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We looked at six of the most popular link-building tools to figure out the pros and cons of each. Here's what you need to know.
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We looked at six of the most popular link-building tools to figure out the pros and cons of each. Here's what you need to know.
Skype targets both Facebook and Twitter in a new marketing campaign aimed to promote "real" interaction.
Via Web Target
I'm sure a lot of you guys have looked into curation software available ...
Obviously with the radically different price points they all do different things, but here's the gist – a whole lot of this you can do for free.
Step One – Define your Parameters
Define your parameters by where you want the goods to go. Make sure everything is accessible from the beginning so you can leverage your curated content efficiently from the start.
Step Two – Choose your Weapons
e.g. Timely.is; G+ and FB
Step Three – Be Intentional with your Schedule
I can't speak to your industry/niche but I can tell you that when I do my curation at somewhere between 6 and 8am EST I find a goldmine of posts that are brand-flipping-new
Step Four – Be Crazy Time Sensitive
I make sure to only curate content that is timely [less than 1% of the time curate something more than 24 hours old]
Open up a google search and type in "content marketing" at the beginning of my day, and set it to the last 24 hours.
Step Five – Be Consistent
As long as you are curating the same general stuff over and over it will work for you.
Notice: Steps 1-5 are all about the setup or protocol. Steps 6-9 are the actual daily work.
Step Six – Prepare for Battle
Open windows to the following places:
Google search
Step Seven – Get Rolling
e.g. search for the term "content marketing" in the last 24 hours as shown above; grab 5 or 6 posts that are relevant and make tweets about them and put them on timely/buffer/scoopit
Step Eight – Natural Overflow
Doing twitter first thing after curation is great, if you have the time.
20-30 minutes after you have your automated posts in place to interact with your feed, clean out the spam tweeps, follow back the real people, etc.
Step Nine – Use what you Learn
Use your curation is as the basis for your own blogs
Not regurgitation, but rather letting your new-found knowledge fuel your next post. Or, add to the list of blog ideas you have on a running list somewhere.
Setting aside this 45 minutes a day to get the most relevant pieces of content your industry has to offer can not only fill your feeds, but it can also fuel your entire day. And it should, because you should be talking about the latest things in your industry.
Great ideas by Amie Marse - http://bit.ly/HfET6B
Via maxOz, janlgordon
Matmi's comment, April 5, 2012 8:16 AM
Some great tips. Would you also spend the time commenting on the curated posts? I know there are some who believe that it is a necessity and others who feel there is no need as you are merely helping others to filter the noise. I try to mix it up depending on time available.
From www
If you do it right, your website can be the best marketing tool you have. Ilya Pozin, founder of the Web design firm Ciplex, on how not to screw it up.
This platform can generate tremendous traffic, leads and sales for your business that you otherwise would not have had.
Unfortunately though, most businesses do not blog well. Why? Because they refuse to think like a consumer.
There are sound blogging practices here that could truly help your company.
1) Leverage the power of "versus":
As consumers, we love to compare. So look for ways to compare the products and services you sell versus the products and services of others in your field. Give factual information about each. The opportunities here are almost endless and the amount of content ideas that can come from this one subject could very well give you dozens or even hundreds of blog post possibilities.
2) People want the best, now give it to them:
There is a very good chance the prospects and customers in your industry are online searching these types of phrases, which is why you should look for opportunities to utilize the word "best" in your content.
3) Focus on problems...
4) Reveal pricing:
Pricing questions are the first ones consumers tend to ask, then we need to figure out ways to address the subject in our content.
Be more open about pricing to set yourself apart from your competitors and garner respect from consumers who appreciate your willingness to address their questions.
5) Break news:
If you truly want to be known as the voice of your industry, the subject of real-time breaking news can have an incredible impact on your company's brand and authority.
Read full article here: http://j.mp/HhRkey
Via Giuseppe Mauriello
iMedia Connection7 ways to increase traffic via PinterestiMedia ConnectionPinterest is now responsible for 1.05 percent of all referral traffic.
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FC Barcelona FantasyManager'13
by: FROM THE BENCH • 8.9K
All Android applications categories
All Android games categories
by: FROM THE BENCH • 8.9K
by Manu Galvez
Explore more
First off you need to make your own team. You can do it creating your own squad, create a squad at random or start playing with the whole squad of Barcelona. The latter is the easiest choice, for newbies. Creating your own squad implies starting with not-so-well-known players and making them improve, transfer players from other teams, etc.
