Customer Service

I went to the doctor the other day for a check up.  The doctors visit went great it was just the confusion with scheduling and getting the appointment that was a hassle.   The doctor that I see is a specialist.  I told her of the scheduling issue when she was examining me.  I told her that I had to cancel the last appointment due to the snow/ice but I had a terrible time getting back into see her.  She told me she knew of the problem and wondered if I took names and notes of who I spoke with and I told her I did.  She wants the names of the people who are in her scheduling office.  The weird part was that when I left the doctor she told me she wanted to see me back in two months and if I had trouble with scheduling let her know. She is booked out for a year in advance.  She told her assistant to go with me to scheduling to make sure I got back in within two months.  The lady went with me and the lady at the front receptionist counter in scheduling was busy.  The doctors assistant told her to make sure that I got an appointment in two months.   The lady finally got to me and told me the doctor was booked and I reminded her that I needed an appointment in two months.  One lady went to go ask why??? and the other lady at the counter acted like she did not want to get involved.  She kept saying we are booked and I will put you on the wait list.  The one lady tried to make a few phone calls to someone who could override the appointment but she could not get an answer.  The one lady came back and said I cannot find anyone to help me.  I will put you on the wait list and someone will call you.   She told me, “You can go now and we will call you”.  Well do you think I will get an appointment in two months.  No one has called me yet.

Electronic Health Record and the back side

I am so excited to see so many hospitals, clinics and physicians offices transitioning to the electronic health record (EHR). As a consultant, I definitely see the advantages for the practices on a daily basis. The goal of the electronic health record is to place comprehensive health information at the fingertips of any medical provider who treats that person. Rather than chasing paper records, physicians, nurses and other staff members or even consultants like myself can access the EHR from any department or facility where the patients receive care. The EHR allows physicians and staff members to:
• Document interactions with patients.
• View medical histories and insurance information
• Make referrals
• Order laboratory tests and view test results
• Send electronic prescription requests to pharmacies (reducing the risk that hard-to-read handwriting will lead to medical errors)
• Flag potentially harmful drug interactions

It also provides physicians with “decision support” tools, such as clinical guidelines and checks for drug interactions; and generates printed post-visit summaries for patients, among other benefits.
While these are the advantages to the electronic health record on the front side, there are areas of concern on the back side. As a consultant, who conducts record reviews, I see a lot of waste. Physicians are documenting in a handwritten format and also electronically. I am not sure why they are doing that. Are the physicians still not comfortable with their systems? Is it just that hold habits are hard to break. This is a challenge for me as an auditor I have to scan that information into a data base for review. The problem comes with trying to get from one system to another. Most of the time, I am printing progress notes and other forms from one system out on paper and then scanning to another system for review. At times it feels like I am reinventing the record. This can all better served with a flash drive. The flash drive can really be a great tool. The flash drive can cut down on the re-printing of a record and make it to where two systems can talk to each other.

Just the other day, I was reviewing some past articles on the electronic health record and I come across one that was referencing the original content of what President Bush had envisioned for the Electronic Health Record. This article that I was reading was dated, April 26, 2004. We are now in 2009 five years later. The article read something like this according to a White House document released Monday, the president “believes that innovations in electronic health records and the secure exchange of medical information will help transform healthcare in America.” The briefing memo says Bush envisions “a dramatically changed system” in which patients carry their healthcare information on a keychain and can authorize any physician or clinician to access their full records electronically. Finally the system would serve as a sentinel to alert public health authorities of a possible disease outbreak or bio terror attack. The ultimate goal is to allow medical information to be stored and shared electronically while assuring privacy and security.

I think President Bush was right on target with envisioning a way to carry health care information on a keychain. Even though he was referencing the patients, this concept is great fro a auditor or consultant. I guess I just didn’t think that I would be using the flash drive like that as a health care information management specialist. I am already using a flash drive for my own health care information called the health care tracker but now when I look in my purse or brief case I have several flash drives. The flash drives are encrypted and password protected. The flash drive is definitely the tool for the back side. How do you feel about the fact that the flash drive can be used this way?

PHR growing pains can be fixed.

The personal health record (PHR) is really facing some challenges now as the awareness of the value of the personal health record becomes known to the American public. What good does it do to sit in front of a computer and input medical information about yourself and your family and then have it coupled with data from a billing record when it is not accurate? People are starting to value their health information and billing information more and more. With the awareness of the Google Health products and their involvement, consumers are now more aware of the overall benefits of keeping a personal health record. But don’t be fooled, Google health products has had its share of headaches up to this point. It seems that we have so many choices with these products yet there are no standardizations measures of where the data comes from among any of them, on the clinical side or the administrative (billing) side.

