IO Practiceware Software Blog's not about the IT, it's about the Patient

Posted by Amal Doleh

Apr 8, 2014 9:54:14 AM


With Meaningful Use, many have noticed that EHR adoption contains many steps and applications for care coordination and quality improvements. Those states that are high in EHR adoption rates, such as Wisconsin, are investigating ways that their EHR systems can pave the way for change when it comes to their doctors and patients.

Early EHR adopters are past the point of choosing an EHR system that best suits their practice's needs and are now focusing on how to best implement these systems in the best possible way. These practices are building patient-centered care models in order to make EHR, not only a part of their technology, but to implement changes in the clinical environment. “This emphasis on trying to help these practices transform what they’re doing to make it more patient-centric — it’s really not about the IT; it’s about the culture and redesigning workflows and things like that” (Stacey Novogoratz, EHRIntelligence, 2014). 

Although some physicians have rallied against EHR systems being used in their practices, it is quite evident that EHR has made quite the impact in shifting medical culture and easing practice workflows to help patients feel important and take part in their own health treatments. Adopting EHR is not an simple task, but one that has to be implemented with patience and motivation. With any new technological advances introduced into the medical field, there's bound to be some resistance, but once these advances become a staple, physicians are able to see the impact it has in improving their practices. While the case with some early adopters and the success of EHR may not be indicative of EHR adoption in other states, it does provide insight into how well implemented health IT systems can serve as the foundation for achieving the real meaningful use of EHR systems.


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Physicians Using Touch Screen EHR Are Happier & More Productive

Posted by Amal Doleh

Mar 31, 2014 1:46:43 PM


According to a recent survey, physicians who use mobile devices and/or touch screen EHR technology spend just over two hours a day computing patient data. Physicians were reported to be happier, more mobile, and more productive when using tablets for clinical work. Also, 84% of the surveyed physicians claim that using touch screen EHR and tablet technology make them better at multi-tasking, helping with increased productivity.

The past few years have shown a huge boost in tablet popularity when it comes to communicating with patients, taking notes in the exam room, and accessing information at the swipe of a finger. Physicians are said to enjoy using tablet technology as it has long battery life, portability, simple user interface, and easy EHR system access. Tablets and other forms of touch screen EHR technology represent a new wave of healthcare in the exam room.

Physicians use touch screen technology and mobile devices to:

  • View patient information
  • Look up non-patient health information
  • Educate and train others on the device
  • Get clinical information
  • Access information from anywhere

Physicians are using this powerful technology to research information once they leave their patient's room as well as easily coordinate with insurers. "I think it's safe to assess that [adoption of electronic health records] will continue into more creative use as the clinicians find more ways to use it effectively" (EHRIntelligence, 2014).

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Electronic Health Records Keeping Patients in the Loop

Posted by Amal Doleh

Mar 25, 2014 11:11:09 AM


Back were the days of thick manilla folders that held patient records, accessible only to the physicians and rarely discussed with their patients. Today, health records are kept electronically and allow patients to access their full history with patient portals. 

Larger hospitals and practices encourage patients to use their health portals in order to better coordinate "patient-centered" care and engagement. "The Centers for Medicare and Medicaid Services wants providers to use information technology as a way to help patients 'further their own health care'" (VTDigger, 2014). EHR systems aim to improve patient health outcomes by allowing patients to personally keep track of treatment plans, medications, office visits, tests, etc. These accessible portals also enhance communication between patients and physicians, making EHR a bridge in which patients can easily discuss issues with their doctors. 

The federal government requires health providers to give patients access to their records in order to allow for speedy transit of health information. Hospitals are given 36 hours after patient discharge to provide patients information online. "The whole idea behind this measure is to start to enable patients and motivate and include them more actively in their own care" (VTDigger, 2014). Whether this will encourage more patients to utilize these health portals will become apparent in the next few months as federal rules become more strict with mandatory EHR systems. Hopeful that the "Meaningful Use" guidelines, which include financial incentives to those who adopt EHR, will push healthcare providers to put electronic health records in effect as soon as possible. 

