How Does Healthcare Reform Address the Topics of Weight and BMI?

What is Body Mass Index (BMI)?

One of the mandates put forth in the 2009 Stimulus Act requires that all EMR/EHR must now track a patient’s Body Mass Index (BMI) in addition to weight and height. Body Mass Index (BMI) is a ratio between a person’s weight and height and interpreted as a BMI score. There is a mathematical formula used to calculate Body Mass Index using an individual’s height and weight. To calculate BMI, divide weight in pounds (lbs) by height in inches (in) squared and multiply by a conversion factor of 703. BMI can also be automatically calculated using a BMI calculator or a scale with BMI capabilities.

A BMI score can determine if an individual’s weight is within a healthy range. Below 18.5 is Underweight, 18.5-24.9 is Normal, 25-29.9 is Overweight, 30-34.9 is Obese and 35+ is Morbidly Obese. As part of the new healthcare reform and EMR requirements, practitioners will have to electronically share their patients’ BMI scores with the CDC and other health agencies, which will streamline data collection and lead to more accurate assessment of public health.

Why does the U.S. government care about Americans’ BMI scores?

Studies show that individuals with a high BMI score are at increased risk for certain health conditions such as Hypertension, Type 2 Diabetes, Coronary Heart Disease and Stroke. Treating patients with these illnesses costs insurers and the public healthcare system millions of dollars each year and one of the goals of healthcare reform is to decrease healthcare costs related to these illnesses. The theory is that by measuring BMI and guiding patients to a healthy weight, providers may be able to help decrease costs by helping to prevent these illnesses.

Leave a comment and let us know what you think about the CDC tracking BMI scores.

Healthcare IT Professional Speaks on EMR Challenges Part 2

Another great feature of the current EMR systems is that the coding is correct. That, of course, means more efficient and possibly higher insurance reimbursements. With the EMR system in place, the system immediately correctly codes the patient encounter based on the data entered. Also, the system will indicate why it chose the encounter code and the level. It will also point out what additional time, tests or comments would need to be accomplished and/or changed in order to comply with a higher level visit or a higher level coding.What a resource! This is a valuable re-check of all the data entered. It is a great time to catch any coding errors so that the insurance is billed at the right level the first time.

The IT Professional's View on EMR

From Norton’s insider view, EMR has a way to go to reach the full promise of its promoters, but it is on the way. To help calm practitioners’ fears, it is common for a practice to see their physicians regaining, or even exceeding, their full patient load in a matter of just a few days. EMR, even at this infant stage, brings value to the practice as it acts as a quality-control officer at the coding stage.

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 Atlanta Women’s Health Group is 11 practices with more than 60 licensed physicians in and around Atlanta, Georgia. They focus on obstetrics and gynecology.

Healthcare IT Professional Speaks on EMR Challenges

The transition to Electronic Medical Records (EMR) can be beneficial to the practice, says one IT professional who has weathered the storm for a large group. The conversion is worrying physicians and IT personnel all over the U.S. Compliance dates are looming and few know how meeting those requirements will affect their practice. Two major concerns are the downtime to learn the new system and the coding/data compliance issues.

How does the EMR transition affect workflow and downtime?

EMR connectivity works fine after the medical professionals have used the new system for about two weeks, according to what Patrick Norton, IT guru for Atlanta Women’s Health Group has found. "I see physicians back up to at least their pre-EMR patient load in a matter of a couple of weeks and by a month, some even are increasing their patient load." Norton reports that he sees no problems at all once the physicians and medical practitioners begin to use the system with real patients. "All the lights seem to come on" when the situation is real to the doctor.

Tips for EMR System Training

Norton tells his trainees that the changeover is not difficult, but there is a lot to learn. First, he advises them to bend their thinking to the EMR’s way of recording the data. It’s all how the data is captured, then it just clicks into place. The physicians begin to understand what is important to the EMR system and what can be skipped in certain cases. Being effective with EMR is all about understanding which boxes to check and which to leave blank, and when. The students catch on fast, but that is partly because of the behind the scenes tweaks Norton has made to make entering the data simple. Norton changes or hides some of the check boxes on the electronic forms. He said the he’s learned that if it doesn’t need to be filled in, it is best to hide it, then the information the doctors do need to enter is very visible. He said that he’s found that it is best to have the capability to record all the data and just hide some of the boxes and spaces than it is to try and add those data entry points later.