As a consultant, I have seen some of the same issues with the electronic health record (EHR). I have seen where errors in the record constitute errors on the billing record or claim. One thing about the electronic health record (EHR) that is different from the personal health record (PHR) is that during the transitioning process, most consultants recommend that the health care facility or the providers fix their issues before they implement a large EHR system. Most consultants recommend that the issue of duplicate records be eliminated or at least be under control before implementing an EHR. Electronic Health Record systems typically only look at health information when they transition they do not necessarily couple this with billing information. Although most health centers do not review every record that is handed out, there is a formal record process for a hospitalized patient record. The hospital record has several built in steps to ensure that meets quality standards, assembled correctly, coded, billed and maintained properly. The same cleaning process needs to take place with the administrative data if it is going to be incorporated in to the personal health record side. Patients do not know to ask if there billing information is clean or not and they shouldn’t have to. The patient has the right to clean and accurate information on their clinical information and their administrative billing information.

When workflow processes are computerized this does not mean they are automatically accurate. This is the part of the puzzle that needs to be fixed just because we spend millions of dollars to implement the electronic health record or we ask that every patient be responsible for their own health care information by completing a personal health record, does not mean that we will NOT have problems. Garbage in is always equal to garbage out. If this data is not cleaned up in the paper medical record and on the claim or billing side with the insurance carrier, we will be wasting money if it is not standardized in some format. If everyone is not held accountable for their entries into the electronic health record or personal health record then we will be wasting money as well.

How do we fix the growing pains of the PHR? We start with educating the vendors so they are not selling products that are programmed to do more than they should be doing with valuable health care information. There are so many programmers being hired to just make the system work, that the people doing the actual work do not understand that health care information is different in one, how it is used and secondly how it is interpreted. Vendors should work closely with groups such as CCHIT to ensure standardization among personal health records. Vendors should work collaborately with other health care professionals on building a standardization format for the medical record so that it can be used easily with a personal health record. Another important step is to train medical personnel on what to down load on to a thumb drive/CD and what to give to a patient. It begins with education. We now need to switch roles and to train others to take more of an analyst approach to the record. We all need to become quality documentation experts in our own practice. Is there anyone auditing the final process or overseeing the results of the record? This needs to be built in. We cannot afford to sit and wait and become another Mr. DeBronkart who eventually discovered a problem: He found out that some of the information in his Google Health record was drawn from his billing record. His story really could have been a disaster. In the end, he had some good advice for others using a personal health record. He recommends that you check it, to see if it is accurate.

As a consultant, I feel that we are allowing too many hands in the pot. I am very concerned that there are too many people building EHR/PHR systems and they do not have the health information management background needed. I am not only scared for the patients but for the health care practitioners who practice.

Electronic Health Record (EHR) can wait! Recession proof my job!

Let’s get real. Times are challenging and even tuff for some hospitals and clinics. They are considering lay offs if they haven’t done so already. How do you stay a float in these uncertain times? I came across some simple steps for those of us that are employed to keep in mind while we are working through this stressful situation. I am not by any meanings saying that the electronic health record is not an important endeavor but first things first. New projects or even old projects that were set to roll out have been placed on hold for most facilities. For administrators and managers they realize the work still has to get done and when times are lean they have to decide who can get it done best and whom they might have to lay off.
If you want to make sure that you are one of the best, consider honing these skills.

As a human resource specialist, I have seen those that possess multiple skill sets are the ones that employers like to keep. The best you can do for yourself is to get or keep your skills up to date, be a life long learner or even make yourself an expert. Let’s face it there are things that are out of our control such as the date a person is hired. If you were one of the last ones on board having multiple skill sets might be the determining factor of having a job or not.

Another area that managers and the human resource look at before considering someone for a pink slip is their performance and or their productivity. One thing that you can do during this time is talk up your contribution, take on more work, and become indispensable. You can also think of ways to generate revenue or even be the go to person. Making yourself valuable or more valuable is a key element. This is not a time to stay in your cubicle and keep your nose to the ground. Those are normally good traits but being seen is vital at this time because out of sight out of mind.

I have also seen companies have a difficult time letting people go because of their attitudes. Yes attitude can make a difference. Are you a team player? Do you get along with others? I know these seem like such simple traits that most of us learned in kindergarten but they really can make it or break it. Your attitude is very important in challenging times. This is the real case where your attitude could determine your altitude. So keep in mind no whining allowed. Be positive and get involved with teams. On almost every job post or job advertisement they will request that you to be able to communicate effectively. Communication be it verbal communication or written communication is essential and must be done correctly. Knowing how to address customers and others is a key element to customer satisfaction.

