Perficient Healtchare Solutions Blog


Posts Tagged ‘EMR’

A Love Letter to Meaningful Use – #HIMSS14

It seems appropriate on Valentine’s Day to write love letters.  This is my letter of adoration to Meaningful Use.  In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills.  My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons.  I could wax poetic about the ease of checking on appointments and reviewing lab results.  The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy.  It was love at first click.

A Love Letter toInstead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic.  I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications!  I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila!  Several hours later, I received an email confirmation from the pharmacy that they were processing my order.  Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software.  I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view.  I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life.  This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. Read the rest of this post »

Healthcare CIOs are carefully moving to the cloud

Recently our company has increased our focus on what healthcare organizations are looking for when it comes to cloud computing, in large part due to our acquisition last year of two fantastic Salesforce partners (ClearTask and CoreMatrix). I found this article in Healthcare Informatics to be very interesting. It’s titled “The Many Flavors of the Cloud” and includes interviews with some key CIOs regarding how they view private vs. public cloud solutions and the sensitivity – and often the mandated security requirements – around health data when stored in the cloud.

There are some obvious advantages to providers moving to private cloud storage for all types of data across the organization, but also some critical considerations for any CIO or CMIO. Here are the key takeaways I got from this article.


Medical imaging takes up a lot of storage space in the healthcare space. Imagine a 24 hour study of your heart that takes up a terabyte of space. The cloud can enable better scale for this type of need.

Key insights about cloud computing in healthcare:

  • CIOs interviewed prefer “private cloud” solutions over public cloud solutions like those of Google, Amazon and Microsoft – more control around access & rules
  • CIOs don’t want to deal with power issues, cooling issues, and capitalizing hardware over time – 3 reasons they enjoy Cloud
  • They enjoy reduced costs in scaling a storage room, servers, etc..
  • CIOs take personal ownership over creating their own stringent security requirements for their cloud vendor, making them feel better about storing PHI or other sensitive healthcare data in it.

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Top 5 Technology Trends in Healthcare – November 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Consolidation and Mergers

Healthcare entities, both payers and providers, have been making an increased effort to capture market share and dominate their geography. Smaller players are being picked up by larger players, consolidating physician practices and health plans. These mergers have driven digital strategy projects and paperless environments, with an increased interest in advertising and public facing websites to try to attract market share. 

Extending Your EMR

Healthcare professionals have been very vocal about the challenges that come along with electronic medical record systems. The workflow in many EMR systems was created by a programmer and works the way it was programmed, not the way healthcare professionals work. Several technology tools were made to extend or approve upon EMRs without ripping the code apart, often by putting it into a browser or allowing it to be mobile.

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Chronic Disease Management through Disease Registries

Chronic diseases, those diseases lasting 3 months or more that cannot be prevented by vaccines or cured by medication1, are placing an increasing burden on our healthcare system.  Unfortunately, the United States has one of the highest rates of illness, disability and death due to chronic diseases, such as asthma, diabetes, coronary heart disease and obesity.  According to the Centers for Disease Control and Prevention (CDC), 7 out of 10 deaths among Americans each year are from chronic diseases and as a nation, 75% of our health care dollars goes to treatment of chronic diseases2.  In 2005, 133 million Americans, almost 1 out of every 2 adults, had at least one chronic illness1. Regardless of the impact of these preventable diseases, a recent survey found that only 56% of recommended care is being provided for patients with chronic illness3.  As a result, provider organizations are seeking new strategies for effectively managing these large and expensive populations4.  “There is a great need for a systematic and comprehensive approach to caring for patients with chronic diseases to help improve the quality of chronic care delivery.” 4  One such strategy is implementing disease registries to capture and track key patient information that assists care team members in proactively managing patients with chronic diseases5.

In this blog post, we will take a high-level look at the some of the key functions and limitations of a disease registry as it relates to chronic disease management.

