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Meaningful Health Care Informatics Blog

October 23, 2012  6:28 AM

Massachusetts statewide HIE connects hospitals and providers

Posted by: RedaChouffani
Accountable care organizations, ACOs, EHR, HIE, HIway, state

The Massachusetts statewide health information exchange (HIE) began the transfer of summary health records on October 16th, 2012 with Governor Deval Patrick’s health record the first official XML file to be exchanged. This marks the first step for Massachusetts to enable local hospitals, physicians, and accountable care organizations (ACOs) to exchange and collaborate on care using a statewide HIE.

There are currently several systems that have been able to successfully exchange health information in accordance with the appropriate standards as part of this project. Vendors such as Siemens, Meditech, eClinicalWorks, Cerner, WebOMR and others have given many of the state’s health organizations the ability to share medication lists, allergies, problem lists, and additional clinical information with the appropriate stakeholders.

The current model that the Massachusetts Health Information Highway (HIway) provides offers three different options for health care participants to use when connecting. The available options are:

  • Direct-enabled EHR systems
  • Local area network device
  • Secure webmail portal

Consumers and patients will likely begin to see the value of having their medical records available to participating entities as the HIE continues to attract more health care providers and organizations who are looking for better ways to efficiently connect and access their patients’ data.

October 23, 2012  6:25 AM

Five important areas for EHR success in the tablet world

Posted by: RedaChouffani
EHR, iPad, mHealth apps, surface, tablets

Tablets are continuing to significantly impact the sales of traditional PCs. There are several needs that must be fulfilled on the application side before there will be a wider adoption of tablets by health care professionals. Software vendors will need to ensure that their products are capable of attracting users on different platforms in the health care BYOD environment. Tablets are being used by a patient’s bedside to review their chart, view medical imaging, make clinical orders, and fill medical prescriptions.

Now more EHR shoppers are asking questions to establish what criteria should be used to select and score products based on their mobility or tablet-based functionality.

The following are the five most important questions to ask when evaluating mHealth App for a specific EHR vendor:

Data Security: Data security is a critical area to review when discussing health data that is accessible via a tablet. A mobile EHR App must have the appropriate safeguards to protect the data and deactivate the device if lost or stolen.

Accessibility online/offline: There are cases where clinicians still need to capture information electronically while working offline, though most apps require constant connectivity. This will help decrease the likelihood of losing data that was never entered into the data repository, which may be an important feature for some.

Platforms supported: Android, iOS, Windows 8, and Chrome OS are some of the platforms available in today’s marketplace. A mobile EHR App must be able to support and work on any of the top platforms since each health care professional has a preferred operating system.

Functionality limitations: It is important to review application functionality on the chosen platform when evaluating mhealth Apps as part of the EHR selection. This will help ensure that all the required functionality is available and user friendly.

Productivity: Capturing and retrieving health information using a tablet is a difference experience than using PCs with a keyboard and mouse. It’s very important to gauge the overall experience of using the system while seeing patients, and ensuring that the tablet is helping the clinician increase productivity and improve their workflow.

Tablets have proven, more than ever, that they are a viable alternative to the traditional PCs. Many tablets provide fast processing, long battery life, low maintenance costs, and low total cost of ownership. IT executives are focusing their attention on picking the appropriate EHR solution for their organization that will meet all the outlined criteria and ensure that these applications have the ability to work effectively on a tablet or smart device.

October 15, 2012  11:40 PM

New open source web-based EHR with modern UI and advanced functionality

Posted by: RedaChouffani
EHR, Open Source

Open Source applications are continuing to gain popularity in the health care market. Some products have gained users including OpenMRS, Mirth, VistA EHR, Connect, and ClearCanvas. Unfortunately there has not been wide adoption from independent physician’s practices of many of these products, despite the high costs and complexity of EHR packages.