So many individuals forget this step; treat your manager and coworkers as your customers. Always remember good customer service without it jobs are cut or being outsourced.

One of the most important things a person can do for themselves is network with others. Networking (internal & external) means keeping a broad perspective. Always have an updated resume close by just in case. Be seen and stay in contact with staffing agencies. This is the time to take their phone calls and see what they have available. I have always advised others to always go on at least one interview a year. This will keep you up to date with the current trends and it will also help your self confidence.

Yes it is true the EHR can wait. People should always come first before purchasing new products or starting new projects. The time for electronic health record implementation is right around the corner and the planning must begin but for some hospitals they are in survival mode. It is sad but it is true. For more information please visit.

Stimulus package links Personal Health Records (PHR) & Electronic Health Records (EHR)

Yes it is true the economic stimulus bill, which President Obama signed yesterday has some provisions for the electronic health record and the personal health record. According to a Washington post article that came out yesterday there is a break down of the stimulus package and it states that $20.2 billion has been allocated to health information technology. I have also noted some provisions for the PHR and I am sure they will be included for the EHR. There are some provisions that go along with it the stimulus package. The stimulus package imposed some new consumer protection requirements on vendors of personal health records. The vendors of the personal health records along with the electronic health record must notify affected individuals following the discovery of a breach of unsecured identifiable health information in PHRs. Vendors also must notify the Federal Trade Commission.
There are rules for those that offer third party provisions. If a third-party service provider provides services to a PHR vendor or covered entities that offer PHRs they must notify affected vendors or entities of a beach. The notification shall include the identification of each individual whose unsecured PHR identifiable health information has been, or is reasonably believed to have been, accessed, acquired or disclosed during such breach,” according to the legislation. The Federal Trade Commission (FTC) shall treat violations as unfair and deceptive acts or practices under the Federal Trade Commission Act. The legislation requires the FTC to publish interim final regulations within 180 days of enactment. The requirements will remain in effect unless Congress enacts new legislation governing PHR breach notifications. The provisions for including security breeches is coming at an optimal time and really the needs for such provisions should have been here yesterday because of information being stolen outright or on computers that house personal information. We have all seen the headlines in the past about personal information being lost or stolen.
In a recent article that I read there was a laptop stolen from a hospital in Texas. The article tried to make light of the fact that there was no patient information involved only employee information. Employee information that was lost or stolen included names, dates of birth and social security numbers. As a consultant, I can see how this can happen. So many health care organizations are not really training their employees in this area. How much training does a health care organization really offer an employee(s) on confidentiality and release of information? I know some hospitals that offer a once year approach about confidentiality via an in service with a short video. Most companies panic after the security breach or after the fact and they do not really take it seriously when they purchase computers and hand them out to employees. It is easy for health care managers to think that since most individuals that work with confidential information are trained initially and are professionals that more training isn’t really needed in this area. This type of thinking is wrong. For those of us that deal with confidentiality and with protected health information this issue needs to be on the front burner at all times in the health care setting.
Even though the stimulus package includes provisions for breeches it really needs to include training on protected health information and security. If you would like more information about health information security, please feel free to contact us.

Domestic Violence Victims Need to Track Health Information

In Oklahoma the number of domestic violence reports has risen by 31% from 1994 to 2003 years according to the 2003 Uniform Crime Report. I know about domestic violence in Oklahoma. I am a survivor. I was involved in an abusive relationship for over 17 years. I was married to a man who started out with mentally abusing me. It was a slow process but over time it led to physical abuse. I ended up in a women’s shelter with my two teenage children. It has been over 10 years now since this relationship ended in divorce. I am remarried but the scars of domestic violence are there forever. Generations have been touched by this awful problem. Women need to be made aware of the resources that are available to them.

One particular spring morning, my husband and I had a heated argument that got out of control, I tried to leave and he reached for everything in my purse. He took the keys to my car, my money and my children’s social security cards along with mine. He even took things like my insurance card and my credit cards. He knew exactly how to play the fighting game. I dialed 911 for help. We were living in rural America at the time so I had two sheriffs respond to the call which is about like having Andy Taylor and Barney 5 off of the Mayberry show, show up at your door step. They questioned my husband and me separately and I told the officers that I wanted to leave. The police officers told me that they did not determine property and ownership so they would not tell my husband to let me have my car. My husband would not let me have the keys to my car so I elected to leave with the officers. They took me to the police station and I filled out paper work. A lady police officer seen me crying and asked if I was okay and I told her about the abuse. She told me to get out while I still could. She was the only one that showed any compassion. Since this time in my life, I have read about domestic violence and the increasing numbers and I have studied it thoroughly. I have read about the men who violate women and how it can began so innocently. It can happen to all walks of life. You don’t have to be a minority or poor, it can happen to anyone. In thinking back I think to myself, oh my goodness how did my husband know to do these things to me and take all those things from me. I didn’t realize at the time how much I was going to need money, my important documents and my medical information along with my children’s information. Today, I am a big advocate of making sure that everyone women knows that she has the right to have access to her medical information and her children’s medical information. Each women has the right to review their medical information and to have a copy made of her medical records or those of her children.