Transferring Patient Data Across Healthcare Facilities

While EMR data transfer among hospitals, practices, laboratories and other health-related professionals is coming along, there are still problems to work out with connectivity with other EMR systems as there is not yet one dominant platform. That means that among hospitals and other practitioner offices the data does not flow easily and is often transferred to a CD and is physically carried to the other practitioner’s office. Uploading a patient’s laboratory results are still not fully automated either. These are definitely issues that will have to be resolved before EMR can reach its full potential.

Check back next week to read the next installment of this article, how EMR systems affect healthcare coding.

What are the top 5 buzzwords in medical weighing scales and what do they mean?

Body Mass Index (BMI)

Body Mass Index (BMI) is a ratio between a person’s weight and height and interpreted as a BMI score. This BMI score is then used as a tool to screen for obesity or excessive body fat. While it does not actually measure body fat directly, according to The Center for Disease Control (CDC), the BMI scores generally correlate with a person’s body fat percentage. There is a mathematical formula used to calculate Body Mass Index using an individual’s height and weight. To calculate BMI, divide weight in pounds (lbs) by height in inches (in) squared and multiply by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5'5" (65")
Calculation: [150 ÷ (65)2] x 703 = 24.96

 BMI can also be automatically calculated using a scale with BMI capabilities.

Physician Scale

Physician scales or doctor’s office scales can include balance beam scales, digital scales and baby scales. They are used daily in primary care facilities to measure a patient’s weight. Some physician scales can also measure height and BMI. New U.S. healthcare reform requirements declare that by 2014 all physicians must track a patient’s weight, height and BMI and store that information in an electronic medical record.

Digital Scale

Digital scales offer many more features and benefits than a standard mechanical scale. Powered by batteries or AC adapter, a digital scale computes weight using load cells and then displays the measurements on a display screen. Digital scales provide features such as hold/release, LB/KG Conversion, LB/KG Lockout, Motion Sensing Technology, EMR Connectivity and Tare. Digital scales using advanced technology can also measure a patient’s BMI or height using a digital integral height rod.

Load Cells

Load cells are sensors located in a scale’s weighing platform that convert the weight load into an electronic signal for the scale’s computer. There are various types of load cells that provide specific benefits. Some advanced load cell technology used in medical scales permit on site scale diagnostics and quick and easy component replacement.

Networked Scale (EMR Capable Scales, EMR Ready Scales, EMR Connected Scales)

Digital scales that are designated as "Networked", "EMR Capable", "EMR Ready", or "EMR Connected" provide either serial port or USB connectivity that enable the user to 1) electronically store information from the scale, 2) communicate with a peripheral device such as a computer or printer, and/or 3) interface with spot monitors. There are many benefits of using EMR connected scales.

Links to U.S. Government Websites Providing Information about Healthcare IT and EMR Compliance

Comprehensive Source about Healthcare IT

http://www.healthit.gov/

A complete list of these meaningful use criteria
http://www.cms.gov/EHRIncentivePrograms/Downloads/MU_Stage1_ReqSummary.pdf

The Official Web Site for the Medicare and Medicaid EHR Incentive Programs

http://www.cms.gov/EHRIncentivePrograms/

The direct link to begin registration for the EHR Incentive Program

https://ehrincentives.cms.gov/hitech/login.action 

ONC list of certified systems

http://www.cchit.org/products/onc-atcb

FAQ regarding new legislation on the CMS website

http://questions.cms.hhs.gov/app/answers/list/p/21,26,1058

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology

http://federalregister.gov/a/2010-17210

Urgent Deadline Approaching – Medicare Reimbursement at Risk!

