Regional Extension Centers Offer Help with EMR Implementation

The Office of the National Coordinator realizes that implementing a new EMR system is no easy task, especially for practitioners in small towns or rural areas. In response, the ONC has provided grants to establish Regional Extension Centers, whose purpose is to aid these practitioners and help promote their adoption of an EMR system. There are currently sixty-two centers serving approximately 100,000 primary care providers in small practices in rural areas. Funded by Health Information Technology Extension Program, the Regional Extension Centers (REC) provide many services to help the healthcare professionals implement a new EMR system with end-to-end project management. These services are available to:

• individual and small group practices (ten or fewer professionals with prescriptive privileges) primarily focused on primary care;

• public and Critical Access Hospitals;

• Community Health Centers and Rural Health Clinics; and

• other settings that predomminantly serve uninsured, underinsured, and medicallyunderserved populations.

Here are the main services offered by the Regional Extension Centers:

1. Training and educational events for doctors, nurses and office staff to learn about topics related to healthcare IT

2. Personalized guidance on choosing the right EMR system for the practice, implementing that system and achieving meaningful use via that system

3. Assistance with negotiating terms with EMR vendors

4. Onsite technical assistance for the practice before, during and after their EMR system has been implemented

5. Advice on redesigning and applying the practice’s workflow to the new EMR system    

6. Instruction on employing privacy and security practices, disaster recovery plans, storage of electronic information and local privacy laws

7. Provide educational materials and handouts

8. Help practitioners participate in health information exchange with applicable state regulations

To find a REC near you, visit http://www.healthit.gov/REC%20

Sources:

http://www.healthit.hhs.gov/portal/server.pt?open=512&objID=1335&mode=2

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_913556_0_0_18/REC_Cycle_3_Final_508_v2.pdf

Thorough Training and Detailed Planning Essential for Successful EMR Transition, Part 2

When planning the training sessions, another factor to consider is the facility’s workflow. Role-play training sessions can be held that mirror patient visits and teach the staff how to use the new EMR system during their actual daily workflow. Or the various segments of the workflow such as patient check-in, vital signs or pre-exam interviews can become their own training sessions. In doing so, the staff will learn hands-on how to apply the system to their daily tasks. If training is just a brief overview of the modules, the staff may not be comfortable once the system is in full use and this will slow down the workflow and there will be productivity loss. One of the benefits of using an EMR system is to increase efficiency, but this can only happen if the staff is fully trained on how the system is used in daily operations. Training by use of the workflow is also a good way to test the EMR system and work out any technical problems that the vendor needs to address.

Upon completion of training it may become clear that some staff members have excelled in learning the new EMR system. Those staff members should be chosen as "super-users" and allowed to give guidance to other staff when using the system. Having on-hand experts will reduce the need for time-consuming calls to the EMR vendor. There will be a learning curve and some staff may try to avoid using the system. But to ease the transition for the staff that is having trouble, additional training should be offered and their questions should be addressed promptly.

There will also be times as the system is first implemented when even the "super-users" will need further guidance or instruction on a module. On-going support from the EMR vendor should always be included in a contract and staff should not be discouraged from using this service. Support costs may vary but having that technical support is essential so mistakes are avoided and the modules are used correctly.

Transitioning a healthcare facility into an EMR system is no easy task and requires thorough preparation. The EMR system is the backbone of the facility’s workflow and therefore it is essential that staff is fully trained and it is implemented properly.

Do you have any additional tips for training staff on a new EMR system? Post your tips below!

Thorough Training and Detailed Planning Essential for Successful EMR Transition, Part 1

When introducing new technology to employees, training on the new equipment or device is essential and depth of that training depends on the complexity of the technology. For example, training healthcare professionals on a new electronic medical record (EMR) system requires strategically planned, comprehensive and extensive training.

