EHR

Reliability and Redundancy of Electronic Health Record (EHR, EMR) IT Systems

December 16, 2011 in EHR Selection by support Team  |  Comments Off on Reliability and Redundancy of Electronic Health Record (EHR, EMR) IT Systems

I am sure that most practices do not spend time thinking about redundant systems to manage and maintain their EMR, EHR, and Practice Management System. We had a major slow down earlier this week when we needed to move all practices to the back-up systems. This made me think of what does a physician office do if their server is down? Do they lose production for a ½ day, a day, two days, or a week? Does an office have a back-up plan if the systems are down? What is the disaster recovery plan? Good cloud-based companies have thought through these issues to maintain your data. When there is a system outage, how a team reacts, learns and improves their systems is important for minimizing the down time for practices.

One of our practices placed the outage disaster recover into perspective for me. Prior to switching to PhysicianXpress, this large practice had a server in their office for the practice management system. A practice in the same building complex moved to a server-based EMR System a few years ago. This year, there was a major lightning storm that ‘fried’ the router of the practice we served and ‘fried’ the server of the practice that was on a server-based practice. Our client needed to install a new router and they were back up and running with no loss of data. The other practice was not so lucky. A server in the office can deliver faster speeds; the down side is that the practice needs a qualified team of IT personnel either on staff or on call to insure back-ups are occurring multiple times per day. Even in this case, not many practices have redundant systems (2+ servers hosted in different locations to minimize chance of loss in a disaster like a building fire).
No system is available 100% of the time. An up time average of 99.95% means that there are >4 hours a year that the system is down. We evaluate system components and design to identify areas to increase system up time as well as verification of data back-up systems. We are in the pursuit of the perfect system design and operation – this requires continuous improvement reviews and changes. When evaluating a system, there are some good questions to ask including: how many locations and how often is the data backed up for my practice? Who is responsible for the back-up? What has your company done in the last 12-24 months to improve the back-up and recovery? If using a cloud based system, can I maintain a daily copy of our records and schedule on a local computer for read-only access?

There are a number of reports related to the reliability of the data in Electronic Health Record Systems. In fact, there are even international publications looking at the actual reliability of the data in the system (see http://www.scielo.cl/pdf/jtaer/v4n2/art06.pdf
By Alhaqbani, Josang, and Fidge). This component shows that there are data errors by other systems or users of the system. In the United States, some insurance companies calculate the HEDIS scores of practices (e.g. evaluating the vaccines given to a select number of patients versus an established recommended vaccine schedule). Their systems miss data routinely (e.g. they capture the vaccines given in the office but not the vaccines given in the Hospital or other locations). This is another area of Medical Reliability compared to the reliability of the hardware or software.

Could your ‘free’ Electronic Medical Records (EMR/EHR) cost you thousands of dollars a year? (A review of some free systems includes PracticeFusion, Mitochon, etc.)

November 29, 2011 in EHR Selection by support Team  |  Comments Off on Could your ‘free’ Electronic Medical Records (EMR/EHR) cost you thousands of dollars a year? (A review of some free systems includes PracticeFusion, Mitochon, etc.)

How does a company that provides a free electronic health record system make money? Do they need to make money? Why should I care if they do not charge my pediatric practice to use their system? Advertising to you while you use a system is one way for a free EMR vendor to generate a small amount of revenue; another method is to sell your treatment patterns and patient data to health plans and other organizations. By agreeing to a well written user agreement, a free EMR company will request you to authorize them to do both. The free system containing a user agreement to provide a company the right to sell your data to payers and other organizations could potentially cost you personally thousands of dollars in reduced income per year. This cost could be substantial even with the promise of using a free system.

The “free” EHR Company might be sharing each of your charts, patients, and billing practices with some of the insurance plans. Imagine your Health Insurance plan being able to audit all your charts and know where
they can pull back payments for what they believe is not enough documentation (they have the file, how easy is it to look before sending the request back for a retraction of money). Of course, the health plans will not audit your charts and show all the visits for which the practice “under coded” visits. This under coding is the loss of revenue to the practice. Additionally, with a list of all your patients listed in the “free” EHR system for which the insurance company has access rights to the data, an insurer will be able to calculate what percent of your revenue if from their insurance company versus other plans. This provides a Health Insurance plan data so they have the opportunity to determine/forecast how to minimize your fee schedule. I could see insurance carriers using sliding scales to determine the amount of pay increase or even decrease payments for a practice. Image an employee from a health plan whom receives a bonus for decreasing payments to providers know that 40% of your practice is with their insurance plan, why not decrease your practice’s payment by 10%?

