tag:blogger.com,1999:blog-67971111096317467872024-03-08T11:00:49.424-08:00Avoid EHR DisastersElectronic Health Record (EHR) failures damage your reputation and frustrate your patients. Learn about the strategies and practical advice you need to successfully use EHRs.Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.comBlogger41125tag:blogger.com,1999:blog-6797111109631746787.post-56581810299831703472013-07-23T06:00:00.000-07:002013-07-28T07:45:31.339-07:00How would Your Practice Protect Kim’s Information?<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Recently,
several employees of Cedars Sinai Medical Center were fired for<a href="http://www.foxnews.com/entertainment/2013/07/14/hospital-where-kim-kardashian-had-baby-reportedly-axes-employees-for-hacking/"> improperly accessing the Protected Health Information (PHI) of Kim Kardashian </a>(a reality TV personality) who went
through her entire pregnancy with cameras in tow. You can be pretty confident that Kim will
lament this invasion of her privacy for several episodes.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Regardless
of the cameras and dissemination of information by the patient, the covered
entity has no choice but to protect Kim’s PHI under the HIPAA Security and
Privacy standards<b>. This incident is a
teachable moment for your practice and your staff, and a warning for both.</b><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">By
September 23, 2013, your organization is required to have implemented the HIPAA
Omnibus rules. If you are like many
practices, you will also need to implement overdue changes for the HITECH rules. The HIPAA Omnibus rules dramatically affect
the concept of a breach. <o:p></o:p></span></div>
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<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">Kim’s situation
illustrates the dilemma facing your organization under the Omnibus rules. </span></div>
<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">Under the <b>pre-Omnibus rules, a breach
required harm</b> to the patient’s financial situation or reputation. In Kim’s case, you could have at least had a
discussion on whether there was harm.
The employees would have still been sanctioned for violations of your
HIPAA Privacy Policies and Procedures, but the <b>covered entity may have avoided
a breach</b> and the potential penalties, etc.
Your practice may have “reasonably” taken the position that the public
disclosure of the information did not do harm since Kim had the whole thing
broadcast on Cable TV, etc. Before HIPAA Omnibus, there was
no documentation requirement for such an analysis and many covered entities do/did
not keep documentation on their breach analysis. Kim could file her own complaint (makes great reality television), but the
covered entity may have “reasonably” avoided admitting to a breach in the
pre-Omnibus era unless Kim claims otherwise.
This is not a legal opinion, but it does illustrate the wide latitude in
the pre-Omnibus environment. <o:p></o:p></span></div>
<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">Under the HIPAA
Omnibus rules, Kim’s situation is clearly a breach since the Omnibus Rules only
require that there not be a low probability of compromise of Kim’s PHI. Kim’s PHI was clearly compromised by the
covered entity staff and the information went out to unauthorized parties. But wait, there is more.<o:p></o:p></span></div>
<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">Under HIPAA
Omnibus, you have to analyze any impermissible disclosure and use of PHI and
keep the documentation. Indeed, Kim’s
breach could open up your covered entity to an examination of previous
impermissible disclosures and/or uses that could affect the actual penalty or
even expose your organization to additional penalties for previous events that
were analyzed in a less than good faith manner.<o:p></o:p></span></div>
<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">This
illustrates the importance of avoiding impermissible uses and disclosures of
PHI by vigorous compliance efforts, effective training and building a practice
culture that protects PHI from events and behavior that could lead to an impermissible use and disclosure or even a breach. For more on this, <a href="http://avoid-ehr-disasters.blogspot.co.il/2013/03/will-hipaa-omnibuss-impermissible.html">click here</a>.<o:p></o:p></span></div>
<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif;">Under HIPAA
Omnibus, impermissible uses and disclosures leave a documentation trail that could
substantially impact on your future breach risk and even your penalties.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;"><br />
For more posts on HIPAA Security and Privacy,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy"><span style="font-family: "Arial","sans-serif";"> click here</span></a><span style="font-family: Arial, sans-serif;">.<o:p></o:p></span></div>
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<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">For expert advice on policies and procedures you need to serve
your patients, contact Sterling Solutions at (800)967-3028 or</span></b><b><span style="font-family: "Arial","sans-serif";"> <a href="http://www.blogger.com/goog_606042352">click here</a></span></b><b><span style="font-family: Arial, sans-serif;"><a href="http://www.avoid-ehr-disasters.com/Contact_Us.html">.</a></span></b><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">© Sterling Solutions, Ltd, 2013<o:p></o:p></span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-24197224643376908512013-07-16T09:15:00.000-07:002013-07-16T11:23:21.870-07:00What are Your EHR Plans for the Next 12 Months?<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
next twelve months present serious EHR scheduling challenges to medical practices. You need to manage and consider the critical
path needed to maintain your EHR strategy and
tactics. The key issues follow:<o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">HIPAA Omnibus
Compliant Security and Privacy</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – The HIPAA Omnibus rules must be
implemented by September 23, 2013. HIPAA
Omnibus requires significant adjustments to HIPAA Security and Privacy policies
and procedures. Many practices have yet
to address the required changes to avoid penalties and exposure. As important, practices will need to train
their staff and doctors on these changes.
In the event of a HIPAA Security or Privacy problem, the penalties could
increase for those practices that did not make changes to comply with HIPAA
Omnibus. For more on HIPAA Security and
Privacy, <a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy">click here.</a><o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Upgrade to Stage 2
Meaningful Use Version</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – Unfortunately, many vendors have yet to release the
Stage 2 Meaningful Use version of their EHR.
Of particular concern to many practices is the announced delivery dates in
the fourth quarter of 2013 or even later for a wide array of EHR products. This late delivery is problematic for a number
of reasons:<o:p></o:p></span></div>
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<br />
<ul>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Your practice will be competing with all of
the other practices who need to attain Meaningful Use Stage 2 in 2014 (Any
practice that first attested to Stage 1 in 2011 or 2012 must move to Stage 2 in
2014</span><b style="font-family: Arial, sans-serif; font-size: 12pt;">.)
Many vendors lack the personnel and processes</b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> to support a rollout
that has regulatory limitations for your practice.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">In 2014, the Medicaid EHR incentive </span><b style="font-family: Arial, sans-serif; font-size: 12pt;">program limits the 90 day period to
quarters.</b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> Thereby, you only have 4
chances to attain the Meaningful Use measures in 2014. Eligible Providers who run into problems
during their 90 day period in 2014 will have to wait until the next quarter to
restart their 90 day period. In 2013,
you can start a new 90 day period whenever you want.</span><span style="font-family: Arial, sans-serif; font-size: 12pt;"> </span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Stage 2 Meaningful Use Core Requirements
include secured messaging with patients and providing patients access to their
medical information. Each measure
requires 5 percent of the unique patients for an Eligible Provider to participate
(5 percent of Unique Patient must send a secure message to the Eligible
Provider and 5 percent of Unique Patients must access their medical record
information.) Most EHR products support
these capabilities through a patient portal.
Unlike the Stage 1 Measures</span><b style="font-family: Arial, sans-serif; font-size: 12pt;">, your
practice will need time to “sell” patients on the patient portal</b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> concept
and have them send messages and access information to meet the Meaningful Use
Measure. Such an effort must be successful
before you can practically start your 90 day period for Stage 2 in 2014.</span></li>
</ul>
</div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Security Risk
Analysis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">
– Practices should carefully plan their 2013 Security Risk Analysis to make the
best use of your time and avoid problems.
The challenge for 2013 is to perform the Security Risk Analysis after
the implementation of the HIPAA Omnibus and perhaps after the implementation of
your EHR Stage 2 version. Note that even
if you are not participating in the Meaningful Use based EHR incentive program,
you are still required to perform a security risk analysis to verify compliance
with the HIPAA Security Rules on an annual basis. The security risk analysis is updated for
significant changes to your systems (like a new EHR version), business or HIPAA
requirements (like HIPAA Omnibus). <a href="http://avoid-ehr-disasters.blogspot.com/2013/03/have-do-you-performed-appropriate.html">Click here for more information.</a><o:p></o:p></span></div>
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<div style="margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<b><span style="font-family: Arial, sans-serif;">ICD10 Implementation</span></b><span style="font-family: Arial, sans-serif;"> – The extended schedule to implement ICD10 coding by October 1,
2014 is still holding. As discussed in
our <a href="http://avoid-ehr-disasters.blogspot.com/2011/12/will-icd10s-be-ehr-challenge.html">previous blog post on ICD10</a>, ICD10 is not just a coding change, but could affect
a variety of EHR features. Therefore,
you could be looking at another significant upgrade to your EHR system in the
second quarter of 2014 which would trigger another Security Risk Analysis and
significant changes to how your EHR is used.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Each of these requirements is not just a change to your
technology, but could trigger a change to your operational use of the EHR and
your workflow. In order to manage these
issues, keep a close eye on your EHR vendor moves to address these issues, and <b>make sure that your organization allows
enough time to manage these changes</b> to protect the integrity of your
patient records and your clinical operations.<o:p></o:p></span></div>
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<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;"><br />
For more information on HIPAA Security and Privacy,<a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy"> click
here</a>.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">For more information on Meaningful Use, <a href="http://avoid-ehr-disasters.blogspot.com/search/label/Meaningful%20Use">click here</a>.</span><br />
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">For expert advice on critical strategies to meet these
requirements, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</span></b><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></div>
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<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">© Sterling Solutions, Ltd, 2013<o:p></o:p></span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com2tag:blogger.com,1999:blog-6797111109631746787.post-53765687467881577252013-04-30T07:00:00.000-07:002013-05-01T10:01:57.323-07:00Should you be using Email for Patient Service?<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
HIPAA Security Rules allow you to communicate with emails that include
Protected Health Information as long as the patient acknowledges and accepts
the risks associated with email<b>. The key question is should you?<o:p></o:p></b></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
argument for using email includes the wide use and familiarity with email among
the general public. Stage 2 Meaningful
Use includes a core/required measure using secured messaging to communicate
with at least 5% of your patients. Email
is a viable option to meet the Measure as is secured messaging through a
patient portal and even messaging through the patient health record. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Emails
are attractive since so many people have access to email. Indeed, we need patient email information
even if you use a patient portal for secured messaging: a number of patient portals
will send a message to the patient that a secured message is on your portal!<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">However,
the vast <b>majority of EHRs do not
directly work with email</b>. In
practice, the exchange of email messages will occur outside of the patient’s EHR
based medical record. Your practice will
have to copy and paste the email exchange into the medical record. The problems with this strategy include
copying only part (or none) of the email, missing exchanges with the patient
after the email has been copied and even nonrepudiation of the contents of the
email. Depending on your EHR, you may
not be able to see the email messages in context with patient visits and other activities.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Emails
lack the auditability that you have with patient portal based secured messaging
such as knowing when or if a patient saw the message or information. In all fairness, emails can be made smarter (although
we have yet to see this in the EHR world), but even a “smart” email can lead to
false impressions. For example, you can
detect when an email has been opened or a link clicked, but the email could
have sent those notifications merely when the security filters in the email
server verified the email without the patient ever seeing the email.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
addition to tracking the exchange of secured messages, patient portals also
allow you to pursue a number of other agendas that will not be as easy with
email exchanges:<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Patient portal exchanges are coordinated with
the EHR and are posted directly to the patient’s medical record. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">A patient may ask for an appointment that has
to be separately managed and dealt with through email, but is directly
supported by a number of patient portal products.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Patients may need additional services such as
requesting refills, submitting HPI or other information, or accessing a treatment
plan that cannot be dynamically managed with an email.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Patients can access other important
information on their situation or care that will be updated on the portal, but
could be obsolete in an old email.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Whether
you are considering supporting patient centered medical homes, accountable care
organizations or shared savings plans, contacts with patients through email,
patient portals, remote patient monitoring tools, or phone will become a
critical patient care and even treatment component. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Establishing
the right communication channel and tools will be critical decisions for your
practice and your patients.
