Original article posted on HealthcareITNews.com.


Historically, physician and nursing systems and workflow have been parallel, but independent, of each other. EHRs are set up for the clinician and clinical documentation, and most do not provide nursing protocols or documentation, nor do they offer a patient engagement functionality. To accommodate all users, and even settings, large enterprises often run a number of EHRs and/or documentation tools to capture all data and documentation. The result might be that information is captured, however it is certainly not being shared efficiently, if at all, across the enterprise.


Fortunately, over the last year, nursing documentation tools that take care of all coding at the point of care have been developed and are interoperable with clinical documentation making it feasible to run one documentation tool across the enterprise. It is also possible to incorporate patient engagement and other allied health professionals into that one system and to even connect the enterprise and ambulatory settings under one documentation tool. The efficiencies that stand to be gained from unifying ambulatory and enterprise setting are significant and the benefits of providing clinicians with a clear picture of the patient are immeasurable.


At some point in the not-too-distant future, all persons who are involved in the care of a patient will be required to coordinate with each other. While that day has not officially arrived, the technology to facilitate coordination of care has. And, as many EHR users continue to become increasingly frustrated with interoperability issues and the inefficiencies that result from running a number of EHRs, documentation systems, and protocols side-by-side, this technology is sure to be a welcomed relief to many frustrated users and IT professionals.


Five key benefits to using one documentation tool across the enterprise: 


1. Improved communications and workflow. With all eyes, and hands, working off of one system, care teams can literally work hand in hand to provide coordinated care for the patient. With protocols for nursing and all ancillary providers integrated into the system, clinicians can view care plans and nurses can see what therapies were administered in prior shifts without having to track down the care team for updates. Notes can be exchanged and communicated bedside minus the paperwork. Working off of one documentation system at the point of care will make it easier for doctors, nurses and therapists to share information and ensure that the appropriate care is being provided to the patient.


2. Real-time view. Clinicians need comprehensive, up-to-date patient information at the point of care. Period. Anything less is not comprehensive. With all users integrated into one system, the clinician in the ER can now view lab reports, patient records from ambulatory settings in real-time. Consequently, that same patient’s records from the event will be available as the attending physician is documenting. This benefit is a huge plus for the patient and stands to dramatically improve delivery of care.


3.  Accuracy and Efficiency. Needless to say, automated coding and documentation increases accuracy. Today, the technology exists to have all documentation and coding requirements satisfied at the point of care. So, as a by-product of caring for the patient, the clinician and all users enter in the diagnosis and care protocols and the documentation tool takes care of the coding, satisfying all requirements. That means no ICD-10 coding or meaningful use documentation, leaving less room for error and no need for extra coding steps. This fluidity with all users on one system cuts down on the additional room for error. Imagine also having all users on one documentation system and how much easier it would be for your IT staff in terms of support.


4. Meaningful Use. With all users connected to the patient and the capability to integrate patient engagement, meaningful use including all of its current and future stages will be much easier to document.


5. Time and Money Saved. Can you imagine the cost savings alone of the busy healthcare professional who stops what they are doing during the course of a day or week and gets in their car, goes to their patient’s doctor’s office to get a file or x-ray out of utter frustration? Or the precious budget dollars that are wasted on running a number of disparate systems and their increasingly costly “workarounds” to facilitate less than efficient connectivity? One documentation system across the enterprise that unifies all users and settings will cut down on all workarounds, both technologically and physically. Wait, let me add “mentally” to that as well. Let’s face it, many of the workarounds and documentation challenges can be a real headache. I would not even want to begin to estimate the cost of those headaches.


As talks continue about big data and how to aggregate and share it electronically, we need to keep our ultimate goal in sight – giving providers the information required to better manage the health of the individual patient, in real time at the point of care. So, as the data tsunami continues with states well underway with HIE development and more ACOs coming online, we still have to bring it back to the patient and ask – what will it take to make the millions of gigs of information out there make a real difference to the guy in the hospital gown? Or, to the grandmother rehabilitating from hip surgery at home?


Fortunately, the government’s investment in health information technology sharing has resulted in faster adaptation of EHRs and information sharing.  Still, many clinicians don’t have convenient access to usable data for a specific patient encounter at the point of care. And this can only happen when all of this big data coming into the HIE and ACOs can be accessed and is usable by all users and in all settings.


