Thursday, July 9, 2015

How Can You Use Your EHR to Prevent Heart Attacks and Strokes?

The Electronic Health Records (EHR) Innovations for Improving Hypertension Challenge, launched by the Office of the National Coordinator for Health Information Technology (ONC), is part of Million Hearts, a national initiative to prevent one million heart attacks and strokes by the year 2017. Co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), Million Hearts brings together communities, health systems, nonprofit organizations, federal agencies including ONC, and private-sector partners from across the country to fight heart disease and stroke. This HIMSS Ask the Expert article is being published in May which is National Stroke Awareness Month and High Blood Pressure Education Month. In case you have not yet seen it, we strongly recommend that you read the Cardiovascular Care High Performers report, that was issued in support of Million Hearts, which highlights health plans and physician practices nationwide that have achieved excellent results in cardiovascular care, including high rates of hypertension control, cholesterol management and smoking cessation. 

The goal of the EHR Innovations for Improving Hypertension Challenge is to gather specific descriptions of Health Information Technology (HIT) tools and approaches used by individual practices to implement an evidence-based blood pressure (BP) treatment protocol that has led to improvement in practice-wide blood pressure control (Phase 1), and identify models for quickly and widely spreading these to other practices (Phase 2). A comprehensive clinical decision support (CDS) approach supports these five protocol elements:
1. Blood pressure measurement/recording
2. Blood pressure follow-up
3. Initiation and titration of medications
4. Patient engagement
5. Workup/referral for poor control 

On Friday, January 23, 2015, there was an outstanding webinar on the EHR Innovations for Improving Hypertension Challenge. The agenda was as follows:
  1. Million Hearts Blood Pressure Protocols – Hilary Wall, MPH
  2. Phase 1 winner: Green Spring Internal Medicine – Holly Dahlman, MD, FACP
  3. Phase 1 winner: Vibrant Health Family Clinics – Christopher Tashjian, MD, Mary Boles, LPN, Rosanne Matzek, Care Coordinator
  4. Challenge Phase 2 – Adam Wong, MPP
The webinar recording and slides are posted on the EHR Innovations for Improving Hypertension Challenge web page. We strongly recommend that providers, EHR support personnel, and healthcare organization leaders listen to this webinar. The two winners of Phase 1 of the challenge, Green Spring Internal Medicine and Vibrant Health Family Clinics, discuss what they did to dramatically improve hypertension control in an effort to prevent heart attacks and strokes. In these presentations, there are several best practice ideas that you might find helpful for treating your patients. The tools of both Phase 1 winning practices can be downloaded from the EHR Innovations for Improving Hypertension Challenge web page. 

Using Health Information Technology tools to improve hypertension control will help us to reach the Million Hearts national goal of preventing one million heart attacks and strokes by the year 2017. It is far better to prevent heart attacks and strokes than to be faced with having to treat them. Much success in using Health IT to be an invaluable enabler in your prevention efforts!

Tuesday, December 16, 2014

How Can an FQHC Use Health IT to Improve the Quality of Care?


The Health Resources and Services Administration (HRSA),, an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care by strengthening the health care workforce, building healthy communities, and achieving health equity. HRSA’s programs provide health care to people who are geographically isolated, economically or medically vulnerable.

Federally Qualified Health Centers (FQHCs)
are health care organizations that meet certain criteria under the Medicare and Medicaid Programs and receive funds under the Health Center Program of HRSA’s Bureau of Primary Health Care (BPHC). FQHCs provide comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations.

Health Center Controlled Networks
(HCCNs) are networks of health centers working together to improve access to care, enhance quality of care, and achieve cost efficiencies through the provision of management, financial, administrative, technological, and clinical support services. Most HCCNs are heavily engaged in clinical quality improvement, technology, and project management services.

Primary Care Associations
(PCAs) provide advocacy, training and technical assistance to health centers and other “safety net” providers (a system of health care providers that primarily serve patients who otherwise cannot afford or gain access to care); support the development of health centers in their state; and enhance the operations and performance of health centers.

HCCN Grant Project Overview

HRSA awarded a total of $18 million over three years to thirty seven HCCNs for a grant project that started December 1, 2012. This grant aims to improve the quality of care at more than six hundred community health centers through the adoption and meaningful use of certified electronic health record technology and technology-enabled quality-improvement strategies in health centers. For this grant project, some HCCNs partnered with their sibling PCAs to leverage resources in order to deliver the best possible results.

The grant project activities include:

1.       Adoption and Implementation: activities to assist participating health centers with effectively adopting and implementing certified Electronic Health Record (EHR) technology at all sites by the end of the project period.

