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EHR & EMR

Improved Diagnostics & Patient Outcomes

When health care providers have access to complete and accurate information, patients receive better medical care. Electronic health records (EHRs) can improve the ability to diagnose diseases and reduce—even prevent—medical errors, improving patient outcomes.A national survey of doctors who are ready for meaningful use offers important evidence:94% of providers report that their EHR makes records readily available at point of care.88% report that their EHR produces clinical benefits for the practice.75% of providers report that their EHR allows them to deliver better patient care.


EHRs can aid in diagnosis

With EHRs, providers can have reliable access to a patient’s complete health information. This comprehensive picture can help providers diagnose patients’ problems sooner.

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EHRs can reduce errors, improve patient safety, and support better patient outcomes

How? EHRs don’t just contain or transmit information; they “compute” it. That means that EHRs manipulate the information in ways that make a difference for patients. For example:

  1. A qualified EHR not only keeps a record of a patient’s medications or allergies, it also automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts.
  2. Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient’s life-threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious.
  3. EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.
  4. EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years.
Risk Management and Liability Prevention: Study Findings

EHRs May Improve Risk Management By:

Providing clinical alerts and reminders
Improving aggregation, analysis, and communication of patient information
Making it easier to consider all aspects of a patient’s condition
Supporting diagnostic and therapeutic decision making
Gathering all relevant information (lab results, etc.) in one place
Support for therapeutic decisions
Enabling evidence-based decisions at the point of care
Preventing adverse events
Providing built-in safeguards against prescribing treatments that would result in adverse events
Enhancing research and monitoring for improvements in clinical quality

 

Certified EHRs May Help Providers Prevent Liability Actions By:

Demonstrating adherence to the best evidence-based practices
Producing complete, legible records readily available for the defense (reconstructing what actually happened during the point of care)
Disclosing evidence that suggests informed consent

EHRs can improve public health outcomes

EHRs can also have beneficial effects on the health of groups of patients.

Providers who have electronic health information about the entire population of patients they serve can look more meaningfully at the needs of patients who:

Suffer from a specific condition
Are eligible for specific preventive measures
Are currently taking specific medications

This EHR function helps providers identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes.

For example, providers might wish to identify:

How many patients with hypertension have their blood pressure under control
How many patients with diabetes have their blood sugar measurements in the target range and have had appropriate screening tests

This EHR function also can detect patterns of potentially related adverse events and enable at-risk patients to be notified quickly.

Studies Show: Better Patient Outcomes With EHRs

 

Using EHR Prompts & Reminders to Improve Quality of Patient Care 

High Patient Satisfaction

92% were happy their doctor used e-prescribing.
90% reported rarely or only occasionally going to the pharmacy and having prescription not ready.
76% reported it made obtaining medications easier.
63% reported fewer medication errors.

High Provider Satisfaction

Reduced overall rate of after-hours clinic calls.


Using EHRs to Improve Quality of Care 

Improved Quality of Care Screenings

Breast Cancer
Diabetes
Chlamydia
Colorectal Cancer

Increase in Services

Blood pressure control for patients with hypertension
Breast cancer screenings
Recording of body mass index and blood testing for patients with diabetes

Using EHR Decision Support to Improve Asthma Care and Compliance 

The Study

Cluster randomization of clinics
Intervention: Clinical decision support (CDC clinical decision support) embedded in EHR

Outcomes

6% greater use of controller medications (preventive or maintenance medications to help prevent asthma symptoms from occurring)
3% greater use of spirometry (a common office test used to diagnose asthma and other conditions that affect breathing)
14% greater use of asthma care plan
Spirometry improved by 6% in suburban practices

 

EHRs Transforming the Clinical Process 

A community hospital in Vermont recently implemented an EHR and reported:

60% decrease in near-miss medication events
20% increase in completion of daily fall assessment helping to avoid prolonged hospital stays
25% drop in the number of patient charts needing to be pulled for signing orders and dictated reports

Using EHRs to Improve Documentation and Coding 

Based on the level of medical decision-making, ~50% of visits under-coded
Rural family practice implementing EHR + Practice Management (EPM) system
Increased case mix (type or a mix of patients treated by a hospital or unit) by 10% over 2 years from 1.34 to 1.47
EHR documentation templates in a multi-specialty clinic
Increased use of ICD code 99214 by 11%
An average billable gain of $26/patient
Increased revenue by >100K during the study period


 

 

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EHR & EMR

What is Certified EHR, and Why is it Important?


