used as guidance for the implementation. An implementation strategy has to be planned and the actions have to be defined and the implementation plan needs to be reviewed and approved, before the implementation is done.

Once the controls are implemented, then the assessment of security controls is done to find out whether the controls have been correctly implemented, working as intended, and giving the desired output with respect to the security requirements. In short, whether the applied security controls are indeed the right ones, done in the right way, giving the right outcome. NIST SP 800-53 [5], NIST 800-53A [6], NIST 800-115 [8-11] can provide the necessary guidance, here. 

***

md-defeated-

[Frustrated Physician]

***

The authorization of information systems is an official management decision, authorizing that the information system can be made operational, with the identified risks mitigated and the residual risks accepted, and is accountable for any adverse impacts on the confidentiality, integrity and availability of information systems. If the authorizing personnel find that the risks are not mitigated and hence can compromise the sensitive information, they can deny authorizing the information system. NIST SP 800-37 [2] provides guidance on authorization. The authorizing personnel are to be involved actively throughout the risk management process.

Risk management is not one-time process, that once it is done, it is forgotten. It is a continuous process, to be integrated with day-to-day activities. One of the key aspects of any risk management is the monitoring of security controls to check whether the controls are performing as intended. The main focus of monitoring security controls is to know whether the controls are still effective over a period time, given the changes that occur in the information systems — the changes in hardware, software and firmware, the changes in environment factors, operating conditions etc. NIST SP 800-37 [2] provides guidance about this. And, if the security controls are found to be ineffective, the cycle starts again, with either re-categorization or selecting another set of baseline controls, or assessing the effectiveness of the controls once more etc.

Regardless, in all the steps in risk management framework, one of the important aspects is communication. Appropriate documents needed to be generated in all the steps, reviewed and kept up-to-date.

Organizational risk management provides great benefits to the organization because it helps to prioritize the resources, increase interoperability, and reduce costs incurred due to the adverse effects. It helps to prevent unauthorized access to personally identifiable information which will lead to security breaches. 

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ABOUT 

Mr. Shahid N. Shah is an internationally recognized healthcare thought-leader across the Internet. He is a consultant to various federal agencies on technology matters and winner of Federal Computer Week’s coveted “Fed 100″ Award, in 2009. Over a twenty year career, he built multiple clinical solutions and helped design-deploy an electronic health record solution for the American Red Cross and two web-based eMRs used by hundreds of physicians with many large groupware and collaboration sites. As ex-CTO for a billion dollar division of CardinalHealth, he helped design advanced clinical interfaces for medical devices and hospitals. Mr. Shah is senior technology strategy advisor to NIH’s SBIR/STTR program helping small businesses commercialize healthcare applications. He runs four successful blogs: At http://shahid.shah.org he writes about architecture issues; at http://www.healthcareguy.com he provides valuable insights on applying technology in health care; at http://www.federalarchitect.com he advises senior federal technologists; and at http://www.hitsphere.com he gives a glimpse of HIT as an aggregator. Mr. Shah is a Microsoft MVP (Solutions Architect) Award Winner for 2007, and a Microsoft MVP (Solutions Architect) Award Winner for 2006. He also served as a HIMSS Enterprise IT Committee Member. Mr. Shah received a BS in computer science from the Pennsylvania State University and MS in Technology Management from the University of Maryland. 

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***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

READINGS

[1] National Institute of Standards and Technology Special Publication 800-30 Revision 1, Guide for Conducting Risk Assessments, http://csrc.nist.gov/publications/nistpubs/800-30-rev1/sp800_30_r1.pdf

[2] National Institute of Standards and Technology Special Publication 800-37 Revision 1, Guide for Applying the Risk Management Framework to Federal Information Systems, http://csrc.nist.gov/publications/nistpubs/800-37-rev1/sp800-37-rev1-final.pdf

[3] National Institute of Standards and Technology Special Publication 800-60 Volume I Revision 1, Guide for Mapping Types of Information and Information Systems to Security Categories, http://csrc.nist.gov/publications/nistpubs/800-60-rev1/SP800-60_Vol1-Rev1.pdf

[4] National Institute of Standards and Technology Special Publication 800-60 Volume II Revision 1,  Appendices to Guide for Mapping Types of Information and Information Systems to Security Categories, http://csrc.nist.gov/publications/nistpubs/800-60-rev1/SP800-60_Vol2-Rev1.pdf

[5] National Institute of Standards and Technology Special Publication 800-53 Revision 4, Security and Privacy Controls for Federal Information Systems and Organizations, http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-53r4.pdf

[6] National Institute of Standards and Technology Special Publication 800-53A Revision 4, Assessing Security and Privacy Controls in Federal Information Systems and Organizations, http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-53Ar4.pdf

[7] National Institute of Standards and Technology Special Publication 800-70 Revision 2, National Checklist Program – Guidelines for Checklist Users and Developers Recommendations of the National Institute of Standards and Technology for IT Products, http://csrc.nist.gov/publications/nistpubs/800-70-rev2/SP800-70-rev2.pdf

[8] National Institute of Standards and Technology Special Publication 800-115, Technical Guide to Information Security Testing and Assessment, http://csrc.nist.gov/publications/nistpubs/800-115/SP800-115.pdf

[9] National Institute of Standards and Technology Special Publication 800-137, Information Security, http://csrc.nist.gov/publications/nistpubs/800-137/SP800-137-Final.pdf

[10] U.S. Department of Health and Human Services, HIPAA Security Series, Security Standards: Technical Safeguards, http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/techsafeguards.pdf

[11] U.S. Department of Health and Human Services, HIPAA Security Series, Security Standards: Physical Safeguards, http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/physsafeguards.pdf

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Electronic Medical Data Exchange in Denmark

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Used by 91% of doctors according to research2guidance

By Ralf Jahns

ralf

Denmark emerges as the number one country to start an mHealth business according to a survey conducted by research2guidance in partnership with HIMSS Europe. Over 5000 app developers, healthcare professionals and mHealth practitioners took part in the “European mHealth App Market Ranking” survey, where participants were asked to rank the mHealth App market readiness of the 28 EU member states. The results were recently revealed by Ralf Jahns, Managing Director at research2guidance, during the HIMSS Europe event in Riga, the mHealth Summit, on 12th May 2015.

