Electronic Health Records (EHR, EMR)

EHR makers Epic and Cerner are building advanced directive features into their software to enable data sharing, an official said. Some lawmakers are looking to make directives portable while U.S. states are building databases to store them.  

CIO Craig Richardville said Carolinas has reduced its duplicate medical records error rate from 2.9 percent to 0.01 percent using the ID and authentication technology in conjunction with its master patient index.

In a deal also involving the private equity firm GI Partners, the EHR maker will combine its Homecare products with Netsmart’s human services offerings.

The Office for Civil Rights has launched a new round of HIPAA audits. Will the program succeed in improving privacy and security practices and protecting patient data? Or could it have the opposite impact?  

The American Medical Informatics Association said that being a CCIO will require lifelong learning to master all the clinical, technological, and management skills the job demands. 

Judy Faulkner readily admits that when she founded Epic Systems she had no idea how to start a company.  Faulkner discussed those early years as well as some of today’s most contentious topics including semantic data interoperability, why the U.S. needs a unique patient ID, and the impact that electronic health records software has on physician productivity. Semantic standards are key for data exchange. If you're going to do interoperability between organizations, which I think is critical, it's limited because you have to define and normalize and harmonize the data so that each group can understand the other. Let's examine gender. I may have one for male, two for female, and then two other kinds of genders, ambiguous and something else. [Also: Judy Faulkner: 'Good software is art.'] On the other hand, they may have one for female and a range of other values. How do you move that over when different groups have different ways of doing that? You need standards. There's a limited number of standards that we have to be able to transmit the data. I use such a simple example as gender, but as you go into the drug and other databases, there is even greater complexity. Within your organization you want to share. It's critically important to also get information back and forth from other groups who aren't yours. Unique patient ID has to happen. I think each person should have a medical identity. I don't care whether it's federal or not. However, the lack of this is not an excuse. You can do a lot of patient matching based on other attribute checking and so the identity would make it easier, but it is not an absolutely critical thing. Remote care is the future. Healthcare going to stay local to a great extent. I think it's going to also move to telemedicine much more than it is right now because we have to reduce the resources that we're using and the expense that we have in healthcare. Also people don't want to travel if they can help it. It will be a little slower than people would like. Physician productivity among Epic's priorities. Make sure your doctors are productive users. Focus on your doctors being productive users and all your users being happy. Because if that happens, then the rest will just fall out. Doctors happy, No. 1. And doctors happy means that they're taking good care of their patients, by the way, because doctors will not be happy if they're not, and I think that's really important, so I don't want to separate that out. 'I had no idea how you start a company.’ After I built it, I went around to a lot of different departments in University of Wisconsin and worked with them. One department had money for six months for a programmer to do something. There were only 20 data elements, and I remember charging them for 45 minutes of time. You can see why customers all around the country told people, ‘Look what they are doing." They'd call me up and say, "Start a company," and I would laugh and say, "No." This went on for about two years. Finally I said ‘Yes.’ You have to realize I wore blue jeans. In the summer I wore T-shirts; in the winter I wore sweatshirts. I cut my hair with scissors, no makeup. I was a normal programmer and I had no idea how you start a company. So I went to somebody who had spun off from the university, and he said three things: One, get permission from the university, get a good lawyer, get a good accountant. I did all three. It was great advice. I started the company, valued it at $70,000, and I invited my customers to join in and be part of the original shareholders. There are a lot of people then who helped start Epic … We divided it up, so if you had 5 percent of the company, you paid $3,500, and that got us started. We started with one and a half people. I had a morning assistant and an afternoon assistant. We were in a basement of an apartment house. That was it. We signed a bunch of contracts and never took outside money from venture capital or went public or anything like that. Twitter: @HealthITNews