Every women needs to have a personalized protection plan and in that plan she needs to make sure that she takes or gets out with all her important documents. Take all your important documents and this includes medical information. I have found a great website about making a protection plan. It is http://www.DVIS.org they have a section under the heading of domestic violence called the safety plan. Please take a moment and read this if you have a friend or someone you know is dealing with the issue of domestic violence. It can truly save a life.

I have developed a product to assist everyone with tracking their health care information. It is called the Health Care Tracker. The Health Care Tracker is a way to monitor or track your health information along with your children’s health care information. You can keep the health care tracker on a key chain or in your purse. The Health Care Tracker holds easy to use and easy to complete professional health care forms. Any physician’s office or emergency room can use them. To learn more, you can visit my website at http://www.healthcaretracker.org

Reflecting back over my past, I wished I would have known these things about domestic violence. Domestic violence is about power and control. It is not your fault. If I can help one woman or several women by sharing my story and sharing how important it is to have a personalized safety plan than maybe just maybe the numbers will decrease. The power is really up to you. It starts with you taking care of yourself. Take responsibility for yourself.

Health Information Process

The numbers are staggering. I just read in my local newspaper a report that stated nearly 98,000 Americans die each year due to medical mistakes. The article stated the source of the report was from the Institute of Medicine. The report was really telling all Americans to take responsibility for their own health care.  I really think this a good thing everyone should take responsibility for their health.  My husband and I work in the health care field. He works in a hospital as an engineer.  In his environment he understands infection control and how important simple things like proper supplies and hand washing can be when you work with hazardous materials.  There has to be good quality air control in a surgery suite to keep down the infection rate.

 

In thinking about these alarming numbers that I read in the newspaper about how many people die, it made me think of my own husband’s surgery. My husband had to have knee surgery last year and he was adamant about writing on his good knee with a permanent marker the morning of his surgery.  He wrote, NOT THIS KNEE.  I thought the nurses might chuckle when they seen the note on his knee but they told him it was a good idea.  His knee surgery was successful and they operated on the correct knee.  I thought to myself this really needs to be done by everyone. Everyone should take this type of responsibility.  I know that the pre-operative staff ask you your name and what are they going to do to you now as a set if standard precautions.  I know that this part of their protocol.  The precautions are there way of making sure that they have the right patient and that the patient understands what they are going to have done to them but one more step of writing on your body part is not a bad idea. 

 

This is one of the things that the article did not mention but could easily be added to the list.  The article mentioned that about 1300 times a year a surgeon operates on the wrong person or removes the wrong limb or organ.  I think after reading the article that most people can afford a black magic marker with those types of errors it might be good item to invest in and carry with you to the hospital.

 

Another point that this article made was that adverse drug events cause one out of five injuries or deaths to hospital patients in the United States.  An adverse drug event can mean that some one was given the wrong drug, administering the wrong dosage, mixing drugs that interact badly, or giving medication to which a patient is allergic.  

 

The article went on to state that the problem is not that we have an epidemic of negligent doctors and nurses rather it’s that the health care system has grown so complicated and that there is a greater chance of that things can fall through the cracks.  There is so much information to be conveyed among providers.  The electronic health record could definitely make this whole process easier and better.  The electronic would make everything more centralized. Papers that are filled in the wrong chart would not happen any more. Today, a paper being filled in the wrong record is a big issue and this could be eliminated with the electronic health record.  We all know that transcriptionist can make errors and then couple that error with the paper being filed with the wrong number in the wrong chart is disastrous.  So many health information management departments have such an issue of duplicate records with the ole paper record.  I really don’t think that we can put blame on the health information department or any one person or department.  The problem is the process of how we handle health information.  Today we have to request everything manually.  If we had the electronic health record in place it could help to reduce the number of adverse drug events.  The electronic health record software program can send a signal if the wrong drug is ordered. The computer programs can print out hand outs for the nurse and patient so that they know how to administer the drug.  Health care organizations and health care provider’s have so much paper to deal with on a daily basis, important paper.  We need this paper to be put into a standardized process where we can all share it, not duplicate it and health care providers can have access to it.  The process seems so simple yet it is so complicated. 

