According to the American Health Information Management Association, health information management professionals have a big decision to make – either cling on to the paper and pencil and go the way of the dinosaurs or embrace EHRs, data analytics, and ICD-10 so that HIM wranglers can flourish in the new era of health IT.
Mary Butler of the Journal of AHIMA writes that “The rapid adoption of EHRs, the transition to the ICD-10-CM/PCS code set, and intense focus on information and data governance all demand an upgrade of skills across the HIM spectrum.”
In order to stay on par with the top minds in the field, including nurses with informatics degrees and physicians with clinical informatics specialty certifications, HIM professionals need to invest in their own education if they want to hold their ground. This is of utmost importance in order for the industry to continue its positive growth.
Seven months into the reporting period for Meaningful Use, only four hospitals and 50 healthcare professionals have achieved stage 2, which is raising concerns about whether stage 2 implementation is helping or hurting EHR adoption.
To qualify for stage 2 MU, eligible professionals must meet 17 core objectives and half of the six menu objectives. Eligible hospitals must meet 16 core objectives and half of the six menu objectives. And providers must order at least 30% of radiology, 30% of labs, and 60% of medication through CPOE.
When the CMS launched the EHR Incentive Programs three years ago, the goal was to reward healthcare professionals for adopting EHR and increasing efficiency. However, it has become more of a burden than a gift due to low attestation figures, hardships on execution, and growing EHR backlash.
Because the question of whether this is helping or hurting EHR adoption is so broad and in depth, the infographic included below identifies adoption trends and illustrates the challenges.
According to a new issue brief from the Office of the National Coordinator for HIT, the technical and administrative infrastructure that receives EHR data must be updated as the volume of data coming in continues to increase substantially.
More healthcare practices are adopting health IT tools as they realize the vast benefits such as reporting data faster, allowing for better communication, and more efficient recording. As these practices switch over to implementing health IT tools, the surge of data increases and the portals that process the information must be capable to collect all that information, in order for it to be used beneficially.
As things continue to move quickly, there are still some kinks to work out, such as establishing the proper infrastructure to support real-time data collection, making sure physicians are reporting correctly and not using unstructured free-text, and organizing the data in a uniform and structured way.
The goal is to harmonize HIT standards and implementation guides to improve communication between clinical care and public health entities for different types of reporting.
Researchers from Baystate Health and University of Massachusetts-Amherst College of Engineering recently analyzed how physicians distribute their visual attention when reviewing electronic notes to see where their eyes spend more time reading and comprehending.
According to the study conducted by Applied Clinical Informatics, Clinical Innovation & Technology, physicians mainly focus on the impression and plan section of EHRs and do not give much attention to the other sections.
Ten physicians were tested used eye-tracking devices to measure their attention patterns as they read three electronic notes. Examined were their reading rates and the sections of the EHRs they read.
The results of the study showed that physicians read through the laboratory results, medication profiles, and vital signs very quickly, almost at a skimming rate and paid more attention to impression and plan sections.
The researchers concluded that optimizing the design of electronic notes may include rethinking the amount and format of imported patient data as this data appears to largely be ignored.
Despite the congressional block, a majority of organizations have recently expressed their intent to proceed with the implementation of ICD-10. An American Health Information Management Association (AHIMA) poll conducted during a two-day summit last week uncovered the industry’s disappointment with the delay, and frustration at the expense of money and energy the delay will cause. More than half of providers are prepared for ICD-10 and will go ahead with the plan on a voluntary basis, if they are allowed.
One reason for the mass disgruntlement is that many organizations have already spent too much money on the transition to stop now. According to the poll, 42 percent said that their organization has already spent more than $1 million on transition activities. Due to the delay, money allocated to make it to October 2014 must now be stretched, and augmented, to make it another full year.
The AHIMA sample is small, with less than 100 professionals responding to questions, but the results mirror other surveys conducted by Deloitte and EHR Intelligence in recent weeks. All surveys show that the overwhelming concern among providers is a loss of momentum and detrimental reallocation of resources as the cost of labor and maintaining the technology builds up.
On April 1, President Barack Obama signed the Protecting Access to Medicare Act, delaying the implementation of ICD-10 until October 2015. This congressional move came as a surprise to members of the American Health Information Management Association (AHIMA) and members of the Centers for Medicare & Medicaid (CMS.)
Yesterday at the AHIMA ICD-10 Summit, CMS’ Denise Buenning addressed the delay and answered questions from the audience. She expressed that CMS was just as surprised by the move as everyone else, and that it has been hard on CMS. Rumors had been circling that the cause of the delay was that CMS was not ready, but Buenning denies this and maintains she did not expect the delay from Congress.