February 29, 2012 – Deadline to Register for Maximum Payments from EHR Incentive Program

By now, most physicians and hospitals are aware of the EHR Incentive Program offered by the U. S. Government as part of the HITECH Act. The EHR Incentive Program provides compensation to medical professionals and hospitals as they adopt and implement EHR technology in their facilities. These incentive programs are offered to help off-set the cost for practitioners as well as to give them an incentive to utilize an EHR system.¹ Eligible hospitals or physicians must successfully demonstrate "meaningful use" of an EHR system for a consecutive 90-day period in their first year of participation and for a full year in each subsequent year to participate in the program and receive incentive payments. To receive the maximum payments in the Medicare segment of the program, up to $44,000, practitioners must register by February 29, 2012. Practitioners can register after February 29, but because payments are made on a sliding scale based on participation start date, they will only be eligible for 4 years of incentive payments or less. Eligible professionals who do not successfully demonstrate meaningful use or become "EHR compliant" by 2014 will lose federal subsidies and be penalized with diminished Medicare payments. The direct link to begin registration for the EHR Incentive Program is https://ehrincentives.cms.gov/hitech/login.action

Connected Medical Devices Will Be Required

Proving meaningful use to receive incentive payments means meeting a series of objectives and measures as outlined by the Centers for Medicare & Medicaid Services. Part of the meaningful use criteria states that vital signs, such as height, weight and BMI must be electronically recorded into the patient’s EHR. Therefore, healthcare professionals will have to closely examine their workflow systems, verifying which of their vital signs measurement devices have EHR connectivity capabilities. The devices that have connectivity capabilities must be interfaced with the EHR system so that measured data can be electronically transmitted. If a device does not have any options to connect to the EHR system, a new device with connectivity capabilities will have to be purchased.

 1 - http://www.cms.gov/EHRIncentivePrograms/

Many physicians’ practices are better equipped to provide great patient care and keep their offices running more economically and efficiently than others. The more efficient facilities are connecting diagnostic and monitoring medical equipment to their Electronic Medical Records.

Making Use of Connected Medical Devices

Connecting medical equipment to patient records has many benefits beyond boosting efficiency.See our previous post. Additionally, connecting diagnostic and monitoring equipment to a patient’s EMR is a Stage 3 Meaningful Use requirement. So hospitals and practitioners’ offices should be anxious to hook up all their information-gathering equipment to their EMR. Unfortunately, that is not the case according to a White Paper released by the HIMSS Analytics and Communications IT firm Lantronix as late as December 2010. It said, "just a third of the 825 U.S. hospitals queried report having active interfaces between devices such as defibrillators, physiologic monitors, vitals monitors and electrocardiographs and their EMRs." It goes on to say that although "71.7 percent of those with hubs for "intelligent medical devices" are interfaced with EMRs" only 11 percent of reported they used those hubs.¹

While the surveyed hospitals are not utilizing connectivity options, many physicians’ offices are. For instance, doctors connected to the Mayo clinics have been using EMR, to keep all their patient information together since 2005.² Every time a patient steps on a digital scale, his/her weight is downloaded and recorded accurately in the records. Every EKG result is electronically transferred to the record without being copied into a paper record and then typed into an electronic record, each human touch increasing the odds of an error. Every x-ray and CT scan is available through an electronic connection so it is immediately available for comparison. "Everything related to a patient's care – physician notes, laboratory reports, surgical dictations, copies of correspondence, appointment schedules, X-rays, ultrasounds, CT and MRI scans, echocardiograms" are all right in the patient’s EMR says the Mayo Clinic Web site. That way any of the specialists can view all of the results at one time. ³

But in smaller practices, such as a six-physician OB/GYN office, many are still implementing their EMR system and diagnostic tools. Since a patient’s weight is monitored carefully during pregnancy, this OB office plans to connect the digital scale first to the EMR system. Of course the plan also includes electronically transferring blood pressure readings, sonograms, lab results and physician notes.⁴

When asked why they have not adopted EMR technology, the most common reasons that healthcare organizations give are cost and fear of losing productivity. Regardless if a facility is physician owned or it is a large hospital, cost is a major factor. Investing in an EMR system and connected technologies is costly and if the facility does not have the funds in reserves and cannot obtain a business loan then the equipment cannot be purchased. The other objection, losing productivity, does have merit but it can be overcome. Implementing a new system requires training of all users and will involve a learning curve. But after some time, users will become adept at the new system and the office may become more efficient.