The results, which establish Denmark as having the best market pre-requisites needed for an mHealth business, are based on the average of the scores in five categories: eHealth adoption, level of digitalisation, market potential, ease of starting an mHealth business and mHealth regulatory framework. Hans Erik Henriksen, CEO of Healthcare Denmark commented on the survey findings: “Denmark has a very digitalised society and is familiar with using technology in healthcare, supported by a regulatory framework. The research2gudiance and HIMSS Europe survey confirms the progress we are making. I sincerely hope that this will inspire the European countries and mHealth community in their efforts to progress mobile solutions, which will make a big difference for our citizens”. Denmark ranked top country for eHealth adoption being the only country where exchanging patients’ medical data electronically is used amongst 91% of doctors, whereas the average of other covered countries is only 34%

In terms of market attractiveness and healthcare investments, Denmark is at the top in the mHealth market potential category, together with Austria which also has one of the highest expenditures for health. The ease of starting mHealth business category describes how easy it is to start and maintain a new business based on the number of days needed to start business, the number of necessary start-up procedures to register a business and the level of tax and, in this case, Denmark also ranked extremely high, as the smaller countries – Ireland was also top in this category – tend to support new businesses better compared to larger countries. Rainer Herzog, General Manager at HIMSS Europe, added: “This year’s survey has revealed that the market conditions for mHealth which Denmark offers are truly remarkable. This has been the largest global mHealth research study to date and there are different learnings that could be drawn from the EU countries’ mHealth App Market Ranking. Ultimately though, although mHealth is still it is an emerging market, and a number of countries in Europe are currently in the process of defining their mHealth roadmaps, Denmark leads the way in all aspects”.

eHRs

Download the full mHealth study report here.

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Health Data Breaches Multiplying

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YET – Fines Remain Rare

By Charles Ornstein @charlesornstein

[ProPublica]

Federal health watchdogs say they are cracking down on organizations that don’t protect the privacy and security of patient records, but data suggests otherwise.

***

Fines Remain Rare Even As Health Data Breaches Multiply

***

data

***

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Even More:

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Hospital Data Does NOT Equal Community Health

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More on Big Healthcare Data

Edward Bukstel[By Edward Bukstel]

 ME-P SPECIAL REPORT

***

Hospital Data does not Equal Community Health.

***

eHR diagram

***

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The Initial [Estimated] Costs of Electronic Health Records Systems

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A Decade Look-Back Analysis

[By Richard Mata MD MIS]

Dr. MataStudies by the Organization for Economic Cooperation and Development (OECD) showed that healthcare spending in the U.S. accounted for 15.3% of GDP, which is more than six percentage points higher than the average of 8.9% in other OECD countries.  This translates into per capita health spending of $5,635 in the U.S. compared with median costs of $2,280 in other OECD countries.[1]

Suggestions as to the economic drivers of U.S. health spending include excessive service use, administrative complexity, population aging, threats of malpractice litigation, defensive medicine practices, and the lack of patient waiting lists.  In further comparisons with the OECD countries, it appears the U.S. overpays for physician visits, hospital stays, and pharmaceuticals.

In 2004

A 2004 OECD paper suggested that one way of improving performance would be to move towards EHR:

Health systems should invest in automated health-data systems, including electronic medical records and systems to automate medication orders in hospitals. Better systems for recording and tracking data on patients, health and health care are needed to make major improvements in the quality of care. [2]

In the U.S., possible savings from the adoption of EHR have been projected to reach $142 billion in physician office visits, and $371 billion in hospital costs over a 15-year period.  These projections have not been validated by the experience in other OECD countries where the adoption movement is ahead of U.S. efforts by anything from four to thirteen years.

Nevertheless, the U.S. began its quest to move towards EHR in 2004 as medical software companies began actively marketing their systems, although funding for this endeavor did not come through until 2006.

In spite of this effort, the U.S. has the lowest percentage of physician providers using any EHR compared to Germany, Canada, United Kingdom, and Australia.  The U. S. physicians’ low adoption rate involves fear of the loss of productivity, lack of financial incentives, and high startup costs of as high as $40,000 per physician EHR adoption.

When spending on IT implementation in the healthcare system is compared on an international level, the U.S. lags dramatically behind the major OECD countries.  The U.S. spends $0.43 per capita compared to a high of $193 in the U.K.  This difference is even more dramatic when compared with the German experience, where IT adoption in the healthcare system is almost universal.  In thirteen years, Germany has spent $1.88 billion.  Their annual per capita cost has been $1.63.  The U.S. has reached only 25% of that expenditure so far.

The greatest barrier to adoption of EHR in most OECD countries has been the need to simplify the health insurance contracts payment structures with standard nomenclatures that can be adapted to EHR.  The major OECD countries also report that there must be a national adoption of IT standards in the healthcare system as well as a national effort to focus on privacy and confidentiality standards.  This assures better coordination of implementation and provides better strategies for adoptions through public incentives and grants.

In the U.S., the five-year costs for a national IT healthcare network have been estimated to be as high as $103 billion in capital and $53 billion in interoperability.  Hospital costs for functionality were estimated to be $51 billion, skilled nursing facilities would bear $31 billion of costs, and physician offices would bear $18 billion of the costs. (Anderson, 2006)  EHR systems that have been implemented have been used mainly for administrative rather than clinical purposes.

***

hospital bills

***

In 2005

A 2005 study by Richard Hillestad and colleagues at RAND [3] estimates that implementation of a nationwide EHR network would take about 15 years and cost hospitals about $98 billion and physicians about $17 billion.  Over the 15-year period, the average annual cost to hospitals would be $6.5 billion and the average annual cost to physicians would be $1.1 billion (CQ HealthBeat [1], 9/14).

However, if 90% of providers adopted such a network, annual savings would total $81 billion, including $77 billion from improved efficiency and $4 billion from reduced medical errors, the RAND study found.  The study estimates that an EHR network would reduce adverse drug events in inpatient hospital settings by 200,000 annually and reduce such events in ambulatory settings by two million annually, saving $1 billion annually in hospitals and $3.5 billion in ambulatory settings.

For hospitals, about 60% of these savings would be from reduced adverse drug events in patients ages 65 and older, while 40% of savings to ambulatory practices from reduced medication errors would be in patients 65 and older (CQ HealthBeat [1], 9/14).

