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Differences between Hospital and Clinic EHR

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Differences between Hospital and Clinic EHR

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In some ways, hospital and clinic EMRs have the same job to get done - to assess, test and treat patients. But they do have to be optimized differently, as hospitals and clinics do things at a different pace and of necessity are organized differently.

Here's some of those differences, courtesy of TELUS Health's Shawn Vincent:

* Difference number one: Minutes count

Hospitals care for patients in acute situations, where minutes or even seconds can determine the patient's outcome. In medical practices, "care is measured in weeks, not hours," Vincent notes.

Result: Hospitals need test results immediately, where clinic patients can wait until their next visit days or weeks later.

* Difference number two: Patient departures

In hospitals, patients consume resources until discharge, and that doesn't happen when tests and treatments are still outstanding. In clinics, patients can leave while tests are outstanding or treatment results are still pending.

Result: Hospitals must perform well at "round trip" test and treatment management.

* Difference number three: Who runs the show?

Hospitals are generally run by a large corps of professional leaders, including boards of directors, business expects, lawyers and many other stakeholders. Medical practices, traditionally, owned by doctors who practice there, and are responsible for care, documentation, and ultimately, liability for all that takes place.

Result: Hospitals usually have tough rules in place about how medicine can be practiced, and also how it is documented, which roll down to everything from how the EMR user interface looks to how events are audited. In clinics, doctors make their own rules.

* Difference number four: Short vs. long-Term Care

Hospital encounters usually call for just enough information to treat the patient - more can be a distraction which slows down care. In medical practices, on the other hand, having longitudinal data on the patient is central to caring for them over the years.

Result: Hospital IT systems must be artfully designed to display "just enough information to make a meaningful medical decision without distracting the user with unnecessary details," he notes.

Readers, what other differences between hospital and medical practice EMRs do you consider to be important?

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Hospital Vs. Clinic EMRs: Key Differences

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In some ways, hospital and clinic EMRs have the same job to get done - to assess, test and treat patients. But they do have to be optimized differently, as hospitals and clinics do things at a different pace and of necessity are organized differently.

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Draft 2017 Interoperability Standards Advisory | HealthIT.gov

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The LTPAC Health IT Collaborative is pleased to submit comments on the Draft 2017 Interoperability Standards Advisory. We see opportunities to address more accurately the adoption levels for standards and have identified critical standards activities/needs related to functional status, care planning, transitions of care, and patient identity/matching.

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Implications for advanced nursing practice and research

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Implications for advanced nursing practice and research

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Health Affairs published a report that uses root cause analysis to help identify common factors in delays in outpatient treatment. Among those factors identified, communication failure was present in all 111 reports used for the study. The reports were generated from the VA’s National Center for Patient Safety between 2005-2012.

In conclusion the study found that delays in diagnosis and treatment in the outpatient setting had multiple and complex origins, many of which were found to be related to communication and coordination failures.

The report goes on to suggest more specifically, that policy- based initiatives to reduce outpatient  delays should promote the implementation of enhancements to electronic health record systems (ie. Interoperability) that would facilitate communication among providers and between providers and patients, as well as improve the coordination of care (Giardina, King, Ignaczak, Paull, Hoeksema, et al., 2013)

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"'EHR companies have a tremendous interest in seeing that their proprietary technology is protected, and I can see some resistance to this movement by the same vendors. We need to be able rapidly and efficiently move patient information from the systems that have it to the systems that need it in the care and interest of the patient; while simultaneously protecting the confidentiality of the patient."

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One of the major drawbacks of the EHR is the lack of interoperability between software systems and environments. Even though the data is digital, there has not been a lot of progress toward making that data available external to the system, and between systems and health care facilities.

This is a big problem in our practice. We use an EHR, but there is no easy way in which to access or import data from another EHR system when we see patients for consults. We are forced to rely on paper records to review past medical and surgical histories, medications, allergies, etc., as we evaluate a new patient. Many EHRs don't have a patient portal that allows patients to access their EHR via the Internet and their handheld devices.

The inroads of the EHR have been significant in the past six years. According to the CDC, 75 percent of physicians are now using an EHR, as is virtually every hospital in the United States. This means that nearly all patients have an electronic "footprint" of their health data in the system. The problem lies in the lack of communication and compatibility between and among the variety of systems that are out there.

Progress was made towards addressing these significant limitations of the EHR in a public-private partnership announced in February 2016 by the U.S. Department of Health and Human Services. Health IT companies and health care systems have agreed to:

Implement application programming interface (API) technology so that smartphone and tablet apps can be created, facilitating patient use and transfer of their health care data.

Work so providers can share patient health care data with patients and other providers whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.

Use the federally recognized Fast Healthcare Interoperability Resources (FHIR) data standard.

While this seems like a "Kumbaya" moment, the devil is usually in the details. EHR companies have a tremendous interest in seeing that their proprietary technology is protected, and I can see some resistance to this movement by the same vendors. We need to be able rapidly and efficiently move patient information from the systems that have it to the systems that need it in the care and interest of the patient; while simultaneously protecting the confidentiality of the patient. This is no easy task.