You have to comprehensively manage the team from line up, transfers and coaching to facilities maintenance, equipment and treasury. From "Team" you can check team file, organize team, line up, train your players, track scoreboard and signings. Bear in mind that contracts, facilities maintenance, profits generation, etc. happens in real time, so you will have to collect benefits, renew contracts or play matches in the given time.
A soccer team is business too. So from "Club" tab you will have to manage jobs, bank, rankings, partners and prizes. Only if you take into account all this stuff you will have any chance. Remember that you play against real players.
After clearing all your to-do tasks you can "play match" to win in-game points and money. Of course, these matches are simulated, you won't play them as in PES or FIFA games. What matters here is the management.
Although it could include dozen of options more than it contains, this is a simple and good-looking soccer management. There are not too many soccer management on Android and this is an advantage. What's more, it's integrated with Facebook games, what makes it even more interesting. Recommendable.
Tags: team menegment fc barcelona , fc barcelona fantasymanager13 , fc barcelona fantasymanager12 , fc barcelona fantasy manager , fantasy barcelona , на андроид fc barcelona fantasy manager 12 , fc barcelona fantasy manager 2013 , دانلود بازی fc barcelona fantasymanager12 , fc barcelona fantasy manager 13
by Manu , Appszoom
Mar 14, 2012
Users review
from 8.926 reviews
Download FC Barcelona FantasyManager'13
Free - V3.30.005 - 22M
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subset: commoncrawl


text:
Best Dishwashers 2017 Followed By Specs & Comparisons By Brand
Scrubber cycles, third drawers or even hard food filters, the efforts of the dishwasher industry are endless when it comes to finding ways to rid you of these hard-to-beat messes. Compare the latest dishwasher models here.
The current best dishwasher 2017 is the Maytag MDB8959SFZ and the 2nd-best model is the Whirlpool WDF560SAFM. Here is the full top 10 list, followed by special categories and, finally, a complete list of dishwasher brands and models.
Maytag MDB8959SFZAvg. rating: (94%) (772 reviews over 2 sources)
Whirlpool WDF560SAFMAvg. rating: (94%) (408 reviews)
Maytag MDB7949SDZAvg. rating: (91%) (2708 reviews over 2 sources)
GE GDT695SSJSSAvg. rating: (94%) (166 reviews over 2 sources)
LG LDF8764STAvg. rating: (80%) (761 reviews over 6 sources)
GE GDT590SSJSSAvg. rating: (98%) (86 reviews over 4 sources)
KitchenAid KDTE104ESSAvg. rating: (93%) (7027 reviews over 5 sources)
KitchenAid KDTE254ESSAvg. rating: (93%) (3322 reviews over 5 sources)
KitchenAid KDTM404ESSAvg. rating: (87%) (1160 reviews over 5 sources)
Whirlpool WDT780SAEMAvg. rating: (92%) (5069 reviews over 5 sources)
Best Dishwashers For Specific Categories
Best Drawer Dishwashers 2017
check out the latest drawer dishwashers. Full list
Best Quiet Dishwashers 2017
check out the latest quiet dishwashers. Full list
Best Panel-ready Dishwashers
check out the latest panel-ready dishwashers. Full list
Best Countertop Dishwashers
check out the latest countertop dishwashers. Full list
Portable Dishwashers
check out the latest portable dishwashers. Full list
Semi-integrated Dishwashers
check out the latest semi-integrated dishwashers. Full list
18-inch Dishwashers
check out the latest 18-inch dishwashers. Full list
List of all dishwasher brands and their latest models 2017:
Our illustration shows the GE GDT650SSFSS. The steam-prewash-equipped GE GDT650SSFSS dishwasher bets on its Cyclone Jet option for taking on tough-soiled dishes, but it gets enlisted in a rather-ordinary-specked platoon, carrying a 48-dBA noise value, a 3-piece place-anywhere silverware basket, and a hard food disposer.
- Compare GE dishwashers.
Our picture shows the Bosch SHP68TL5UC. Its 44-dBA noise rating might not make it the quietest in the Bosch dishwasher lineup, and the 3rd-rack-equipped Bosch SHP68TL5UC dishwasher also comes with a couple of quite-familiar specs, such as the Rackmatic upper rack and a 30-minute Express cycle.