Buenning stated that CMS is looking into the law and has plans to develop an option to take to the management level and the U.S. Department of Health and Human Services secretary for approval.
In order to prevent any future delays, Buenning stated that CMS intends to communicate better with physicians on the benefits of ICD-10 and will work through various associations, as she believes that they will be much more effective with numbers on their side.
The rapid growth of EHRs in the health IT industry has created a dramatic increase of jobs in this field. Hospitals have even expanded their budgets 35% specifically for retaining health IT personnel and technology. The most popular EHR related jobs range from entry-level medical record technicians to executive positions at hospitals and physician offices. Health organizations need people to install, design and implement EHRs, train and support, provide mobile health, integrate EHR data, redesign workflow, and maximize efficiencies.
There are even job opportunities before EHRs are rolled out, such as clinical transformation specialists who perform all the preliminary work to understand how the requirements are translated into software. Nursing jobs have also felt a boost because hospitals are recognizing their value in assisting with integration into clinical processes.
Additionally, since ICD-10 is delayed for another year, there is still a demand for people who can efficiently convert ICD-9 to ICD-10.
The following are eight of the most popular jobs in health IT right now:
Implementing EHRs might seem like a daunting task for physicians who haven’t yet done so because they don’t know where to begin and the cost of the systems can be discouraging. Web-based EHRs however, offer a cost-saving and simple solution.
Cloud-based systems store all of the practice’s information on external servers that are accessed online, and only require a computer with Internet connection. Client-servers store data internally, requiring a server, hardware, and software to be installed in the office.
While client-servers have been popular for some time, the growth of healthcare IT has caused many physicians to transition to the cloud. The benefits of cloud-based systems are outlined below:
Easier implementation - Since the EHR system runs on the web, there is no need for any additional installation on computers. This prevents interruption of cash flow, allows for a quicker return on investment, and simplified implementation.
Savings – The biggest cost for practices is the initial cost to install the EHR system. While client-servers can cost upward of $40,000 for installation, cloud-based systems simply require a monthly utility fee and no set-up costs.
Requirements are reduced - When medical records are moved to a cloud, all requirements typically done by IT professionals are done internally and automatically, including updates, tests, configurations, and installations, so practices are always running on the most up-to-date version available.
Superior accessibility and collaboration - Patient records and internal documents can be accessed remotely from any computer, anywhere. This allows doctors to collaborate on patient care more effectively.
Simplified scalability - Small practices can expand without the complications of adding more servers, which is costly. New users, doctors, and locations can be added easily and quickly.
With healthcare technology becoming more and more popular, many physicians are looking for ways to utilize it in ways that will help them connect with patients and also make the patients’ experience more pleasant and seamless.
Smart devices, like the iPad, allow easier sharing of information between doctors and patients, optimization of care, and streamlined workflows.
Below are some easy ways to improve patient care and engagement:
Reception area- patients can become very stressed waiting to be seen by their doctor, especially if the check-in process is disorganized. Having patients use iPads equipped with apps for checking in, filling out paperwork, and even loaded with medical-related articles for entertainment as they wait will make their experience a pleasant one.
Treatment/consultation room- providing patients with images of their x-rays or scans and interactive demos will help them get a better understanding of their condition and treatment.
Practice administration- presenting practice updates and patient information to your team in an interactive way allows them to be more involved. Using a cloud system allows them to access documents, make notes, share their opinions, progress, etc.
Appointment management- providing patients with apps that allow them to make, confirm, cancel, and check on appointments makes their time commitment quicker and therefore more convenient.
Access on the go- mobile apps allow physicians to view appointment and patient information remotely from virtually any location, which optimizes patient care.
The SMART (Substitutable Medical Apps and Reusable Technology) platform has started an advisory committee to help support the growth of modular apps for EHRs. The committee includes representatives from The Advisory Board Company, AARP, BMJ, Canadian Institutes of Health Research, Centers for Medicare and Medicaid Services, England National Health Service, Hospital Corporation of America, Eli Lilly and Company, MyHealthBook, Polygot Systems, Surescripts, and professor Clayton Christensen from the Harvard Business School.
The responsibilities of the committee are to advise on how to scale adoption as well as use SMART themselves. They will help create an environment where SMART is the standard for mobile health, with a higher demand for the economy of scale provided by a SMART API.
SMART was created to allow app developers to have a large market for innovation and the ability to run apps, specifically mobile medical apps, anywhere. The current environment for innovation is limited and companies have a hard time getting their products off the ground. SMART counteracts this issue and allows quicker deployment into hospitals and integration from a one-off perspective.
SMART API allows health IT platforms and EHRs to connect to specifically designed HTML5 or iOS apps. The app has already demonstrated use and has a number of large vendors utilizing it.