In addition, the study estimates that a national EHR network would save Medicare about $23 billion annually and save private insurers about $31 billion annually.  The study projects that the estimated total annual savings of $81 billion would double if providers followed all checkup reminders and other prompts from the system (AP/Las Vegas Sun, 9/14).  Currently, about 20% to 25% of hospitals and 15% to 20% of physician offices have EHR systems, according to the study (CQ HealthBeat [1], 9/14).

Assessment

What about today in 2015? How close have these estimates been?

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[1]    For details of the report, see http://www.oecd.org/dataoecd/29/52/36960035.pdf.

[2]   OECD, Towards High-Performing Health Systems, see http://www.oecd.org/document/26/0,2340,en_2649_37407_31734042_1_1_1_37407,00.htm.

[3]   See http://www.rand.org/health/feature/2006/060414_shekelle.html.  The report is also discussed in some detail in Neergaard, AP/Las Vegas Sun, 9/14/05.  See http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=114707.

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Understanding “Meaningful Use” Attestation Numbers for 2014

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Providers versus Hospitals

By CMS

ME121014_PAGE_16

Assessment

So, what do the hospitals know –  that the doctors do not?

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Saving Private Medical Practice?

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Can the EHR Save this Business Model?

[Dr. David Edward Marcinko MBA]

Dr David E Marcinko MBAHealthcare insurance reform from the Obama Administration – as incremental as it will be on both the Federal Medicare and State Medicaid levels from 2014 to 2018 – forces medical providers to look for more efficient ways to provide services, as well as additional sources of revenue in a margin-diminishing business model.

Total federal spending for both programs, under current Office of Management and Budget [OMB] assumptions, are growing. Skepticism is prevalent throughout the healthcare industry about the benefits and the role of market competition in the provision of healthcare services, despite pronouncements by the Federal Trade Commission (FTC) and Department of Justice (DOJ) that competition has positively affected healthcare quality and cost-effectiveness, and recommendations that many of the barriers to competition that prevent it from fully benefiting consumers be removed.

And so, according to Cimasi, Alexander and Zigrang of Health Capital Consultants LLC, and others; this growing economic tension has threatened the traditional private medical practice business model.

[Private communication: http://www.HealthCapital.com]

***

EHR

 ***

Link: http://www.medicalpracticeinsider.com/news/infographic-can-ehr-save-private-practice

Assessment

The “tipping point” has been reached, according to some experts, as the private practice model falls below 50/50.

Rhetorical Questions

  • What will save private medical practice as we know it.
  • Does it need to be saved, at all?
  • Will EHRs be the salvation?

Conclusion

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EHRs – AMA versus ADA

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Will Electronic Health Records Ever Be Usable?

[By Darrell K. Pruitt DDS]

1-darrellpruittThe American Medical Association

The AMA attempts to address the frustration EHRs create, especially for doctors and other healthcare workers. ‘It’s easy to use, once you know where everything is,’ the instructor said during an EHR training session I recently attended.

Most EHR companies seem to believe this is an acceptable way to design software. EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue.

This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians’ professional satisfaction.” Commentary by Stephanie Kreml for InformationWeek, September 26, 2014.

http://www.informationweek.com/healthcare/electronic-health-records/will-electronic-health-records-ever-be-usable/a/d-id/1316071

The American Dental Association

On the other hand, “EHRs provide long-term savings and convenience,” no byline, ADA News, December 6, 2013.

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

boxing-gloves-1053702

[POW – SPLAT – BIFF – UGH]

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs
  5. Borges versus Kvedar Video eHR Debate

EHRs versus the Federal Government

Government mandated EHRs – what a waste!

“Doctors, Hospitals Went Digital, But Still Can’t Share Records – After spending billions to switch from paper to digital records — much of it taxpayer subsidized through the economic stimulus package — providers say the systems often do not share information with competitors.”

[Kaiser Health News, October 1, 2014]

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/01/marketplace.aspx

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Divorcing your EHR Sytem [A How to Approach]

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Planning for an Escape Hatch

[By Shahid N. Shah MS]

Shahid N. ShahAs a doctor, or physician executive, you will spend weeks or months in the “sales and demo cycle” for selecting an EMR. If you’re lucky you will have time to consider all workflows; if you’re even luckier you will test drive the UI and make sure training goes smoothly.

You will also try to ensure that deployment will be easy.

However, another thing not to forget is to plan how to get out of an application or system after it’s been installed for a while.

It’s Harder to Get Out – Than Get in

Why is getting out important? Every application looks better in a demo than in a working environment and every solution becomes “legacy” sooner or later. Every system will be replaced or augmented at some point in time. The cost of acquisition (“barrier to entry”) is well understood now as something we need to calculate. But the “barrier to exit” or switching cost is something you must calculate at the time you decide what systems to purchase.

If you can’t answer the “how, in 6, 18, or 24 months, will I be able to move on to the next-better technology or system?” question then you’ve not completed your due diligence in the sales cycle. Vendor sales staff are quite reticent to answer the “how do I leave your system” question; you will need to press hard and ask for a plan before signing any contracts.

Some Vendor Queries

When preparing an RFI or RFP, ask vendors specific questions about how easy it is to get out of their technology (rather than just how easy to it is to deploy and interoperate). Put in specific test cases and have your folks consider this fact when they are looking at all new purchases.

Here are some specific factors to consider:

  • Do you own your data or does the vendor? If you don’t have crystal clear statements in writing that the data is yours and that you can do whatever you want with it, don’t sign the contract. Look for a new vendor.
  • Is the database structure and all data easily accessible to you without involving the vendor? If only your vendor can see the data, you’re locked in so be very wary. Find out what database the vendor is using and make sure you can get to the database directly without needing their permission.
  • Are the data formats that the system uses to communicate with other vendors open? If not, you don’t own your data. Be sure that at least CCR and CCD formats are available and that all document data is accessible in standard PDF or MS Office friendly formats. Discrete data should be extractable in XML or HL7.
  • How much of the technology stack is based on industry standards? The more proprietary the tech, the more you’re locked in.
  • Are all the programming APIs open, documented, and available without paying royalties or license costs? If not, when you try to get out you’ll pay dearly.