- Compare all Bosch dishwashers.
Our illustration shows the Frigidaire DGCD2444SA. Flashing a rather-uncommonly-seen top-rack-only wash cycle, the 14-place-setting Frigidaire DGCD2444SA dishwasher opts to get enlisted to an entry-level platoon, backpacking a 34-minute Quick cycle and a 54-dBa sound value.
- Compare Frigidaire dishwashers.
Our illustration shows the Whirlpool WDF560SAFM. Its 12 place settings and 50-dBA sound rating are fairly-commonplace, especially among entry-level models, and its Heavy wash program lags behind with its 203-minute completion time, but the Whirlpool WDF560SAFM, at least, gets to show off a load-sensing feature, which is not commonly offered by a lot of low-tier dishwashers.
- Compare Whirlpool dishwashers.
Our illustration shows the Miele G 6505 SCi AM. The Miele G 6505 SCi AM dishwasher maintains a high-end wardrobe, which consists of a hot water connection, a 40-dBA-valued Extra Quiet cycle, a door that automatically opens after the cycle has finished, and ten preset programs, which include a Maintenance cycle for clearing the tub.
- Compare Miele dishwashers.
Our illustration shows the KitchenAid KDTM804ESS. The 44-dBA-valued KitchenAid KDTM804ESS dishwasher will most likely turn some heads with its rarely-seen windowed design while striking a top-tier pose with its 9-in-1 Dynamic wash arm, a 40-spray-jey ProScrub feature, and a self-cleaning filter.
- Compare KitchenAid dishwashers.
Our picture shows the LG LDF5545ST. The LG LDF5545ST dishwasher bring something fairly-new to the table by being able to take in new wash programs via the NFC Tag-On smartphone app, and it busies itself with 15 dish settings, four multi-motion spray arms, a varied-wash-setting for the top and bottom racks, and a 48-dBA sound rating.
- Compare all LG dishwashers.
Our picture shows the Fisher and Paykel DD24DCHTX9. Able to wash two different loads at once, the Fisher and Paykel DD24DCHTX9 two-drawer dishwasher climbs on to a somewhat-high-end shelf space with its on-screen error/diagnostic indicator, two cutlery baskets, and a 33-minute quick-wash cycle.
- Compare all Fisher and Paykel dishwashers.
Our illustration shows the Samsung DW80K7050US. The 15-place-setting Samsung DW80K7050US dishwasher scores style points with its Black Stainless Steel variant (DW80K7050UG) while putting on a middle-tier attire with its 44-dBA rating, a 3rd rack, and an AutoRelease door.
- Compare Samsung dishwashers.
Our picture shows the Danby DDW1802EBLS. The Danby DDW1802EBLS dishwasher waves around its seven wash cycles to draw some applause, but it soon takes a seat among other basic 18-inchers, bearing already-seen specs, such as eight place settings, a three-stage filter, and a basket for holding silverware.
- Compare all Danby dishwashers.
Our illustration shows the Electrolux EI24CD35RS. The load-sensor-equipped Electrolux EI24CD35RS dishwasher sticks up its SatelliteSpray wash arm to draw some attention, but it also pulls up a cluster of relatively-ordinary features, such as a 30-minute fast-wash cycle, a 49-dBA noise value, and a 3rd rack for accommodating utensils and ramekins.
- Compare Electrolux dishwashers.
Our picture shows the Blomberg DWT58500SS. Cleaning up its tub with the ProCare wash program, the 45-dBA-rated Blomberg DWT58500SS dishwasher brushes up a somewhat-mid-level picture, which consists of 14 place settings, a removable 3rd rack, and a Half Load cycle for dishes in the top or bottom rack.
- Compare all Blomberg dishwashers.
Our illustration shows the SPT SD-9252SS. Being equipped with commonly-seen specs, such as its six wash settings, 55-dBA sound rating, and stainless-steel tub, the SPT SD-9252SS dishwasher projects a low-end vibe, and its 90-minute Speed wash cycle is also among the slowest we have encountered -- at least as of 2016.
- Compare SPT dishwashers.