A successful transition to an EMR/EHR system begins with a detailed plan. When the EMR system is purchased, the healthcare facility should consult the EMR vendor on their recommendations for training. The EMR vendor should also provide on-site training for an agreed-upon time period. Some vendors may extra charge for this training or it may be included in the purchase price of the system. It is imperative that training is provided to employees and cost should not be a factor. If training is cut short because of cost concerns, those costs could be incurred elsewhere in lost productivity time or errors. For example, untrained employees could make fatal prescription errors if not trained in the e-prescribing module of an EMR system or could mistakenly mark a diagnosis that does not apply to a patient resulting in insurance coverage problems.

The next step in the training plan is to determine when the training sessions will be held. Training should be done in long stretches of time, not in short increments when there is a lull in patient visits. These long blocks of time can be set aside by closing the office for full or half days. Practices can also hire temporary staff to help with the patient load which then allows the permanent staff the time to attend training sessions. "Practices should anticipate 12 to 16 hours of classroom training a week before the system is in place" says Dan Marino, CEO of Health Directions, a consulting group in Oak Brook, Il.¹

Scheduling the training sessions should be based on the usage of modules in the EMR system. Each module involves either some or all of the staff and some modules are more complex than others. Whomever is in charge of the training should evaluate the staff’s usage of each module and then schedule the training accordingly. For example, all staff will need training on the system’s general functions and navigation. But if only certain staff will handle the billing or insurance modules then other staff need not attend training on those modules. The same goes for modules that involve scheduling, e-prescribing or vital sign measurement.

Visit us again next week for Part 2 of this series that will provide more training tips and guidelines.

 Source: 1- http://www.ama-assn.org/amednews/2011/04/04/bica0404.htm?goback=%2Egde_700187_member_109441961

New Study Shows Obesity Leads to Higher Health Care Costs, Further Supporting Government Regulation of BMI Measurement

A recent study, performed by Cornell University and published in the Journal of Health Economics, reports that an obese person incurs medical costs that are $2,741 higher than if they were not obese. Analysts of the study say that these results provide further support for the government to include BMI measurement as part of the HITECH Act.

Why are costs higher for obese patients?

Obese patients are more at risk for many diseases such as cancer and heart disease. Treating these conditions is costly as they require medications, surgeries and frequent doctor visits. Obese patients can also incur costs with longer hospital stays as they are inclined to more surgery complications with healing and anesthesia.

Why does the government care what Americans weigh?

Since some of these obese patients are covered under Medicare and Medicaid, the government has a financial interest in keeping Americans at a healthy weight. To initiate more awareness of healthy weight and preventing obesity, the government is requiring that practitioners begin measuring Body Mass Index as part of the HITECH Act and the EHR Incentive Program. Body Mass Index is a ratio between a person’s weight and height and interpreted as a BMI score, which then categorizes the patient as Underweight, Normal, Overweight or Obese. By requiring healthcare practitioners to measure BMI, the government will be able to gather important statistics about Americans’ weight and BMI scores. This data will help the government determine funding for healthcare programs that help prevent obesity. Additionally, making patients and their doctors more aware of BMI scores may also motivate patients to achieve a healthy weight resulting in fewer obese and overweight Medicare/Medicaid patients and reduced costs for the government.

Do you agree that this study is good support for the BMI regulation? Or do you think the government should not be concerned with Americans’ weight? Voice your opinion in the comments section!

Source: http://www.sciencedirect.com/science/article/pii/S0167629611001366

Updated Educational Materials on the CMS Website

The CMS recently updated the documents on its Educational Materials page. Visit the site for helpful and useful guides pertaining to the EHR Incentive Program registration, meaningful use attestation, and more!

https://www.cms.gov/EHRIncentivePrograms/55_EducationalMaterials.asp#TopOfPage

Are Healthcare Practitioners Making the Most Out of Medical Device Technology?