2.       Meaningful Use (MU): activities to support participating health centers in making the necessary technical upgrades and workflow changes to meet meaningful use requirements and access incentive payments under the Medicare and Medicaid EHRs Incentive Programs.

3.       Quality Improvement (QI): activities to advance participating health centers’ QI initiatives to improve clinical and operational quality, reduce health disparities, improve population health through Health IT, and achieve Patient Centered Medical Home (PCMH) recognition.

In addition to measuring the annual progress of adopting and implementing EHRs, attesting for MU Stages 1 and 2, and achieving PCMH recognition, the following Clinical Quality Measures (CQMs) are monitored for each health center (note: annual progress is measured using the Health People 2020 Goals which are in parentheses):

1.       Hypertension Control (HDS12: 61.2%)

2.       Childhood Immunization Performance Rate (IID8: 80.0%)

3.       Start of Prenatal Care (MICH10.1: 77.9%)

4.       Low Birth Weight Statistics (MICH8.1: 7.8%)

5.       Diabetes Control (Complement of D5.1: 83.9%)

6.       Cervical Cancer Screening (C15: 93.0%)

7.       Tobacco Screening (TU9.1: 68.6%)

8.       Tobacco Cessation Counseling (TU10.1: 21.1%)

Sustaining the Activities of the HCCN Grant Project

As part of the QI effort, several of the HCCNs have implemented a Data Warehouse and/or Population Health Management System as one of the grant project activities. There are also activities for ensuring HIPAA compliance. These data tools and HIPAA compliance activities along with the MU and PCMH efforts need to be continued well beyond November 30, 2015, which is the end of this grant project.

HCCNs will be exploring additional funding opportunities to sustain these all-important QI activities that use Health IT tools. The lessons learned and best practices that have emerged from this grant project will be instrumental in continuing to improve the quality of health care for the patients served by the health centers. After all, it’s all about continuing to improve the quality of patient care!

Tuesday, January 22, 2013

Tips for Focusing on the Patient in the EHR Exam Room

It has been a long time since my last post. My work passion continues to be: helping physicians and their practices successfully implement an EHR, connect to an HIE, and achieve Meaningful Use. I spent over a year addressing several major challenges in my life and now I look forward to be back working on making meaningful contributions that help to deliver quality patient care.

The other day, I had a discussion with a friend who is a cardiologist with a very illustrious healthcare leadership career. He expressed his concern about how the quality of healthcare appears to be decreasing. During the course of our conversation, he told me a story about one of his patients who went to a specialist recommended by him. The patient said that the specialist spent about 1 minute examining him and then spent the rest of the time in the exam room with his back to the patient asking questions and typing the answers into his computer. My friend was appalled by the poor, impersonal physician-patient interaction in the exam room and he alluded to the EHR as being the cause of the problem.

Unfortunately, this scenario of physician-patient interaction in the exam room has been repeated too many times. In addition to being detrimental to developing a good physician-patient relationship and to fostering good communication by observing body language, it also contributes to alienating physicians from wanting to use EHRs.

The goal of EHRs is to provide a tool that helps to improve the quality of patient care. The challenges faced by physicians who use EHRs in the exam room include:
  • becoming comfortable and proficient at using a computer as a pen and paper replacement
  • incorporating the computer into an effective exam workflow so that the computer enhances communication with the patient rather than diminishing it
  • adjusting to a new way of working that realizes benefits that were unattainable in the past
Overcoming these challenges requires an investment in time, hard work, and persistence. Consequently, many physicians are understandably very stressed when they transition to using EHRs especially when more time is often very scarce. The EHR road needs to be paved with excellent training in much more than just the technology - the hardware and the application software. A successful and smooth transition to an EHR environment mandates the inclusion of training on how to deal with change and how to create a new, highly effective workflow that improves upon the old manual environment and does not just mimic it in an automated fashion.

As part of a clinician's EHR training curriculum, it is important to discuss and practice ways to stay focused on patient communication in the exam room. There are some very helpful ideas proposed in the July 23, 2012 "How to communicate well with a patient while working on an EHR" article in the American Medical Association's The article describes the LEVEL system which was designed by Kaiser Permanente to help clinicians use an EHR in the exam room. LEVEL stands for:
  • L: Let the patient look on
  • E: Eye contact
  • V: Value the computer
  • E: Explain what you are doing
  • L: Log off
Larry Garber, MD, an internist and medical director of informatics at the Reliant Medical Group in Worcester, MA created a YouTube video explaining the LEVEL system. The video gives "good clinician" and "bad clinician" examples. The video is called "Physician Exam Room EHR Etiquette, Fallon Clinic" and can be viewed by clicking here.

