Industry Insight

Researchers to Tackle EHR Barriers With $2.5 Million Grant

The University of Nebraska Medical Center (UNMC) has received a $2.5 million grant to make the EHR more useful for health professionals and safer for patients.

The five-year grant was awarded by the Agency for Healthcare Research and Quality to measure best practices across existing EHR systems, listen and learn what providers believe to be the ideal system, and then build and test a model EHR system that can improve patient care.

John Windle, MD, a professor and chief of cardiology at UNMC and principal investigator of the grant, says the funding came from an understanding that the intended consequences of EHR adoption also had significant unintended consequences. His preliminary research suggested that physicians resisted EHR adoption because they felt it adversely affected their workflow, communications among the health care team, and patient care.

"EHRs were originally designed, developed, and optimized as a financial system and a way to document payment and services rendered," Windle says. "But the EHR really has never been designed or developed for the people using it to take care of patients. We've been adversely affected by it because of how we take care of patients. It slowed us down. It was a barrier to communication."

The project is a partnership between UNMC and the University of Nebraska at Omaha (UNO). Ann Fruhling, PhD, director of the Interdisciplinary Informatics School at UNO, is coprincipal investigator of the grant and will lend her expertise in human-computer interactions to build models of the optimized EHR.

The study will involve measuring how cardiologists at diverse health care systems use their EHRs. The sites are Duke Medical Center in Durham, North Carolina; Christiana Health, a large multicenter hospital system in Delaware; Parkview Health, a community-based hospital system in Fort Wayne, Indiana; and Faith Regional Health Services in Norfolk, Nebraska.

Windle says the research team expects to be able to identify—even at the end of the first year—four or five best practices on how to improve efficiency, effectiveness, and safety of the EHRs. While focused on cardiovascular patients, the results, which will translate across the health professions, will be shared with EHR vendors.

Unique to the grant is the development of realistic, complex clinical scenarios and the use of research team members trained as simulated patients to test EHR functionality. "The use of well-defined clinical scenarios and simulated patients allows us to obtain detailed measures of usability without violating privacy or security concerns."

The impact of this study could be huge, says Windle, noting that J. Marc Overhage, MD, PhD, one of the original pioneers of EHRs, published that the EHR added about two minutes per patient in outpatient clinic visits.

"When you realize that there are 1.2 billion clinic visits a year in the US, that equates to a loss of a staggering 40 million hours of physician productivity," Windle says. "The EHR impacts not only physicians, but it affects nurses, technologists, pharmacists and the overall effect is a much larger impact.

"There is potential for the EHR to do good things. I think the impact of this small grant is going to ripple. We're just learning how to appropriately use this very powerful technology."

— Source: University of Nebraska Medical Center

 

HIT Groups Form Alliance to Improve Data Exchange

HIT customers expect products to work efficiently and consistently—whether it’s a Wi-Fi connection for a computer or the ability to securely share health data across computer systems, states, or regions.

Building on its current effort to connect EHRs to health information exchanges (HIEs), the EHR/HIE Interoperability Workgroup (IWG) has formed a strategic relationship with HIMSS and Integrating the Healthcare Enterprise (IHE) USA to streamline the process for achieving connectivity between EHR and HIE systems. This alliance will strengthen IWG’s current program to test and certify EHRs and HIE vendors to enable reliable transfer of data within and across organizational and state boundaries. ICSA Labs has been selected as the testing and certification body for this effort.

The value of this collaboration affects more than one-half of the US population and their health care providers who will now have the ability to securely access health data that are shared across multiple states and systems. Working together, these organizations want to make sure that health care providers implementing HIT solutions buy products that are interoperable with other software products.

“This joint effort will help pave the way for health information to be exchanged seamlessly between systems, allowing clinicians and health systems to more easily and securely share patient data,” says Dave Whitlinger, executive director of the New York eHealth Collaborative (NYeC), the coordinator of the Statewide Health Information Network of New York. “By making it easier for electronic health record systems to communicate, this new collaboration will help fulfill the promise of health information exchange, improving patient care and lowering health care costs.”