One of the biggest obstacles faced by these healthcare providers is getting patients to actually enroll in their programs. No official figures are out at this time, however, those who are signed up are not utilizing this form of patient-physician communication to its full extent. Although it has been an uphill battle for physicians to encourage patients to enroll, hospitals and larger practices are hopeful that numbers will increase once EHR becomes a necessary staple in healthcare. Patients who already use these healthcare portals have noticed enhanced communication including quick email responses from their physicians, sparing them from the tedious string of phone calls made when they had questions. 

Healthcare providers are optimistic that patients will see the great benefits of EHR and that they will adopt this new technology as part of their regular doctor visits. 

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Small Medical Offices Take Lead in Growth of EHR Adoption

Posted by Amal Doleh

Mar 24, 2014 1:36:10 PM

dreamstime_xs_31068316An ongoing study conducted by SK&A, a leading provider of healthcare information, shows a 10% point increase in EHR adoption in solo and smaller practices from 2013-2014. 

A telephone survey was conducted with 270,036 medical sites, an ending report showing an EHR adoption rate of 61%, up from 50.3% from the prior year. Also, the adoption rate of single-doctor offices grew 11.4% points, from 42.3% to 53.7%, while larger medical offices consisting of 26 or more physicians grew only 1.6% points. 

“What has accelerated the adoption of electronic health records among smaller practices is the availability of more than 450 different solutions to fit their practice needs, size and budget. The healthcare IT community responded well to the opportunity presented by the EHR adoption incentives by providing a variety of options to physicians with relatively easy implementation and training support. Physicians also realize they have a limited window of opportunity to take advantage of federal reimbursements by showing ‘meaningful use’ of digital record-keeping technology.” (Schember, BusinessWire, 2014). 

Other EHR utilization trends include:

  • EHR adoption among Integrated Health Systems had the highest rate of all site ownerships. The percentage jumped to 71.4% from 63.4% a year ago.

  • EHR adoption rises as the number of physicians practicing at each site rises. Offices with 3-5 practicing physicians had 69.6% adoption, while offices with 11-25 practicing physicians had 78.1% adoption.

  • EHR adoption rises as the number of exam rooms at each site rises. Offices with 1 exam room had 39.7% adoption, while offices with 11-plus exam rooms had 74.8% adoption.

  • EHR adoption rises as the average daily patient volume at each site rises. Offices with average daily patient volumes of 1-50 patients had 57.5% adoption, while offices with 101+ patients had 76.3% adoption.

  • Physician specialties with the highest adoption rates are dialysis (80.6%), internal medicine/pediatrics (75.8%), nephrology (70.5%), and pathology (69.4%).

  • Top five states for EHR adoption are Utah (71.6%), South Dakota (71.2%), Wyoming (71.0%), Iowa (70.8%), and North Dakota (69.2%).
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Occasional alcohol consumption can aid in the prevention of vision impairment

Posted by Amal Doleh

Mar 20, 2014 10:43:25 AM


According to a recent ophthalmology study, occasional alcohol consumption, as well as a physically active lifestyle, can lead to the decreased risk of visual impairment. "Visual impairment – sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses – is associated with a poorer quality of life and, when severe, loss of independence" (HealthCanal, 2014). 

It is predicted that, in the next five years, the amount of those with visual impairment will increase by 70% as compared to those in 2000. To understand the causing factors of visual impairment, researchers at the University of Wisconsin studied different lifestyle behaviors including smoking, drinking, and physical activity. The study was conducted among 5,000 adults over the course of 20 years. Of those participants, researchers found that 5.4% had developed some sort of visual impairment.

  • Participants who led a sedentary lifestyle were 58% more likely to develop some sort of visual impairment compared to those who engaged in regular physical activity. 

  • Those who were occasional drinkers (having consumed alcohol in the past year) were 49% less likely to develop visual impairment compared to non-drinkers.

  • Heavy drinkers and smokers were at higher odds in the risk of visual impairment.

Researchers found that, although these behaviors affect the overall risk of visual impairment in adults, age proved to be the most significant factor in the study and one we cannot change. 