Much continued success in providing your patients with the best possible care!

Wednesday, August 31, 2011

On the Road to Meaningful Use

The June 28, 2011 Healthcare IT News article, "Mostashari to providers: MU is not about 'hoop jumping'", reports on the speech given by Farzad Mostashari, MD, the National Coordinator for Health IT, at the National Health IT and Delivery System Transformation Summit in Washington, DC. Dr. Mostashari made an "eloquent and persuasive case for how meaningful use is not just an arbitrary set of requirements the government is asking of providers in exchange for incentives". He said: “Look at meaningful use not as a distraction or a bureaucratic list of hoops to jump through. Meaningful use is the best-we-could-make-it roadmap to prepare for delivery of higher quality care and mitigating some of the costs toward getting there,” he said. “If its a distraction we need to change it and I want to hear from you personally.” Dr. Mostashari explained how “the sum total of meaningful use is to provide what is needed to make sure fewer people die prematurely for things that could have been prevented.

The HITECH Act established programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to Eligible Professionals (EPs) as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology. The programs began in 2011. These incentive programs are designed to support providers in this period of health IT transition and instill the use of EHRs in meaningful ways to help the United States to improve the quality, safety and efficiency of patient health care.

For more detailed information on EHR Incentives & Certification see the following on the web site:
To learn how to get started click here. The web site outlines the following steps:

The Official Web Site for the Medicare and Medicaid EHR Incentive Programs is:

The Medicare & Medicaid EHR Incentive Program Registration and Attestation System is at:

The Certified Ambulatory Product List is at:

The "Meaningful Use OneSource" web site, powered by HIMSS, is at:

If you have not already started, now is the time for you to begin your journey of becoming a meaningful user of EHRs. If you have already started on this all-important journey, persistence and patience will be your biggest allies for achieving success.

Sunday, July 3, 2011

Electronic Health Records (EHRs) At-A-Glance

The following is from the Centers for Medicare & Medicaid Services (CMS) web site's July 13, 2010 fact sheet on Electronic Health Records At A Glance:

“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives.”
- President Obama, Address to Joint Session of Congress, February 2009


As promised by the President, the American Recovery and Reinvestment Act of 2009 included under which, according to current estimates, as much as $27 billion over ten years will be expended to support adoption of electronic health records (EHRs). This is the first substantial commitment of federal resources to support adoption and help providers identify the key functions that will support improved care delivery.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Medicaid providers can receive their first year’s incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.

Since enactment of HITECH in February 2009, the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS) and other HHS agencies laid the groundwork for the massive national investment in EHRs:
  • Created Regional Extension Centers (RECs) to support providers in adopting EHRs
  • Developed workforce training programs
  • Identified “Beacon Communities” that lead the way in adoption and use of EHRs
  • Developed capabilities for information exchange, including building toward a Nationwide Health Information Network
  • Improved privacy and security provisions of federal law, to bolster protection for electronic records
  • Created a process to certify EHR technology, so providers can be assured that the EHR technology they acquire will perform as needed
  • Identified standards for certification of products, tied to “meaningful use” of EHRs
  • Identified the “meaningful use” objectives that providers must demonstrate to qualify for incentive payments.
  • Supported State Medicaid Agencies in the planning and development of their Medicaid EHR Incentive programs with 90/10 matching funds.

Why EHRs?

Electronic Health Records improve care by enabling functions that paper records cannot deliver:
  • EHRs can make a patient’s health information available when and where it is needed – it is not locked away in one office or another.
  • EHRs can bring a patient’s total health information together in one place, and always be current – clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
  • EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
  • EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.
  • EHRs can link information with patient computers to point to additional resources – patients can be more informed and involved as EHRs are used to help identify additional web resources.
  • EHRs don’t just “contain” or transmit information, they also compute with it – for example, a qualified EHR will not merely contain a record of a patient’s medications or allergies, it will also automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts.
  • EHRs can improve safety through their capacity to bring all of a patient’s information together and automatically identify potential safety issues -- providing “decision support” capability to assist clinicians.
  • EHRs can deliver more information in more directions, while reducing “paperwork” time for providers –for example, EHRs can be programmed for easy or automatic delivery of information that needs to be shared with public health agencies or quality measurement, saving clinician time.
  • EHRs can improve privacy and security – with proper training and effective policies, electronic records can be more secure than paper.
  • EHRs can reduce costs through reduced paperwork, improved safety, reduced duplication of testing, and most of all improved health through the delivery of more effective health care.