EHR giant Cerner on Friday completed the initial stage in a $4.5 billion expansion that company officials and the state’s governor are promising will add thousands of jobs. Missouri Gov. Jay Nixon said at the ceremony that the area is already seeing benefits of this project, pointing to nearly 4,000 jobs created. “Once complete, this campus will accommodate Cerner's growth and bring up to 16,000 new jobs to the area strengthening Missouri's position as a top destination for growing tech companies,” Nixon said.    Kansas City has been rebranding itself as a technology innovation hub some people have been calling it Silicon Prairie for the last several years, looking to attract entrepreneurs and employees alike. The region, in fact, was the first to implement the Google Fiber gigabit Internet service. In addition to Cerner, other technology companies in Kansas City include Sprint, DST Systems, and Garmin. Cerner’s construction ceremony on Friday “marks significant progress for the project and completion of the structural framework for the first two office buildings on our new campus," Cerner COO Mike Nill said. Nill announced the first buildings would house more than 3,000 engineers and was designed with open concepts and collaborative meeting spaces to encourage creativity and community. When Cerner first broke ground on the new campus, in late 2014, the company said it intended to add 16,000 jobs in the next decade. Twitter: @HealthITNews    

A whistleblower blog claimed many other executives within the NYC Health + Hospitals EHR project were deeply concerned. But the health system countered that the electronic health record software would be ready by implementation.

Medsphere Systems Corp., whose OpenVista electronic health record is based on the architecture of the Department of Veterans Affairs' VistA EHR, has released a mobile version of the technology called Mobile OpenVista Enterprise, or MOVE. With secure and real-time access to patient data wherever a clinician has Wi-Fi or cellular coverage, officials say MOVE – which includes Medsphere's NoteAssist patient documentation system – allows physicians and nurses to review medication orders and record patient information on the go. [Also: OpenVista EHR maker Medsphere merges with MBS/Net] "Without doubt, healthcare IT is moving toward mobility and enhanced, streamlined processes," said Medsphere President and CEO Irv Lichtenwald in a statement. "Medsphere is excited about moving OpenVista in that same direction." On March 17, Medsphere also announced an expansion of it products and services since its recent mergers with Phoenix Health Systems and MBS/Net. Phoenix Health continues to integrate its infrastructure support and application management skills with Medsphere's offerings. Meanwhile, MBS/Net's technology, such as physician practice management system and ambulatory EHR, are being integrated with OpenVista, officials said. Twitter: @MikeMiliardHITN

Primary care doctors now lose more than an hour a day to sorting through approximately 77 electronic health record notifications, researchers at Baylor University found. “Information overload is of concern because new types of notifications and ‘FYI’ (for your information) messages can be easily created in the EHR (vs in a paper-based system),” the researchers wrote in the Journal of the American Medical Association  Internal Medicine.      Making the workload harder to endure, reading and processing these messages is uncompensated in an environment of reduced reimbursements for office-based care, according to the study. [Also: Epic to develop Apple Watch app, 'Limerick,' a test results notifier] Physicians are receiving these increasing amounts of notifications in EHR-based inboxes such as Epic’s In-Basket and General Electric Centricity’s Documents. The messages include test results, responses to referrals, requests for medication refills, and messages from physicians and other healthcare professionals. The system is crying out for change the researchers wrote. “Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed.” What’s more, optimistic predictions that EHRs would improve patient care through better doctor-patient communications have not ubiquitously materialized. “Unfortunately, we are far from this promise and now also grapple with the unintended consequences of EHRs,” Joseph Ross, MD wrote in an editorial accompanying the research.  In fact, electronic “paperwork” has burdened doctors and reduced the time for patient care. Ross advocated that inbox notification capabilities be periodically reviewed to be sure EHRs are working in the best interests of patient care and not creating an unnecessary burden on physicians. [Like Healthcare IT News on Facebook] In addition, doctors should be reimbursed for time spent reviewing EHR notifications. “Although many of these notifications are in the service of patients,” Ross wrote, “we need to be sure that physicians’ reimbursement, particularly for primary care physicians, is taking into account the full time needed to manage patients’ care.”  Twitter: @HealthITNews