***

EHRs

***

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Chapter 13: IT, eMRs & GroupWare

Medical Records as Malpractice Defense

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A “Complete and Accurate” Record  

By J. Christopher Miller JD

J. Christopher Miller, Esq

The best defense against any medical malpractice liability claim is a complete and accurate written or electronic record of the facts.

To Observe and Treat

In particular, medical malpractice claims will frequently be stalled or thwarted by a consistent written description of the symptoms you observe and the treatments you prescribe.

Extensive record keeping will not only help formulate a defense against a claim, but it will also (and perhaps more importantly) create the appearance that you are careful and highly competent in all of your affairs. Members of a jury may not be able to discern whether the medical judgments you made in a particular case were good or bad, as they do not have the years of education and training that you do.

Trial Jurors

Jurors can, however, sense whether your practice is organized and professional. If your records are thorough and consistent, jurors will assume that you dedicate as much attention to the substantive aspects of your work as you do to the tedium of recordkeeping. If you are active in the management of your office, you should keep track of its operations and establish logs for your employees to complete as they perform their daily tasks.

Assessment

Not all information, however, ought to be written down. Keep your written records to the facts you have observed and leave your speculations for department meetings.

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Can Politically-Correct Names Save Obamacare?

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Saving Electronic Health Record Interoperability?

1-darrellpruittBy D. Kellus Pruitt DDS

If HHS successfully persuades Americans to use happy names for its bad ideas, will the cheap trick save electronic health record interoperability which is critical to the success of Obamacare?

Healthcare Lexicon 

According to the government’s modernized healthcare lexicon, doctors have been demoted to “providers,” insurance companies, including Medicare/Medicaid, have been promoted to “payers,” and patients’ position in the hierarchy has diminished from “principals” to “stakeholders” – a rank on par with 3rd parties such as insurers, HHS and other unaccountable parasites.

Wall of Shame

Ominously, HHS recently changed the contentious name “Wall of Shame” to a more innocuous“ breach reporting tool,” to describe the public list of data breaches involving the medical records of more than 500 patients. It turns out that the growing list of major data breaches is unexpectedly shaming  far too many providers and payers – including Medicare/Medicaid. Imagine that!

In fact, since Americans’ growing disgust with privacy breaches threatens the very success of Obamacare, there is evidence that HHS has turned to betraying its lawful obligation to the nation by hiding breaches from those who are most vulnerable – Americans.

HIPAA Failure

The half-baked plan to shame providers who experience data breaches – perhaps through no fault of their own – is not working out like HHS had hoped. Due to HIPAA’s abysmal failure to halt data breaches, the Wall of Shame has become a national embarrassment and an obstacle to EHR adoption. I expect the public listing of major breaches to be quietly scrapped soon in favor of keeping patients in the dark concerning their risks of identity theft.

Dentistry 

In dentistry, on the other hand, common sense as well as market resistance evidently caused HHS and other stakeholders to give up trying to prohibit use of the 8 syllable “electronic dental records” in favor of the 14 syllable “electronic health records for dental practices.”

Nevertheless, holdouts (including Dissent Doe) still occasionally feel it is important to correct this dentists when I use “EDR” instead of “EHR.” You got to love ‘em.

Obama Care 

Assessment 

Transparent silliness suggests that HHS is failing in its duties. Due to lack of accountability, we can expect EHRs and EDRs to become even more expensive and more dangerous, possibly bringing an end to Obamacare.

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Common Daily Clinician Health Technologies

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Most Commonly Provided to Support Daily Activities

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Health Technology

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Do Medical Practices Really Like EHRs?

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Do practices like functionality and cost?

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EHR

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  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs

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Are Dentists Satisfied with their EDRs?

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Major Discontent With EHR Adoption

[By D. Kellus Pruitt DDS]

1-darrellpruittUnlike physicians, dentists never complain. That means they are probably 100% satisfied with their electronic dental records.

What do you think, Doc?

MarketWatch 

Recently, the Wall Street Journal’s MarketWatch posted a press release titled, “Physicians Cite Major Discontent With Adoption And Use of Electronic Health Record Systems, Despite Government’s $27 Billion Incentive Program”

http://www.marketwatch.com/story/physicians-cite-major-discontent-with-adoption-and-use-of-electronic-health-record-systems-despite-governments-27-billion-incentive-program-2014-02-07

“CLEVELAND, Feb. 7, 2014 /PRNewswire/ — The $27 billion government experiment to incentivize physicians to convert to electronic health records (EHRs) has not been worth it, according to nearly 70% of physicians surveyed.

Medical Economics 

***

In fact, a national [Medical Economics] survey of nearly 1,000 physicians, set for release on February 10, 2014, shows widespread dissatisfaction related to the functionality and cost of these patient record systems. About 45% of physicians believe patient care is actually worse as a result of adopting EHR technology, two-thirds would not purchase their current EHR system again, and 43% of physicians say these systems have resulted in significant financial losses.

In addition, the current state of technology has not improved the coordination of care with hospitals, physicians say.”

***

It is probably better for HHS that very few dentists were able to participate in the ARRA stimulus giveaway. Otherwise, tax-paying citizens might have learned about the wastefulness of Meaningful Use requirements for dentists – which nobody has the guts to reveal. That pretty much rules out brilliant Meaningful Use ideas.

Those who might patriotically defend the benefits of the tasks would do so, if they were idiots.

So how do dentists feel about their electronic dental records? It’s hard to tell. Over 96% of them are HIPAA-covered entities, making them vulnerable to audits, which can be “random” now. As one can imagine, very few dentists openly discuss EDRs. Do you think the silence is more likely to improve or harm patient care?

doc

Even though thousands of physicians have participated in dozens of national surveys like Medical Economics’ over the last few years, as far as I know, not one survey of dentists’ opinions has ever been published. Perhaps someone can prove me wrong. I doubt it.

The Survey

The results from the Medical Economics survey include:

  • 67% say that system functionality influences their decisions to purchase or switch systems.
  • 48% say that cost is influencing their decisions to purchase or switch systems.
  • Nearly half of physicians say that implementation of EHR systems has made the quality of patient care worse.
  • 69% of respondents say that coordination of care with hospitals has not improved.
  • 45% say they have spent more than $100,000 on an EHR
  • 77% of the largest practices (more than 10 physicians) spent more than $200,000 on an EHR.
  • 38% doubt their systems will still be viable in 5 years.