There have been many attempts from the software development community and start-ups to deliver the next best open source EHR, and some are beginning to truly show their potential. GaiaEHR is an open source web-based application that provides electronic medical records, scheduling capabilities, and billing as well as prescribing capabilities. It is an application that runs on Apache web server using the free database engine MySQL. It’s operational on any browser and it is also supported through many widely used mobile platforms.

The following are some of the highlights of the product:

Open architecture: The application’s design will enable further improvements and extendability. This allows for further development of interfaces with other systems such as low-income subsidy (LIS), health information exchanges (HIEs), and other platforms.

Fully functional: The application offers several of the functions that are needed from an EHR application like tracking patients’ vitals, listing problems and medication and other health related data.

Interactive and friendly user interface: The web application is very easy to use and intuitive. You are able to get to where you need to be quickly with its clean and functional accessibility.

Web-based solutions: This open source application is completely web based, as described earlier.

There is still little known about the application and its author. The solution is robust and has the potential to attract many health care software developers to improve on it and contribute with additional functionality, according to the initial review of the GaiaEHR source code. A product like this may be one of the examples of disruptions to the current EHR arena and can one day provide a strong option for physicians to adopt an open source package. The application is available for download and also does not require client-side installs or substantial horsepower on the end users’ workstation.


October 15, 2012  11:18 PM

The convenience of quick visits at retail clinics

Posted by: RedaChouffani

Health care seems to be one of the few areas that we may not have quick service turnaround, in a time when we expect immediate service. I experienced one of those inconveniences this week during a family trip. My wife and I found ourselves away from our pediatrician when our youngest came down with something. The comfort of having some relief from a potential ear infection was not coming soon enough for my little one.

We looked for the nearest urgent care or retail clinic well into the evening, it became clear that it was going to be a visit to the urgent care since the clinics were already closed. After filling out paperwork (a retail clinic likely would have had our information in the system since we have visited them back home) and seeing the on call physician, we were sent home with a prescription and told that we should expect our little angel to gain her strength back in a matter of days. I began to wonder how retail clinics can possibly help with situations like these as I considered how many people have encountered the same situation. One of the health care clinics around the nation used by retailers such as Walmart called Smart Care Doc, offers immediate access to board certified physicians through teleconferencing. This provides patients with quick and easy access to a clinician.

Many parents and uninsured patients could seek these retail clinics as a quick and convenient alternative to a primary care physician (PCP) to treat non-life threatening and routine conditions.

Retail clinics offer the following benefits:

Convenience and easy access:

Large chain retailers such as Walmart, CVS, and others offer their products and services throughout the nation. Having access to that real estate would mean that clinics will be available in many communities throughout the country.

Lower cost:

Most of the retailers require copay similar to that of a standard office visit. However, after regular business hours, the copay is still considered lower than what urgent care copay is. There are still a number of retail clinics that offer lower rates and discounts for uninsured patients.

Health Information Exchange:

Most, if not all, of the existing retail clinics in the market today have EHR deployed and are cloud based. This allows the patient’s record to be available to any of the visited clinics.

Many of the services available at retail clinics are limited to what can be received from a family physician and or specialist, though they are a convenient alternative to the traditional office visit. The services being offered will continue to improve over time and as more large organizations partner with some of these models to cut cost. Patients may soon see that these one stop health shops have more to offer.

October 8, 2012  9:09 PM

What more can we do with a RTLS?

Posted by: RedaChouffani
BIG DATA, business intelligence, HIMSS 2012, RFID, RLTS

More hospitals are evaluating different available products and beginning their selection process, as radio-frequency identification (RFID) hardware prices continue to decline. The process of evaluating an real-time locating system (RTLS) vendor takes many things into consideration. Some of the top items on the checklist are technology, costs, maintenance, company, system benefits and most importantly return on investment (ROI).

As the functionality and system capability of some of the vendors begin to level off, we start to wonder what will be the next features and functionality that set some apart from the rest. The introduction of business intelligence and how it can be apply to all the data that is collected behind the scenes is one of the areas that received attention in the RTLS world during the Health Information and Management System Society (HIMSS) conference 2012 in Las Vegas.