There are other risks with a “free” EHR company selling your data. One risk is that a health plan or other organization will know the breakdown of the number of patients for each disease. For example, maybe you are very aggressive at identifying and treating ADHD to a point that you do not miss a signal diagnosis as well as treat patients with the most innovative methods. This ability has made you the “go to” pediatrician in the practice and/or community. However, since your “free” EMR allows your data to be sold, a health plan or other group might label you as an “over user” of ADHD medications. Do they send you letters directly to address their concerns or do they develop a list to ‘report overuse’ which in fact is not really overuse based on your patient profiles. The problem is, this list might not be accessible to you or known to you and who knows what they will do with the list (do they lower reimbursements or audit higher for Pediatricians on this list?).

The “free” EMR Company might advertise that they store your data in a secure manner. They should advertise how they make money as well as that users of their system provide them the authority to sell your data to organizations that have their own agenda (e.g. insurance companies). I believe many physicians whom ‘gave away’ their rights to their data are not aware of the potential risks to their income and the way they practice medicine. The user agreement is found when you sign up and there is a prompt that states you agree to their user agreements (you can click to review). If you are not sure, before using a system, ask for a signed letter stating that the company will not sell your data.

How do you know if a ‘free’ EHR company has the right to sell your data? REVIEW the USER AGREEMENT. If the user agreement is more than 7 pages, usually this is a reason to be very concerned (some agreements that allow the ‘free’ EHR company to sell as much of your data as possible have greater than 15 pages). Our user agreements are usually 4-5 pages, we only provide access to the data to the users of the practice as well as our staff (we maintain the servers and data files), we maintain the data with triple backup and use firewall systems designed for commercial grade systems. We do not sell your data and do not have any right to sell your data. Our interests are to serve our pediatric practices.

http://www.healthleadersmedia.com/page-1/TEC-249477/Free-EMRs-Too-Good-to-be-True

Why the HITECH Act requires Certified E.H.R. products to read lab result data into E.H.R./EMR systems using an HL-7 Interface.

November 10, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Why the HITECH Act requires Certified E.H.R. products to read lab result data into E.H.R./EMR systems using an HL-7 Interface.

There is much discussion about the HITECH act and certified E.H.R. products. There are over 42 PDF files that contain the Health and Human Services criteria for certifications. One of these files discusses the need for a ‘certified E.H.R.’ to read in lab results using an HL-7 interface. What is an HL-7 interface and why is this important?

HL-7 “Health Level Seven International” is the global authority on standards for interoperability of health information technology. HL-7 has been around since 1987 and was founded as a non-profit group. The vision of this organization is to “create the best and most widely used standards in Healthcare”. There are many details related to the HL-7 that can be found on their web site at www.hl7.org Many in the industry state that we have an HL-7 Interface. There are different versions of the HL-7 messages as well as different applications of HL-7. For instance, HL-7 can be utilized to exchange information with state immunization authorities, collect/send lab results as well as connect to a health exchange.

Related to Lab results, lab companies usually have the capabilities to send the data in lab reports in a structured format via an HL-7 interface. The advantage of this is that the lab results, in a proper system, can be searched to identify patients with certain lab values (e.g. H1AC >7.0). To meet the ‘certified E.H.R.’ requirements a vendor must be able to demonstrate that their HL-7 connection can read results into the E.H.R. The certifying body tests with specific patient lab test data to see how the system responds.

If your practice has an E.H.R. system that contains a HL-7 interface, it might take months or longer for the lab company to approve the connection. The reason is that the lab company usually verifies that the volume of lab requests meet a certain threshold for them to have their programming team connect the lab results interface. If your practice has an E.H.R. system with a working HL-7 interface, recommend work with your E.H.R. vendor as well as laboratory company representative to work out the details of the HL-7 interface. Once connected, the HL-7 interface provides the practice better connectivity and less scanning versus utilizing the paper method. Additionally, having the lab data as structured data into the system provides additional options for searching patients by lab results.