EHR or EMR software that is certified by ONC-ATCB is called Certified Electronic Health Records Technology, or CEHRT. … You must use a certified EHR to qualify for Medicare and Medicaid EHR Incentive Programs. In order to adhere to Medicare and Medicaid requirements (and to qualify for incentive programs), an EHR system must meet a set of requirements, and then further, a medical practice or organization must put those features appropriately to use.

Certification offers quality assurance that the software used has the needed capabilities, security, and usability needed by a health care provider to reach the criteria to be categorized as meaningful use. It also provides confidence for health care providers and patients alike that their electronically stored information is safe and securely held in confidentiality even when there is coordination with other healthcare systems for information sharing.

Who Certifies EHR Technology?

The requirements for certified EHR technology are generated and regulated by the federal government. Both the Centers for Medicare & Medicaid Services (CMS) as well as the Office of the National Coordinator for Health Information Technology (ONC) determine the regulatory requirements for certified EHR systems.

General Certification Criteria


In order to adhere to Medicare and Medicaid requirements (and to qualify for incentive programs), an EHR system must meet a set of requirements, and  possess the following functionalities:

(a) Drug-drug, drug-allergy interaction checks

(b) Drug formulary checks

(c) Maintain up-to-date problem list

(d) Maintain active medication list
(e) Maintain active medication allergy list

(f) Record and chart vital signs

(1) Vital signs

(2) Calculate body mass index

(3) Plot and display growth charts

(g) Smoking status

(h) Incorporate laboratory test results

(i) Generate patient lists

(j) Medication reconciliation

(k) Submission to immunization registries

(l) Public health surveillance

(m) Patient-specific education resources

(n) Automated measure calculation

(o) Access control

(p) Emergency access

(q) Automatic log-off

(r) Audit log

(s) Integrity

(t) Authentication

(u) General encryption

(v) Encryption when exchanging electronic health information

(w) Accounting of disclosures (optional)


Ambulatory Certification Criteria

(a) Computerized provider order entry

(b) Electronic Prescribing

(c) Record demographics

(d) Patient reminders

(e) Clinical decision support

(f) Electronic copy of health information

(g) Timely access

(h) Clinical summaries

(i) Exchange clinical information and patient summary record

(j) Calculate and submit clinical quality measures

Conclusion

Functionality, adaptability, ease of use, good customer support, and an easy learning curve are important considerations when choosing the right CEHRT for a practice. Affordability and easily accessible billing and scheduling are necessary to make this technology practical. By using the cloud and sophisticated integrations of the patient and billing systems,Tekrapy Fusion addresses these issues, making an EHR that is both practical, highly functional, and cost-effective. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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EHR & EMR

What is “Cloud”



The cloud has been for a while and businesses have been using remote or off-premise based services via the Internet for quite a number of years now. When you use a cloud-based application, you are accessing the system via the Internet where the application is hosted in shared, private or dedicated resource environment as opposed to being provided from your own on-premises servers. Cloud services are designed to provide easy, scalable access to the resources and services of the application, which are managed by a 3rd party provider. A cloud service can dynamically scale to meet the ever-expanding needs of its users. Popular examples of cloud services are web-based e-mail services like Yahoo Mail, hosted office suites like Microsoft online apps, and document collaboration services like Dropbox.

The development of a unitary environment able to support both an extensive use of the EHR and the implementation of a Big Data Analytics platform is made possible by the adoption of the Cloud Computing paradigm, a novel computation framework based onInternet and on the virtualization technology.




Why use a cloud-based EMR or EHR?