Unfortunately, email may not seamlessly allow you to support such
exchanges and maintain the patient’s medical record at the same time. Indeed, email may direct important care information
through a mechanism that will be difficult to manage and may undermine the
collection of information to support continuity of care and maintenance of
patient records.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
the final analysis, you need communication tools that will seamlessly work with
you EHR for the convenience of patients and the integrity of your patient
charts. Patient portals can meet that
requirement but emails can’t.<o:p></o:p></span></div>
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<br />
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"><br /></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">For more posts on HIPAA Security and Privacy,<a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy"> click here</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For expert advice on policies and procedures you need to serve your patients, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">© Sterling Solutions, Ltd, 2013</span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-91316915802296208632013-04-11T09:05:00.000-07:002013-04-12T04:43:00.845-07:00Should You Take a Second Look at Your Business Associates?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
HIPAA Omnibus rules significantly affect Business Associate (BA) relationships and
will require an adjustment to your Business Associates Agreement (BAA). Indeed, you may need to <b>take another look at your BAAs, contractual relationships and even your
vendor strategy.</b><o:p></o:p></span></div>
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<a name='more'></a><b><br /></b>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Under
the original HIPAA Security and Privacy Rules, non-employee entities or persons
who worked with your Protected Health Information were required to abide by the
applicable HIPAA Security and Privacy standards through the Business Associates
Agreement. However, the Business Associate
was not subject to penalties and your organization was pretty much limited to
the power to fire the BA, if you could.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Under
the “new and improved” HITECH Rules and made better by the HIPAA Omnibus rules,
BAs and even their subcontractors that use your PHI to do their job are now
responsible for penalties for breaches.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">However,
these changes require some additional considerations in managing your Business
Associates and your contractual relationship.
The key issues to consider are:<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Do BAs sign your BAA
or will you sign the BA’s BAA?</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – Many vendors that have significant
business with Covered Entities have their own BAA that they want their customers
to sign. These vendor BAAs will address
compliance with HIPAA Security and Privacy, but may also include some <b>additional terms at the discretion of the
Business Associate.</b> For example,
BAAs may include limits on costs to notify patients of a breach, use of deidentified
patient information, decisions on response to a breach, and even termination
triggers that could compromise your clinical operation. If you have your own BAA that includes favorable
terms that you prefer, then you will want to negotiate whose BAA will be used
as part of your contract discussions.
However, if you do not have a BAA, carefully review the vendor BAA
before signing to get rid of surprises in their BAA and even how the BAA works
with the contract.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">How do you insure
that your Notice of Privacy Practices prevails?</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – Your organization
cannot provide authority to handle or use PHI that is beyond you published
Notice of Privacy Practices.
Organizations with obsolete NPPs need to update the documents and need
to take a look at the NPP on a periodic basis, <b>but the NPP is basically a part of the BAA</b>. For example, your NPP may state that you
would not use patient information (in PHI or any other form) for any purpose
but clinical care. Some vendors reserve
the right to use deidentified information for other purposes. Regardless of how the BAA may deidentify your
PHI, <b>you cannot authorize the BAA to use
deidentified information if your NPP represents that your will not</b> use
patient information for any purpose but clinical care. Indeed, you may consider deidentified PHI as
confidential practice information.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">How do you monitor
vendor protection of PHI?</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – Under HIPAA Omnibus, BAs and subcontractor Business
Associates (SBAs) have to maintain a mechanism to evaluate impermissible
disclosures and uses of PHI to determine if there is a breach and act
accordingly. However, the BA and SBA
only have to report breaches to your organization. In other words, your <b>BAs and their SBAs could have a variety of impermissible disclosures
and uses of PHI</b>, but the events never exceeded the low probability of
compromise barrier. . Indeed, a BA vendor could have serious and
frequent events involving impermissible disclosure and use of PHI that didn’t
qualify as a breach or whose <b>analysis
may be more generous that you may want</b>. Such a situation is certainly an
indicator of problems to come or perhaps a liberal interpretation of the probability
of compromise. In order to monitor what is happing with
impermissible uses and disclosures, add the right to periodically review the
BA’s and their SBA’s log of impermissible disclosures and uses as well as their
probability of compromised PHI analysis<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">As
part of you compliance with HIPAA Omnibus, you need to reevaluate your Business
Associates Agreements to add appropriate terms to meet the Omnibus Rules. However, you need to think beyond the HIPAA Omnibus
rules to insure that you do not end up with a contract or Business Associate
relationship that does not protect your interests or business objectives.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">For more posts on HIPAA Security and Privacy,<a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy"> click here</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For expert advice on HIPAA Security and Privacy, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">©
Sterling Solutions, Ltd, 2013</span><o:p></o:p></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-42119279520164441442013-03-25T12:00:00.000-07:002013-05-01T09:55:11.852-07:00How Do You Perform An Appropriate Security Risk Analysis?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
Meaningful Use Measures include a Security Risk Analysis. The Security Risk Analysis evaluates your
practice’s compliance with the HIPAA Security Standards. Failure to complete the Security Risk
Analysis can prevent you from collecting the EHR incentive and/or risk the EHR
Incentive you do receive in the event of an audit. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
a disturbing number of situations, <b>practices are not properly completing the
Security Risk Analysis.</b></span></div>
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;">For example, a
number of practices are using boilerplate risk analyses that do not account for
size, structure or even the technology base being used by the practice. Such an approach could ignore key areas of
vulnerability and risk such as EHR customization or interfaces with diagnostic
equipment. Indeed, some practices are
instructed to just fill out the form to “get your money.” However, an incomplete security risk analysis
presents two substantial problems:</span><o:p></o:p><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Meaningful Use Disqualification</b> – The EHR
incentive program requires satisfying
all of the MU Measures. Reporting
completion of the MU requirements with a failed or even missing Security Risk
Analysis places your entire payment at risk.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>HIPAA Security Penalties</b> – If the Security
Risk Analysis is not properly completed or the practice fails to address issues that would have been uncovered
during a more appropriate analysis, your practice may be subject to HIPAA
Security penalties. Indeed, such
penalties can amount to more money per provider than you will ever receive for
the EHR incentive program.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
order to fulfill the Meaningful Use and perform a valid Security Risk Analysis,
consider the following issues: <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Compile a Security
Risk Assessment</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">
- A proper Security Risk Assessment includes from 100 to 300 or more evaluation
criteria depending on your situation. There
are a variety of sources to get a template to frame your analysis. However, these tools are general and require
editing to meet your situation. For
example, <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Use of a cloud based EHR service (also known
as Software as a Service, and Application Service Provider) relies on the
vendor to meet a number of security risks.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">A larger practice needs a formal review,
reporting, and supervisory structure to meet security risks and may need an
office level assessment for each office.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
security assessment tool includes questions covering the Administrative, Physical and Technical
controls for your Protected Health Information.
You are better off starting with a more comprehensive analysis tool and
edit it for your practice rather than trying to take an overly simplistic tool and
improve it to review your real risks.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Perform the Security
Assessment</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">
– The purpose of the assessment is to identify risks and threats. In some cases, the problems uncovered in the
Security Risk Assessment may be addressed through changes to procedures, a
discussion with your vendor or additional hardware. In any event, it is not in the interest of
your practice or patients to dumb down the assessment or your process. Indeed, it is not the publisher of the
checklist or the technogeek you hire to help you that will have to live with
the implications and problems that result from a process that ignores or
bypasses problematic answers or areas. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
fact, it is literally pennies on the dollar to do a correct and thorough assessment
that identifies problems and allows you to come up with solutions before you lose
Protected Health Information, or have an impermissible disclosure. For example, a practice performed a security
risk analysis that bypassed some “problematic” issues associated with dated
hardware and old software. The practice
lost a significant amount of patient information due to a hardware failure and
a backup process that was inadequate and flawed. To avoid similar problems, the analysis
process should be vigorous and not seek to “do the absolute minimum.” If you don’t come up with a problem that you
need to address from you analysis, chances are you have not done an adequate
analysis.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Implement Changes to
Correct Security Deficiencies</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – The most thorough analysis is pretty
useless if you are not prepared to address the problems that you uncover. The key issue is to identify the
vulnerabilities and threats to your electronically stored PHI and initiate
actions to avoid problems. You may be
able to solve a problem with some changes to your process, or require the next
version of your EHR software. Either
way, you should maintain an inventory of the items you need to fix and track
the status of your efforts. Indeed, you
should report on the status of your remediation efforts to practice/HCO
management on a periodic basis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Performing
a Security Risk Analysis is a critical component of your compliance with HIPAA
Security Rules and meeting Meaningful Use.
However, a flawed process can provide a false sense of security and an
even more troublesome risk profile that could seriously affect your ability to
serve patients and meet the evolving care standards in the healthcare
industry. A thorough and effective
Security Risk Analysis insures that you address threats and vulnerabilities
before a crisis emerges.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on HIPAA Security and Privacy,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>For expert help to complete your Security Risk Analysis and avoid HIPAA Security problems, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">©
Sterling Solutions, Ltd, 2013<o:p></o:p></span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com2tag:blogger.com,1999:blog-6797111109631746787.post-16495957361300626802013-03-20T07:45:00.000-07:002013-05-01T21:41:42.748-07:00Will HIPAA Omnibus’ Impermissible Disclosure and Use Standards Complicate Your Compliance Efforts?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
HIPAA Omnibus Rules, released in January 2013, will dramatically affect how you
manage and deal with the impermissible disclosure and use of Protected Health
Information (PHI). Indeed, the new HIPAA
Omnibus rules place a burden on your healthcare organization to analyze and
document your review of potential PHI breaches.
As a practical matter, your healthcare organization <b>could be looking at substantial problems</b> complying with these requirements unless you strengthen
your monitoring strategy. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></div>
<a name='more'></a><br />
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Under
the “old” HIPAA/HITECH Breach rules, a breach required</span><span style="font-family: Arial, sans-serif; font-size: 12pt;"> </span><span style="font-family: Arial, sans-serif; font-size: 12pt;">a significant risk of financial,
reputational, or other harm to the individual.
Under the “new” HIPAA Omnibus rules, a breach is based on a much lower
standard of PHI disclosure or use that <b>does
not have a low probability</b> that the PHI has been compromised. As important, you can now evaluate potential
breaches and document your “good faith evaluation” and “reasonable conclusion.” Alternatively, you can just assume that the
event is a breach.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">The evaluation is based on four factors:<o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>PHI Nature and Extent </b>– You can evaluate the sensitivity of the impermissible
disclosure as well as the ability to identify the patient or even the presentation
options. For example, a list of dated deidentified
lab results disclosed with a separate list of patient appointments for the day
of the lab would present a higher probability of impermissible disclosure or
use. Similarly, PHI scanned images may
include patient identifiers and present a higher probability of disclosure.</span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><b>Unauthorized
Person Received or Used PHI</b> – You must evaluate the recipient of the impermissible
disclosure or use to determine the extent of the problem.</span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">For example, impermissible disclosure to a
party that has been properly trained in HIPAA Privacy and Security who works
for a Covered Entity or Business Associate may present a lower probability than
the impermissible disclosure of PHI to an employee of your own organization
that has not been trained on proper HIPAA Security and Privacy standards.</span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><b>Actual Acquisition or Viewing of PHI </b>– In
evaluating the problem, you can determine if there was an opportunity to access
the PHI. </span><span style="font-family: Arial, sans-serif;">For example, a file of information that requires a special reading
program presents a lower probability than a patient record in a PDF file. </span><span style="font-family: Arial, sans-serif;">Similarly, if a device was lost, but upon
recovery, you can determine that the device was not accessed, you have a low
probability of disclosure or use.</span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<span style="font-family: Arial, sans-serif;"><b>Mitigation Factors –</b> In the final step of you
evaluation, you can determine if there were mitigating issues that leads you to
a good faith and reasonable conclusion that the information was not
disclosed.</span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">For example, a thumb drive
containing PHI on a patient lost in the HCO, but recovered in a nonpublic area
may present a mitigating factor.</span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">Indeed,
you may reasonably rely on the promises of the party to whom the information
was improperly disclosed.</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-line-break-override: restrictions; punctuation-wrap: simple; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">The evaluation of these four factors has to
be documented as well as your good faith and reasonable conclusion. If you determine that the probability of compromised
PHI is low, you do not have a problem. <b>
Otherwise, you have a breach</b> and have to respond according to the breach
notification requirements.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">However, you should seriously consider the implications
of the impermissible disclosure and use on your organization. You should:<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Examine the
events that lead to the impermissible disclosure and use in light of your HIPAA
Privacy and Security policies and procedures.