One of the things that I have noticed is that the "evolution" of the EHR has made a dramatic shift over the past decade. The original EHRs were about the needs of the system, to gather the information that the system needed for billing, reporting, etc. The needs of the providers at the point of the sword were an afterthought, and the interfaces and the difficulty of using early EHRs reflected this bias.

Over the last year or two, significant emphasis has been placed on the provider end of the EHR, to make it more intuitive, and functional in the work of documenting patient care, and presenting the data to the provider so that the provider needs to safely and efficiently care for patients in and out-patient environment. We are seeing better and more linear interfaces in the hospital that present the patient data, and allow for the quick and efficient documentation of patient care. We are also seeing the migration of EHR software to portable devices such as smartphones and tablets. However, until we solve the behind the scenes interoperability issues that are faced by disparate incompatible systems, we will reach a roadblock preventing us from moving forward on the EHR front.

We have been using a tablet-based EHR in our private practice for three years, and would never go back to the other data management systems we have used in the past. Our hospital system is in the process of rolling out a tablet based implementation of the industrial strength EHR they have been using for years. It has promise, but there is still work to be done.

As an end user, with the interest of the patients under my care in mind, I'm all for all of the players in the EHR industry working together. It is about better patient care, and about being able to use the data in a way that makes our communities better and safer. I may not be alive to see the promise of the EHR fully delivered, but I can see the finish line and it is in the not-too-distant future.

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One of the major drawbacks of the EHR is the lack of interoperability between software systems and environments. Even though the data is digital, there has not been a lot of progress toward making that data available external to the system, and between systems and health care facilities.

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Recent studies show that in 2014 HER adoption was at 74.1% up from 67.5% in 2013.

Despite the increase, several barriers stand in the way of health information technology playing a more significant role in improving care quality, coordination, and delivery (Murphy, 2016).

Those barriers include:

·      Inconsistent EHR adoption across the care continuum

·      A lack of interoperability

·      Concerns with Health IT safety and Health data security

limited health IT infrastructure across the care continuum hampers health information exchange as patients transition between clinical settings

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Acceptance is the first stage on the road to recovery. With that, here are four barriers limiting EHR use and health information exchange.

- Despite increases in physician EHR use over the past few years, four major barriers remain in the way of future advancements in health IT adoption.

This is one of several takeaways from a recent report to Congress by the Office of the National Coordinator for Health Information Technology (ONC).

The report emerged a month after the Centers for Disease Control (CDC) released findings of certified EHR adoption and health information exchange by office-based physicians between 2013 and 2014.

Chief among those findings were that 74.1 percent of these providers had completed the adoption of certified EHR technology (CEHRT) in 2014 - up from 67.5 percent in 2013 - and 32.5 percent were using these technology for information sharing with other providers.

The progress made by office-based physicians, however, provides only a snapshot of physician EHR use and HIE adoption. So what barriers then stand in the way of health IT use playing a more significant role in improving care quality, coordination, and delivery?

READ MORE: AHA Calls for Data Blocking Clarification on Senate HELP Bill

What follows is a look at the four major barriers preventing progress in health IT adoption, use, and exchange according to ONC.

Unsurprisingly, one major barrier is inconsistent EHR adoption across the care continuum, much of which has to do with a lack of incentives for non-primary care providers to invest in health IT:

Under current law, Medicare and Medicaid programs have no authority to provide financial incentives for the adoption of certified EHR technology among psychiatric hospitals, community mental health centers, residential and outpatient mental health and substance use disorder treatment clinics, and non-physician mental health professionals. Only eligible facilities (hospitals and critical access hospitals) and eligible professionals (physicians and dentists, as well as some nurse practitioners, certified nurse midwives, physician assistants in Federally Qualified Health Centers (FQHCs), optometrists, and chiropractors) can currently receive incentives under the EHR Incentive Programs.

For its part, ONC recognized the need for extending EHR adoption and use to behavioral health and long-term post-acute care providers more than a year ago in its Federal Health IT Strategic Plan. To be expected, limited health IT infrastructure across the care continuum hampers health information exchange as patients transition between clinical settings.

"Hospitals' rates of both sending and receiving patient summary of care records to and from long-term care and behavioral health care providers were considerably lower than electronic exchange with outside hospitals and ambulatory care providers," the ONC report states.

READ MORE: Majority of Physicians Seeking Prior Authorization in EHRs

The federal agency also attributes these disparities in health IT adoption and use to a lack of health IT transparency - that is, the "persistent lack of transparency and access to reliable information about health IT products and services, including for electronic health information exchange."

According to ONC, increased health IT transparency should lead to improved health IT interoperability:

This lack of transparency and reliable information about health IT products and services impacts the efficient functioning of health IT markets, reducing opportunities to advance interoperability through vigorous competition and innovation in the marketplace. In particular, providers cannot effectively compare solutions and select those that meet their needs when they lack access to basic information about the costs, limitations, and trade-offs of competing health IT products and services. This includes capabilities that will enable them to participate in new care delivery and payment models that leverage health information exchange and analytics. In addition, providers are more likely to become "locked in" to technologies, which diminishes incentives and opportunities for health IT developers to improve their technologies and compete to deliver more innovative, more advanced, and less expensive products and services that meet the needs of providers, patients, and the health care system.