It’s a better business strategy. Spend time working with your patients, not your patient healthcare software. When your software is installed in your office, you have to deal with potential interruptions such as power outages, software upgrades, hardware failures and human error.  With the software installed in the cloud, we upgrade the software for you without disrupting your practice. The cloud infrastructure is built on redundancy, meaning that your system is always available, even if there is an outage on our end. The services are designed so that outages are not noticeable to the users and all services remain available.

Again, it is scalable. Over time your EHR system will grow largely due to the increasing amount of patient data and additional updates in the application software that may require more computing power. This will require additional computing resources in order to maintain optimal performance. On the cloud,  more server space can be added automatically using auto-scaling capabilities. This eliminates the need to buy additional costly hardware and perform ground-up configuration and disruption that would be required with an in-office solution to keep your system running.

It’s secure. With the increasing threat from hackers, both foreign and domestic, patient information is becoming more of a target and harder to secure. A local installation (in your office) requires extra attention to detail to keep secure. When you install the system in your office, you take on the responsibility of making sure the environment is safe from unauthorized access. By using our cloud-based solution you benefit from the infrastructure that is already in place to provide both security benefits such as a private IP network isolation, encryption, server load balancing and automated backups. The diagram above describes the high-level architecture of the Tekrapy Fusion System.

Ensuring the system is always available

It is a fact that Internet connectivity and the cloud environment are subject to outages just as an in-house system is also subject to hardware or software failures. We don’t have control over the Internet connectivity, however, we can minimize the possibility of the system being unavailable due to hardware or software problems. In a cloud-based system, there are highly skilled technicians supporting the infrastructure 24/7 monitoring it to keep it in its best condition. Tekrapy Fusion EHR utilizes server load balancing. Server load balancing means that there are two or more servers for every piece of the application software. If one of the servers experiences a malfunction due to hardware or software problems, it is automatically removed from production to prevent it from causing an impact on the service. When the issue is resolved, it’s automatically placed back into service. In addition to server load balancing, the databases that store the EMR application data are replicated to a “hot standby” in real-time.  This means if the main database is unavailable for any reason, the system will use the replicated database. These fail-safes can be costly to put in place in an in-house system due to the additional storage and resources to administer and manage the system. With a cloud-based system, not only can you take advantage of ensuring your system has this protection, it is also more economical.

Protecting against loss of electronic health information

Backups are used, in the very unlikely event, to recover data after loss or corruption. All electronic protected health information (ePHI) and transaction logs are automatically backed up on a schedule allowing the ability to restore the data back to the point of the retention period. Instead of having to maintain an expensive onsite backup system and deal with tapes, backups are automatically performed within the cloud.  Our backup policies include:

  1. Daily full database backups.
  2. Binlog backups taken every five minutes and stored in separate servers.
  3. The backups are also backed up to separate cloud drives daily.
  4. Databases are encrypted and replicated in real time to servers located in a different geographic location.


Keeping your electronic health information protected

Encryption is used to protect the health information while it is in transit. The encryption process encodes the information in a way that unauthorized parties or hackers cannot read it. We use 2048 bit SSL encryption throughout the entire user session to better protect against security threats. In short, the larger the key size, the more computationally expensive it is for an attacker to use brute force to compromise the infrastructure. The US National Institute of Standards and Technology (NIST) recommends that organizations depreciate the use of 1024-bit keys by year-end 2013. While 2048-bit keys deliver greatly increased security, they also require significantly greater processing power than 1024-bit keys. This means in order to maintain application performance and availability organizations need to adopt new SSL infrastructure specifically designed for stronger SSL. Our infrastructure is already designed to provide the same level of performance (speed) and as technology evolves and security requirements change, we will continue to update and change to protect sensitive health information.

What about disaster recovery and business continuity?

Your system is prepared for worst-case scenarios to ensure business continuity in the event of a disaster. Every component of the system is periodically placed into a “snapshot.”  These snapshots can be used to start up a new component on any system to restore service quickly in the event of a disaster. This is in addition to the automated backups. 


 

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