Now developers and providers are finding themselves at the place of actually aggregating and sharing big data electronically and getting closer to the ultimate goal of giving providers the information required to better manage the health of individual patients, in real time and at the point of care. For some, this must feel like the moment of truth. Still, there are a number of barriers and rivers to be crossed before we can actually make this data personal or work for the patient and the clinician. And over the last four years, many of us have experienced many challenges on the road to HIT nirvana.


So, what will it take to get to the HITECH end-goal where we use technology to make healthcare safer, more efficient, effective and, of course, patient-centric?


If I were a betting man, I would say another requirement.


In time, it certainly appears that the government will require integration of all care providers across the spectrum to not only report, but to improve patient outcomes at the point of care. This of course, will require documentation by all users and all settings to be interoperable and connected. There are a number of steps that EHR developers and providers need to consider and take to get to move closer to providing patient-centric care.


1) Integration and expansion of all users. While many physicians are on EHRs and sharing data with physicians in their network, the care isn’t coordinated across the enterprise or with other users. Namely, with the nurses, who are responsible for administering the care based on the clinician’s diagnosis and orders. Until recently, nursing protocols were not available for documentation. They are today and as they come online and available in more EHRs, clinically coordinated healthcare is no longer going to be the exception, but will rapidly become the norm. The efficiencies and accuracy achieved as a result will make it impossible for providers who don’t use technology to coordinate care to compete. Protocols for ancillary caregivers and therapists will also be integrated into EHRs so that the entire care team can use the EHR to document and share information in real time. This will facilitate communications between doctors, nurses and therapists, improving efficiency and accuracy.


2) Integration of all settings. Until we can communicate across the enterprise and ambulatory settings, the clinician really isn’t able to get a clear picture of the patient nor is care expedited or comprehensive. The capability exists to do this today and the efficiencies that stand to be gained from unifying ambulatory and enterprise setting are huge. Not only are the foreseeable meaningful use requirements a motivator to unify all settings, but the cost savings and competitive edge should be as well. Think of how this could improve communications, reporting accuracy and of course, patient care.


3) Accurate, timely documentation that meets all requirements. In addition to ensuring that all users and settings are using technology to share information and document patient encounters, providers and developer need to ensure that documentation is accurate and meets all requirements. Think about it this way, if information isn’t coded accurately and quickly, then errors get moved along to the next clinician. And given that the clinician needs information in real time at the point of care, it’s really imperative that documentation occurs in real time on the spot. If the enterprise hasn’t employed an EHR that takes care of documentation at the point of care, then now is the time to consider upgrading or adding a tool that will take care of documentation, of course, without burdening the clinician.


4) Interoperability. EHRs have to, sooner than later, talk with other EHRs outside of their network. Open-ended design software is critical to flexibility and adaptability. Very seldom do patients stay within one network nor do they stay at home or in one location. Healthcare has to be mobile along with their medical records. It’s becoming increasingly important to not just be able to network stateside, but globally as well.

In today’s medical settings, data means nothing if it’s inaccessible to the people who need it in a split second. A doctor at the bedside or in a practice setting, a coder in the billing department, a nurse on rounds – they all need what they want, when they need it, without having to look for it.


That is what Quippe is all about.


Medicomp Systems’ Quippe software development kit (SDK) enables most existing EHRs to provide usability at the point of care and incorporate all coding and billing requirements, without burdening the clinician. Quippe provides a single enterprise documentation platform for both ambulatory and inpatient settings. It is easily integrated into most systems, and can run over the internet and on most mobile devices.


Quippe software is powered by Medicomp’s MEDCIN Engine, a knowledge engine that sorts, filters, translates, and delivers usable information in various languages and codes, such as LOINC, SNOMED, and RxNorm. The MEDCIN Engine and Quippe work together to sort through all codes – and MEDCIN’s 300,000-plus concepts – to deliver relevant, patient-specific information at the point of care. This information is delivered in a format that is usable for each type of user, whether they’re clinicians, nurses, administrative staff or allied health partners.


With Quippe, patient-centric data is delivered through intuitive, intelligent prompting that works like clinician thinks. This eliminates the need for the clinician to have to search through patient information, and lets the caregiver focus on care. It also allows for truly coordinated clinical care between clinician, nursing staff and allied health partners.