Our illustration shows the Maytag MDB7949SDZ. Traipsing around a mid-tier arena, the sensor-equipped Maytag MDB7949SDZ dishwasher displays a collection of rather-ordinary specs, such as 15 place settings, a stainless-steel 4-blade food disposer, and a speed-wash program that takes a fairly-long 59 minutes to complete.
- Compare Maytag dishwashers.
Our picture shows the Amana ADB1500ADS. Having a soil sensor might provide some cheer for this dishwasher, but the 55-dBA-rated Amana ADB1500ADS dishwasher seems to feel at home with mostly-basic specs, such as its 1-Hour Fast Wash option and 12 place settings.
- Compare all Amana dishwashers.
Our picture shows the DCS DD24SVT7. The DCS DD24SVT7 single-drawer dishwasher looks set to draw some applause with its 13-inch-plate-accommodating rack, nine wash cycles (with four Eco options) and three safety locks.
- Compare all DCS dishwashers.
Our picture shows the Avanti DWE1802SS. Its 65-minute Speed Wash does not look very speedy, and the 8-place-setting Avanti DWE1802SS dishwasher strikes a basic pose with its stainless-steel tub and four wash cycles.
- Compare all Avanti dishwashers.
Our picture shows the EdgeStar BIDW18SS-1. The EdgeStar BIDW18SS-1 dishwasher seems to keep a low profile by offering mostly ordinary specs, such as its eight dish settings and six wash programs, and it even uses an ancient-looking dial selector knob.
- Compare all EdgeStar dishwashers.
Our picture shows the SoloRock SRDW180813S. Its stainless steel tub and 24 hours of delay start time are quite commonplace, and the SoloRock SRDW180813S dishwasher's 65-minute speed wash cycle does not seem very speedy.
- Compare all SoloRock dishwashers.
Our illustration shows the jenn-Air JDB9800CWX. A built-in dishwasher with a noise rating of 40dBA, interior LED illumination, a panel-ready design and a built-in water softener with 3-stage filtration.
- Compare jenn-Air dishwashers.
The 18-dish-holding Lamber F92EKDPS commercial dishwasher takes on quick and water-efficient washing with its claimed 1/2 gallon water usage per cycle and 600 dishes washed per hour. -- Full specs
The Koldfront PDW60EW apparently shouts "energy-saver!" with its low $24 yearly energy cost, but seems to turn a cold shoulder when asked about quiet performance, with its 55dB noise rating. -- Full specs
With a panel-ready design (pictures suggest there might also be a version with its own stainless-steel panel) and a 34-minute speed-wash cycle, the 52-dBa-rated Summit DW18 dishwasher seems to project an energy-efficient image with its 210 kWh/year Energy Star rating and Half Load wash program. -- Full specs
Available only in a white-colored variant, the 57-dBA-rated Moffat MDF400SGFWW dishwasher might eat up slightly more power, even if it only performs basic washing tasks. -- Full specs
Looking past its average 48-dB noise rating, the Dacor RDW24S dishwasher seems to present its customizable handle (sold separately) and rather-low 235 kwh/year Energy Star as its main focal points. -- Full specs
Its 50-dBA noise rating and fourteen place settings are unremarkable, and when compared to most semi-integrated dishwashers, the Asko D5424XL looks a bit more streamlined with its touch buttons arranged in a circle and seems to wash faster with its 20-minute Quick wash program. -- Full specs
Its uncommon 24-hour delay start feature does seem to stand out, but we cannot disregard the Midea ADC3203DWW's less-rejoicing $27 annual power consumption. -- Full specs
Its polished stainless-steel finish seems to give the 8-dish-capacity Fagor LFA45X a more "commercial-looking" aura, and its 55-minute fast-wash cycle and 55-dBA noise value are quite-unimpressive for an 18-inch dishwasher. -- Full specs
The Magic Chef MCSCD6W3 dishwasher sits on your kitchen countertop, pulling typical specs from up its sleeve, such as a 45-minute fast-wash program, six basic wash cycles, and a vintage-looking dial selector. -- Full specs
Parading its eighteen stemware holders and Wave-Touch fade-away controls, the 45-dB-rated AGA ALTTDW-SS dishwasher aims to get even more attention with its ivory- and cranberry-colored variants. -- Full specs
The Energy Star-rated Haier HDBC100AFS 18-inch dishwasher seems to show itself as an energy-efficient dishwasher (though its 265kWh/year rating is nothing to call home about) and yields a 55-dBA washing-noise value, six wash programs and eight place settings. -- Full specs
The leak sensor seems to be the RCA RDW3208's dishwasher main perk, as it has a basic-specked vibe going on, carrying a basket of simple features, such as six place settings, a foldable bottom rack, a stainless-steel tub, and three wash cycles. -- Full specs
With an option to be custom-fitted with Viking door panels (with seven colors to choose from), the 14-place-setting Viking FDW301 dishwasher marches onward with a low 214 kWh/year Energy Star score and rarely-seen LED interior lights. -- Full specs
You Should Also Check Out:
See The Latest Out of This World Dishwashers
|The latest 2017 dishwashers surprise us with stay-put doors, complex water-spraying systems, super-low noise and... what else? Get clean on the latest dishwashers in this discovery gallery.