 The Importance of Connecting Periphery Medical Equipment

With the requirements for EMR Meaningful Use Stage 2 and 3 looming in the not so distant future, physician’s offices and hospitals are connecting more and more periphery equipment to the EMR systems, streamlining their patient record keeping. With EMR and periphery equipment connectivity a Stage 2 Meaningful Use requirement and the efficiency of data entered accurately into the patient’s record, there are driving forces for practitioner’s offices and hospitals to move towards connecting medical equipment readings directly to the patient’s EMR.

1- Automatic Charting of Medical Device Data and EMR Integration – A Status Update, 12-2-2010, http://www.fierceemr.com/story/himss-analytics-few-medical-devices-connect-emrs/2010-12-02#ixzz1iP2LfspE, 12-29-2011

2- Mayo Clinic, The electronic medical record at Mayo Clinic, 2011, http://www.mayoclinic.org/emr/, 12-9-2011

3- Mayo Clinic http://www.mayoclinic.org/emr/, 12-9-2011

4- Interview with a doctor who responded anonymously

The Benefits of Using EMR Connected Medical Devices

Medical facilities utilize a multitude of diagnostic devices such as blood pressure cuffs, scales and thermometers. Traditionally, when a patient’s vital signs are taken, the data is written in their chart. But as more facilities are implementing Electronic Medical Records, practitioners are seeing the value of EMR connected medical devices. An EMR connected medical device has the capability to communicate and transmit data into an EMR system via the device itself, an external adapter or software application. This means that the data that the device measures will be automatically entered into a patient’s electronic medical record. The medical professional does not have to print, scan, or type anything, there is no need for any manual input. This automatic measurement and transmission of data has many benefits.

Error Reduction

Eliminating any manual input reduces the possibility of transcription errors. This is especially important when recording weight as doctors use weight to formulate the proper dosage of medications. Incorrectly inputting a patient’s weight can lead to over or under dosing of medication as well as incorrectly diagnosing someone as obese or underweight.

Consistent Documentation

If a medical facility is utilizing all of their connected devices in the proper way and as part of consistent procedures, then each patient’s chart will be completed in the same fashion. A doctor can then access a patient’s chart and see each test result, vital sign or diagnosis noted in a consistent manner. For instance, if the office’s scale is set to transmit weight into the EMR as pounds only, then a practitioner knows how to interpret the chart. But if an office is manually inputting weight into an EMR or still using paper charts, practitioners can inconsistently record weight in pounds or kilograms which can cause confusion.

More Efficient Workflow

There is no question that EMR connected medical devices are more efficient. Automatic measurement and transmission of the data directly into the EMR system saves the practitioner the time of manually typing data into the chart or recording data into a paper chart. For optimum efficiency, a facility can create a central work station with all of their devices together connected to a central computer where they can measure all of the patient’s data at once, rather than walking around the office to various devices.

Medical device manufacturers are just starting to develop EMR connected technologies but practitioners are already realizing their value. These devices will also become necessary in all medical facilities by 2014 as part of the HITECH Act. What other benefits do you think connected devices provide? We would love to hear your opinions below!

"How Can a Medical Facility Achieve Meaningful Use?"

One of the meaningful use criteria uses the phrase "electronically record" in reference to taking a patient’s vital signs. This means that whatever device is measuring a particular vital sign must be doing so electronically, not manually. The criteria also requires that the vital signs are electronically retrieved, which means that when the vital sign is measured it must also be electronically transmitted into the patient’s EMR. Only a truly "connected" medical device can do these things and help the practitioner become EMR compliant in regard to this meaningful use criterion.