We will begin to see RTLS playing a significant role in two main areas as we move toward 2013:

Location aware-applications:

RTLS will act as a GPS locator and allow for the applications to deliver content or functionality based on the location. For example, when a nurse leaves the patient room and goes back to her or his station, the system recognizes that the nurse was with that patient based on the data reported back through the RTLS and allows for the nurse to have that chart ready for the patient. There are many other potential uses such as visual notification on an interactive TV when a nurse enters the room and the patient gets a quick summary of his or her caring nurse.

Big Data:

Location data combined with external data sources will provide valuable information that can be analyzed. By reviewing the data and linking it with other relevant sources will provide more complex and significant insights to hospitals.

There will likely be other new areas where RTLS will be utilized within health care organizations. RFID is currently being used to track linens as well as temperature to ensure compliance withing hospitals. These products will continue to be used in different ways and the journey toward recognizing improved workflow, cost cutting and improved care will continue to be the driving force for adopting the right solution.

October 8, 2012  9:07 PM

Letter to HHS outlines reasons to stop incentive payments

Posted by: RedaChouffani
HHS, Kathleen Sebelius, MU

A letter requesting the stoppage of the distribution of meaningful use incentive money and signed by lawmakers was sent to Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS) several days ago.

In the letter there was a rundown of the reasons why the following actions were requested:

  • Immediately suspend the payments from the Medicare and Medicaid incentive program.
  • Increase the requirements associated with the different stages of meaningful use
  • Work toward the elimination of the subsidization of business practices that block the exchange of information between providers.

The implementation of electronic medical records and some of the rules associated with meaningful use has been challenging, as many health care professionals know. Several of the adopters have seen significant improvements and value from the program in many regards. The upfront investments are much larger than the first payments from federal or state programs in many cases. The program is voluntary in its early stages, and many of the participants are looking to gain more from it than simply the incentives.

The requirements of the different stages of meaningful use are the result of collaborative work from health care executives, physicians, nurses and other stakeholders, it should be noted. Some of them also are the result of the feedback that was received form the public. Increasing the requirements may result in eligible professionals (EPs) and eligible hospitals (EHs) opting out completely from the program and not engaging in initiatives such as the exchange of electronic health records and other critical initiatives that would help improve patient care and reduce costs.

Health care is going through a transformation that will further leverage technology and help deliver a new model of care. Patients will have everything to gain by focusing on outcome measures as hospitals and physicians are incentivized to improve their health. HHS must continue to focus on maintaining the balance between incentivizing and penalizing in order to untimely improve the population’s health.

October 1, 2012  9:30 PM

A preview of what’s being considered as part of meaningful use stage 3

Posted by: RedaChouffani
HHS, Meaningful use, Meaningful use stage 2, MU 3, ONC, Stage 3

The Office of National Coordinator for Health IT and the Center for Medicare & Medicaid Services released the final requirements for stage 2 EHR incentive programs in August 2012.

Among the items that have been identified as part of the requirements in stage 2 were information exchange, care coordination, patient engagement, data encryption, and content standardization.

The health IT policy committee released its preliminary recommendations for meaningful use stage 3 in September 2012. There have several adjustments made to stage 2 as part of the initial recommendations for stage 3. The following is a list of some of the proposed measures:

Under the quality safety improvements, and reduction in health disparities, there have been the following changes:

  • More than 20% of referrals/transition of care orders created by the emergency physician (EP) or authorized providers of the eligible hospital’s or critical access hospital’s (CAH) inpatient or emergency department (place of service (POS 21 or 23)) during the electronic health record (EHR) reporting period are recorded.
  • More than 60% of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized physician order entry (CPOE)
  • More than 30% of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using certified EHR technology
  • Capture of additional data as part of patient registration: sex, occcupation and industry codes, sexual orientation, gender identity, disability status
  • Implement 15 clinical decision support interventions that are presented at a relevant point in patient care for the entire EHR reporting period.
  • More than 80% of all clinical lab tests results ordered by the EP or by authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data
  • More than 20% of all unique patients who have had an office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference
  • More than 30% of medication orders created by authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using electronic medication administration records (eMAR).
  • Record electronic notes in patient records for more than 30% of office visits within four calendar days.