Assessment

Not long ago, Wisconsin became the first state to outlaw paper dental records, which are both cheaper and safer than digital.

So, is it still too soon for dentists and patients demand more transparency in dentistry? When costs and danger are hidden in dental care, it is always the last in line who suffer the most – clueless, trusting dental patients.

Am I right, Doc?

More:

  1. Sales of Dental Equipment and eDRs Down
  2. Military Electronic Dental Records [eDRs]
  3. Dr. Pruitt Invites Dr. Cohen to Discuss eDRs
  4. Cyber Insurance for Dentists

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Before You Jump to a Full-Fledged EMR Check Out Other Options [Part 2]

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HIT: PART TWO

By Shahid Shah MS

Shahid N. ShahWowsa!

What a year [2013] in the HIT business?

Because of all the talk about EMRs and medical records software you’ll have many reasons to start immediately looking for an EMR vendor.

Try to resist that urge and look at broader non-EMR solutions that can help remove some of the non-clinical burdens from your staff in 2014:

  • Fax Server – a fax server allows you to centrally manage all incoming and outgoing faxes. Since most medical practices live on fax, this is one of the fastest investments you can recoup.
  • Shared drives – start using shared drives either using your existing software or you can purchase inexpensive “network disks” for a few hundred dollars to share business forms, online directories, reports, scanned charts, and many other files.
  • Online backups and Internet PACS storage – there are online tools like JungleDisk.com that allow you to store gigabytes of encrypted data into the Internet “cloud” for just a few dollars a month.
  • E-mail (beware of HIPAA, though) – internal office messaging and email is a great place to start. If you haven’t started your office automation journey here you should. If you’re going to use it for patient communications you’ll need to make sure you have patient approvals and appropriate encryption. If you’re on Gmail today and you want to have customers immediately be able to communicate with you on Gmail, that’s generally HIPAA compliant because communications between two Gmail accounts stays within the Google data center and is not sent unencrypted over the Internet.
  • E-Prescribing – e-prescribing is a great place to start your automation journey because it’s a fast way to realize how much slower the digital process is in capturing clinical data. If e-prescribing alone makes you slower in your job, EMRs will likely affect you even more. If you’re productive with e-prescribing then EMRs in general will make you more productive too.
  • Office Online and Google Apps (scheduling, document sharing) – Google and Microsoft® have some very nice online tools for managing contacts (your patients are contacts), scheduling (appointments), dirt simple document management, and getting everyone in the office “on the same page”. Before you jump into full-fledged EMRs see if these basic free tools can do the job for you.
  • Modular clinical groupware – this is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most-needy patients and leave the remainder of them as-is. By automating what’s taking the most of your time you don’t worry about the majority of patients who aren’t.
  • Patient registry and CCR bulletin boards – if you’re just looking for basic patient population management and not detailed office automation then patient registries and CCR databases are a great start. These don’t help with workflow but they do manage patient summaries.
  • Document imaging – scanning and storing your paper documents is something that affects everyone; all scanners come with some basic imaging software that you can use for free. Once you’re good at scanning and paper digitization you can move to “medical grade” document managements that can improve productivity even more.
  • Clinical content repository (CMS) – open source systems like DrupalModules.com and Joomla.org do a great job of content management and they can be adapted to do clinical content management.
  • Electronic lab reporting – if labs are taking up most of your time, you can automate that pretty easily with web-based lab reporting systems.
  • Electronic transcription – if clinical note taking is taking most of your time, you can automate that by using electronic transcribing.
  • Speech recognition – another “point solution” to helping with capturing clinical notes; you can get a system up and running for under $250.
  • Instant Messaging (IM) – IM gives you the ability to connect directly with multiple rooms within your office using free software; if you want, you can also connect with patients and other physicians during work hours.

working with computer

Assessment

Can you think of any others?

Part One: Before you Jump to a Full-Fledged EMR Check out Other Options [Part 1]

Conclusion

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Before you Jump to a Full-Fledged EMR Check out Other Options [Part 1]

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HIT: PART ONE … OF TWO PARTS

By Shahid Shah MS

Shahid N. Shah MSWowsa!

What a year [2013] in the HIT business?

Because of all the talk about EMRs and medical records software you’ll have many reasons to start immediately looking for an EMR vendor.

Try to resist that urge and look at broader non-EMR solutions that can help remove some of the non-clinical burdens from your staff in 2014:

  • Using Microsoft Office Outlook® or an online calendaring system like Google to maintain patient schedules. While most vendors of clinical scheduling will tell you that medical scheduling is too complex to be handled by non-medical scheduling systems, most small and medium sized physician practices can easily get by with free or very inexpensive and non-specialized scheduling tools. By using general-purpose scheduling tools you will find that you can use less expensive consultants or IT help to manage your patient scheduling technology needs.
  • Using off-the-shelf address book software such as those built into Microsoft Office®, the Windows® and Macintosh® operating systems, or online tools such as Google apps you can maintain complete patient and contact registries for managing your patient lists. While a patient registry may not give you all of the features and functions you need immediately they can grow to a system that will meet your needs over time.
  • Using physician practice management systems you can remove much of the financial bookkeeping and insurance record-keeping burdens from your staff. Unlike calendaring or address book functionality which can be adapted from non-medical systems, insurance claims and related bookkeeping is an area where you should choose specific software based on how your practice earns its revenue. For example if a majority of your claims are Medicare related, then you should choose software that is specifically geared towards government claims management. If however your revenue comes less from insurance and more from traditional cash or related means you can easily use small business accounting software like Quicken® or Microsoft accounting.
  • Using computer telephony technology you can integrate automatic call in and call out the services that can be tied to your phone system so that you can track phone calls or send out call reminders.
  • Using integrated medical devices that can capture, collect, and transmit physiological patient data you can reduce paper capture of vital signs and other clinical data so that your staff are freed to do other work.
  • Using e-mail, instant messaging, social networking, and other online advanced tools you can reduce the number of phone calls that your practice receives and needs to return and yet continue to improve the patient physician communication process. One of the most time-consuming parts of any office is the back-and-forth phone calls so any reduction in phone calls will yield significant productivity increases.

eHRs

Assessment

Can you think of any other work-arounds?