A lack of interoperability represents the second major barrier to progress in health IT adoption, use, and exchange. The ONC report identifies three challenges contributing to a lack of health IT interoperability.

"First, there is variation in how standards are tested and implemented," the report states. "Second, there is significant variation in how health IT stakeholders interpret and implement government policies and legal requirements. Third, health IT stakeholders are reluctant to embrace supportive business practices that can reinforce and expand collaborative data use arrangements and foster meaningful consumer engagement and action."

READ MORE: AHRQ Announces Health IT Research Funding Opportunities

As noted by ONC, these challenges are "interrelated." For example, hospitals report limited EHR capabilities - either the lack of EHR technology or capable EHR technology - as the leading causes of limitations in health information exchange.

Contributing to a lack of interoperability is the absence of nationwide policies for supporting health information exchange, claims ONC in the report.

"Local or regional areas have done this through contract vehicles; however, to get to nationwide interoperability, stakeholders need to have common policies and practices that hold entities accountable and that federal agencies can require through their programs," it observes.

Additionally, the federal agency points to data blocking as a contributing factor:

Evidence and experience suggest that information blocking is occurring and may become even more prevalent as technical and other challenges of sharing electronic health information are reduced. Inevitably, some market participants will regard this trend towards greater data liquidity as contrary to their individual business interests and will seek to retain control over electronic health information in ways that limit its exchange and use.

The two remaining barriers focus on health data security and health IT safety and usability.

For the former, variation in state and federal privacy laws create a complex legal landscape for providers considering health information exchange. "The variation causes confusion among exchange partners, and makes it difficult and expensive to harness technology to ensure privacy compliance. This, in turn, impedes interoperability," ONC claims.

For the latter, questions about health IT safety and usability have raised the need for stakeholders to come together and share best practices. For its part, the federal agency views collaborative efforts as the means to ensure that health IT use does not negatively impact patient safety.

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4 Barriers Limiting EHR Use, Health Information Exchange

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Despite increases in physician EHR use over the past few years, four major barriers remain in the way of future advancements in health IT adoption. This is one of several takeaways from a recent report to Congress by the Office of the National Coordinator for Health Information Technology (ONC).

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What are the advantages of an Electronic Health Record?

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What are the advantages of an Electronic Health Record?

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What are the advantages of an Electronic Health Record

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Interoperability of Electronic Health Records– Benefits and Opportunities

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Software companies should continue to strive to achieve interoperability for consumers 

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Software companies should continue to strive to achieve interoperability for consumers 

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At the 2017 Cerner Health Conference this week, attended by more than 16,000 customers from around the world, the company put interoperability and patient access front and center.

First, Cerner announced a new consumer-directed patient record, "at our cost," said Cerner President Zane Burke.

That means, he explained, that Cerner "will work in concert" with a given provider's patient portal so every patient "has the ability to take our information and create our own experience."
[Also: Cerner's third-party apps draw crowds at annual conference]
The tool would enable health records to be shared together in one place, rather than separate providers running on separate systems.

He added that "it's time for the patient to be part of the care team, and it's time for us to embrace that."

Burke also announced an extension of free CommonWell services to Cerner customers, for three more years through 2020.

Cerner, of course, was one of the founding members of the CommonWell Health Alliance, alongside competitor EHR vendors such as Allscripts, athenahealth and Greenway.

Since its launch in 2013 - and since Cerner first offered free access to the service at the Cerner Health Conference the following year - the initiative has grown significantly, with more than five dozen companies enabling easier data sharing across 60 million patient records.

"It shouldn't matter if it's Cerner's EHR or someone else's EHR," said Burke. "We need data from multiple places, and we need that data to flow freely."

Just how to define interoperability has often been a point of contention in the healthcare industry, but for Cerner the definition is simple, he said: It's "Can I have my patient record?"

That patient-focused approach to data exchange is especially poignant at this user conference, the first since the passing of Cerner founder and CEO Neal Patterson this past summer, followed shortly afterward by Patterson's wife, Jean Lillig Patterson, who had spent years fighting breast cancer while transporting her own medical charts from doctor to doctor.

Before he died, Patterson implored his company to "fix Jeanne's health record," according to the Kansas City Business Journal.

That's part of the impetus behind the re-upped commitment to CommonWell and the consumer patient record, Burke told the KCBJ.

"If you want your health record, you should be able to have it, much like a bank account and an ATM," he said. "You have to think about that consumer-directed patient health record in the same way."
Twitter: @MikeMiliardHITN
Email the writer:mike.miliard@himssmedia.com

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Cerner tackles interoperability from two new angles

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At the 2017 Cerner Health Conference this week, attended by more than 16,000 customers from around the world, the company put interoperability and patient access front and center. First, Cerner announced a new consumer-directed patient record, "at our cost," said Cerner President Zane Burke.

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Maria, Stephanie, and Alicia