The subgroups of the committee proposed the following recommendations for patient and family engagements:

  • EPs should make info available within 24 hours if generated during the course of a visit
  • For labs or other types of info not generated within the course of a visit, it is made available to patients within four business days of info becoming available to EPs
  • Signal potential for increasing both thresholds (% offer and % use) based on experience in stage 2
  • Offer 10% of patients the ability to amend information (e.g., offer corrections, additions or updates to their records)
  • More than 10% of patients use secure electronic messaging to communicate with EPs
  • Record communication preferences for 20% of patients, based on how (e.g., the medium) patients would like to receive information for certain purposes (including appointment reminders, reminders for follow up and preventive care, referrals, after visit summaries and test results).

Patient Coordination recommendations:

  • EP/emergency hospital (EH)/CAH to whom a patient is referred acknowledges receipt of external information and provides referral results to the requesting provider, thereby beginning to close the loop.
  • Measure:  For 10% of patients referred during an EHR reporting period, referral results generated from the EHR are returned to the requestor (e.g. via scan, printout, fax, electronic clinical document architecture ((CDA) Care Summary and Consult Report)).
  • The EP, eligible hospital, or CAH that site transitions or refers their patient to another setting of care (including home) or provider of care provides a summary of care record for 65% of transitions of care and referrals (and at least 30% electronically).

Population and Public health recommendations:

  • Documentation of timely and successful electronic receipt by the certified EHR technology of vaccine history (including null results) from an immunization registry or immunization information system for 30% of patients who received immunizations from the EP/EH during the entire EHR reporting period.
  • Implement an immunization recommendation system that: 1) establishes baseline recommendations (e.g., Advisory Committee on Immunization Practices), and 2) allows for local/state variations. For 10% of patients receiving an immunization, the EP/EH practice receives the recommendation before giving an immunization.
  • Documentation of ongoing successful electronic transmission of standardized reports from the certified EHR technology to the jurisdictional registry.  Attestation of submission for at least 10% of all patients who meet registry inclusion criteria during the entire EHR reporting period as authorized, and in accordance with applicable state law and practice.
  • Documentation of successful ongoing electronic transmission of standardized (e.g., consolidated CDA) reports from the certified EHR technology to a jurisdictional, professional or other aggregating resource. Attestation of submission for at least 10% of all patients who meet registry inclusion criteria during the entire EHR reporting period as authorized, and in accordance with applicable state/local law and practice.
  • Documentation of successful electronic transmission of standardized health care acquired infection reports to the National Healthcare Safety Network (NHSN) from the certified EHR technology. Total numeric count of hospital-acquired infections (HAIs) in the hospital and attestation of certified EHR electronic submission of at least 20% of all reports during the entire EHR reporting period as authorized, and in accordance with applicable state law and practice.

The current plan is to transmit the final stage 3 recommendations to HHS during the month of May in 2013, but there are still several stages that the recommendations will undergo. Some of the content of the initial recommendations listed above will likely change through public comments and revisions.

October 1, 2012  9:28 PM

Can EHR vendors learn anything from game developers?

Posted by: RedaChouffani
EHR, games, Luminosity, RFID

Many startups are looking for creative ways to attract users and entice them to share more about their whereabouts and likes and dislikes. This is due to the widespread adoption of smart devices, and the need for companies to find creative ways to increase app adoption. Many of the newer apps have adopted the gaming model. Application functions have been tied to point systems and rewards so that their users become more engaged. You earn more points and bragging rights the more you use the app.