Conclusion

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The Percentage of Office-Based Doctors with EHRs

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US 2001-2013

By www.MCOL.com

EHR

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The RAND Corporation’s Health IT Legacy‏

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Understanding ObamaCare and HIT Data Breaches

[By Darrell K. Pruitt DDS]

1-darrellpruittTwo current topics in the HIT industry: (1) A dishonest 2005 RAND study set up lawmakers for disappointment in electronic health records, which are essential to Obamacare, and (2) I told you so.

The Reports

Just the other day, there were reports of two data breaches of EHRs involving over 734,000 patients in Texas and California.

http://www.ihealthbeat.org/articles/2013/10/23/health-facilities-in-california-texas-report-health-data-breaches

For reasons like this, the wisdom of an ambitious mandate for paperless healthcare by 2014 is beginning to be questioned by the same lawmakers who were sucked in years ago by RAND’s tainted 2005 study.

According to the vendor-friendly results gleaned from vendor-friendly data supplied by vendors, EHRs should have started saving 100,000 lives and $77 billion a year, years ago. Predictably, that has not happened. Far from it!

The Findings 

The happy findings – discredited even by RAND in January of this year – were paid for by Cerner and GE, who profited immensely from their RAND investment. Since nationwide adoption of EHRs became a bi-partisan goal with bubbly beginnings and millions of campaign dollars, the costs and danger of healthcare IT didn’t appear to bother conservatives until three months after RAND admitted the study was garbage.

In April, six GOP senators, led by Sen. John Thune (R-S.D.), released a detailed report criticizing HHS Secretary Kathleen Sebelius’ execution of a $35 billion initiative to promote EHRs as part of the ARRA stimulus package. (See: “GOP senators raise concerns with push for electronic medical records,” by Sam Baker, April 16, 2013, The Hill).

http://thehill.com/blogs/healthwatch/medicare/294273-gop-senators-raise-concerns-with-push-for-electronic-medical-records

Wither ARRA?

Have you ever wondered why ARRA was passed as a jobs bill rather than as part of healthcare reform? Any ideas?

More recently, with the conservatives’ failure to stop Obamacare even by shutting down government, EHRs have become recognized as the ACA’s next best weakness. Yesterday, Greg Scandlen, writing for RightSideNews.com, posted “The Tyranny of Electronic Systems.” It goes downhill from there.

http://www.rightsidenews.com/2013102333379/life-and-science/health-and-education/the-tyranny-of-electronic-systems.html

Even More

Also yesterday, Michelle Mailkin writing for Townhall.com, an ultra-conservative website similar to RightSideNews, posted, “Don’t Forget Obamacare’s Electronic Medical Records Wreck.

http://townhall.com/columnists/michellemalkin/2013/10/23/dont-forget-obamacares-electronic-medical-records-wreck-n1730172?utm_source=TopBreakingNewsCarousel&utm_medium=story&utm_campaign=BreakingNewsCarousel

Assessment 

Conservatives found traction: Without the anticipated healthcare savings from EHRs, Obamacare will not survive. These times are not as happy for EHR stake-holders as RAND led them to expect.

Conclusion

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Informatics at the Intersection of Healthcare IT

An Informative Inforgraphic

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Did you know that 50,000 HIT professionals will be needed in the next 7 years?
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Well, that’s according to the University of Illinois at Chicago’s Online Health Informatics Program, which published an infographic asserting that the industry needs new ways to provide improved care, sans errors. And, healthcare informatics is where that potential resides.
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But, what do healthcare informaticists actually do? What are the sub-disciplines of the practice? And, how do they enhance medical care delivery? … Scroll down to find out.

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it

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Related Resources

Conclusion

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The Danger of Used Health Information Technology

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Remember to destroy that hard drive!

By D. Kellus Pruitt DDS

1-darrellpruittNEWS FLASH!

Affinity Health Plan to Pay $1.2 Million+ for HIPAA Violations -The HHS Office for Civil Rights on August 14 sent the industry a message on the importance of erasing protected health information on hardware being sold, recycled or returned,” by Joseph Goedert, HealthDataManagement.

http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-affinity-46483-1.html

Talk about bad luck

A photocopier once leased by Affinity Health was purchased by CBS Evening News – which discovered that the copier’s hard drive contains 344,579 individuals’ unencrypted Protected Health Information.

The Response

In response to the federal investigation triggered by the CBS discovery, the Office of Civil Rights announced: “OCR’s investigation indicated that Affinity impermissibly disclosed the protected health information of these affected individuals when it returned multiple photocopiers to leasing agents without erasing the data contained on the copier hard drives.

Moreover ….

In addition, the investigation revealed that Affinity failed to incorporate the electronic protected information stored on photocopier hard drives in its analysis of risks and vulnerabilities as required by the Security Rule, and failed to implement policies and procedures when returning the photocopiers to its leasing agents.”

Assessment

Before disposing of used technology, remember to destroy the hard drive.

Conclusion

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Do Nurses like EHRs?

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Do RNs like using electronic health records?

[A seldom considered POV]

1-darrellpruitt

BY Darrell K. Pruitt DDS

Some Facebook comments:

Big problems when you have unexpected “downtimes”.

July 15 at 3:10pm · Like · 4

It is an absolute train wreck. I haven’t seen one record of mine that is not riddled with mistakes. Especially the allergies, they show me taking meds I’m allergic to and not taking meds I’m actually on. A true mess!! And now the records are all intertwined. I don’t like it at all!!

July 15 at 3:10pm · Like · 2

It is a nightmare!

July 15 at 3:18pm · Like

I retired just in time so I don’t have to deal with this fiasco.

July 15 at 3:19pm via mobile · Like · 2

IT SUCKS

July 15 at 3:19pm · Like

I don’t like them; my doctors don’t like them; how it will affect patient care is still a ‘jury out’ matter, but we can guess it will NOT help.

July 15 at 3:30pm · Like

Our Rural Community Healthcare system is just now switching over to this .. along with our hospital switching over to a totally new computer system .. the 2 systems do not talk to each other..In my personal experience I find that the “computer” world takes us away from Direct Patient Care (to busy playing “ring around the Rosie” on the computer).

July 15 at 3:40pm · Like · 4

I like them, but it is frustrating having “downtime.”