Quippe also handles billing, coding and compliance requirements as a natural by-product of the clinician’s documentation process, so there is no extra work needed.


Quippe is easy to learn and use. Training takes under 20 minutes, with clinicians then putting it to use in a busy clinical setting.


We’re proud to bring the medical community this industry-changing technology that provides documentation at the point of care for all users, in all settings, satisfying all requirements. Thanks to our dedicated team at Medicomp, we’re helping clinicians turn information into action. And that translates into better care for all of us.

In my last article, I told you about an experience my colleagues and I had on a business trip in Thailand. My friend needed new contacts, and didn’t have a chance to get them before he left DC. Since we were meeting in Bumrungrad, one of the leading medical tourism hospitals in the world, he decided to put them to the test, [blinking profusely the whole time, I might add.] With minutes, he was registered, seen by a nurse, seen by a doctor, tested and given a prescription for new lenses. M-i-n-u-t-e-s. Try finding that in the U.S., where I always end up spending three hours to get 30 seconds with a doc. Read Full Article →

On a recent trip to Thailand, two colleagues and I saw efficient hospital workflow in action. Just for kicks, let me present the following, in a single act.

Act 1, Scene 1:  A group of jet-lagged Americans sitting in a conference room at Bumrungrad Hospital in Bangkok. One of them begins to make faces at his colleagues.

Colleague #1: “Are we doing something to annoy you?”
Blurry-eyed Guy: “I meant to get my new contact lenses before I left DC.”
Colleague #2: “We’re sitting at one of the leading medical tourism hospitals in the world. Why don’t you put them to the test?” Read Full Article →

The words “single payer” are among the dirtiest in healthcare’s lexicon — but mostly here in America. Some of the other countries operating either single payer or so-called dual systems that essentially pit a public option against private care have seen certain measures of success. And that is among the reason that some other countries, such as Singapore, have superior healthcare.


So contends David Lareau. As CEO of health IT vendor Medicomp Systems, Lareau regularly globe-treks to service and search out customers and, along the way, witnesses myriad health systems from the inside. Lareau spoke with Government Health IT editor Tom Sullivan about the competitive virtues of a thriving public option, how the U.S. healthcare system stacks up against some of the superior nations, and why low-cost incentives are not aligned with care delivery outcomes in a fashion to bend that cost curve. Read Full Article →

HHS’s proposed delay for the ICD-10 transition has spurred both support and criticism from various professional organizations, including the AMA, HIMSS, and the AHA. Despite disagreement on the compliance timeline, most stakeholders agree the new code set will reduce inappropriate coding, facilitate better care management, and improve reporting.


Regardless of the deadline, providers and payers are already evaluating potential IT upgrades and considering training requirements for coders and clinicians. The move to ICD-10 will affect both clinical and billing operations; workflow changes are inevitable. For physicians, changes in clinical documentation requirements may be one of the most significant challenges. Read Full Article →

Historically physician and nursing systems and workflow have often been parallel, but independent of each other. Physicians and nurses must be able to share information to provide coordination of care.

For example, physicians must comply with standards such as ICD-10, ICD-9, Snomed CT, RxNorm, LOINC, DSM-IV, and CPT, while nurses employ terminology like NANDA, NIC, NOC, ICNP, PNDS, and CCC. With so many different standards in place, creating an integrated picture of patient care can be difficult at best. Read Full Article →

In just over two years, the US health system will shift from the ICD-9 to ICD-10 transaction standard. The move to ICD-10 will undoubtedly result in better insight into individual patient conditions and create a wealth of data to assess the efficiency of healthcare delivery, population disease states, and the quality of care. However, the increase from 14,000 to 68,000 unique codes promises to be both expensive and challenging in terms of IT system updates, training for staff and physicians, and potential losses in productivity.

To minimize adoption challenges, providers are considering advanced technologies for identifying the most appropriate codes. Automated coding tools – particularly those embedded in an EHR, can maximize practice efficiencies and streamline the coding process. Consider some of these benefits: Read Full Article →

If physicians have access to more clinical data, does this mean that patient outcomes are enhanced? Possibly, but only if providers can retrieve the most relevant information quickly,in a logical format, and at the point of care.

More clinical data is available to physicians than ever before. New government initiatives encouraging electronic data exchange and advanced technologies make it easier to translate disparate but related clinical concepts from multiple sources. Read Full Article →


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