text:
If you're going to work in a place that serves alcohol or provides gambling services, you'll need to have completed training in Responsible Service of Alcohol (RSA) and/or Responsible Conduct of Gambling (RCG).
After you've completed your training and received your NSW RSA and/or RCG Interim Certificate(s), you need to apply for your RSA/RCG photo competency card. You can do this at service centres, digital stores and selected Roads and Maritime Services motor registries.
Once you have your RSA or RCG competency card you can access it digitally using your mobile phone or tablet device. You'll need to have a MyServiceNSW account and the latest version of the Service NSW app. Then you'll need to link your MyService NSW Account to the Liquor & Gaming NSW.Find a service centre


text:
The Apple-Pip Princess
The Apple-Pip Princess
By Jane Ray; Jane Ray (Illustrator)
Candlewick Press (MA), Hardcover, 9780763637477, 32pp.
Publication Date: March 25, 2008
List Price: $16.99*
* Individual store prices may vary.
Buy at Local Store
Enter your zip code below to purchase from an indie close to you.
Not Currently Available for Direct Purchase
About the Author
Jane Ray has illustrated numerous award-winning children's books, including LUGALBANDA: THE BOY WHO GOT CAUGHT UP IN A WAR by Kathy Henderson and SHAKESPEARE'S ROMEO AND JULIET by Michael Rosen. She lives in London.


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Private In-Home and Online SAT Tutoring in East Point, GA
Receive personally tailored SAT lessons from exceptional tutors in a one-on-one setting. We help you connect with in-home and online tutoring that offers flexible scheduling and your choice of locations.
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text:
Bitumen Or Asphalt For Sale - Cameroonprice: contact company for price
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Company Contact:
- Posted By: Metrix Creations
- Phone: 91196737
- Address: 54 bali rd, Douala, Cameroon
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Published date: January 23, 2014 -
- Business Description: Large enterprises we see in London stock market all have someday started
as a small entity but with ambitious visions.
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There are a lot of third world countries in the world need to be constructed and theirs roads need to be paved, Our crucial concern is to generate new ideas and innovate modern methods of doing business.
Our bitumen is available in a variety of grades. Specifications vary to meet the needs of the consuming industries and are based on a series of physical tests that define the safety, solubility, physical properties and durability of bitumens. The physical properties are designed to define performance characteristics that are required under the climatic and loading conditions that the bitumen will experience in service.
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Angel Costumes for Women Sexy(14 products)
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Sit, stay, save 20% sitewide. 24 hours only. Use code GOFETCH20
Arctic Valley in the Chugach Mountain range near Anchorage, Alaska. On a snow shoeing hiking trip.
This Altered verson makes it look like there are eyes in the sky.The two spots are actually the sun breaking through the clouds.
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When doctors consider switching to a new EHR, there are many variables. It is important to be aware of the pros and cons before switching to a new EHR.
In the past 8 years the growth has EHR adoption has skyrocketed, from 9% in 2008, up to 83% in 2015.
However not all doctors are satisfied with their EHR. In fact due to EHR satisfaction rates dropping in the past few years, many doctors are thinking about switching to a new EHR in 2017.
To assist with this task, here are x tips to help doctors make the switch to a new EHR.
1. Find a simple system
The reality is that most people who operate the EHR system in your practice are not IT trained professionals. They may basic computer literacy (typing, emailing, web navigation) but aren't likely to be able to manage detailed reports or streams of data.