 

We know the risk or barriers to the electronic health records and we know the advantages today yet the process is really the issue.  We can implement the best product but if we haven’t clearly looked at our processes we are not doing ourselves any favors.

One of the advantages of implementing an electronic health record is this staggering number of 98,000 Americans could be decreased to a lower number if we had a different process in place.  I believe our clinical processes need to be re-evaluated and they need to include the electronic health record. If you would like more information on this topic please visit our website at www.healthcaretracker.org

Barriers to Implementing an Electronic Health Record (EHR) system

Barriers to implementing an EHR system
Beleow is a list of ten things that are true barriers for most health care organizations today. Please review the list and decide which barrier your organization is facing. The first step is to acknowledge the issue(s) and then you can tackle them head on. Good luck.

#1 Difficulty in adding older records to an EHR system

Today there are organizations that pick a start date and then implement their new EHR system but older paper medical records ought to be incorporated into a patient’s electronic health record. One method of doing this is to merely scan the documents and retain them as images. However, surveys suggest that 22-25% of physicians are less satisfied with records systems that use scanned documents alone rather than fully electronic data-based systems. The reason is that they are hard to read. EHR systems with image archival capability are able to integrate these scanned records into fully electronic health records systems. This method makes the record more complete. Another method is to convert written records (such as notes) into electronic format is to scan the documents then perform optical character recognition. For typed documents, accurate recognition may only achieve 90-95%, though, requiring extensive corrections. Furthermore, illegible handwriting is poorly recognized by optical character readers. This means that there might be some records that are hard to read. Some states have proposed making existing statewide database data (such as immunization records) available for download into individual electronic medical records. This would make this process easier and more beneficial for the health care provider and the patient.
#2 Long-term preservation and storage of records

Most organizations do not really think of preservation of the EHR record. An important consideration in the process of developing electronic health records is to plan for the long-term preservation and storage of these records. The field will need to come to consensus on the length of time to store EHRs, methods to ensure the future accessibility and compatibility of archived data with yet-to-be developed retrieval systems, and how to ensure the physical and virtual security of the archives. Considerations about long-term storage of electronic health records are complicated by the possibility that the records might one day be used longitudinally and integrated across sites of care. Records have the potential to be created, used, edited, and viewed by multiple independent entities. These entities include, but are not limited to, primary care physicians, hospitals, insurance companies, and patients. The required length of storage of an individual electronic health record will depend on national and state regulations, which are subject to change over time. Requirements for the design and security of the system and its archive will vary and must function under ethical and legal principles specific to the time and place.
While it is currently unknown precisely how long EHRs will be preserved, it is certain that length of time will exceed the average shelf-life of paper records. The evolution of technology is such that the programs and systems used to input information will likely not be available to a user who desires to examine archived data. One proposed solution to the challenge of long-term accessibility and usability of data by future systems is to standardize information fields in a time-invariant way, such as with XML language.
#3 Synchronization of records
When care is provided at two different facilities, it may be difficult to update records at both locations in a coordinated fashion. This is a problem that plagues distributed computer records in all industries. Standardization needs to occur first with medical documents. Synchronization programs for distributed storage models are only useful once record standardization has occurred.
Merging of already existing public healthcare databases is a common software challenge. The ability of electronic health record systems to provide this function is a key benefit and can improve healthcare delivery.
#4 Privacy