I begin to wonder if the way new applications are being developed will cross over to the health care market, as we see the next generation enter the workforce and use EHRs. One recent example was an innovative new product called Luminosity Health, as described by Jason Harwell, which contains functionality that uses the data collected from radio-frequency identification (RFID) badges used by nurses and physicians, then captures the distance traveled in the hospital facility. The captured data is then assigned a value through a point system. Each employee can view their stats and compare them to the rest of the team and be rewarded. While the application’s primary goal is real time asset-tracking, the application developers have implemented a capability that already existed in the product and made the solution more exciting.

There are many takeaways from the way gamers collaborate when playing some of the complex games out there. Many game developers enabled their players to communicate via the Internet. These are simply examples of what can be learned from games that have been developed and new functionality that will engage users to efficiently use a solution and have fun while doing it.


September 24, 2012  8:52 PM provides significant value to marketing departments in hospitals

Posted by: RedaChouffani
Analytics, BIG DATA,

Many hospitals recognize the challenges that are ahead of them, some of which are: reimbursement reductions, penalties associated with many of the regulatory requirements, and economic pressures. Because of this, hospitals are engaging in several initiatives that will help attract new patients to their facilities.

The current US population is growing at a rate of over .96% (2012) yearly, 0.16% higher than what was reported in 2008. Hospitals are looking for creative ways to provide services to the growing population and maintain their competitive edge. There are many areas in which hospitals are focusing in order to set themselves apart from their competitors. Some of the areas that hospitals are working on are: patient satisfaction, lower readmission rates, hospital national ranking, and advancement in patient care, patient education, outcome measures, and technological advancements.

Measuring growth in the net revenue captured from new patients is the most effective way to identify how well a health care organization is doing. Visiting and utilizing some of the publicly available data is another method that patients are beginning to use to rank hospitals.

The following data sets available for download and review at

  • Patient surveys of their experience:

HCAHPS, or Hospital Consumer Assessment of Healthcare Providers and Systems, is one of the measures being used to identify patients’ experience during their stay at a hospital facility.

  • Outcome measures data:

As more hospitals submit their data as part of meaningful use stages 1, 2 and 3, all the information will be used to compare the success of EHR implementation, interoperability as well as additional measures for patient outcome improvements.

  • Hospital acquired conditions (HAC):

The percentage of patients who acquire any condition (infections or other diseases) after their hospital stay is measured with this statistic. Compliance with hygiene practices in a specific facility can also be estimated with the data from this statistic, whether the facility has a high or low HAC percentage.

  • Medicare spent per patient:

Hospitals can identify how their average cost per Medicare patient compares to others in the same county or region using this data.

Much of this data can provide powerful insights to the scores of hospitals. Combined with some of the visual tools and trends available through the portal, a single hospital can truly have a summary of their performance in all the areas that patients will consider when making their selection of health system.

September 24, 2012  8:49 PM

How mobile OS upgrades and BYOD can challenge organizations

Posted by: RedaChouffani
BYOD, mhealth, mobility

Many questions came up around device management and BYOD implementations this week, as more people began using the latest iOS release on their existing devices. Some of the challenges that IT teams faced were around user frustration that a few apps have not functioned as originally anticipated. Others were disappointed that their favorite apps, such as YouTube and Google Maps, were no longer included on the iPad and iPhone and the alternatives were not as good as the originals.

Most issues experienced around the latest release of iOS are not as concerning or critical as inaccuracy of the map app for a patient trying to race to the ER. Should the device owner or manufacturer control what is on the device? That is the question that has been raised by the release of the latest iOS. IT departments have typically waited several weeks, months, or sometimes years prior to any significant upgrades. Delayed upgrades, like the ones seen when upgrading windows operating systems for desktops, simply allowed IT to evaluate the functionality and minimize interruptions to end users.

However, BYOD adds more challenges to IT folks in the health care as they are not in full control of the devices. Sometimes upgrades are done without any review by IT and can render some of the apps useless or even make them disappear. There will be a need for end user education on mobile devices as mobile dependency continues to increase and businesses continue to adopt a BYOD policy. To ensure that upgrades will not interfere with the business critical apps that clinicians and other health care professionals use, that process should be centrally managed.

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