Why “meaningful use” requirements?

EHRs do not achieve these benefits merely by transferring information from paper form into digital form. EHRs can only deliver their benefits when the information and the EHR are standardized and “structured” in uniform ways, just as ATMs depend on uniformly structured data. Therefore, the “meaningful use” approach requires identification of standards for EHR systems. These are contained in the ONC Standards and Certification regulation announced on July 13, 2010.
Similarly, EHRs cannot achieve their full potential if providers don’t use the functions that deliver the most benefit – for example, exchanging information, and entering orders through the computer so that the “decision support” functions and other automated processes are activated. Therefore, the “meaningful use” approach requires that providers meet specified objectives in the use of EHRs, in order to qualify for the incentive payments. For example: basic information needs to be entered into the qualified EHR so that it exists in the “structured” format; information exchange needs to begin; security checks need to be routinely made; and medical orders need to be made using Computerized Provider Order Entry (CPOE). These requirements begin at lower levels in the first stage of meaningful use, and are expected to be phased in over five years. Some requirements are “core” needs, but providers are also given some choice in meeting additional criteria from a “menu set.”

Identification of the “meaningful use” goals and standards is the keystone to successful national adoption of EHRs. The announcement of final “meaningful use” regulations on July 13, 2010, marks the launch of the Nation’s push for EHR adoption and use.

Tuesday, June 28, 2011

A Resource for Your EHR Journey: Your Regional Extension Center (REC)

The American Recovery and Reinvestment Act (ARRA) of 2009, the economic stimulus package, was signed into law by President Barack Obama on February 17, 2009. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is an integral part of ARRA 2009, promotes the adoption and meaningful use of Health Information Technology (HIT).

The Office of the National Coordinator for Health Information Technology (ONC) spearheads the federal government's HIT efforts and is a resource to the entire health system to support the adoption of HIT and the promotion of nationwide Health Information Exchange (HIE) to improve health care. ONC reports into the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the HITECH Act of 2009.

The HITECH Act authorizes a HIT Extension Program. This program consists of a national HIT Research Center (HITRC) and HIT Regional Extension Centers (RECs). The HITRC will gather information on effective practices and help the RECs work with one another and with relevant stakeholders to identify and share best practices in EHR adoption, meaningful use, and provider support. The RECs will support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs are designed to make sure that primary care clinicians get the help they need to use EHRs.

ONC has funded 62 RECs (pronounced R-E-Cs) to help more than 100,000 primary care providers meaningfully use EHRs. Eligible Providers who adopt and meaningfully use EHRs may receive incentive payments through the Medicare and Medicaid EHR Incentive Programs. Providers do not have to become technology experts to achieve meaningful use of EHRs; RECs will provide them with on-the-ground assistance. REC services include:
  • Outreach and education
  • EHR support (e.g., working with vendors, helping choose a certified EHR system)
  • Technical assistance in implementing health IT and using it in a meaningful way to improve care.

RECs represent a range of organizations that serve local communities throughout the country. The RECs’ focus is to provide on-the-ground assistance for:
  • Individual and small practices, including primary care providers, physicians, physician assistants, and nurse practitioners
  • Medical practices lacking resources to implement and maintain EHRs
  • Those who provide primary care services in public and critical access hospitals, community health centers, and other settings that mostly serve those who lack adequate coverage or medical care
If you need assistance and/or some guidance for implementing an EHR, qualifying for Meaningful Use, and/or connecting to an HIE, you should consider contacting the REC that serves your local community. Click the following links to locate the REC in your local community:

Sunday, June 26, 2011

Embarking on Your EHR Journey

The Electronic Health Record (EHR) is a tool and Health Information Exchanges (HIE) are services which can be effectively combined and used in a meaningful way to assist physcians and their practices to achieve ambulatory care excellence. The EHR Journey involves a lot of hard work on the part of every member of a physician practice and requires buy-in by everyone. Technology plays an important role in the EHR Journey, but this journey is mainly involved with creating a cultural shift in the way a practice operates. This cultural shift is the enabler in the practice for reaching its goals of delivering the highest quality patient care.

To start the EHR Journey, the following brief documents should be read and digested:
  1. Getting Started with an EHR
  2. The Legal Electronic Health Record
  3. Selecting a Partner for Your HIT Project
  4. Selecting the Right EMR Vendor
The small physician practices (1-10 physicians) face the bigger challenges for EHR implementation since they typically have fewer resources at their disposal than the larger practices. The following documents will help the small practices gain an understanding what needs to be done to succeed in their EHR Journey: