BEST PRACTICES FOR MANAGING THE EVOLUTION OF EHRS

Transcription

1 E-Guide BEST PRACTICES FOR MANAGING THE EVOLUTION OF EHRS SearchHealthIT

2 W ith a focus on, the next wave of EHRs will incorporate powers of big data, speech recognition and new database models. This eguide explains why vendors may stave off stricter EHR with the development of two new vendor codes of conduct. Read on to find out how the meaningful use stage contains eight principal objectives for what s expected to be the final stage of the EHR program. PAGE 2 OF 16

3 NEXT-GENERATION EHRS WILL DRIVE HEALTH DATA INTEROPERABILITY Reda Chouffani The relationship between physicians and EHR systems is a complex one. At one time, these applications acted as repositories for digitized patient charts. Now, more practices are using these systems to help manage patient data generated within the facility, as well as data captured from multiple sources, such as medical imaging systems, referring physicians and lab results. There comes a point when most physicians recognize there is more to an EHR than simply a place for patient medical and social histories, as well as access to labs and digital imaging. But as we consider all the current applications in the marketplace and watch new disruptive technologies emerge, several signs tell us that tomorrow s medical records systems, driven by, will be very different from what we are used to. To evaluate the driving forces behind the evolution of EHRs, we can study the following areas: PAGE 3 OF 16

4 Volume, velocity and variety of health information: EHR systems will need to evolve from using traditional, outdated databases into using robust data engines that can successfully support the three Vs of big data. Many technical folks recognized quickly that traditional database engine systems were not the appropriate tools to manage the data for massive information systems. New systems were introduced by the likes of Google, Yahoo and others, which in turn forced other vendors to adapt their systems to support greater health data. In a similar way, health information is changing; it is constantly being created and it comes in many different formats. Medical devices and integration needs: Many social media sites are buildingopen application programming interfaces (APIs). These APIs enable third-party vendors to easily push and pull information from their sites. Examples include how Facebook can receive score updates from online games, or how fitness applications can post activities directly to Facebook. Because more patients are using more medical devices and their smartphones, EHR vendors will have to open their systems to accept data requests and data submissions in much simpler ways than they do now, without the need for complex integrations and interfaces. PAGE 4 OF 16

5 More natural interactive systems: There has been a significant increase in interest by companies in natural language processing (NLP) engines. In acquiring SkyPhrase last December, Yahoo became another example of how large companies in the tech world are acquiring NLP intellectual property. Others -- such as Apple with Siri and Google with its own engine driving Google Now -- have been leveraging these technologies to help improve the interactions with their end users. But from a healthcare perspective, these tools will have a significant impact on how we interact with systems. EHRs will have a virtual assistant layer that will allow clinicians to interact with the system naturally. Providers will no longer need to deal with complex forms to document discrete data. Nurses will simply have the system record sessions with patients to document their medical and social histories, and NLP will analyze the recordings and correctly populate EHR data fields. More patient-centric and less specialty-based care: The use of accountable care models is on the rise, as is the need to view patients as a whole, comprehensively treating them and closely staying in touch with their environment, lifestyle and mental health state. This is forcing developers to improve how information is collected and presented in EHR systems. PAGE 5 OF 16

6 EHR platforms have continued to adapt over the years. Requirements from meaningful use have forced providers to make changes at a much faster rate. Recognizing the rate of change and some of the disruptive technologies that patients and providers are using will likely force electronic record vendors to invest in more innovation and interoperable. They ll need to become very aggressive when it comes to change to be able to compete and provide value. PAGE 6 OF 16

7 VENDORS CRACK THE CODE ON HOW TO HEAD OFF FUTURE EHR REGULATIONS Ed Burns With its recent release, the EHR Association became the latest member of the health IT vendor community to publish an EHR development code of conduct. The move could help the industry stave off stricter EHR. The EHR Association (EHRA), a partner of the Healthcare Information and Management Systems Society, and which counts among its members some of the largest IT vendors in the country, including Allscripts Healthcare Solutions Inc., Cerner Corp., Epic Systems Corp. and McKesson Corp., published its ninepage Code of Conduct in June. The document sets out principles that would dictate certain practices to vendors who choose to sign on. The principles cover the areas of general business practices, patient safety, and data portability, clinical and billing documentation, privacy and security, and patient engagement. At the time the code was announced none of the EHRA vendors had committed to following it, but Farzad Mostashari, M.D., former national PAGE 7 OF 16

8 coordinator for health IT, said during a Web conference unveiling the code that the announcement was a sign of progress in the industry. It s very positive to see the community coming together and creating those social norms, Mostashari said. These are things that are important for the industry to grow and have our patients prosper. He said he was pleased to see the code cover the area of patient safety. He noted that EHRs have the potential to improve safety, but if designed or implemented improperly could lead to unintended consequences. Mostashari has been an outspoken critic of the EHR vendor community. In several presentations he has talked about the need for the industry to come together and agree upon common standards that would foster. He has said if vendors do not stop competing by hoarding data and locking providers into siloed systems, his office may have to consider new EHR. Michael Barr, M.D., senior vice president of the American College of Physicians, said during the Web conference that the code is a bold step forward toward improving care in the U.S. He said many physicians are experiencing difficulty complying with all the meaningful use measures, as well as other pressures hitting the healthcare PAGE 8 OF 16