Privacy concerns in healthcare apply to both paper and electronic records. Today records can be exchanged over the Internet and they are subject to the same security concerns as any other type of data transaction over the Internet. The Health Insurance Portability and Accountability Act (HIPPA) was passed in the US in 1996 to establish rules for access, authentications, storage and auditing, and transmittal of electronic medical records. This standard made restrictions for electronic records more stringent than those for paper records. However, there are concerns as to the adequacy of implementation of these standard. As the ever-changing healthcare industry evolves, one key topic within the electronic health record (EHR) is privacy. The Federal government has set guidelines that all healthcare organizations will have to comply with in regards to electronic health transactions. Most supporters believe that the EHR will improve care and reduced costs, while transforming the health care system, but whether the privacy of the records will be upheld is yet to be determined. A successful partnership for administrative health data standards can promote the development of clinical data standards and their application in computer based patient record systems.
One major issue that has risen on the privacy of the U.S. network for electronic health records is the strategy to secure the privacy of patients. President Bush calls for the creation of networks, but federal investigators report that there is no clear strategy to protect the privacy of patients as the promotions of the electronic medical records expands throughout the United States. In 2007, the Government Accountability Office reports that there is a “jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers.
According to the Wall Street Journal, the DHHS takes no action on complaints under HIPAA, and medical records are disclosed under court orders in legal actions such as claims arising from automobile accidents. HIPAA has special restrictions on psychotherapy records, but psychotherapy records can also be disclosed without the client’s knowledge or permission.
Within the private sector, many companies are moving forward in the development, establishment and implementation of medical record banks and health information exchange. By law, companies are required to follow all HIPAA standards and adopt the same information-handling practices that have been in effect for the federal government for years. This includes two ideas, standardized formatting of data electronically exchanged and federalization of security and privacy practices among the private sector. Private companies have promised to have “stringent privacy policies and procedures.” If protection and security are not part of the systems developed, people will not trust the technology nor will they participate in it. The private sector knows the importance of privacy and the security of the systems and continues to advance well ahead of the federal government with electronic health records.
#5 Hardware limitations
Computer access is required to use an electronic health record system. A sufficient number of workstations, laptops, or other mobile computers must be available to accommodate the number of healthcare providers at any one facility. EHR software ought to be backwards compatible with older technology so that existing technology infrastructure can be used. Furthermore, most healthcare facilities have at least some degree of existing computerization, whether in the lab or in billing services. EHR systems need to interface with existing systems, again mandating a modular approach. In the past, poor networking technology was a limiting factor in the adoption of EHR software. There are now solutions which profit from new networking and mobile technology.
#6 Cost Advantages and Disadvantages
Most practitioners and healthcare organizations will agree that both quality healthcare and medical error reduction take precedence over many other healthcare concerns. Common knowledge to most, the U.S. allocates a vast amount of funds towards the health care industry. Unfortunately, these distributed funds have not significantly improved the U.S.’s quality of healthcare. The implementation of electronic health records (EHR) can help lessen patient sufferance due to medical errors and the inability of analysts to assess quality. This type of savings will not occur overnight and will require EHR adoption by most healthcare businesses. Obviously, these savings can lead to healthcare quality promotion. In addition, these savings are not limited to businesses alone: If patients are aware of their opportunities, they are more likely to comply with their doctors’ recommendations; thus, reducing future hospital visits and saving money. Despite the advantages, many providers have not adopted EHR due to its expensiveness: The steep price of EHR and provider uncertainty regarding the value they will derive from adoption in the form of return on investment has a significant influence on EHR adoption. One of disadvantages is that systems crash and experience technical difficulties, which is very costly to repair. Such issues make providers question if EHR is a step they are willing to take. Overall, EHR systems provide more benefits than disadvantages to patients and the economy. These systems can improve savings and the quality of healthcare to a superior level. Even though the use of health IT could generate cost savings for the health system at large that might offset the EHR’s cost, many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it. For example, the use of health IT could reduce the number of duplicated diagnostic tests. However, that improvement in efficiency would be unlikely to increase the income of many physicians.” If a physician performs tests in the office, it might reduce his or her income. “Given the ease at which information can be exchanged between health it systems, patients whose physicians use them may feel that their privacy is more at risk than if paper records were used.
#7 Start-up costs and software maintenance costs
In a 2006 survey, lack of adequate funding was cited by 729 health care providers as the most significant barrier to adopting electronic records. At the American Health Information Management Association conference in October 2006, panelists estimated that purchasing and installing EHR will cost over $32,000 per physician, and maintenance about $1,200 per month. Vendor costs only account for 60-80% of these costs.
Some proponents of EHR systems suggest that startup costs will be recouped within 3 years. Some physicians believe the data is skewed by vendors and by others who have a stake in the success of EHR implementation. Many are resistant to invest in a system which they are not confident will provide them with a return on their investment.
Furthermore, software technology advances at a rapid pace. Most software systems require frequent updates, often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only the budget but also workflow. Physicians desire modular upgrades and ability to continually customize, without large-scale reimplementation.
Training of employees to use an EHR system is costly, just as for training in the use of any other hospital system. New employees, permanent or temporary, will also require training as they are hired.
In the United State there a few recently-trained medical professionals but they will be inexperienced in electronic health record systems. Elderly practitioners who have never used computer-based systems probably will retire.