Indeed, the impermissible disclosure or use should trigger an analysis
of the relevant policies, and procedures as well as supervision and training of
employees.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Track all impermissible
disclosures (including breaches) to support analysis of problems that may lead
to more serious issues in the future.
For example, just because you have not graduated to a breach for a
number of impermissible disclosures and uses does not mean that you do not have
a weakness. Indeed, continuing PHI
disclosure and use problems could be an indication of a potential problem and<b>
higher risk profile than your breach log shows.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">The updated breach rules in the HIPAA Omnibus
Rules lower the barriers for a breach and increase the work that you need to do
to track impermissible uses and disclosures of PHI. The analysis of impermissible disclosures and
use can help you identify weakness and strengthen your Privacy and Security
strategies. Alternatively, a history of impermissible
uses and disclosures may unfavorably reflect on your effort to protect PHI even
if you have avoided an actual breach.<o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on HIPAA Security and Privacy,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For expert advice and training on HIPAA Omnibus to comply with the Security and Privacy requirements by September 23, 2013, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: Arial, sans-serif;">(c) Sterling Solutions, Ltd, 2013</span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-6583947923337746232012-11-14T07:30:00.000-08:002013-04-12T04:49:19.789-07:00What are the Key EHR Training Strategies?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Too
many practices are struggling with performance and productivity issues in the
use of their EHRs. In many cases, the
real problem is the strategy and process around the training of staff and
physicians. <b>Failure to focus the training
strategy on your practice and not the EHR product can lead to a variety of problems
that will damage your efforts for years to come. </b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></div>
<a name='more'></a><br />
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Most
EHR vendors offer standard training programs that teach practices to operate the
EHR. However, most EHR vendors do not
address how to use the software in the practice. For example, staff may learn how to enter a
message, but managing messages and assigning work is just as much a part of the
training strategy as how to send a message and update the status. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Vendor
training materials present general information on the use of the EHR, but typically
fail to address: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Area of medicine considerations –</b> Each
specialty and area of medicine has different issues and challenges. For example, processing outgoing referrals
are critical for primary care practices, but may be insignificant for a
specialty practice. Certain specialties
will want to include specific information on managing orders for internal
diagnostic services and surgery scheduling.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Practice specifics – </b>Office setup, staff
composition and offered services will affect how your use the EHR and the
responsibilities of doctors and staff in maintaining the patient records. For example, some practices use the nurse to
educate patients on disease issues, while other practices may rely on videos
and printed materials. Practices with
technicians, and mid-level providers need to use the EHR within a collaborative
care model.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Failure
to address either of these issues may <b>undermine the patient record</b> as providers
and staff members develop their own EHR coping strategies. Indeed, coping strategies will vary within
the practice since a standard was never designed as a basis for EHR use and
training. For example, if some people
document certain items in a clinical note, while other staff members document
that same issue in a clinical message, practice management will be hard pressed
to keep track of practice operations.</span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">More
problematic is the inconsistencies in the patient record produced by a variety
of techniques. For example, how will the
practice be able to verify review of incoming documents if some doctors note
findings on the document before scanning while other doctors document their
comments in the EHR after the document has been scanned? How will physician and clinical staff be able
to tell what the status of the patient is and maintain the accuracy of the
patient record?<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
key training issue is to design training materials and strategies that reflect
the redesign of practice operations and processes from a paper focused strategy
to an EHR enabled one. Failing to
consider the impacts on office flow and patient service will undermine the use
of the EHR and limit EHR based improvements to the practice regardless of how
great the EHR may be. Failure to develop
training materials and programs to establish appropriate EHR use in a practice
will prevent capitalizing on the EHR investment. In the worst cases, poor training may create
problems which destabilize patient records.
For example, inconsistent use of messages and notes could prevent
doctors from reviewing the context of patient interactions.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
key to training is insuring that the practice has developed training materials
that reflect and establish standards for practice EHR use. In other words, practice training materials
do not focus on the particular screen or function (like most vendor
documentation), but rather the clinical or operational process. For example, many EHRs accept patient orders
to reflect the care plan of the doctor. The
practice focused training materials would include the use of the order feature by
the referral staff, surgery scheduling and lab staff.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
order to develop the operational basis for training users, the practice should
evaluate how the EHR features will be used in the practice and develop a
procedure outline by process. The
procedure outline will be the basis for the training materials and
segments. For example, an outline of EHR
issues at the front desk may include verifying patient entry of history of
present illness information into the patient portal, scanning clinical
paperwork delivered by the patient, and triggering notification to the clinic staff
that the patient has arrived. An outline
of a nurse’s role may include vetting information from the patient,
establishing baseline information in the EHR for the patient, processing
procedure and diagnostic orders from the physician, and processing consent
forms for in-office procedures.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
training process should be supported with the following:<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Training Materials -</b> Training materials should include screen
shots of the relevant EHR feature as well as practice specific instruction on
using the feature. For example, the
materials may include screen shots of the order screen, lab flow sheet, and
findings interpretation for the in-house lab as well as instructions on how to
highlight abnormal results and exchanging messages on test issues with doctors
and staff. The training materials for
physicians and clinical staff would include screen shots of the lab results and
instructions on recording interpretations and assessments of labs.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Online Training Sessions – </b>Online meeting
tools offer a cost effective way (for any size practice) to record training
programs that can be viewed by users when needed. The key benefit to recorded training is that the
practice can discuss the specifics of how the practice uses the EHR while
presenting the EHR in use. There are a
number of cost effect web conferencing services that can be used to record
these sessions and make them available to practice staff on demand. The sessions should be 10 to 20 minutes and
target a specific aspect of the EHR. The
recording should include appropriate references to practice workflow and
operations. For example, an ophthalmic
practice may record information on scheduling and coordinating differences
between elective and medically necessary procedures.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Training Classes –</b> The training materials are
used to structure classes targeted to various roles. Classes should be used for training staff
after they have completed the practice’s online training sessions. The 60 to 90 minute sessions should be
focused on selected roles in the organization.
For example, you may have a class for administrative EHR issues that
covers front desk and billing issues. A
separate class for clinical support staff may target nurses, and MAs while another
class addresses EHR use for diagnostic testing staff and lab employees. Staff and doctors should practice using the EHR
on a daily basis after training leading up to EHR Go Live for their area or
office.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>One on One Training –</b> Super users are an
excellent resource to provide one on one training to staff and doctors. One on one training may be necessary to
address an evolving problem or deviation from standard EHR use as well as
training users on refinements to EHR use or handling of new situations.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Integrating
practice specific issues with the EHR training strategy will help your practice
more effectively use their EHR. Such an
approach to EHR training is necessary to insure that the EHR is used to address
the specific care and services provided by the practice without suffering with EHR
distortions and problems from a more general training and EHR use approach.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more solutions to a wide range of EHR Implementation issues,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/EHR%20Implementation" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For help developing your training program that focuses on what you need to know and not extraneous information that will confuse staff and doctors, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com2tag:blogger.com,1999:blog-6797111109631746787.post-2818950128532857062012-10-24T06:00:00.000-07:002013-04-12T04:53:09.666-07:00Why Do You Need to Attain Meaningful Use by December 31, 2013?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
final rule for Stage 2 Meaningful Use (MU) presents a number of strategic
challenges for practices that are attaining Meaningful Use and <b>places those
practices that will not meet Meaningful Use at a significant disadvantage.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></div>
<a name='more'></a><br />
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
order to avoid such problems, practices need to attain Meaningful Use by
December 31, 2013 to facilitate meeting Stage 2 of Meaningful Use in 2014. This is not a requirement of the EHR
incentive program but rather a competitive issue that all practices will be
facing.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
key problem is that Stage 2 Meaningful Use includes measures that will raise
the level of engagement with patients and other healthcare providers through
the EHR. If your practice has not
attained Meaningful Use, you will be competing against other health care
organizations that offer more communication options to their patients and will
be able to exchange electronic referrals.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Patient
Communication Options – </b><o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">A new Stage 2 Core (Required) Measure requires
secured messaging with patients. Secured
communications with patients will typically be through a patient portal. The patient portal also offers a variety of
other opportunities to interact with and serve your patients (<a href="http://avoid-ehr-disasters.blogspot.com/2011/07/why-are-patient-portals-more-important.html">See Patient Portal Blog Post</a>). <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Combined with other Meaningful Use measures
such as making electronic medical information available to patients, delivering
patient education and sending reminders to patients, patient portals use will
become a basic expectation of patients who want easy access to their
information and options to interact with your practice.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Patient portals require planning and design
of the portal itself, and workflow to support interactions through the patient
portal. However, <b>many practices have
found a more challenging problem getting patients to use the portal.</b> As a practical matter, you have to educate
your patients on the use and benefits of the patient portal. Practices that wait to establish their
patient portal may find themselves facing a difficult task driving patient
activity to the portal that is also a requirement of the Stage 2 Measures. For example, Stage 2 requires 5% of patient
to exchange messages with the practice.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>Electronic
Referrals – </b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The Stage 2 Transition of Care Measure will
be particularly problematic for specialists that do not attain MU. The Stage 1 MU Menu Measure for Transition of
Care merely requires the referring provider to print a Transition of Care
document to be sent to the specialist or other care setting. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Stage 2 requires that the eligible provider
send 10% of their Transition of Care records electronically. In other words, primary care providers (the
focus of the MU program) who meet Stage 2 of MU will be sending electronic
Transitions of Care to other providers who have attained MU. If a specialist is not able to support MU,
they may be unable to receive their transitions of care.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Assuming that the referring practice meets
the minimum 10% Electronic Transition of Care, then only 10% of referrals are
at risk. However, if the electronic
method is easier, cheaper, and/or more effective that printing and faxing the
Transition of Care document, then <b>practices should not be surprised that referring
sources will seek to send more than 10%, or perhaps all of their referrals
electronically</b>.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Both
of these initiatives will be pursued by Eligible Providers who achieve MU in
2011, and 2012, to support Meaningful Use Stage 2 in 2014. If other practices want to provide the same
options to patients or be able to exchange transition of care records, then you
need to pursue Meaningful Use by the end of 2013 to make sure that you are
ready to strategically pursue Stage 2 in 2014 to better serve your patients and
work with incoming and/or outgoing Transitions of Care. <o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<br />
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For additional strategies to attain MU,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/Meaningful%20Use" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To analyze, plan and design a results oriented Meaningful Use strategy for 2013 and beyond, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">(c) Sterling Solutions, 2012</span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-54083988376171864402012-06-28T06:45:00.005-07:002013-04-12T04:54:01.580-07:00How Can You Achieve and Attest to Meaningful Use?<br />
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In
order to qualify for the Medicare EHR Incentive, you have to attest that each Eligible
Provider (EP) meets the Meaningful Use requirements. The two key issues are <b>how can you get a provider to work up to
the MU Measure Requirements and how can you document the same for your Eligible
Providers.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"></span></div>
<a name='more'></a>A
point of frustration for many providers is that they have to attain all of the
core MU Measures and 5 Menu items to initially qualify for the incentives and
then maintain those levels each year thereafter. CMS can request documentation on Meaningful
Use attainment for up to six years after you have attested to CMS. Note that you need to maintain appropriate
information for each Eligible Provider: not for the practice. <o:p></o:p><br />
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Attaining MU for Each
Provider </span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;">-
In practice, <b>few physicians attain the Meaningful Use measures from day one or at
a set date. </b> In actuality, providers work
towards Meaningful Use as they become familiar with the EHR specific
requirements for each measure. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">To
help physicians focus, consider waiting until they are familiar using the EHR
with patients in order to ease the refinements that may be necessary for the MU
Measures. At this point, you should run
the MU Measure reports for the physician and analyze the physician performance. <b>Provide feedback</b> to the EP on a weekly
or daily basis depending on their progress.