The EHR/HIE IWG is a New York-led consortium of 19 states and 47 EHR and HIE vendors that was formed in 2011 to increase the adoption of EHRs and HIE services by eliminating the significant “interface” cost and time barrier.

NYeC created, led, and financed the IWG whose members work together to develop integrated EHR capabilities so that data sharing across and between states and HIT systems will be more compatible.

This effort builds on and accelerates consensus on national standards, adopting EHR certification criteria and testing procedures as relevant for stage 2 meaningful use. The collaboration will continue to provide feedback to the national HIT standard-setting initiatives established by the Office of the National Coordinator for Health Information Technology.

“Both IWG and IHE USA have worked independently with notable accomplishments. However, the consolidation of our efforts, along with the commitment of these organizations, offers the most promise to create a real, lasting impact and make interoperability a reality in health care,” says Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, president of IHE USA.

Sensmeier explains the contributions of the four organizations, noting the expected synergies of the collaboration. IWG offers the specifications; a robust, automated testing tool; and significant workgroup membership of states and vendors. IHE USA brings specifications that form the foundation of interoperability, industry expertise and support, and experience in system-to-system and product testing. HIMSS is known for its consistent convening strength, public policy channels, stakeholder representation, and sector support. ICSA Labs, the testing and certification body chosen for this program, provides expert HIT analysts, and a proven testing and certification framework.

“HIMSS, IWG, and IHE USA recognize the definitive power of collaboration to reach our shared vision for robust, secure, and interoperable health information exchange. This new program builds on current activities to certify EHR and HIE products that are able to reliably transfer data within and across organizational and state boundaries,” says Carla Smith, MA, CNM, FHIMSS, executive vice president of HIMSS North America.

— Source: HIMSS

 

Dart Chart Systems Launches The Map & Track Contract Solution

DART Chart Systems, which optimizes skilled nursing reimbursement, solves the complexities of managed care with the launch of The Map & Track Contract Solution.

According to the Kaiser Family Foundation, skilled nursing Medicaid and Medicare payer mix shifted from a fee-for-service majority in 2003 to a managed care majority in 2013. Managed care contracts are complex, each with different rules for how nursing, therapy, and pharmacy services are rendered. Missing unique details of each contract results in lost reimbursements, denied claims, and delayed cash flow. As a result, an average skilled nursing provider loses 20% on managed care patients, due to ineffective care tracking and billing management.

The Map & Track Contract Solution eliminates the binders, spreadsheets, and labor hours it takes for staff to compare allowable care against actual care. Contracts are mapped into the system, and then connected to pharmacy, therapy, and nursing software to automatically pull specific fields related to contract requirements. As care is documented, Map & Track guides staff on contract details, flags missing documentation, and alerts teams when preauthorizations are needed. Central patient dashboards track performance of each patient and contract, including which ones generate revenue. “Map & Track has elevated us to a level of awareness that we otherwise wouldn’t have,” says Kevin O’Connell, administrator of GEER Healthcare. “Staff meetings on managed care patients weren’t supplying us with the data Map & Track is able to capture.”

DART Chart’s Map & Track combines multicontract workflows with reporting analytics to provide utilization data for present and ongoing treatment approval. According to Justin Border, vice president of rehabilitation and managed care services of LifeHOUSE Health Services, “Map & Track will allow the teams at our communities to effectively collaborate and communicate the high level of clinical and operational detail necessary for successful management of this patient population. Many of our MCO patients are members of very complex health plans that involve multiple potential payer sources and administrative services.”

“Map & Track takes a proactive approach and transforms the current method of insurance management by deconstructing each contract and automating workflows to optimize revenue,” explains Bernard Hoffmann, CEO of DART Chart Systems. “Mysteries about which contracts are making money are eliminated.”

Linda Kunz, president of DART Chart Systems concludes, “With real-time views in dashboards, truth in revenue can be tightly managed. Providers are capitalizing on managed care vs being buried by its complexities.”

— Source: DART Chart Systems