#8 Inertia
Most large organizations resist change. The institutional stress of implementing any new large-scale system must be anticipated by management. According to the Agency for Healthcare Research and Quality’s National Resource Center for Health Information Technology, EHR implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself.
The healthcare industry has more licensed professionals with advanced degrees than any other industry. However, systems analysis and computer science has not, until recently, been an integral part of healthcare training. Most health administrators also lack training in computer science.
#9 Legal barriers
[Liability barriers
Legal liability in all aspects of healthcare was an increasing problem in the 1990s and 2000s. The surge in the per capita number of attorney and changes in the tort system caused an increase in the cost of every aspect of healthcare, and healthcare technology was no exception. Failure or damages caused during installation or utilization of an EHR system has been feared as a threat in lawsuits.
This liability concern was of special concern for small EHR system makers. Some smaller companies may be forced to abandon markets based on the regional liability climate. Larger EHR providers (or government-sponsored providers of EHRs) are better able to withstand legal assaults.
In some communities, hospitals attempt to standardize EHR systems by providing discounted versions of the hospital’s software to local healthcare providers. A challenge to this practice has been raised as being a violation of Stark rules that prohibit hospitals from preferentially assisting community healthcare providers. In 2006, however, exceptions to the Stark rule were enacted to allow hospitals to furnish software and training to community providers, mostly removing this legal obstacle.
Ownership of electronic records
HIPAA standards allow patients the right to review the content of their medical records.
When records are centralized, it is often difficult to determine whose responsibility it is to maintain the records. If a company agrees to manage and maintain records but goes out of business, how does that impact the healthcare provider whose ultimate responsibility it is for record maintenance?
If a healthcare provider retires or goes out of business, what arrangements to convert records to archival formats are available? This is an issue that has to work out with a policy and procedure in place to follow.. If an individual physician and a hospital system share a record database system but then the individual physician leaves that healthcare system, how does she separate her practice’s records from the hospital’s central database to take them with her for archival, as often required by law? Another question that often arises is who determines the frequency of “purging” of records?
A patient may store a portion of his/her health records online or with an independent storage service in which case that subset of records is no longer under the control of the healthcare provider. This transfers HIPAA liabilities to the databank that stores the records for the individual. Concerns about loss of data integrity and lessened HIPAA adherence arise, because these records are no longer part of the health record maintained by the healthcare provider.
Unalterability of records, spurious records, and digital signatures
Medical records must be kept in unaltered form and authenticated by the creator. However, simple mistakes often create spurious documents. How are spurious documents identified so that they do not clutter the medical record without altering or disposing of them illegally?
Most national and international standards now accept electronic signatures. However, a database of electronic signatures must be created as an EHR system is implemented.
#10 Customization
Each healthcare environment functions differently, often in significant ways. It is difficult to create a “one-size-fits-all” EHR system.
An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment. Modularity in an EHR system facilitates this. Many EHR companies employ vendors to provide customization or you can hire an outside consultant to assist you.
This customization can often be done so that a physician’s input interface closely mimics previously utilized paper forms.
At the same time they reported negative effects in communication, increased overtime, and missing records when a non-customized EMR system was utilized. Customizing the software when it is released yields the highest benefits because it is adapted for the users and tailored to workflows specific to the institution.
Customization can have its disadvantages. There are higher costs involved in implementation of a customized system initially. More time must be spent by both the implementation team and the healthcare provider to understand the workflow needs.

My Dog Has a Microchip and So Does Grandpa

Wow! What a concept, could it be that veterinarian practices are a step ahead of our human health care practices? Just think about it.

I have always loved to raise pure breed dogs. I really like the poodle family. They are so cute and smart and, for the most part, they do not shed. I have always taken my dogs to the veterinarian for regular check ups and when they are sick.

It is not always the most pleasant thing to do, taking a pet to the veterianarian but it is one that I do regularly. My veterinarian, after careful examination and treatment, would always give me an itemized description of what he did to my dog along with an itemized bill. This is different than what my own family doctor provides for me. When I go to the doctor, I am treated. I am then told what is wrong sometimes after x-ray or lab testing. At the end of my visit, I am given a sheet of paper with circles and scribbles to hand carry over to a cashier. The cashier then takes the paper from me and requests a co-payment amount from me. A amount that I am expected to pay after treatment. I leave the physicians office with a perscription and a receipt for my payment when I am sick, but I still have to rely on my memory so that I can recite back to my husband all the details the doctor told me on that particular visit about my condition.

The difference between a vetinarian and my health care provders is that most of the time I do not receive a copy of my medical record when I leave the doctors office, but I have a complete profile on my poodle when he leaves the vet. Does this make any sense?

If I am a dog and I wonder off or if I am at risk of being stolen, my owner can have a veterinarian implant a chip on the back of the dogs neck. This will allow the dog to be scanned and provide the humane society or verinarians office with valuable information about the dog such as my owners name, address and phone number. The chip is about the size of a grain of rice.

Sounds great if you’re a dog lover! If your dog is lost this could mean a quicker recovery period and your dog could be returned to you if the local animal shelter has a scanner. The veterinarians have been selling these devices for years.

Is there a connection with how we treat those with Alzheimer’s? In a recent article from Guayama, Puerto Rico — five Puerto Ricans with Alzheimer’s disease had microchips implanted in their forearms Thursday to provide data about their medical condition and ways to contact their caretakers.