Consider more frequent feedback for providers that are not making
progress and weekly feedback for providers that are making progress. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">When
the EP is close or has attained the MU Measures levels for all relevant
measures, you can start the 90 day period.
Throughout the 90 day period, you should monitor Eligible Provider
measures on at least a weekly basis. If
you detect some degradation on the measure levels, you should consider more
frequent or even daily feedback. Note
that some EHR products have a dashboard that provides real time results while
other EHRs are limited to daily MU reporting.
In either case, you want to monitor the EP in support of their effort to
attain MU.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">After
the 90 day period is completed, continue to monitor the MU Measures at least
one a week until the provider is consistent and does not need prompting to
accommodate the MU Measure strategy for your EHR. However, you should <b>monitor performance at least monthly</b> and increase the frequency to weekly
or even daily to help providers maintain MU performance. Remember that you do not want to have to
catch up to a measure that may have little room for error. For example, some measures require fulfillment
for at least 80 percent of unique patients.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Maintain Separate
Attest Records for Each Eligible Provider</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – At the completion of each period (initial
90 day or annually), you should accumulate a separate set of documentation for
each individual Eligible Provider:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Assure that you have <b>documentation for each MU
Measure</b> for each Eligible provider. For
example, generating a list of patients meeting clinical criteria (Stage 1 Menu
Measure) should be directed to the specific physician for whom you are
compiling information. Similarly, you
should perform a test of electronic exchange of clinical information (Stage 1 Core
Measure) for the specific Eligible Provider.
Documentation should include the relevant support or results that meet
the MU Measure. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">The <b>security risk analysis</b> will probably be
completed for the practice, but will have to be part of the documentation for
each eligible Provider. You should put a
separate copy of the Security Analysis documentation in the documentation for
each Eligible Provider. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Include a copy of the <b>documentation from your
EHR on how the MU Reports are generated and the calculation </b>of the MU Measure by
the EHR. Note that future MU
calculations may change to meet Stage 2, and to account for EHR product
changes. If you have made changes to the
EHR MU calculation or calculation, you should include supporting documentation
for the change and the results. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">At
the end of the process, you should have a separate set of documentation that
fully supports your attestation for the relevant EP.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Attaining
MU and maintaining the supporting MU documentation for each Eligible Provider
is a continuing process that requires consistent monitoring of performance and
documentation for each individual provider.
Thereby, you will help your providers qualify for the EHR incentives and
be able to prove the same if ever challenged by CMS.<o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For additional strategies on MU,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/Meaningful%20Use" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To analyze, plan and design a results oriented Meaningful Use strategy for 2013 and beyond, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
</div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-5245476716239070192012-06-21T05:45:00.000-07:002013-04-12T04:57:41.194-07:00How does Your EHR Calculate Meaningful Use Measures?<br />
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In
order to support Meaningful Use (MU) attestation, you need supporting
documentation for each measure by Eligible Provider (EP). The reports from you EHR will be the
reference point for documenting your compliance with many MU Measures. However, the <b>MU measure calculations can dramatically different from EHR to EHR</b>.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"></span></div>
<a name='more'></a><br />
<br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">If
your printed MU measure reports do not meet the required levels, then you
should not assume that you can explain your way around the discrepancy. Convoluted explanations about not using the EHR
as prescribed by the vendor will <b>only
complicate your efforts to meet the MU audit standards</b> and could undermine
the use of the EHR. For example, <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">You may document a smoking discussion with
the patient in a free form note, but if you do not check the appropriate
smoking item in the EHR form, the EHR will not count the free form note. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">You may have specific patient education items
for each major service area. But, if
your EHR only calculates the patient education resource measure using a general
item, your measure calculation will understate your actual efforts. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">A significant number of EHR products allow
or, in some cases, require MU report customization to properly calculate MU based
on your use of the EHR. For example, you
may have to identify the clinical variables that you use to document certain MU
Measures. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">You
need to have a clear understanding about how your EHR calculates the
measures. In some cases, EHRs logically
calculate the measure from the EP’s activities.
For example, a prescription entered for a patient can be clearly
determined and counted. Other measures
are more complex or impossible to count.
For example, distribution of a clinical summary to a patient may be
supported by printing the document, but it is not clear that every printed clinical
summary fulfilled the MU Measure (Some clinical summaries may be used for other
purposes or never make it to the patient.)
Similarly, if you use a patient portal to distribute the clinical summary,
the EHR may never know if the document was ever accessed by the patient.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In
order to produce the reporting results that you need for your Eligible
Providers, you should have a clear understanding and strategy to accommodate the
EHR’s MU Measure calculation:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Inventory how your EHR calculates the MU
Measure for each measure and the appropriate findings and activities needed to
meet the specific requirements of your EHR.
For example, the specific clinical findings that trigger each MU Measure
should be catalogued.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Review how your doctors use the EHR and
verify that they are using the EHR in a way that proper MU credit is counted
for each measure.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Understand how the EHR deals with measures
that may not depend on the EP. For
example, patient reminders may be determined by the EP recording the patient
plan items in a certain way, but depend on the practice staff to issue the
patient reminder.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Monitor physician performance by physician
using the EHR MU reports to verify the measure and the appropriate use by the
Eligible Provider to trigger the count.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Note
that the same issues that are encountered by many practices with general use of
an EHR apply to Meaningful Use. If an EP
records information without considering the inner workings of the EHR, the
patient information may not be properly presented, tracked, or counted in the
MU Measure.<o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For additional strategies to attain MU,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/Meaningful%20Use" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To address your MU challenges and develop a strategy to collect and keep you EHR incentive money, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
</div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1tag:blogger.com,1999:blog-6797111109631746787.post-2698450255605118402012-06-06T10:31:00.001-07:002013-04-12T05:00:11.247-07:00How Does Stage 2 Meaningful Use Relate to Stage 1?<br />
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Your Meaningful Use (MU) Strategy will have a
significant impact on your ability to avoid extra work and disruption to your
operation. One of the most important
issues to consider in your EHR and MU strategy is the Proposed Stage 2 MU
Measures. The proposed Stage 2 Measures provide important insights into what you should choose as your Stage 1 Menu Items and even your EHR product and implementation plan</span></div>
<div style="text-align: left;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">This following table presents the Stage 1
and 2 Measures in a way that will help you analyze the effect of Stage 2 on MU
and focus your strategy to avoid problems: </span></div>
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<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: Calibri, sans-serif; font-size: 11pt;">MU Measure<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: Calibri, sans-serif; font-size: 11pt;">Stage 1 Requirement<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: Calibri, sans-serif; font-size: 11pt;">Proposed Stage 2 Effect<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: Calibri, sans-serif; font-size: 11pt;">Proposed Stage 2 Requirement<o:p></o:p></span></b></div>
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<tbody>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Computerized Provider Order Entry (C-1)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE - Medication Orders for 30% of Unique
Patients.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increase Percentage.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Added Radiology and Lab Orders.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 60% of Medication, Lab, and Radiology
Orders.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Drug-Drug and Drug Allergy Interaction Checks
(C-2)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE - Enabled for Reporting Period.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Not a Separate Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<br /></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Up to Date Problem List (C-3)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Not a Separate Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Transmit eRx (C-4)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Added Stage 1 Menu Item on Formularies.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Transmit 65% of Rx Electronically. Use at Least One Formulary.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Active Medication List (C-5)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Not a Separate Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<br /></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Active Medication Allergy List (C-6)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Not a Separate Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Record Demographics (C-7)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 50% of all Unique Patients.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Record Vital Signs (C-8)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 50% of all Unique Patients > 2.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Record Smoking Status (C-9)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 50% of all Unique Patients > 13.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 80% of all Unique Patients > 13.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Report Clinical Quality Measures (C-10)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Not a Separate Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Clinical Decision Support Rule (C-11)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Implement One Rule.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increase Number of Rules.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Implement Five Rules.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Electronic Copy of Health Information (C-12)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Provide Information to 50% of Patients
Who Request Within 3 Days.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Consolidated With Stage 1 Menu Item on
Patient Electronic Access.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">See Patient Electronic Access.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Clinical Summaries (C-13)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Provide Clinical Summary for 50% of
Office Visits within 3 Days.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Shorter Timeframe.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Provide Clinical Summary for 50% of
Office Visits within 24 Hours.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Electronic Exchange of Clinical Information (C-14)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Core – Perform a Test.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">NO LONGER REQUIRED.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Protect Electronic Health Information (C-15)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Perform a Security Risk Analysis.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">No Change.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Perform a Security Risk Analysis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Drug Formulary Check (M-1)<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Implement at Least 1 Drug Formulary.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Added to Stage 1 Core Item to Transmit Rx.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Clinical Lab Test Results (M-2)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 40% of Lab Test Results In EHR as
Structured Data.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 55% of Lab Test Results In EHR as
Structured Data.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Patient Lists (M-3)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Generate a List of Patients Using
Condition Criteria.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Generate a List of Patients Using
Condition Criteria.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Patient Reminders (M-4)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Send Reminders to at Least 20% of
Patients > 65 or < 5.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Send Reminders to at Least 10% of
Patients with an Office Visit Within 24 Months Prior to Start of Reporting
Period.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Patient Electronic Access (M-5)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 10% of All Patients Provided Access
within 4 Business Days of Receipt of Information.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Consolidated with Stage 1 Core Item for
Electronic Copy of Health Information.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 50% of All Patients Provided Access
within 4 Business Days of Receipt of Information.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">10% of All Patients View, Download or
Transmit Information.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Patient-Specific Education Resources (M-6)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 10% of Unique Patients Provided
Resources Using EHR to Identify Appropriate Resources.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Change Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 10% of Office Visits Result in
Providing Patients Education Resources Using EHR to Identify Appropriate
Resources.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Medication Reconciliation (M-7)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Performed for 50% of Incoming
Transition of Care Patients.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Performed for 65% of Incoming
Transition of Care Patients.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Transition of Care Summary (M-8)<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 50% of Transitions of Care Supported
with a Care Summary.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Increased Percentage.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – 65% of Transitions of Care Supported
with a Care Summary. 10% of
Transitions Are Electronically Transmitted.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Immunization Registry (M-9)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Test Successful Submission.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Moved to Stage 2 Core.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Change Measure.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – Ongoing Transmission.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Syndromic
Surveillance Data Submission (M-10)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Test Successful Submission.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Change Measure.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Ongoing Transmission.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Secured Messaging<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">New Stage 2 Core<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">CORE – For More than 10% of Patients Seen, a
Secure Message was Sent.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Imaging<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">New Stage 2 Menu Item.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 40% of Scans and Tests Resulting in an
Image Are Accessible from EHR.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Structured Family Health Data<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">New Stage 2 Menu Item.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – 20% of Unique Patients have Structured
Family Health Information.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Cancer Case Reporting<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">New Stage 2 Menu Item.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Ongoing Transmission.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 93.15pt;" valign="top" width="124"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">Cases Other Than Cancer Reporting<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">N/A<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">New Stage 2 Menu Item.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0pt 5.4pt 0pt 5.4pt; width: 111.45pt;" valign="top" width="149"><div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;">MENU – Ongoing Transmission.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri, sans-serif; font-size: 11pt;"><br /></span></div>
</td>
</tr>
</tbody></table>
<br /></div>
<div style="text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif;">Analyze this table to develop your MU strategy and simplify the challenge of attaining MU and implementing your EHR.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For additional strategies to attain MU,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/Meaningful%20Use" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To analyze, plan and design a results oriented Meaningful Use strategy for Stage 1, Stage 2 and beyond, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">(c) Sterling Solutions, 2012</span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1tag:blogger.com,1999:blog-6797111109631746787.post-43961753151092891472012-05-02T07:15:00.000-07:002013-04-12T05:02:02.645-07:00Why Should You Care about Deidentified Information?<br />
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">According
to the HIPAA Security and Privacy standard, your practice is responsible for
maintaining the confidentiality of Protected Health Information. Unfortunately, a number of vendors and other
parties want access to your information and are <b>placing the confidentiality of your business information and even your
patient information at risk.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b></b></span></div>
<a name='more'></a><b><br /></b>
<br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Many
contracts and Business Associates Agreements include standard language that
protects you patient’s Protected Health Information from disclosure. Indeed, there are a wide range of statutory
penalties. However, deidentified
information can be used for other purposes that may not be helpful to your practice or your patients.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;">.