Recently, a patient visited their primary care physician for a new patient exam. As the patient was called into the exam area she was asked to step on the scale and the physician assistant recorded the weight in the patient’s electronic medical record using a small, portable laptop.  As they entered the exam room, the patient was then asked for her height measurements. Next, the assistant took the patient’s temperature with a portable digital thermometer and measured her blood pressure using a manual cuff along with a stethoscope. Once those vital signs were taken, they were manually input into the EMR. This scenario is typical of many doctor visits as more doctors implement EMR systems into their practice. However, this workflow could have been expedited with fewer steps and mouse clicks if the office was making the most out of medical device technology.

 Use the Scale to Measure the Patient’s Height and BMI

The patient noticed that the scale used to measure her weight also included a height rod. Yet, the physician’s assistant chose to ask the patient her height, assuming the patient knew her correct height or was willing to provide the accurate measurement. Had the assistant utilized the technology of the scale's built-in height rod she could have measured the patient’s height and weight simultaneously, while also allowing the scale to calculate the patient’s BMI. The assistant could have also entered the measurements into the EMR system with fewer clicks if she had the scale interfaced with the EMR system. Some scales offer the option to interface with EMR systems via software or external adapters. Utilizing this option would make measuring height, weight and BMI much more efficient.

Incorporate an EMR Connected Vital Signs Monitor

If the healthcare facility is already using an EMR system, it makes sense for them to be utilizing EMR connected medical devices in their workflow. The most useful and convenient device would be a connected vital signs monitor that measures both blood pressure and temperature. The assistant could then quickly measure both temperature and blood pressure and the vital sign would be directly input into the EMR system. Utilizing one tool is faster and not having to manually input the measurements is more efficient and reduces the risk of error.

Medical device technology is evolving faster than they are being put into use by healthcare facilities. Why aren’t more practitioners adopting these devices that can drastically improve their workflow efficiencies? Is it fear of the complexity of the technology? Is it cost? Is it complacency? If you are a healthcare professional, what is holding you back? If you are a patient, would you prefer your practitioner use these new technologies? Post your comments below!

Why is it Important to Maintain a Healthy Weight?

Maintaining a healthy weight is one of the major ways an individual can prevent many diseases and increase their life expectancy. To determine what weight range is healthy for an individual, physicians calculate the patient’s Body Mass Index. 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.

If an individual’s weight is in the overweight or obese range that is considered an unhealthy weight. The weight measurement is deemed unhealthy because being overweight puts one at risk for many diseases such as heart disease, diabetes, high blood pressure and certain cancers. The Centers for Disease Control reports that "obesity is a national epidemic, causing higher medical costs and a lower quality of life."¹ Excessive body weight is usually a result of lack of physical activity and consuming too many calories.

To maintain or achieve a healthy weight the CDC recommends living a "lifestyle that includes good eating habits and daily physical activity."²  Balancing calorie intake with calories burned through physical activity will help individuals lose weight and maintain a healthy weight. Choosing foods that are low in fat and sugar and high in nutrition helps keep calorie intake in moderation. Regular physical activity not only burns extra calories but it also makes the body stronger.

Physicians are well aware of the benefits of maintaining a healthy weight. With obesity numbers on the rise, many doctors are incorporating measuring BMI as part of their vital sign measurement workflow and educating their patients on losing weight. If you are a physician or work for a healthcare facility, do you measure your patients' BMI score? If you are a patient, has your physician counseled you about maintaining a healthy weight? We would love to hear your comments below!

1 - http://www.cdc.gov/vitalsigns/AdultObesity/LatestFindings.html

2 - http://www.cdc.gov/healthyweight/prevention/index.html

Choosing the Right Medical Devices for Your Practice

Following up on last week’s post regarding small practices having to utilize new EMR systems, we wanted to share this post from Healthcare IT News.

http://www.healthcareitnews.com/news/top-5-it-rules-smaller-practices

It discusses 5 rules for smaller medical practices to follow when deciding which EMR system to purchase for their office:

1. Ease into the technology

2. Focus on interoperability and best of breed.

3. Ask the right questions.

4. Make sure the technology fits your desired outcomes (not tasks).

5. Be sure it can handle the different data you have.

The main goal of the EMR system should be to streamline the practice, but choosing the wrong system can actually slow things down, in turn causing other problems. Some of these same rules can be applied when the practice needs to choose the right medical device.