9 industry. The fact that many are trying to alleviate these pressures with multiple IT systems that may have been developed with competing objectives makes this challenge even more difficult. However, he said getting EHR vendors to abide by the code could help with some of these issues. I can now go back to our members and say this code addresses some of those concerns, he said. The code would address more specific issues that have grown in prevalence in recent years. Vendors that sign on to the code would agree to enable customers to share data freely with other providers, regardless of the system used by their trading partner. Vendors would also agree to help customers export patient data in the event the customer wants to switch to another EHR system. The code also states that participants must make information about their billing and documentation approaches available to customers. This is intended to make providers aware of coding guidelines and encourage conformity with applicable regulatory and documentation standards. During the EHR upcoding controversy, some commentators said EHR systems make it too easy for doctors to bill for services they did not provide. This provision could help doctors understand their options and limitations. PAGE 9 OF 16

10 The code released by the EHRA is not the first of its kind. Toward the end of last year, EHR vendor athenahealth Inc. published its own Code of Conduct, which it is encouraging other industry stakeholders to sign. This code includes many provisions that are similar to the EHRA code, including allowing providers to take patient records to a new vendor, supporting patient safety and encouraging. In some cases, the athenahealth code goes further than the EHRA code. For example, the EHRA requires participants to make providers aware of coding practices to discourage fraudulent behavior, while the athenahealth code explicitly states that companies that sign will monitor customers for changes in billing patters indicative of fraud or upcoding. Dan Haley, vice president of government and regulatory affairs for athenahealth, said athenahealth is supportive of the EHRA code and the company will sign on to it. However, he feels it is more of a declaration of principles, whereas athenahealth s code is a set of hard commitments. We think it s useful, but of course the EHRA is a large membership- and consensus-driven organization, Haley said in an interview. We have the benefit of corporate structure -- we re basically a dictatorship. A membership organization governed by consensus may have started with what we did, but PAGE 10 OF 16

11 those statements have to endure thousands of slings and arrows and what comes out at the other end is considerably softer. Still, Haley said the fact that the industry as a whole is moving to create these codes, with individual vendors signing on in the future, is a positive step. He said the criticism that vendors have done to further the cause of is fair. The industry is far behind most others in terms of creating networked systems, but by getting vendors to sign on to a code of conduct -- whether it s the EHRA or athenahealth -- that requires them to support data portability is a step in the right direction. It might also help the industry avoid stricter EHR. Everybody talks about in healthcare as if it s some horribly difficult hurdle, Haley said. The way I reference it when I m doing our thing in Washington is, for whatever reason, health information technology lags roughly a decade behind the rest of the economy and everybody pretends that makes sense somehow. PAGE 11 OF 16

12 MEANINGFUL USE STAGE 3 PROPOSED RULE TWEAKS EHR PROGRAM Reda Chouffani Healthcare providers working to qualify for EHR incentive payments and avoid payment adjustments have a new set of criteria to prepare for. The Centers for Medicare and Medicaid Services released a proposal for the third -- and what is expected to be the final -- stage of the meaningful use program, in which it details the final requirements to be met by participating eligible professionals and hospitals. The meaningful use stage represents the culmination of the EHR incentive project that began as part of the HITECH Act. The broad goal of the meaningful use program is to encourage eligible professionals (EPs) and eligible hospitals (EHs) to use more health IT tools. More specifically, the program is set up to promote collaborative and less costly patient care through health information exchange and data. PAGE 12 OF 16

13 The meaningful use stage lists several significant changes that will affect incentive program participants. Stage 3 s preliminary emphasis is on reducing the complexity of the program established during stages 1 and 2. MEANINGFUL USE IN 2017 AND BEYOND If the proposal stands, EPs and EHs will face a year-long attestation period. The only exception to that rule will be Medicaid EPs and EHs that attempt to demonstrate meaningful use for the first time. They will have to attest only for the duration of the current 90-day period. The reporting period for stage 3 will begin in 2017, when it will be optional for participants. In 2018, it becomes required for all EPs and EHs. REQUIREMENTS, OBJECTIVES AND MEASURES To simplify the set of requirements in this stage, HHS has proposed a limited set of eight objectives to help achieve the goals of the final stage. Objective 1: Protect patient health information -- Providers will have to guard patients electronic protected health information by maintaining physical and technical security measures. PAGE 13 OF 16

14 Objective 2: Electronic prescribing -- Under the proposed objective, EPs would have to electronically create and transmit prescriptions to patients. Objective 3: Clinical decision support -- Stage 3 would have clinical decision support efforts target improvement in treating high-priority conditions. Objective 4: Computerized provider order entry (CPOE) -- Credentialed medical staff will be able to use CPOE for laboratory, diagnostic imaging and medication orders under the stage 3 proposal. Objective 5: Patient electronic access to health information -- Patients will be offered access to their health information through an API within 24 hours of its availability. Objective 6: Coordination of care through patient engagement -- This objective would have providers interact with patients about their care through certified EHR technology (CEHRT). Objective 7: Health information exchange -- EPs, EHs or critical access hospitals will receive and transmit a patient s summary of care record as that patient moves between different care facilities. PAGE 14 OF 16

15 Objective 8: Public health and clinical data registry reporting -- This proposed objective would have meaningful use participants communicate with and share with public health agencies or clinical data registries. PAGE 15 OF 16

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