<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Most
EHR contracts and a wide range of other service contracts include language that
gives the Business Associate wide latitude to use your practice’s deidentified
information. For example, many EHR
vendor contracts allow use of deidentified information for purposes and at
times of the vendor’s choosing. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Your
practice should have a number of problems with such conditions:<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Will the vendor properly
deidentify protected health information?</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In reality, it is very difficult to properly
deidentify protected health information.
In addition to the obvious identifiers such as name, address, SSN, and
date of birth, an email address and biometric information also needs to be eliminated. However, other information that could lead to
identifying the patient must also be removed from the record. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Removal of such information could require a
painstaking review of the record. For
example, some patient records may include <b>descriptive
information about the patient or events </b>surrounding the encounter that
could lead to identification of the patient.
At a recent seminar I presented on HIPAA Privacy, one of the
participants used the internet to search for the identity of a person using the
fact that the injury was related to a motorcycle accident on a particular day
in a town. In less than 20 seconds, the
name of the patient and other identifying information was on the screen of the
person in the accident. It is fairly
standard practice to include such information in the exam note to provide
context to the visit and document the injury for insurance purposes.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Considering the variety of search tools and potential
use of information that you needed to properly document the visit, you have to <b>seriously consider the practicality of the
vendors deidentification effort</b>.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Could deidentified
information disclose information about your practice?</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – Even if the
Protected Health Information has been completely deidentified, you need to
consider whether the resulting information could disclose confidential information
about your practice. With information on
the EHR product you use and the ability of the EHR vendor to use deidentified
information for any purpose, confidential business information could be derived
from deidentified information. For
example, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">A Business Associate could sell analyses of
service coding and drug use using your deidentified information. Depending on the size of your practice and
location, such information could focus on your practice and reveal a wide array
of information about your revenue, service mix, patient base, and internal
practices. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">An EHR vendor could provide deidentified information
that would reveal device or product use.
For example, an analysis of DME would enable a vendor to determine competitive
product use at your practice. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In
order to avoid use of deidentified information to reveal confidential information
about your patients or practice, you should make sure that <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">No party has any rights that would allow them
to make <b>unilateral use</b> of your
patient information for any purpose.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Use of information is <b>limited to structured information</b> that has been properly
deidentified. Free form notes and
unstructured information is difficult to properly deidentify and should not be
available for use.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Use of any deidentified information in
specific or summary form will be <b>comingled
with enough data from other sources</b> to prevent anyone from identifying your
practice as the source of the deidentified information. For example, if you are the only EHR user in
the zip code, the vendor should not sell zip code specific deidentified
information. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In
the case of your Protected Health Information, you need to control the use of information by any party that could divulge information about your practice or
lead to the identity of a patient. <o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on HIPAA Security and Privacy,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span><b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For strategies that you need to avoid HIPAA Privacy and Security lapses, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-55091760602933698512012-04-24T07:00:00.000-07:002013-04-12T05:03:30.983-07:00Do You Have HIPAA Security and Privacy Exposure?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">With
the focus on Meaningful Use Measures, many practices are neglecting procedures
and policies needed to comply with HIPAA Security and Privacy. The recently announced $100,000 settlement
with a 5 doctor Phoenix based practice should trigger a closer look at your own
compliance situation.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></div>
<a name='more'></a><br />
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">On
April 17, HHS settled a HIPAA Privacy and Security Case with Phoenix Cardiac
Surgery. According to the HHS
announcement, the practice failed to establish and maintain the policies and
procedures needed to protect patient information. Additionally, the practice failed to document
appropriate training or even appoint a Security Officer. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">This
incident should trigger a review of your own HIPAA security and Privacy
exposure in the following areas: <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Maintain Policies and
Procedures</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">
– According to the HIPAA Security and Privacy standards, you need written
policies and procedures to safeguard protected health information as well as a
process to insure that the procedures are enforced. Indeed, <b>the
lack of adequate procedures is a HIPAA violation</b>. Note that is not just a matter of initially
creating the appropriate policies and procedures, but also maintaining the
policies and procedures according to changes in your practice or to
standards. For example, <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
implementation of an EHR will require changes to your HIPAA Privacy strategy as
well as rethinking your entire HIPAA Security strategy.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 18.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
HITECH based changes to HIPAA Security and Privacy should be considered in your
internal procedures as well as any Business Associates Agreement that you may
have.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Training </span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">– In a surprising
number of situations, many practices do not adequately train employees on HIPAA
Security and Privacy Issues. Commonly,
practices trained employees initially (maybe years ago), but do not have a
formal training process for new employees.
Many more <b>practices fail to
update employees on a continuing basis</b> or in the event of a change to your
policies and procedures. For example, <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
release of a new version of your practice management or EHR system may require training
relevant to HIPAA compliance. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 18.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">HIPAA
Security and Privacy training should be customized for your own situation and
operation. A general class on HIPAA
Security and Privacy may not address how your staff may be notified about disclosure
limitations on the patient’s HIPAA consent form or the contents of the patient
medical record for your organization. <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Vendor Features</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> – In some cases,
vendor features or strategies may not adequately comply with HIPAA Privacy and
Security. Note your practice is
responsible for HIPAA Security and Privacy, not your vendor. For example, some EHR vendors offer email
facilities from their EHR. However, you
would need specific procedures governing or perhaps prohibiting the use of such
a feature. Indeed, your practice should
only be communicating with patients on clinical issues through a secured
messaging facility.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Security Risk
Analysis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">
– <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">A Security Risk Analysis is part of any HIPAA
Security compliance plan and also a Meaningful Use requirement. Note that Security Risk Analysis needs to
examine the physical, technical, and administrative safeguards over protected
health information. <b>Even if you do not have an EHR, you may still need to perform a
security risk assessment.</b> For
example, an online directory containing
transcription Word files is covered by the HIPAA Security standards. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">However, the <b>use of an EHR product does not address your HIPAA Security exposure</b>. For example, even if you use an EHR service,
your practice still needs administrative procedures to control access and prohibit
storing information in an unsecured environment: taking screen snapshots and
storing the image on a personal PC or other device.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Although
we have focused on the compliance issues, do not forget that a HIPAA Security or
Privacy problem can affect your practice’s reputation and relationship with
your patients. The recently announced
settlement with Phoenix Cardiac Surgery should be a wakeup call to your
practice that HIPAA Security and Privacy standards are important and that HHS
will not hesitate to pursue compliance issues in smaller organizations.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">To
see the HHS notice, <a href="http://www.hhs.gov/news/press/2012pres/04/20120417a.html">click here</a>.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on how to deal with HIPAA Security and Privacy,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span><b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For expert advice to address your HIPAA Security and Privacy exposure, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-37099386270474318402012-04-04T06:30:00.000-07:002013-04-12T05:15:51.570-07:00How Reliable are your EHR Patient Notes?<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">A
disturbing number of EHR issues and medical professional liability claims are
based on serious problems with exam notes and other clinical documentation
recorded in an EHR. Regardless of the
legitimacy of care and treatment, the inappropriate use of EHRs and/or EHR
design vulnerabilities are exposing physicians to questions on the quality of care
and physician due diligence. Some key
areas to consider follow:<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></div>
<a name='more'></a><br />
<br />
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Initial Patient
Charting: </span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> In some cases, the transition of the patient
information to the EHR was not adequately structured: resulting in serious
omissions in the patient EHR based record.
For example, few physicians consider the patient care information and
history that is needed to provide proper context in the EHR for a patient. Previous surgical history and access to
previous test results may be critical information to support continuity of
care. However, if the historical
information is not properly entered, then the EHR will not provide appropriate
warnings and notifications to the staff and physician.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Signing Notes: </span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> If the EHR note is not signed, then the note
remains open until someone signs it, or the EHR automatically closes the
note. Failing to sign a note can raise a wide range of questions
about the justification of billing and whether the doctor properly authorized
care. Any practice using an EHR should
have an end of day process that includes verifying signing of all patient
notes.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Systemic EHR Issues:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> Reliability issues may
result in systemic problems for many or even all patient records. For example, a note template may make
representations that are not appropriate for all patients. Similarly, a script that produces an exam
form or a disability statement may have an error that appears on all documents
issued by the practice. The failure of
the physician to understand how to accurately chart and verify patient
information could lead to a wide range of care and compliance problems. Avoiding systemic problems requires diligent
evaluation of the clinical templates that you use, as well as periodic review
of the EHR tools and their use. In too
many cases, practices treat EHRs as static tools, when in fact EHRs can change
due to vendor upgrades and even daily use by physicians.<o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Amending Patient
Notes: </span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Unfortunately, many EHR
products do not provide all of the tools needed to maintain proper patient
information. Indeed, some EHR systems
allow the user to attach a free text note to amend completed documentation,
while the specific information in the note stays the same. For example, you may enter free form text
noting a change in findings, but the actual exam note still shows the original
finding. All EHR processes that use
specific information to display an alert for a patient will be based on the
original finding, and not the free form text addendum used to refine the
note. Thereby, the EHR could fail to
warn you about a treatment standard, drug interaction, or emergent problem.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">EHRs
can be very useful and support outstanding patient services and effective
clinical operations. However, practices
need to closely examine how the EHR is set up and used on a continual basis to
maintain the efficacy of the patient records and efficiency of the practice. <o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on EHRs and Medical Professional Liability Risks,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/EHR%20and%20Medical%20Liability" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span><b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To measure and address liability risks associated with how you use and maintain your EHR based patient records, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-41980690345439872322012-02-07T06:50:00.000-08:002013-04-29T03:34:11.433-07:00What Should You Do with a Failing EHR?<br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Unfortunately,
you need to protect your practice and your patients against a failing EHR. Some recent examples demonstrate the
vulnerability of any practice to a failing EHR:<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">An EHR cloud service added customers which
resulted in substantial delays for the physicians in the practice.<o:p></o:p></span></div>
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<a name='more'></a><br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">A new version of an EHR resulted in thousands
of records disappearing from the patient database.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Physicians discovered that old patient plans
were being printed as the current visit plans due to a program error.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Support from the vendor failed due to a
shortage of staff, too many customers, or problems with the software. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">With
over 1,000 Certified EHRs and more on the way, practices face a dizzying array
of EHR product options and vendors. As a
practical matter, not all of these products will be successful. Indeed, physician practices need to seriously
monitor their vendors and communicate with vendors on any concerns that may
evolve with use of their product. Your
practice needs to monitor the stability of your EHR product and the vendor that
is behind the EHR.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">If
you practice does encounter serious EHR problems, you need to protect your
patient’s medical records and preserve the integrity of patient care. </span><span style="font-family: Arial, sans-serif; font-size: 12pt;">When encountering an EHR reliability problem, practices need to
undertake a protection and recovery effort. <o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Protect Records</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> - Protection activities may range from holding
a backup from your backup rotation to moving documentation to paper
charts. For example, one practice was
using an EHR that stopped correctly generating the exam notes. The practice moved their chart back to paper
since their EHR had become error prone and unreliable. <o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Remediation </span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;">- The remediation effort should include
assessing the damage and trying to recover information. For example, the
practice should assess the reliability of the current information and make sure
that they recover missing information from patients as they see patients going
forward. You may also be able to gather relevant information from your
billing system, and other parties such as labs, hospitals, etc. For example, a pediatric practice may recover
some immunization information from the billing system or immunization registry.<o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></b></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Document Due Diligence</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> - The practice should document EHR problems
with appropriate letters and paperwork to EHR vendors to demonstrate due
diligence in trying to protect your patient records. In too many cases,
practices accept EHR vendor explanations for problems without communicating the
impact on their organization or records. Failure to document the problem
and the practice response could cause operational problems and a variety of
legal issues.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The best defense against
a failing EHHR is to monitor the performance and well being of the EHR that you
use and your vendor. Make sure that any
changes to management or software is understood and evaluated to verify the continuing
reliability and viability of your EHR.
For example, if a vendor is moving their EHR offering to a cloud
product, then you need to seriously evaluate the vendor commitment to your
current inhouse system.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In most cases, practices with failing EHRs
encountered early warning signs, but failed to act. You owe it to your practice and your patients
to monitor the health of your EHR and develop a go forward strategy before you
are caught in a difficult situation with a failing product or vendor.</span><span style="font-family: Arial, sans-serif; font-size: 12pt;"><o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<br />
<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For additional strategies to cope with EHR problems,</span><a href="http://avoid-ehr-disasters.blogspot.com/search/label/EHR%20Strategic%20Issues" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To analyze, plan and design a recovery from your problems with your EHR, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1tag:blogger.com,1999:blog-6797111109631746787.post-12250127598706368202011-12-19T08:00:00.000-08:002013-07-13T23:04:52.000-07:00How are EHR Contracts Getting More Difficult?<br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">EHR
contracts contain an increasing array of complicating structures and dense
terms that <b>offer fewer and fewer commitments
to your practice</b>. </span><span style="font-family: Arial, sans-serif; font-size: 12pt;">The problematic
terms include:</span></div>
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</span></span><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Broad disclaimers </span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;">further distance EHR
vendors from any responsibility or liability that may result from the use of
their products regardless of the cause:<o:p></o:p></span></div>
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<span style="font-family: 'Courier New'; font-size: 12pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">Many
contracts offer <b>no warranties</b> and sell
the products “as is.” Thereby, they have
no obligation to fix problems or maintain product relevancy. For example, a disclaimer that the product is
offered with no representation of fitness for any specific purpose provides
little to compel a vendor to address an issue or problem.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: 'Courier New'; font-size: 12pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">Many
contracts include <b>practice indemnification
of </b>the software vendor for a variety of issues. For example, some contracts do not warrant
the clinical content or the ability of the software to record information, but
pass risk of any problems to the practice through broad indemnity clauses. On a similar note, some business associate
agreements have the practice indemnifying the business associate <b>for inappropriate disclosures committed by
the business associate</b>. <o:p></o:p></span></div>
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<span style="font-family: 'Courier New'; font-size: 12pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">A
number of EHR vendors will not commit to support HIPAA Security or Privacy
standards or Certified EHR status. <o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Jointly marketed </span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;">EHR, PMS, and/or
patient portal products may require separate agreements for each product. Each agreement includes separate terms with frequently
conflicting agendas and conditions. In
the event of a problem, you could not only get caught between the different
companies, but have contracts that specifically disavow any responsibility for
the actions and interfaces with any “third party products.”<b> </b>For example, some EHR contracts
put the responsibility on the practice to maintain interfaces with any other
products, including the partner PMS<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">More restrictive
Agreements</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;">
to protect their products and businesses.
EHR vendors are rightfully concerned with protecting their intellectual
property. However, many EHR contracts
include terms that could hamper the ability of the practice to operate. For example, many contracts prohibit
disclosures about the EHR to any non-employee.
Such terms trigger technical contract violations when the practice
provides EHR access for chart review or to demonstrate the EHR to prospective
physicians. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Interestingly,
we are typically told that the legal terms do not represent the commitment of
the vendor, and that they could not stay in business if they were not
responsive and effective. However, the
legal terms of the contract frames the relationship with the vendor. In the vast majority of cases, your practice
will be dealing with a much larger and more sophisticated EHR vendor. In order to protect your practice and
preserve your patient records, you need a balanced contractual relationship.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Your
practice should be wary of any PMS/EHR/Patient Portal contracts and have the
contract thoroughly reviewed by a qualified professional. In general, vendors are willing to
accommodate issues you raise to get your business. Otherwise, you are committing to a
contractual relationship that puts your practice in a difficult situation that
could cost you money and disrupt patient care.<o:p></o:p></span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">For more posts on HIPAA Security and Privacy,<a href="http://avoid-ehr-disasters.blogspot.com/search/label/HIPAA%20Security%2FPrivacy"> click here</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
<br />
<b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For expert advice on EHR contracts that will avoid problems and save you money, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">© Sterling Solutions, Ltd, 2013</span><br />
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-14880179959707438722011-12-12T07:30:00.000-08:002013-06-25T10:22:17.706-07:00Should ICD10s Affect Your EHR Strategy?<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">On
October 1, 2014, practices will start submitting claims using the ICD10 coding
system. Any practice planning on using EHR
systems to facilitate the transition to ICD10 needs to <b>take a close look at the practicality of implementing an EHR in time to
support ICD10 coding.<o:p></o:p></b></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
move to ICD10 will be dramatic and challenging.
The ICD10 coding system uses a level of specificity beyond the ICD9
system and requires more details that match up with the CPT code. For example, ICD10 codes may include site and
severity information which will have to be consistent with your procedure codes
and modifiers.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
order to use an EHR to support your ICD10 coding challenge, you cannot expect
to address ICD10 coding a in the middle of your EHR effort. Indeed, <b>you
will want to have completed the rollout of the EHR before you tackle the ICD10
challenge.</b> Consider the following
calendar issues as you plan ahead to meet ICD10 coding with the help of an EHR:<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Selection
of PMS and EHR products can take 2 to 4 months or more before you have
finalized your decision.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Implementation
of an EHR can take 4 to 6 months depending on a variety of policy, and practice
issues.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Once
the EHR implementation is complete, your practice will need 4 to 8 months to
transition individual patients to the EHR.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">If
you will be replacing your PMS system as part of your EHR project, allow an
additional 4 to 6 months for your project.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><b>A
full PMS/EHR project can take anywhere from 10 to 18 months or more.</b> Considering that you should be ready to focus
on ICD10 by the beginning of the summer of 2013, it is not too early to tackle
the EHR project on your critical path to ICD10 compliance.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Note
that differences between ICD9 and ICD10 coding systems will probably lead to changes
to the EHR and PMS systems that you use leading up to the ICD10 start date.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Depending
on the size of your practice, you need to be well along on your transition to
an EHR before you focus on the transition to ICD10. Otherwise, you could be facing overwhelming uncertainties
in your clinical and billing operations that could lead to disruptions in
patient service, clinical operations and cash flow.<o:p></o:p></span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-12559406895832974302011-12-07T08:00:00.000-08:002011-12-07T17:54:27.377-08:00Will ICD10s be an EHR Challenge?<br />
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In theory, EHR systems will make ICD10 coding tolerable. <b>However, ICD10 coding presents a wide range of challenges to EHR vendors and users.</b> <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The key problem is that EHR systems are designed for ICD9 codes which dramatically differ from ICD10 codes. EHR systems use and retain ICD9 codes for a number of practical purposes including:<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">ICD9 codes are used to organize the patient record and support coding of charges. For example, many EHRs include lists of patient problems based on ICD9 codes. Prescriptions, orders, and even images can be related to an ICD9 codes.<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">ICD9 codes associate related visits and other information within the EHR. For example, you can view all exams dealing with a specific ICD9 code.<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">ICD9 codes trigger patient care items. For example, an ICD9 code for diabetes may trigger a health maintenance item associated with a periodic lab test.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">However, the switch to ICD10 codes could have a significant effect on how EHR systems relate information and trigger patient service items. For example, the seven ICD10 character is different for an initial visit versus a subsequent visit. ICD10 codes can also include the site and characterize the severity of the patient’s condition. As a practical matter ICD10 codes can change for the same basic patient problem.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">ICD10 structure and characteristics present a number of serious challenges to physician practices as the vendors migrate to ICD10 compliant versions.</span></div>
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<li><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px;">The structure and additional information built into ICD10 codes will require substantial changes to EHR systems to maintain the current functionality.</span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;"> </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;">For example, a wide range of ICD10 codes may trigger patient services items that are driven by a few, or even a single ICD9 code.</span></li>
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<li><span style="font: normal normal normal 7pt/normal 'Times New Roman'; text-indent: -24px;"> </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;">Mapping previously ICD9 classified information to the ICD10 codes will be problematic.</span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;"> </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;">Many ICD9 codes may map to more than one ICD10 code.</span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;"> </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;">As important patient problems that span encounters over a long period of time may require look back strategies that account for the change to ICD10 code.</span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;"> </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 16px; text-indent: -24px;">Otherwise, physicians may be unable to locate related patient information based on the diagnosis codes.</span></li>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In the final analysis, the changes needed to ICD10 codes is not just a matter of presenting ICD10 codes in place of ICD9 codes for billing purposes, but will require significant changes to EHHR functionality to maintain the benefits of EHR systems using a dramatically different diagnostic coding strategy.</span></div>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-50321353374070720402011-09-02T10:33:00.000-07:002013-04-29T03:35:45.589-07:00Does Your EHR Present What Your Recorded?<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">With paper exam notes, the doctor and staff record information and the note reflects what they recorded. <b>Unfortunately, EHR based notes may not be as direct.<o:p></o:p></b></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Many EHR systems store the information that you enter in one way, and offer a variety of presentation and reporting options. The ability of the EHR to offer multiple presentation options is a powerful tool. For example, <o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">You may generate an exam note, referral form, and a disability notice from a single set of exam information. </span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">You may view the patient information on a formatted screen, in note form, and even in a longitudinal format depending on the EHR.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">However, EHR features are frequently <b>based on programmable interpretations, translations, summarizations, and even derivations </b>by the scripts that create the desired view:<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">The script may display a message that is not in the exam note but derived from the note. For example, a health maintenance warning for mammograms may be based on the date of the patient’s last mammogram. Similarly, a message to come in for a periodic visit may be presented based on previous services or problems. If the underlying EHR information is not properly recorded, inappropriate notes may be added, and/or critical notes not included.<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">A patient problem may be presented in text form without the ICD9 or even using another text description. For example, one system used a general migraine code (346.80) under a problem list labeled migraine, when in fact the one of the 14 more specific migraine codes was more appropriate for billing and problem definition purposes. In another instance, the labeled text item was connected to a more specific ICD9 code than indicated in the description. The lack of precision in the underlying codes could lead to a wide range of patient service issues.<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">Some EHRs link partial medication information in the exam note to very specific prescription information that may lead to a distortion in the exam information. For example, several EHRs use a listing of the drug name in the exam note and generate a prescription for a specific strength and form. When this prescription is processed in the prescription module, the doctor can change the prescription, but the exam note is not updated. <o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">Some EHR systems allow the user to change the note, while the connected information stays the same. For example, you may change the diagnostic order on the note, but the selected items associated with the original order remains. Other EHRs require recording the order in several places, which could be separately modified due to a clinical or patient service issue. <o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt;">A script may add text to the document that was not contained in the medical record. For example, some EHRs include information in the letter template that is not reflected in the patient’s medical record.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">These problems must be addressed by insuring that you adequately understand the operation of your EHR as well as the clinical content used to document patient services. Such a process requires vetting the clinical content as well as the documents and information that can be printed from your patient record. Otherwise, you may have records that do not accurately present the care and due diligence provided to your patients.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><a href="http://avoid-ehr-disasters.blogspot.com/2011/04/what-are-issues-with-clinical-content.html">See another post on clinical content.</a></span><br />
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<span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">For more posts on EHRs and Medical Professional Liability Risks,</span><a href="http://www.avoid-ehr-disasters.blogspot.com/search/label/EHR%20and%20Medical%20Liability" style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;"> click here</a><span style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">.</span><br />
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span><b style="font-family: Arial, sans-serif; font-size: 15.555556297302246px;">To measure and address liability risks associated with how you use and maintain your EHR based patient records, contact Sterling Solutions at (800)967-3028 or<a href="http://www.sterling-solutions.com/contact.html"> click here</a>.</b><br />
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-73900483791095429672011-07-14T10:17:00.000-07:002011-07-18T06:23:46.535-07:00Why Are Patient Portals More Important Than You Think?<div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portals facilitate the exchange of information between patients and physician practices. What was once considered a nice option for your EHR is becoming a necessity. Unfortunately, not all patient portals offer the same features. <b style="mso-bidi-font-weight: normal;">Failure to acquire an adequate patient portal could limit your EHR benefits and increase your costs.<o:p></o:p></b></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"></span></div><a name='more'></a><br />
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<div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portals can help you get updated patient demographic information, and new insurance information as well as coordinate appointment scheduling, and process payments. Clinical patient portal features include requesting refills, exchanging messages, reminding patients about treatment plan items, and accessing patient exam notes. Patient portals can also collect patient family/social history and even history of present illness as well as monitor patient wellness on a periodic basis. Clinical information may be accepted directly into the patient note for editing by the doctor or staff. Thereby, you save time documenting patient conditions and history.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">From a product development standpoint, patient portals have paralleled the EHR industry. Originally, most patient portals were developed as stand-alone products that were painstakingly interfaced with EHR and medical billing systems. Many EHR vendors have now established joint marketing programs with patient portal vendors or purchased patient portal products. In other words, your ability to pick “best of breed” patient portals to work with your EHR is rapidly diminishing.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">The lack of patient portal choices is not a trivial issue. Not all patient portal strategies are based on the same principles or support the same features. Indeed, many vendors have patient portal strategies that meet the minimum for Meaningful Use and not necessarily present an efficient or effective way to collaborate with patients. For example, some patient portals only support medical billing exchanges and do not deal with any clinical information.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portal evaluations should consider the following key issues:<o:p></o:p></span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Cost – <o:p></o:p></span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">One of the surprise patient portal issues is the pricing model. As EHRs have become very competitive on price, patient portal costs have shot up. Typically, practices look at patient portal add ons after the fact and do not completely consider patient portal costs. <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portal costs may include upfront software, installation, annual maintenance, and a per transaction fee. Transaction costs may be assessed for each transaction through the portal. For example, you may pay a transaction fee for each patient reminder, message and released office note. Transaction costs could grow into a significant portion of your computer costs as the patient portal is deployed for use. The patient portal costs need to be effectively projected to understand the full scope of the EHR financial commitment. <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Meaningful Use – <o:p></o:p></span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portals are a convenience under Meaningful Use Stage 1, and a necessity under Meaningful Use Stage 2. Stage 1 includes a core measure to provide clinical summaries for office visits. There are a number of clinical summary delivery options including paper summaries, CD, and secure email as well as patient portal. However, looking at the costs and logistical issues of providing summaries, a patient portal provides the most cost effective and patient service oriented strategy to fulfill this MU measure. <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Stage 2 of Meaningful Use includes patient messaging which will require a patient portal strategy.<o:p></o:p></span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">EHR Working Strategy – <o:p></o:p></span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portals have a number of different EHR working strategies. In some cases, the patient portal sends messages which must be manually interpreted and processed by the medical staff. In other cases, the patient portal generates targeted messages that are connected to the relevant EHR information and features. For example, some patient portals will send a message that a patient has requested a refill of a particular drug. The clinician has to locate the drug in the patient chart to issue the refill. Other patient portals will connect the refill to the patient medication record. When you look at the patient summary, you see the refill request message and the highlighted refill drug on the medications list. <o:p></o:p></span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Features - <o:p></o:p></span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient portals may dramatically differ in the supported features and interactions. For example, some patient portals only support secure messaging to fulfill Stage 2 Meaningful Use. Other patient portals products support a complete exchange of specific information on patient care issues. For example, some patient portals can present condition specific forms for patients to fill out. The information on the form can be accepted into the patient chart by the doctor or nurse. <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">The patient portal features may affect your implementation strategy and EHR use. For example, patient portals that are limited to messages would frequently be implemented after the EHR was in use for the majority of active patients. However, patient portals that accept information on family and social history as well as history of present illness will be an invaluable tool to help introduce a patient to the EHR.<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">An expanding list of patient service agendas requires a patient portal strategy and effective workflows between the patient portal and your EHR. Unfortunately, many practices have not carefully examined the patient portal strategy of their EHR vendor and the implications of the patient portal to their EHR strategy and use. EHR buyers should understand the specifics of the companion patient portal to their EHR options and consider the features and costs of such portals in their evaluation as well as their EHR implementation strategy.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">© Sterling Solutions, 2011<o:p></o:p></span></div>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1tag:blogger.com,1999:blog-6797111109631746787.post-32193167833727579042011-07-14T07:28:00.000-07:002011-07-16T20:37:29.296-07:00What ACO Features Are Needed in an EHR?<div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Most EHR systems are based on strategies that predate accountable care organizations (ACO) and Certified EHR standards. The key EHR requirements for ACOs are the ability to electronically exchange patient information, support provider collaboration, and monitor patient care. The EHR focus to date has been on creating patient exam notes and specifically meeting the Evaluation and Management documentation standards. <b> Most EHR products do not adequately accommodate the operational or management needs of the ACO structure.<o:p></o:p></b></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"></span></div></div><a name='more'></a><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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</div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Many Certified EHR products have structural designs that will not address ACO patient care needs. The active management and tracking of patient service issues and the maintenance of referential integrity for patient care is an area that requires dramatic changes to many EHR products. As important the expanded use of electronic exchanges necessitates auditable tracking of information sources as well as activities associated with those incoming and outgoing transactions. <o:p></o:p></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Certified EHRs can accept electronic transactions such as the Continuity of Care Record (CCR), but mostly do a poor job of tracking CCR related clinical activities. For example, the incoming CCR may trigger some clinical activities that will be reported back to the CCR source provider as well as tracked internally as the trigger for the follow-up patient service items. In most EHRs, each event is treated as a discrete item that is not related to the CCR or subsequent events. The lack of life cycle management and tracking tools makes management of ACO relationships and quality assurance difficult, if not impossible.<o:p></o:p></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">The lack of tracking tools could pose a number of patient service and medical; professional liability issues to the ACO as well as participating ACO providers. For example, the lack of tools to track appropriate clinical and patient service responses would make it impossible to monitor ACO activities and standards. In the event of a compliance audit or a medical professional liability discovery process, the EHR would not adequately reflect the due diligence for the patient situation. For example, many EHR products do not consider workflow messages part of the patient medical record. Such workflow messages may be a necessity for collaboration on care issues triggered by an incoming CCR.<o:p></o:p></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">ACOs require several components that are not typically found in EHR products today:<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Patient Service Tracking –<o:p></o:p></span></b></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">The patient service tools in many EHR products lack adequate management and standards monitoring tools to assure adequate provider response and handling. In some cases, the lack of referential integrity within the EHR makes patient service tracking impossible. For example, a number of EHRs require a patient service item to be recorded in three places: the exam note, the order feature and a message for staff. You cannot verify completion of a patient service item from the exam note and the order frequently is not connected to the exam note.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">ACO oriented patient service features track the relationship of all events triggered and derived for the patient visit as well as contextual tools to manage the lifecycle of patient service events.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Collaboration Within the ACO –<o:p></o:p></span></b></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Effective and efficient collaboration on patient care is a strategic necessity for any ACO. In most cases, CCR transactions and other electronically received information are magically inserted into the EHR without an effective or adequate audit trail of the source transaction or response. Other ACO related exchanges with other providers are typically entered as a miscellaneous message without context or connections to the ACO relationship. Indeed, in many EHRs, the person who receives the information and posts the information to the patient chart is identified as the audit source.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">An ACO’s EHR must clearly identify the source of EHR information from ACO partners as well as track the state of such information. For example, the incoming information could be pending an action, completed, or awaiting further activities. As important, links should be maintained to provider activities related to the incoming information. ACO participants will also need effective management tools for exchanges of information as well as the ability to focus on particular ACO related activities or participants. For example, the provider may want to examine the outstanding patient service items sent to a particular ACO provider. <o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div></div><div class="MsoNormal" style="margin-left: 36pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span style="font-family: Arial, sans-serif; font-size: 12pt;">Electronic Transaction Workflow –<o:p></o:p></span></b></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">A Continuity of Care Record (CCR) structure is used to transmit patient health summary from one EHR to another EHR over a network such as a Health Information Exchange. However, many EHR systems discretely create the CCR in support of Meaningful Use, but fail to track the lifecycle of the CCR. For example, a CCR transmission could be in support of a treatment plan item from a doctor. From an ACO and practice perspective, the transmission of the CCR is part of the patient service process and requires tracking tools at the sending and receiving points. Unfortunately, most EHR systems do not adequately track the status or source of incoming information from other parties. For example, the ACO and practice will be interested in the form of the original incoming information as well as changes to the information and activities triggered by the incoming CCR transaction.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal" style="margin-left: 72pt;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">ACO participants will be interested in electronic transactions that are related in the much the same way that we are interested in the relationship between an authorization, claim and explanation of benefits in medical billing systems. For example, we may want to be able to track the CCR into the EHR and the resulting patient visit note, as well as the transmission of the visit note to the source of the CCR.<o:p></o:p></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">EHR deployment and use is a necessity for any ACO and ACO provider. However, the assumption that an EHR will adequately support the collaborative structure of the ACO or the exchange of electronic information among ACO providers is not a good strategy for any ACO or ACO participant. ACOs and ACO providers need to seriously review and examine the underlying EHR features to assure that the EHR can support ACO related life cycle activities as well as provide management with tools to monitor ACO relationships and performance. <o:p></o:p></span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">© Sterling Solutions, 2011</span></div></div>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1tag:blogger.com,1999:blog-6797111109631746787.post-85055848590357400172011-06-16T07:07:00.000-07:002013-04-12T05:07:29.937-07:00Why You Need a Clinical End of Day Procedure?<div class="MsoNormal">
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">At the end of the working day, every healthcare organization performs a reconciliation of fee tickets and receipts to assure that all charges and payments were properly posted and applied. This effort assures the integrity and accuracy of the financial records. A similar process is needed to <b>maintain and assure the integrity of your EHR based patient information.</b><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">EHRs include a wide array of information that traverse through an EHR life cycle to completion. Some clinical lifecycles last a few hours and others may last years. For example, a refill request may be completed in a few hours or even in the current session while an order for annual checking of a patient with an implant may be completed within the year. Colonoscopy orders may take ten years to complete.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Note that paper charts have similar issues. However, we cannot practically monitor or identify open items in a paper chart or unaddressed patient messages. EHRs can instantly analyze the status of a particular message or identify all open messages meeting a certain criteria. For example, we can produce a list of outstanding surgery orders that have not been completed. This management capability allows you to improve patient service and monitor workflow.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In the course of an average day, each physician may generate or respond to a hundred or more clinical events, each with its own lifecycle. The exchange and movement of these clinical events may involve several administrative and clinical personnel. However, the EHR’s ability to support care and patient service can be undermined by not maintaining the correct status of various EHR items.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">These lapses may be the result of a lack of training, temporary issues in the practice or a good faith effort to completely document a patient situation before completing the patient record. A myriad of problems arise when users fail to control and track lifecycle events:<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Messages</b></span><span style="font-family: Arial, sans-serif; font-size: 12pt;"> - Tasks or messages may result from a variety of patient interactions and practice activities. Patients calling in for refills or advice may generate a message. Physicians may send a message to staff to follow-up or refer a patient issue. Failure to maintain appropriate status of messages could lead to cluttered inboxes which will confuse doctors and staff. For example, a review lab results message may remain open for results that have been reviewed. New documents may be displayed as already been reviewed. Users will waste time looking for the open tasks or in the worst cases stop using messages and tasks to document activities.</span><span style="font-family: Arial, sans-serif; font-size: 12pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Orders</b> – Many EHR systems accept orders for future services such as tests, procedures, and therapy. Orders may be fulfilled by a service provided by the practice, or a report from a third party provider. If the order status is not properly maintained, then the display of patient orders on the patient summary screen will be incorrect, and management tools to survey open orders across all patients will be distorted. Note that corruption of order status may inhibit your ability to meet the Patient Reminder Meaningful Use Menu Measure.