July 15 at 3:41pm · Like

I hear patients stating things like “my doctors don’t know who I am because they don’t look at me they are glued to the computer”. It saddens me patients feel less valued. I’ve worked in places where they’ve had paper charts and places computerized. Seems the computers are redundant and I personally prefer paper charts. Chart one assessment not one assessment 4 different places.

July 15 at 3:44pm via mobile · Like · 3

It looks to me like physicians are cutting and pasting old histories and physicals, complete with the errors. Doctors in a local ER charted complete physicals on me when they did not get closer than 5 feet away. The records are difficult to read, difficult to find information; and it is not number in chronological order.

July 15 at 3:47pm · Like

I dislike it. Besides the down time, I find it very impersonal. I don’t feel as if I am giving my full attention to my pt, nor do I feel my PCP is hearing what I’m saying . They are too busy putting in info on the computer. As for the down time you then have to work late to put in the info gathered while the system is down.

July 15 at 3:47pm via mobile · Like · 2

eHRs

Assessment

https://www.facebook.com/friendanurse/posts/654085127954821

More: On DIgital Deaths

http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

(50+ other comments)

Conclusion

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Update on Physician SOAP Notes

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An Encore Presentation

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

www.BusinessofMedicalPractice.com

DEM 2013I wrote on this topic previously. Both as primary paper driven SOAP notes, and as next-gen electronic SOAPier notes, to much acclaim and derision.

  • Why? Because, now more than ever, inadequately documented medical charts can mean civil and criminal liability to the sloppy and/or unwary practitioner. And, medical records were previously used to aid in the quality of medical care.

Today, they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing.

What is a SOAP Note?

SOAP notes

Assessment

SOAP[IER] eMRs [Beware the Alphabet Soup Switcher-Roo]

Conclusion

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Understanding the “Language” of Healthcare Finance, IT, Economics and Insurance

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By Ann Miller RN MHA

The ME-P is Doing Its’ Part with Comprehensive Dictionaries and Glossaries

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The Flaws of Electronic Records

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Reporting on an Op-Ed by Drexel University’s Scot Silverstein

By Darrell K. Pruitt DDS

pruittRecently, on Philly.com, I read the following interesting essay and counter-opinion.

“The flaws of electronic records – Drexel University’s Scot Silverstein is a leading critic of the rapid switch to computerized medical charts, saying the notion that they prevent more mistakes than they cause is not proven.”

by Jay Hancock, writing in:

KAISER HEALTH NEWS.

http://www.philly.com/philly/entertainment/20130218_The_flaws_of_electronic_records.html

Do you recall that I advised dentists to wait a year or so before purchasing electronic dental records?

Dr. Silverstein warns Hancock that we’re in the midst of “a mania” as traditional patient charts are switched to computers. “We know it causes harm, and we don’t even know the level of magnitude. That statement alone should be the basis for the greatest of caution and slowing down.”

Silverstein Speaks

Silverstein tells Hancock that he doesn’t discount the potential of digital records to eliminate duplicate scans and alert doctors to drug interactions and unsuspected dangers.

“But, the rush to implementation has produced badly designed products that may be more likely to confound doctors than enlighten them, he says. Electronic health records, Silverstein believes, should be rigorously tested under government supervision before being used in life-and-death situations, much like medical hardware or airplanes.”

Physician George Lundberg, editor at large for MedPage Today, says Silverstein “is an essential critic of the field,” and that “It’s too easy for those of us in medicine to get excessively enthusiastic about things that look like they’re going to work out really well. Sometimes we go too far and don’t see the downside of things.”

Hancock Writes

Hancock writes. “Many say he comes on too strong.” Remind you of anyone? It’s easy to fall into a habit of “coming on too strong” once politeness proves ineffective and not nearly as much fun.

Silverstein points out that since the government doesn’t require caregivers to report problems, “many computer-induced mistakes may never surface.”

In dentistry, EHR stakeholders bury computer-induced mistakes even deeper by ignoring and even censoring dentists’ concerns about cost and safety.

Shah Opines

Furthermore, ME-P thought-leader Shahid N. Shah MS opines in Chapter 4 of the book: www.BusinessofMedicalPractice.com

Chapter 13: IT, eMRs & GroupWare

And … Pruitt Wonders?

I sincerely wonder how many dentists have been kicked off of DrBicuspid, DentalTown, Dental Economics and LinkedIn for pointing out dangerous flaws in advertisers’ dental products. I offered to start a listing of the censored, but got no response. Nevertheless, I bet I’m not the only one.

Assessment

More opinions from ME-P contributors and essayists:

Conclusion

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How I Lost my Battle Against the NPI

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Refusing a National Provider Identifier Number

By Darrell K. Pruitt DDS

pruittI can no longer refuse to apply for a National Provider Identifier (NPI). I lost that long battle. Anyone rejoicing?

I’m spent. My leverage has vanished. Telling insurers “I have no NPI” held much more inherent power than “I have an NPI but I won’t share it with you on principle.” Far too many words. My profession has become dominated by unresponsive, unaccountable 3rd parties that dental leaders in the ADA welcome as policy. Working together, they promote and commandeer the technology dentists purchase and clueless patients pay for in increased fees. I have painfully learned that principles are only for dentists who can still afford them, and it’s a bad economy for luxuries.

Non-HIPAA Entity

Since I am not a HIPAA-covered entity and therefore not required by law to adopt an NPI, my capitulation to extortion disappoints me as an American citizen. I still find it hard to believe that an anti-consumer HIPAA rule enthusiastically enforced by the dental benefits industry could force me to “volunteer” for a PERMANENT identifier. As I and 96% of dentists become jerked around by our NPIs, I hope dental historians note that I am the ONLY dentist who publicly asked “Why?” instead of “Why not?” After 6 years, I’m still awaiting an answer to that question from leaders who continue to promote the NPI to dentists while ignoring their questions.

Dental Benefits Providers

I was able to hold out up until Aetna, Delta Dental and other dental benefits providers deprived my office of access to details of patients’ dental benefits unless I have an NPI. I’m waiting for someone – anyone – to tell me how the identifier can possibly improve the dental care of those who pay Aetna and Delta Dental premiums, especially if their benefits are intentionally kept secret from their dentists. I am certain that if the nation’s employers who purchase dental benefits were aware of the transparent nonsense, they would never purchase such products. Where’s the US Chamber of Commerce? Where’s the FTC? How about the US Constitution?