 Understanding Connectivity Capabilities of Your Medical Devices

Healthcare professionals must understand the connectivity capabilities of their medical devices in order to become EMR compliant. Unfortunately there are no standards for connectivity solutions and manufacturers can tout their products as "EMR Ready" or "EMR Compliant", regardless of the multitude of channels or software that it may require to interface with an EMR system. To help their hospital or practice meet meaningful use criteria, the practitioner should begin working with their EMR vendor to determine if their software is able to interface with any of their existing medical devices. They will then be able to determine if they will need to purchase new devices with connectivity capabilities.

For example, if a doctor’s office only has manual blood pressure cuffs they will have to manually enter the reading into the patient’s medical record. However, the HITECH Act mandates that by 2014 that vital sign measurement must be electronically measured and input into an EMR. Consequently, the doctor will have to purchase an electronic blood pressure cuff that not only electronically takes the blood pressure reading, but it must also be able to take that data and transmit it into the patient’s EMR – they need a connected diagnostic device. A medical device that has connectivity capabilities will be able to communicate and transmit data into an EMR system via the device itself, an external adapter or software application. These connectivity solutions are what enable the devices to transfer patient data into the EMR and will help the practitioner meet the meaningful use requirements to become EMR compliant.

The Next Steps to Becoming EMR Compliant

To become an EMR compliant medical facility, healthcare professionals will have to closely examine the meaningful use criteria and determine what they need to change to meet the new rules. This includes looking at their workflow procedures and verifying which of their medical devices have connectivity capabilities. Those devices that have connectivity must be interfaced with the EMR system so that measured data can be electronically transmitted. If a device does not have any options to connect to the EMR system a new, connected device will have to be purchased and put into the workflow.

There are many benefits of using connected devices, beyond EMR compliance. Stay tuned for an upcoming blog post to cover these points. In the meantime, we would love to hear about what other topics you would like us to explore or investigate. Please leave a comment below and we look forward to fostering meaningful conversations about our industry and hearing what you have to say.

Welcome to the Health o meter^® Professional Scales Blog!

Our first blog post is the perfect opportunity to illustrate to our readers the purpose behind our corporate blog. This blog is intended to be an educational resource for the healthcare community and to help create meaningful conversations about the multitude of changes occurring in the medical industry. We will cover topics such as the challenges that healthcare professionals are facing on a daily basis; what innovations are being developed to help increase workflow efficiencies; and why it is important for physicians to implement new IT solutions in their practice. There is a lot going on in healthcare right now and we are standing on the front lines along with the medical professionals looking for answers.

Electronic Medical Records -  A HOT Issue At Least Until 2014!

Perhaps the biggest, most current issue in the healthcare community is EMR - Electronic Medical Records. Medical professionals are either currently using an EMR system or working on implementing one. It has been a hot topic since 2009 when the U.S. Government passed the Economic Stimulus Act which inundated the healthcare community with new mandates, regulations and reform. As part of the 2009 Stimulus Act, the National Coordinator for Health Information Technology (HIT) was mandated to update regulations to require utilization of an electronic health record for each person in the U.S. by 2014. In other words, under this new HITECH Act, by 2014 it will be mandatory for physicians and hospitals to use EMR/EHR for all patients.

Meaningful Use

The HITECH Act not only requires that doctors and hospitals must use a certified EMR/EHR system, but they must also adhere to established criteria of "meaningful use", that includes up to 30 measures and objectives. As outlined by The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), abiding by these meaningful use criteria is referred to as "EMR compliant".

Proving meaningful use sounds like a complicated undertaking and it can be. There are numerous rules to follow to prove your EMR compliance and only a few ways to abide by those rules. For example, according to the "General Certification Criteria for Complete EHRs or EHR Modules" as outlined by the HITECH Act, a certified EMR system must "Enable a user to electronically record, modify, and retrieve a patient’s vital signs including, at a minimum, the height, weight, blood pressure, temperature, and pulse."

Look for next week’s post that will continue this conversation by asking "How can a medical professional achieve this particular standard of meaningful use?"

Source: http://www.hipaasurvivalguide.com/hit-subchapter-d/hit-170-302.php