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Exam Note Signoff</b> – Patient EHR notes require a signoff to acknowledge completion of the patient encounter. Signing the note is essential to document physician approval of the note and plan for patient treatment as well as document the level of service. With the best of intentions, some physicians prefer to leave notes unsigned in case a subsequent event affects the analysis or plan. However, without checking each and every note, notes could remain unsigned long after the patient is seen. Some EHR systems will automatically lock the note without the doctor ever signing the note.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Document Review</b> – Incoming documents may be received by fax or scanned into the EHR. Unlike paper records, electronic images can be tracked through the status of the image or associated messages. However, failing to maintain the appropriate status can lead to inaccurate documentation of patient services and even missed opportunities to review the document.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Incoming Patient Portal Information</b> – Patient portals facilitate the exchange of information with patients through a secure internet connection. Typically patients can request appointments, submit refill requests, send messages, and even submit clinical information. Each portal interaction is presented through the EHR to support physician activities. However, these patient portal items have to be tracked and managed with the same due diligence discussed for messages.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In the event that the EHR status is not properly maintained, some practices have resorted to a shadow paper based system that further degrades the utility of the EHR, and undermines the maintenance of the patient medical record.<o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 12pt;">THE END OF DAY CLINICAL PROCESS<o:p></o:p></span></b></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Many EHRs include a variety of tools to monitor the status of the patient medical record contents, messages and other patient service items. However, such management tools are subject to the proper disposition of messages, orders, patient notes and other EHR patient information. In order to maintain the effectiveness of the EHR and properly manage the patient medical record, the practice needs a daily process to assure that the EHR is being properly used and maintained.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The end of day clinical process should be based on a set of standards established by the doctors covering that various activities and tolerances for response or completion. For example, doctors may have to sign exam notes before the end of the day. The actual end of day process will mostly consist of reviewing lists of messages, orders and other items that exceed these limits and following up with the appropriate physician, or staff member. Summary statistics should be maintained on a daily basis and reported to the administration on a weekly or monthly basis.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Message and task management is the most complicated part of the clinical end of day process. Messages and tasks analysis should be based on practice level performance standards for each type of task. Thereby, the daily close procedure will actually consist of several different processes. For example, messages classified as refill requests should be completed within 24 hours of receipt. Patient care questions should be answered within 4 hours. A separate reporting and analysis process will be performed for each type of message or task.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The EHR should have a management screen or supporting reports that present tasks and messages based on a date and time tolerances. Users should make liberal use of start dates for messages and tasks. However, stop dates for clinical messages and tasks should be carefully controlled. In many cases clinical tasks do not stop, but are superseded by a new treatment strategy, or a change in the patient status.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Document Review</b> – Unreviewed documents should be identified within the review standard established by the practice. Some EHRs have time limits on document review and will automatically accept or lock the document into the chart. The end of day process will have to work ahead of such a locking mechanism.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b>Periodic Order Management</b> – On a weekly or monthly basis, all orders should be similarly reviewed based on established standards for each order type. Orders should be entered with a trigger and a due date. The key issue will be follow up on orders that are past their due date with the patient and/or physician. For example, certain types of orders beyond the due date may trigger sending a letter to the patient while other order types may warrant a phone call. Be especially careful to insure that you can change the order status to correctly classify the patient situation. For example, the order may be superseded, or the patient refused the care recommendation.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Recovery from failure to maintain the various life cycles of your EHR could entail an expensive and time consuming effort. More seriously, the collateral problems could be felt for many months or years thereafter. For example, the automatic locking of unsigned patient notes would not allow you to update an unsigned note. In some cases, you may have to create a new note that duplicates the information from the old note. In other situations, failure to follow up on prescribed patient treatment orders could expose the practice to a variety of patient service problems and potential medical professional liability exposure.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">A clinical end of day process will allow you to monitor the appropriate maintenance of your patient service records and documentation to avoid distorting your patient records and undermining your substantial investment in EHR based patient records.<o:p></o:p></span></div>
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Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-17323057299642936802011-05-25T05:47:00.000-07:002013-04-12T05:09:06.392-07:00Do You Know The Paper Chart to EHR Transition Risks?<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">I co-authored a <a href="http://conventusnj.com/Media_PDFs/EHREventDataConversion.pdf">case study on Medical Professional Liability (MPL) Risk</a> with Susan Lieberman, Vice President of Risk Management for Conventus Inter-Insurance Exchange. This case study highlights the importance of making good transition decisions as well as the substantial number of MPL Risks and, more importantly, risk reduction strategies you need to use to avoid serious problems in the future.</span>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-6140207183801373572011-05-09T03:45:00.000-07:002011-07-14T07:53:55.986-07:00Can Your Practice Afford Vendor Best Practices?<div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">In addition to the pressure on practices to implement EHRs, EHR vendors have seen a surge in activity that is stretching, if not breaking, their ability to implement and/or support their products. In order to deal with the accelerated adoption of EHRs, a number of vendors have developed “best practice” guides. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">This cook book approach to EHR implementation helps the vendors standardize use and, in some cases, use less experienced people to put in an EHR. Such<b> “best practices” may implement your EHR in a way that may not be most effective for your organization.</b><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"></span></div><a href="http://www.blogger.com/post-edit.g?blogID=1490698594460990274&postID=1646062013577317722" name="more"></a><br />
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<div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Unfortunately, it is extremely difficult, if not impossible, to determine the provenance of the “best practices” that you are being asked to use. Seldom do you find conditional best practices or even a decision tree that helps you figure out the best practice for the situation. Are best practices the same for primary care and specialty practices? Are there no differences in best practices between physicians that work with mid-level providers and those that don’t? Are best practices identical regardless of the area of medicine or the type of services that you provide? Are the same best practices applicable to all sizes of practices and organizational structures?<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">The best practices document may be imposing a process that is not effective for your practice. In the worst cases, “best practices” may undermine EHR use. For example, many “best practices” defer a wide range of decisions until after you have used the EHR for a period of time. However, deferring decisions could lead to constant changes to classification, presentation, and even use. Subsequent changes could result in additional costs to rework the use of the EHR, “fix” information from the old best practices, and retrain staff. Such changes can complicate access to patient information since the order and/or location of patient information location could vary from the old best practices to the new and improved best practice.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">For example, using a preloaded set of document types (advertised as best practices) included very general classifications such as notes, tests, insurance. If the practice used these classifications for the initial EHR implementation, they would have been unable to more granularly classify document types. For example, an OB/GYN practice may want to separate Pap smear results from general lab tests, while an orthopedic practice may want a separate document type for physical therapy reports. Unfortunately, the best practice document types affected document views, security and even workflow.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Such compromises can lead to a wide range of operational, patient service, workflow and even medical professional liability issues. The key challenge is to assure that your properly analyze, design and plan your EHR installation with a critical eye towards recommended best practices or any other cookie cutter approach. In order to avoid running into strategic or tactical “best practices” issues for your organization, consider the following:<o:p></o:p></span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Design Your Own Best Practice Strategy</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – You can certainly use the best practices recommendations of the vendor as a starting point. However, you should carefully evaluate the proposed best practices and not assume that the proposed best practice is right for you or even your area of medicine. You should evaluate the affect on workflow, patient service, and charting issues. Additionally, you should not defer too many issues until after the EHR is in use. For example, deferring staff EHR responsibilities could result in inappropriate transitions from the paper chart and a lack of confidence in the EHR. You analysis should include detailed discussions on practice services and operations as well as how the EHR will be used to address the operational challenge rather than compromise on practice issues to accommodate the vendor’s best practices. Be especially careful to analyze EHR use that could be difficult to change or would require a lot of rework. For example, changes to clinical information could require additional work on reports and exam documents. Similarly, enhancing document types to better organize patient information could result in the op reports located under different document types: initial vendor best practices and updated practice focused practices. <o:p></o:p></span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Test and Verify Your Decisions</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – Before using the EHR or training all of the staff on a process that is destined to change, you should verify how you set up the system and how you plan to use the EHR. Thereby, you avoid changes and retraining before your start production use of the EHR. Implementation of an EHR is difficult enough without having to deal with the wide array of problems that are caused by a failure to adequately design and develop the detailed procedures for success in the clinical environment. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Unfortunately, pushing back on best practices may put you in a challenging situation with the vendor. Vendors have been known to warn you that they can’t help you if you don’t use their best practices. In other situations, vendors have warned practices that failure to use the cookie cutter approach could lead to more costs to figure out the specific procedure for the practice. However, it is your practice that will have to cope with how the EHR system is established and used. Failing to critically analyze EHR use and the vendor’s “best practices” at the beginning of your effort could leave you with continuing challenges and costs to use the EHR rather than additional implementation costs to do it right the first time.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 12pt;">© Sterling Solutions, Ltd., 2011<o:p></o:p></span></div>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com0tag:blogger.com,1999:blog-6797111109631746787.post-8769610550680239572011-05-02T11:38:00.000-07:002011-06-03T15:02:44.878-07:00Why Should Your EHR Be “In Service” by December 31, 2011?<div style="margin-bottom: .0001pt; margin: 0pt;"><span style="font-family: Arial, sans-serif;">As we move further along on 2011, you should seriously consider your plans for the year and the most advantageous (and soon to be extinct) tax benefits of an EHR investment in 2011 or 2012.<span style="color: black;"> <o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><br />
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<div style="margin-bottom: .0001pt; margin: 0pt;"><span style="color: black; font-family: Arial, sans-serif;">Until December 31, 2011, EHR investments are eligible for 100% Bonus depreciation. 100 % Bonus Depreciation allows a practice to completely write off their hardware and software EHR expense without limit in 2011. (Bonus Depreciation drops to 50% in 2012 and reverts to regular depreciation in 2013.) Another interesting aspect to Bonus Depreciation is that Bonus Depreciation is not limited to an offsetting profit. Without getting into too much number crunching, that means that you may be able to generate positive cash flow depending on financing etc.<br />
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To take advantage of Bonus Depreciation, you need to have the EHR in service and you only have 8 months to do it. If you plan to take advantage of this one-time tax benefit, your still need to allow for enough time to select the right product and correctly put the product “In Service” subject to your tax advisor.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0pt;"><span style="color: black; font-family: Arial, sans-serif;">Anyone wanting to qualify for 100% Bonus Depreciation needs to act now since you are facing a limited timeline to put the EHR in service:<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><br />
</div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Selection</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – Practices can select an EHR within two to three months. This includes analyzing options, reviewing products and performing due diligence before making a final decision. However, many practices take more time to arrive at a final selection.<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Contract Negotiation</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – EHR contracts have a number of issues and details that deserve careful consideration and design. Typically, a contract can be completed in two to four weeks. However, you may need additional time to firm up your hardware and/or communication strategy.<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">Establishing Technology Infrastructure</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> – Before many implementation activities can occur, you need to order, and install hardware as well as provision communication upgrades. For an EHR, installation of the technology base can take anywhere from thirty to ninety days.<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;"><br />
</span></b></div><div class="MsoNormal" style="margin-left: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial, sans-serif; font-size: 12pt;">“In Service”</span></b><span style="font-family: Arial, sans-serif; font-size: 12pt;"> –The specifics of putting the EHR in service should be coordinated with your tax advisor. However, regardless of the In Service process, the EHR In Service effort requires the same level of due diligence and care that is needed to support any EHR transition.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><span style="color: black; font-family: Arial, sans-serif;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><span style="color: black; font-family: Arial, sans-serif;">As you can see, time is not on your side if you want to place the EHR in service in 2011.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0pt;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0pt;"><span style="color: black; font-family: Arial, sans-serif;">Placing an EHR in service does not require attaining Meaningful Use and qualifying for the Stimulus Incentives. Nonetheless, the 100% Bonus Depreciation for 2011 or 50% Bonus Depreciation for 2012. Bonus Depreciation may offer a significant advantage for your practice and your owners.</span><span style="color: black;"><o:p></o:p></span><br />
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<span style="color: black; font-family: Arial, sans-serif;">For more information on the specific tax issues, Mark Estroff of Gates Moore in Atlanta has written <a href="http://www.hitechanswers.net/wp-content/uploads/2010/10/Tax-Considerations-for-Technology-Investments-3.pdf">an excellent article on the subject</a>.</span></div><div class="MsoNormal"><br />
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</div>Ron Sterlinghttp://www.blogger.com/profile/14282383210539572049noreply@blogger.com1