Ask the right questions.

When exploring your options for a particular medical device be sure to ask your sales representative the right questions for that product. How will this product be incorporated into the current workflow? Does this product have connectivity capabilities with the practice’s EMR system? What are the features and benefits that this product provides versus its competition?

Make sure the technology fits your desired outcomes (not tasks).

Just because a device does the task that you need it to do, it may not be the exact right fit for your practice. For example, your workflow may require that you measure a patient’s weight, height and BMI during each visit. You would need a scale that measures all three of those vital signs, but not all scales have those features. It would also be best if that scale has the ability to connect to the practice’s EMR system, but many scales do not provide connectivity capabilities. Your ideal scale would be one that offers EMR connectivity and measures weight, height and BMI. Be sure to ask your sales representative for the devices that offer the technology that you need not just now, but also what you will need in the future.

Do you have other suggestions for practitioners to consider when choosing medical devices? Post your suggestion below!

Who is Responsible for a Medical Practice Achieving EMR Compliance?

This question does not have a definite answer, as each practice is different and there is no governmental definition. Larger practices with multiple doctors may have enough revenue to employ an office manager, IT administrator or compliance officer. In these cases it may be their responsibility to keep the practice in compliance with all government requirements such as HIPAA laws and the new EMR compliance regulations. However, if it is a smaller practice with a solo physician assisted by medical technicians and nurses, it is most likely up to the physician to keep his practice in compliance.

Investing in a new EMR system is very challenging, especially for private practices. To ensure that the best system for the practice is purchased, many questions must be asked of the prospective EMR vendors and much time must be taken to consider the practice’s current and future needs. This can be overwhelming for anyone to undertake alone. Ideally, technicians, administrative staff, nurses and physicians should all be involved in the process of choosing the right EMR for their practice. But if a practice does not achieve EMR compliance by the 2014 deadline, they will get penalized with diminished Medicare and Medicaid payments. If that occurs the practice may have accounting troubles that cannot be overcome and the practice will have to close. In that instance all employees are at a loss of a job and the physician has lost his practice. So, it can be said that since the physician has the most at stake to lose he is ultimately responsible for the practice to achieve EMR compliance. 

We would like to hear your opinion, leave a comment below about who you think is responsible for the practice to meet healthcare reform regulations.

What Medical Devices Need to Be EMR Connected?

In 2009, the Department of Health and Human Services outlined the criteria for practitioners to prove meaningful use of their EMR/EHR system, as part of the EHR Incentive Program. Section 170.302 (f) specifically refers to the measurement of vital signs stating a certified EMR/EHR system must "Enable a user to electronically record, modify, and retrieve a patient's vital signs including, at a minimum, height, weight, and blood pressure."¹ This means that the devices used to measure those vital signs must be "connected" devices that can electronically communicate with the EMR/EHR system.

What is a "connected" medical device?

 A "connected" medical device can electronically measure, record and transmit data into an EMR/EHR system.

What devices do practitioner's need to meet meaningful use?

A practitioner needs a connected scale that electronically measures height and weight and an electronic blood pressure cuff. Many scales claim they are EMR capable, but that does not mean the scale is EMR compliant. The scale must have the functionality either within the scale or through an external adapter that allows the measurement of the weight and height to be electronically transmitted into the EMR system. The same concept applies to the device used to measure blood pressure. That device must be able to electronically record the patient’s blood pressure and electronically transmit and record that reading into the patient’s EMR. To be compliant by 2014 physicians and hospitals need to begin analyzing the devices they currently use to determine if they have EMR capabilities.

See our previous post to learn more about how to determine if your medical device is EMR connected.

http://homscales.com/blog/post/2011/12/16/Achieving-Meaningful-Use.aspx

 1 Source: https://www.federalregister.gov/articles/2010/07/28/2010-17210/health-information-technology-initial-set-of-standards-implementation-specifications-and#h-37