This is exactly why there needs to be more openness in our profession, Doc. The cockroaches who were invited to quietly overrun dentistry cannot withstand transparency, yet I don’t know how much longer I can fight for it without further risking the health of my practice.

As anyone can understand – and as anticipated by corporate executives in the insurance industry as well as by those with vested interests in the ADA Department of Dental Informatics – to have to explain to new patients why I cannot estimate how much they will owe for treatment would destroy my practice. Outside the US, other societies deem it unethical to deny patients informed consent to treatment for any reason. The NPI is such an egregious blunder that I never expect those who promoted to accept ownership.

###

NPI

Assessment

If I lost the battle, who won? Do EDR enthusiasts in the ADA call this a glorious victory and a likely source of ADA pride for decades to come? Or is it much more shameful? Since I lost freedom, I want to know who won?

Conclusion

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Medical Records [Time Benefits versus Financial Benefits]

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Paper versus eMRs [Organization – InterOperability – Accessibility]

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MRs

Assessment

Chapter 13: IT, eMRs & GroupWare

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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How Physicians Use Digital Media for Interaction

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A Break-Down by Medical Specialty

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Taking-the-Pulse-US-2012

Assessment

Chapter 13: IT, eMRs & GroupWare

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Confusion About “Meaningful Use” Reigns

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Are Doctors Embracing or Ignoring ARRA?

By D. Kellus Pruitt DDS

pruittAre physicians embracing ARRA Meaningful Use cash incentives or ignoring them? That depends on whom one asks.

Doctors versus the Feds

National progress towards Meaningful Use of expensive EHRs depends on whether one talks to federal employees whose jobs depend on the stimulus mandate, or doctors who purchase EHRs to improve care rather than to use them … Meaningfully.

The Feds

Today, Joseph Conn, writing for ModernHealthcare, posted a rosy outlook for MU adoption according to researchers working for HHS’ Office of the National Coordinator (ONC). They base their optimism for job security on a recent National Center for Health Statistics (NCHS) survey:

“A growing number of office-based physicians are using more-robust EHRs that have higher-level functions needed to help the doctors qualify for federal EHR incentive payments [for Meaningful Use] and assist them in providing better, safer care for patients, the researchers reported.” (See “Researchers: More doctors using more-sophisticated EHRs”).

http://www.modernhealthcare.com/article/20121212/NEWS/312129956/researchers-more-doctors-using-more-sophisticated-ehrsJust

eMR and HIT Security

The Doctors

However, yesterday, in an InformationWeek article by Ken Terry titled, “Meaningful Use Doesn’t Drive Doctors’ EHR Selection,” doctors suggested a more depressing future for MU sophistication based on the same NCHS survey:

“Jason Mitchell, MD, assistant director of the Center for Health IT at the American Academy of Family Physicians (AAFP), told InformationWeek Healthcare that he found [the lagging adoption of MU-capable EHRs] puzzling. While there’s no doubt that Meaningful Use has driven much of the increase in EHR use, he said, it seems strange that so many physicians would buy and implement EHRs that could not be used to show Meaningful Use.”

http://www.informationweek.com/healthcare/electronic-medical-records/meaningful-use-doesnt-drive-doctors-ehr/240144093

Assessment

Whom should doctors believe – HHS employees who give away billions of stimulus dollars for Meaningful Use, or family physicians who have determined that the subsidy isn’t worth the cost and effort?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

 

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The “Price” of eHRs

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Race to electronic health records may come with a price

By Fred Schulte

Amid all the enthusiasm over increasing the use of information technology in health, politicians and policy makers paid little attention to the implications of a gold rush sparked when billions of taxpayers’ dollars suddenly came up for grabs. Hundreds of medical technology companies scrambled to sell digital systems — often by promising doctors and hospitals they could boost revenues by billing higher rates to Medicare and other health insurers.

The fallout from those early decisions could be coming back to haunt taxpayers, according to a three-part investigative series from the Center for Public Integrity. The series documented that thousands of medical professionals steadily billed Medicare for more complex and costly health care over the past decade — adding $11 billion or more to their fees — despite little evidence elderly patients required more treatment.

In this essay, reporter Fred Schulte explains how the project came about, how the Center did its reporting and provides plenty of background on medical coding, Medicare billing and the potential fallout as health care providers install and use electronic systems.

Assessment

Full link: Race to electronic health records may come with a price

Publisher’s Note: Fred Schulte is a four-time Pulitzer Prize finalist, most recently in 2007 for a series on Baltimore’s arcane ground rent system. Schulte’s other projects exposed excessive heart surgery death rates in veterans’ hospitals, substandard care by health insurance plans treating low-income people and the hidden dangers of cosmetic surgery in medical offices. He spent much of his career at The Baltimore Sun in Maryland, where I first noted his work, and then the South Florida Sun-Sentinel. Schulte has received the George Polk Award, two Investigative Reporters and Editors awards, three Gerald Loeb Awards for business writing and two Worth Bingham Prizes for investigative reporting. The University of Virginia graduate is the author of Fleeced!, an exposé of telemarketing scams. Schulte can be reached at fschulte@publicintegrity.org or 202-481-1210.

eHRs

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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A Financial eMR “Got-Ya” from Uncle Sam?

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CMS and the Feds Want to Verify Docs eMR Info Before Meaningful Use Payment

By ME-P Staff Reporters

The conversion to electronic medical records [eMRs] is “vulnerable” to fraud and abuse because of the failure of Medicare and CMS officials to develop appropriate safeguards, according to a sharply critical report just issued by federal investigators.

###

[mobile eMR in clincal use]

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Full Report: https://oig.hhs.gov/oei/reports/oei-05-11-00250.pdf

Assessment

Requiring an audit before paying hospitals and doctors could  significantly delay payments to providers.

Ya think!

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Health IT Vendors Ponied-Up Political Cash to Both Parties

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The Presidential Election 2012

This November saw healthcare executives pay big campaign money to both political parties.

Health IT vendors, however, upped the ante this election year, paying out some hefty donations of their own. Judith Faulkner, CEO of Epic, and Allscripts CEO Glen Tullman are among this year’s top spenders.

Source: http://www.govhealthit.com/news/infographic-health-it-vendors-pony-political-cash-both-parties?topic=75

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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