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New Orleans Academy of Ophthalmology 63rd Annual Symposium

Posted by Amal Doleh

Mar 19, 2014 3:39:39 PM

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Navigating the EHR jungle not as daunting as it first appears

Posted by Amal Doleh

Mar 18, 2014 10:18:22 AM

Ocular Surgery News U.S. Edition, March 10, 2014
Mitchell A. Jackson, MD
Government incentives, avoiding penalties and improved practice efficiency are benefits to implementing electronic health records.
The jungle of electronic health records has been quite controversial over the last few years, especially in terms of the selection process, implementation process, financial implications and, ultimately, true clinical value to patient care. The various vendor claims, government promises and staff resistance have fueled the fire on whether EHR is a necessary evil or realistic advantage to the bottom line of profitability, efficiency and better patient care.
Selection process

Various practices have business/administrative computer programs in place but without electronic medical record or electronic prescribing capability. I spent 2 years of due diligence in trying to find the correct system to integrate into my practice, which entailed looking at a demo of each system with all key personnel from administrator, front desk, billing manager, lead technician and optometrist, to myself the surgeon. All of us have different needs and wants from an EHR system, so trying to find the system to make all of us happy was indeed a daunting task. For the next step, I actually followed up on each EHR system’s practice reference and interviewed the same personnel as above from the various practices to find out the real story on each system. Lastly, once I had my selection down to one or two systems, I went to visit a practice with each system to see it live and followed a patient from check in to check out to see how the flow was from a patient side and from the staff side.

Originally, we had Medisoft as our business software, which would only link to McKesson for EHR purposes. I did not like that I would have two vendors plus an IT vendor, for a total of three vendors that could point fingers at each other if something were to go wrong once implemented, so my practice chose a fully integrated system requiring only the EHR vendor and my IT vendor to allow for a smoother transition. IO Practiceware was our final choice because of its easy patient exam navigation process, touch-screen efficiency and ability to handle all the government requirements for incentives and penalty avoidance. Some practices have even looked at systems that have a presence in Europe because these systems are already prepared for the ICD-10 overhaul expected on Oct. 1.

Implementation process

Before implementation on our “go live” date, all of our systems had to be in place in terms of hardware and software. Mounting secondary computer screens in each room, planning for a temperature-controlled and secure main server hub location, and transferring all appropriate data from our prior business software to our new fully integrated IO system were critical. Establishing a 24/7/365 contract with our IT vendor was completed as well to avoid any potential patient care downtime once on the new EHR system. Lastly, our IO vendor placed two to three personnel in our office for 2 weeks during our “go live” period to make sure our transition was as seamless as possible. There is nothing more valuable than a hands-on approach to a real-life stressful conversion process. Having your vendor’s team on site allows for immediate customization of the software as it pertains to a specific practice’s needs.

Financial implications

Despite the initial exorbitant costs of implementing an EHR system, there are financial incentives that can be obtained from the federal government and penalties (up to 6% per billed claim) that can be avoided. Although there are additional costs per doctor in a practice for EHR, there are additional incentives per doctor as well from the government. The digital conglomerate of meaningful use (meaningful use, or MU, stage 1 year 1, stage 1 year 2, stage 2, stage 3), physician quality reporting system (PQRS), clinical quality measures (CQM) and electronic prescriptions (eRx) is so complex and intimidating that my advice is to get a consultant involved who knows your EHR vendor well to make sure all these processes are accomplished in a timely and effective manner.

Our practice utilized the services of consultant Patricia Morris, from Excellence in Eyecare, an expert on IO Practiceware, who recommended that your EHR vendor must be ready for all the necessary changes before you can be. A few key pointers from our consultant was that the meaningful use Stage 1 Year 2 attestation period, which was typically a 365-day period, is now only 90 days in 2014, allowing for additional incentive dollars in the same year. She also advised that Year 2 of Stage 1 and Year 1 of Stage 2 only needs a calendar quarter up until Feb. 28, 2015. The key to succeeding with meaningful use, for example, is to stay on top of what your numbers are vs. what they should be, and this can be easily achieved by reviewing your data throughout the reporting period. If you can master this section, you are the “king of the digital jungle,” with maximal profitability potential and even recovery of the costs of your EHR investment in the first place. The next way that EHR will most likely minimize your pain will involve ICD-10 coding, which is scheduled to come on Oct. 1.