Functions of a Disease Registry

A registry can be defined as “an organized system for the collection, storage, retrieval, analysis, and dissemination of information on individual persons exposed to specific medical intervention who have either a particular disease, a condition (e.g., a risk factor) that predisposes them to the occurrence of a health-related event, or prior exposure to substances (or circumstances) known or suspected to cause adverse health events.” 6

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The Quest for My Complete, Portable Health Record

As I have written before, I currently see several physicians who do NOT use an EMR in the office.  They are awesome diagnosticians, people and mentors but they have not taken the leap to the electronic health world.  Now, add in two hospital networks that do NOT have patient portals for accessing my records and you get one big, fat medical record quagmire!   I would love to have my entire medical record in one place AND have portable access to it.  Will I ever reach that goal?  Do I need to establish a relationship with a new physician just to obtain my goal?  I certainly hope not!  So what can be done to make my dream a reality?

puzzle personThis quest has certainly led me to devour insights from industry experts, read countless blogs and articles and consider the drastic move to a new physician.  So I was intrigued when I read the Wall Street Journal article, “Image Sharing Seeks to Reduce Repeat Scans”, this week.  Allowing patients to have access and the ability to TRANSFER images to multiple providers reduces cost, redundancy and ultimately, radiation exposure for the patient.  In addition, it allows the patient to “own” their health.  Although this is certainly a step in the right direction, this is an isolated sharing of information, not connected to the rest of the patient’s history, just another piece of the puzzle.  How can we solve the entire puzzle?

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EMR 3.0 and Doctors Lacking an Analytic Engine

As a big fan of, I enjoyed reading David Nash, MD’s take on how doctors need an “EMR 3.0” analytic engine for accountability and that creating an analytics tool that monitors gaps in care for a provider’s population is very important for accountable care.  We also agree that as successful as the big EMR vendors have been that they don’t have an analytics engine that promotes accountability and measurements of quality and safety.  My argument is that as a result of the large number of data sources in the typical healthcare organization due to the myriad of healthcare applications, the analytics engine needs to combine data from all of those sources, normalize the data and deliver the quality and gaps in care dashboards independent of the EMR system.

David’s practical idea that clinicians need an analytics engine that sits on top of the EMR, one that is capable of sweeping up clinical data and converting it to information that will improve clinical decision making, is accurate and exists today.  Moving all of those data sources into a centralized enterprise data warehouse with a comprehensive and standard healthcare data model is the key to success.  Reconciling the medical vocabularies to a set of consistent data elements empowers real analytics.  Those capabilities exist in a well-established product called BI-Clinical from CitiusTech and that product has the key capabilities outlined on David’s wish list as an “accountable” primary care clinician in the modern healthcare environment, including: Read the rest of this post »

EMR Selection: Caveat Emptor

Based on the most recent meaningful use statistics published by CMS, the majority of Eligible Physicians submitting MU claims for Medicare have not been paid.  Medicaid is only marginally better.


Providers who are shopping for EMR systems must pay attention to the track record of the vendor and investigate claims these systems are MU compliant.  Vendors have to conduct an in-depth certification process.  Shoppers should expect to see the resulting confirmation from ONC proving EMR systems they are considering have passed this certification.  They also should be clear all along what is expected from them to qualify for MU stage 2 reimbursements.Collecting Meaningful Use dollars is difficult but not impossible.  It will require the Provider to study and understand the nuances of these requirements and start developing habits that ensure payment well in advance.  Providers must shop wisely.  The statistics above indicate many systems claim to support Meaningful Use during stage 1 apparently fall short in some way or another.   Meaningful Use stage 2 will be much more onerous for both the EMR vendor and the Provider to qualify. This implies the majority of EPs are not demonstrating MU as per the CMS guidelines.  In my last blog, I talked about software forcing providers to change the way they practice medicine to qualify for Meaningful Use.  Today, I’m sharing some numbers that illustrate the difficulty of getting paid even after all this change.In order to be included in this report, Providers must successfully demonstrate Meaningful Use, and meet the allowable-charges threshold as well as all program requirements to be included in this report.

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Angry Docs: A Mission to Conquer Meaningful Use Requirements

Who would have imagined ten years ago that many of us would spend hours using a slingshot to fling hacked off birds on a single mission to destroy arrogant pigs?  We do this using computers smaller than our dinner plates while sitting on airplanes, park benches, the family room sofa, and sometimes at work.  For those of you who have not heard of the game “Angry Birds,” you should make this a goal over the holidays.

