Monday, January 16, 2017

The Value of Backing Up Your Electronic Health Record with a Fail Safe Plan

The Gazette reported, the University of Iowa’s Electronic Health Records went down to a server problem that lasted six hours. The problem was resolved quickly. Keep in mind that for a busy ER, six hours is NOT quick! 

The main problem is what to do during those hours of downtime. A back-up system that is not on the same server can protect the data and mostly protect the patients from inadvertent errors. These errors can lead to poor outcomes, loss of crucial information, and potential liability.
Installing a stand-alone back-up system that is easily used and can be later scanned into the Enterprise system will save time, money, greying hair and endless stress. The occasional power failure will be survived with minimal cost and avoid the “group insanity” that’s accompanies these events. 

Hospital systems should write a guaranteed functionality clause into contracts for EHR implementation.   It is the enterprise vendor that should assure their system continues despite potential catastrophes.  After all, it is during catastrophes, environmental stresses, and local disasters, that the continued operation of the ED is most needed.  Thinking about the inevitability of such events in advance is essential, and should always be a part of the EHR package.

Monday, January 2, 2017

“Meaningless Use” Stage 3 To Disappear?

In the article AHA to President-elect Trump: Cancel Stage 3 Meaningful Use, the American Hospital Association make a plea for the elimination of meaningful use Stage 3. AHA calls for focus on EHR interoperability, interoperable health IT infrastructure instead of demonstrations of certified EHR technology use.
The unstainable regulatory burden which includes MACRA (Medicare Access and CHIP Reauthorization Act) is unrelenting and cost ineffective.  Reading this article will help providers understand what they may be facing with the coming confusion of MACRA.
[MACRA = Medicare Access and CHIP Reauthorization Act, a 2,400 page rule which establishes new ways to pay for physician services to Medicare beneficiaries, and will be likely extended to all insurers as well. MACRA reimbursement will be based (in theory) on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology.  Ever heard the term “Meaningful Use” before?) This includes an effort to base payments on outcomes. Of course outcomes require measures to be assessed.  Payment changes are scheduled for 2019]
The AHA makes multiple recommendations that are favorable to hospitals but not necessarily providers that make reasonable sense.

“Advance health IT by supporting the adoption of interoperable EHRs, promoting a more consistent use of IT standards and providing improved testing, certification, and transparency about vendor products.”

Bottom line is that all the billions of dollars spent on meaningful use to capture endless data points that have little value to the average practitioner, this has created significant burden to cause acute on chronic “burnout” leading to chronic dissatisfaction.
The money spent could have been used on a robust national database that would have been the basis for Electronic Health Records interoperability. This would have included a national computerized order system that ended the hours relearning multiple systems.

From an EHR provider point of view, these rules have squelched creativity, efficiency, and what should have been a positive clinical adjunct into minefield of clicks and workarounds. When one adds the various meaningful use rules to the EH R, it significantly damages the EH R usability experience. While the Electronic Medical Record with artificial intelligence will hopefully someday be looked at as an asset, the barrier that interoperability imposes has yet to be solved. Why? 

Currently it is not in the interest of any EHR vendor to make their system interoperable.  Why should they allow a small (quite inventive and easy to use) system work well with theirs?  The large enterprise-level vendors have long suppressed interoperability efforts, while the smaller, creative ones, and have pushed for it. Such activity is not uncommon in the tech world.  Roku was once a small company too, and look how they have impacted the cable companies. But interoperability suppression is in no way appropriate in health care.