Clinical value

The real value of any EHR, in my opinion, is the true clinical advantages. Malpractice liability is reduced to due to handwriting misinterpretation errors. Fraud risk is reduced due to clear reporting of the core objectives of the exam to substantiate the coding that was billed. More importantly, a physician can review many diagnostic tests performed on a single visit or over a span of visits in just seconds. For example, it is simple to compare changes in visual fields without the manual flip of pages through a traditional chart to see if there is stability or not. The ability to show patients on dual screens corneal vs. lenticular astigmatism will help conversion rates to advanced toric IOL technology, helping the patient’s visual outcome and the practice’s profitability simultaneously. Comparing multiple refractions in advance of laser vision correction is much simplified in a single-page grid to assure refractive stability before performing surgery. The examples are numerous when it comes to patient care and improving outcomes with EHR. Finally, practice efficiency has improved significantly with the ability to see more patients in less time, a factor critical in a climate of reduced reimbursements.

In the end, the daunting task of bringing an EHR system into the office does not have to be the digital jungle it appears to be. Rather, proper due diligence in selecting a fully integrated system that fits your practice’s needs and implementing it correctly by the “go live” date are just the first steps in achieving the true benefits of EHR. The profitability from government incentives no matter what the lingo (MU, PQRS, CQM eRx), avoidance of penalties for lack of EHR, and improved practice efficiency with reduced clinical mistakes and maximized conversions to premium technology are the true ways to become king of the jungle.

You can read the original post here.

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Topics: software

It's a bird! It's a plane! It's a flying hospital!

Posted by Amal Doleh

Mar 17, 2014 11:00:00 AM


By the looks of it, this DC-10 aircraft resembles any other plane on an airport runway. The inside of the jet, however, is a completely different story. This plane is equipped with a surgical theater as well as a screening room that seats 48 for the training purposes of opthalmology medical students on board.

"This is the world's only "Flying Eye Hospital" -- a converted plane that has been landing at airports in the developing world for the last 30 years. It's mission is to treat people suffering from blinding diseases -- many of whom are children" (Ott, CNN, 2014). The aircraft travels to such countries as Panama and Cameroon to treat patients suffering from various eye diseases and poor eye health. These trips have sparked the interest many students to take on the field of ophthalmology in their respective countries, giving hope for future ophthalmologists in developing countries everywhere.

ORBIS, the non-profit organization behind the Flying Eye Hospital, hopes to expand its operations to prevent and treat visually impaired people across the world. "Flying Eye Hospital doctors treat blinding diseases...many of them are easily treatable with the right medical care, which developing countries often lack" (Ott, CNN, 2014). It has truly brought joy to both the doctors and students alike after sight is restored in these patients. So far, in the 30 years of operation, the Flying Eye Hospital has visited 78 countries and expects to grow this number significantly.

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Billions of Dollars in EHR Incentives

Posted by Amal Doleh

Mar 12, 2014 4:05:00 PM

Electronic health record (EHR) incentive payments skyrocketed to a staggering $21.9 billion by the end of January 2014. This amount, up $2.7 billion from December, demonstrates the success of "Meaningful Use" - a program designed to offer financial incentives to eligible medical professionals as well as hospitals in return for the implementation of EHR technology.

  • To date, there are an estimated 448,750 registered providers in the EHR incentive program.

  • Nearly 9 out of 10 eligible hospitals have made a financial commitment to an EHR.

  • Approximately 60% of Medicare EPs are meaningful users of EHRs.

  • Approximately 79% of Medicaid EPs of have received an EHR incentive payment.
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Google Developing Contact Lenses To Measure Glucose Levels

Posted by Leo Vilenskiy

Jan 27, 2014 11:05:18 AM


Google announced that it is testing contact lenses that monitor individuals' blood sugar levels, which could help eliminate daily finger-prick tests for patients with diabetes, Reuters reports (Oreskovic, Reuters, 1/17).

The "smart contact lenses" measure glucose levels in tears using a microchip embedded in the contact. They then transmit the glucose data to a mobile device.

In addition, Google is looking into using the device as an early warning system for wearers. 

Specifically, it might integrate small LED lights that would light up to suggest that glucose levels have reached certain thresholds.

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