The premise of the game is simple.  The pigs have stolen the bird’s eggs and they want revenge.  Each bird has their own specialty and the gamer has to use these specialties to destroy all the pigs in each scene.  If they fail, the pigs laugh at you.  If they win, the birds celebrate.  Each scene gets a little harder to complete creating the addiction.

Last week, I was part of a conversation describing physicians in much the same way.  They are angry because they spent a lot of money to purchase an EMR solution that qualifies for Meaningful Use only to find the system forces them to change the way they practice, doesn’t meet all their needs, or isn’t going to be upgraded to meet Meaningful Use stage 2 requirements.  We concluded many independent physicians are ready to find something better but they are afraid of losing their current investment of having to spend a lot of time and money migrating to a new system.

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Top 5 Technology Trends in Healthcare – November 2012

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Predictive Analytics

Predictive analytics are able to help healthcare organizations manage clinical issues in a timely manner and analyze statistical data to identify potentially preventable conditions. Doing so can not only help organizations meet accountable care objectives, it is also able to reduce costs, waste and fraud. Providers are able to proactively provide better care, reduce costs, and more effectively meet industry standards.

Social Media

Social networking and collaboration tools provide one-to-one streams of interactive communication which enable patients to seek out information about diseases and treatment options. Social tools can also be used to facilitate collaboration within the enterprise between clinicians, researchers, and partners.

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Driving Value in Healthcare with EMRs and SharePoint

My colleague, Michael Porter, posted a blog from the SharePoint Conference about an interesting session he attended. During the session, a business case on how SharePoint can benefit healthcare was presented. The case focused on a doctor working with a clinical IT director, utilizing technology to improve patient care.

Here is an excerpt from Michael’s post describing the problem at hand:

They focus on Medical Handover clinical care from one set of specialists to another.  They have a variety of processes and best practices in how to do this.  The World Health Organization even has this. In the UK, bad handover resulted in 3,500 deaths last year.  That’s like 7 planes falling out of the sky.  In other words, it’s a problem.

The old system was driven by manual and paper processes. Meetings that happen don’t deliver responsibility of the patient to people.  No one takes notes on it. You want or need to track new decisions, that doctors annotate records of the patient, and that any discussion is captured for all to see it. Read the rest of this post »

EMR adoption doesn’t have to hurt a bit

I have blogged about change a few times already.  This is a pretty important topic as it relates to healthcare reform and technology adoption.  It can be summed up in a single sentence: Change is coming.

Physicians don’t have time for change.  Nurses don’t have time for change.  Administrators don’t have time.  Everyone in the industry has more demands on their time every minute and technology isn’t making it any better.  Or is it?

A physician friend of mine told me he spends an extra two to four hours a day updating his new EMR system.  This is time he used to spend visiting patients and growing his practice.  Now he is forcing himself to do this in order to comply with Meaningful Use requirements.   This is typical and there is a lot of angst in the healthcare community as a result.

Many technology vendors focus on the technology and ignore the change.  They build systems that are optimized to collect and present data.  Most of these systems fall short as it relates to the user experience.   Designers and developers assume the users think like they do and are comfortable entering information based on how computers work.

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Patient Safety and Transparency: My experience as a parent, not a physician

I recently had the opportunity to experience healthcare from a different point of view.  My daughter had an emergency appendectomy, which forced me to navigate the healthcare system from the other side.  As an Emergency Physician, I am used to quickly synthesizing data to care for my patients and make decisions that affect their lives.  Patient safety and transparency are naturally woven into my workflow…..I really don’t concentrate on them.  But when my nine year old daughter looked worried and said that she’s afraid something “bad” might happen, I wanted patient safety and transparency to be top on the healthcare list!

How are we, as a Healthcare IT industry, addressing these issues?  Why are there 200,000 preventable medical deaths in this country every year?  In September 2012, Johns Hopkins University’s Dr. Marty Makary, author of the recently published book, Unaccountable, wrote that American surgeons operate on the wrong body part as often as 40 times a week.   Patient safety and improved outcomes should be our top priorities.  With the advent of EMR, EHR, CPOE, decision support at the point of care, Healthcare BI, portals and several other technological advances in medicine to guide us, we should be able to streamline workflow, reduce errors, improve outcomes and cut costs.  But it needs to start from the top.

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