The microchip costs US $200, is voluntary, and is made by the Florida-based Verichip Corp. Four hospitals in the U.S. Caribbean territory plan to begin using them in August on patients who have significant health problems or illnesses that cause memory loss.

Okay, we are not dogs and people shouldn’t be treated like dogs, but is there really something to this? The company has the right idea in mind. They stated that they intend to help the relatives of these patients feel more secure when they stay alone or under the care of other people, according to Awilda Sidanes, president of the Alzheimer’s Federation of Puerto Rico.

It will provide emotional support to everyone since the microchip contains data such as the patients’ medical histories, medicines they take, and the contact information for their doctors and caretakers, according to Sidanes

For most of us, this information sounds like a source for good gossip, but the Federal Drug Administration (FDA) has already approved the microchip for humans. The FDA approved micro-chipping humans back in 2004 and so now we have hospitals that can scan those that are unconscious or disoriented.

According to the Washington Post, the chip maker plans to equip 200 hospitals by the end of the year. Doctors in some communities are already offering the procedure to patients.

This can be a good thing and a bad thing. Yes, it is true we might be able to have information at our finger tips or as close as someone’s arm as health care providers, but what about privacy and security concerns. Who is providing the information? Is it valid? Is it from a source we can trust? This technology raises a different set of questions then when it is used for our pets. No matter what side of the fence you’re on about this issue, health information technology is advancing and it is being utilized with veterinarian medicine as well as with human medicine. So yes, it is true a microchip can be used to find Fido the poodle or even grandpa, if he is missing and it can be used to communicate valuable health information when someone is unconscious or disoriented. Is this a good answer?

 

The answer is that Verichip is still around today. 

Health Care Tracking

Let’s look further into more on how to get started with step #3 of How to Track your Health Care Information.  Last week we examined Step #1, complete health care forms.  We also looked at step #2.  We found that step #2.was to collect your health care information.  Today we will be reviewing Step #3 which is to Organize and understand your health care information.  First we ask that you pull your information out of the shoe boxes and file cabinets and organize it. It is recommended to put things in chronological order. If you just recently requested information from your health care information, review it and make sure it is your information that you requested.  Grab a three (3) ring binder. Place a divider in a three ring binder for each family member to separate the information. The first thing that we need to do is organize our health care information.  This step is so important because it can save us time.  Next, read over carefully all the information. For some you will need the aid of a good medical dictionary so that you can look up words that you do not understand.  It is good to try to memorize some of your health care information. You should know the names of your medications and their dosages.  It is also good to know if you are allergic to any thing because this is a commonly asked question.  If you are on a hand full of medications then write them down but carry the list with you along with important emergency numbers. Try also to remember what is normal for you.  What is a normal blood pressure for you or pulse?

 

Another rule of thumb is to be cautious with looking up health care information on the internet or sharing it.  The internet can be a powerful tool but it can also scare you because sometimes it gives too much information on conditions and diseases and it can make a disease sound much worse than it really is.  If deciphering your own medical record sounds too intimidating then you can request the assistance of a health care professional.  It is okay to ask questions about your health care information when there are things that you do not understand in your medical record. The doctor or nurse should be able to explain things so that you can understand.  Another suggestion is to have someone in your family review your record. Make sure that this person is a trusted source.   There are patient advocates that can explain your patient information to you and assist you with questions about your medical record, medical bills and your health insurance. We need to know what we have, where it before we can start really utilizing the information. Knowing what is in your record can possibly save you from having duplicate or unnecessary test.  It has been noted that almost 10% of all tests and procedures are unnecessary or duplicated.  If you know what is in your medical record you could match it to the itemized bill thus, saving you money.

 

Let’s look at step #4, Protect your health care information.  Make sure that your information is not lying around so that it can be seen. A safe deposit box is a good idea or a fire proof box is great for storing your health care information securely. Using these types of boxes keeps the information safer than just a regular filing cabinet drawer.  Protecting your information from fire and water are very important. You have the right to make sure your information is being protected.  Discuss your concerns with your health care providers.  Know your rights under HIPAA.  Your health care information can be shared among health care professionals to ensure treatment, payment and quality but when it comes to disclosure you do have some rights.

 

If you are already putting your health care information on a computer make sure it is secure with a password, and virus protected.  Back up your health care information routinely. If you subscribe to an online medical records service make sure that you and your health care providers can access the information when it is needed but that it is also secure. Sometimes it is best to encrypt your information if it is being used a great deal. Be cautious with giving out free health care information in order to receive a free cholesterol screening at health care fairs when they advertise they are using the information to assist you with a screenings.  Ask what they are doing with the information.  Look for safer ways to use your health care information.