Looking for an EHR with a user-friendly, customizable interface is a great first step. In basic terms, the harder it is to figure out how to use, the less likely you will get full benefit from switching to a new EHR.
2. Don't follow old routines
Just because an older EHR system has 5 steps to complete a task, doesn't mean this should be the accepted norms. Look for an EHR that can automate simple tasks (e.g. reminders, messaging, schedule confirmation) so that your team can focus on more important details.
It is very clear now that paper-based processes aren't the most efficient, but the same is true for. many long established EHR systems. Look for new innovations and automations to make your workflow and day simpler.
3. EHR Training and Support is essential
If you and your staff are not properly trained when switching to a new EHR, then you are likely going to limit yourself greatly. There are so many nuances and technical shortcuts that proper training and support can offer you. Make sure everyone receives as much training as they need. Keep in mind that support is the invisible value that is a part of implementing a new EHR. in fact, any EHR that doesn't provide support as a part of the setup or monthly fees is not likely to be a great match for your medical office. The cost saving initially may lead to a loss of productivity and revenue down the track.
4. Look for the ability to connect with patients
While your staff may receive training, often patients have no idea that you have moved to a new EHR system. For them, they may be comfortable with a paper based system, or phone calls to confirm appointments. If this is the case, take special care to coach your established patients through the new EHR process. Doing so will ensure a smooth transition and a better relationship between the doctor, team and patient.
While it may seem costly and time consuming, switching to a new EHR can open up new opportunities to your medical office. It can automate old systems, reduce costs, and even increase revenue. Look at a wide variety, but choose an EHR that is simple, up-to-date and good value for the services provided.
Technical Dr. Inc.'s insight:
Following the implementation of an electronic health records (EHR) system, optimization should be the next critical objective for a medical practice. One way to plan a road-map for optimization is to generate benchmarks.
Below are three important benchmarks to help your practice determine if you're getting the most out of your EHR system.
Some of the most important benchmarks in EHR optimization center around computerized physician order entry (CPOE) indicators. These indicators are critical for identifying the efficiency of an EHR, and complying with Meaningful Userequirements. Fortunately, these are often easy to benchmark. For instance, one indicator for a practice with a high volume of electronic prescribing is the number of pharmacist calls regarding contraindicating medications. This indicator is simple to follow, and can inform a practice whether or not an EHR system's Clinical Decision Support (CDS) alerts or notifications are effective.
Other CPOE indicators that are simple to follow include anything from provider and staff logins to printer use and more. Bottlenecks in data entry can also indicate issues with in-house adoption and areas that could benefit from optimization.
Setting benchmarks for these indicators are an important way to track post-implementation optimization for an EHR system.
One very common area in need of optimization post-EHR implementation is standardization of workflows. Technicians, nurses, medical assistants, providers, and staff may all do the same task differently. While there will always be slight variation in workflows between team members, major differences (i.e. printing and scanning a document rather than importing data electronically) can lead to large gaps in optimization further down the road. Fortunately, this is measurable, and can be an important indicator to monitor as you optimize your EHR system. Striving for benchmarks within certain tasks and workflows, such as importing medical histories or documenting in-office medications, can help to clarify standardization (or the need for standardization) within a medical practice.
Successful implementation of an electronic records system should reflect financial benefits as well as positive workflow and improved patient indicators. Therefore, important benchmarks in EHR optimization include Revenue Cycle Management (RCM) indicators. Leveraging costs per provider vs. clinic volume before and after implementation (taking into consideration training and adoption periods) can help clarify areas that need further optimization. This may involve taking a closer look at EHR pricing models and what the practice's needs are heading into the future, along with considerations such as personnel volume, clinic growth, federal reimbursements, and more.
Making Benchmarking Actionable
Benchmarking may begin as a method of determining the efficiency of an EHR system, but it doesn't stop there. Monitoring indicators and determining strategies to achieve those goals also aligns a practice with the many objectives of electronic health records in the first place: improved patient safety, thorough documentation, and more efficient workflows, to name a few. Therefore, making benchmarking actionable is critical for the health of the entire practice and its patients. Creating teams to address issues with optimization and working through kinks in workflows after benchmarking and monitoring is the next step to operating a truly successful EHR system.
Technical Dr. Inc.'s insight:
Every component of a successful electronic medical records system implementation requires a thoughtful, strategic approach. Naturally, this includes EMR training, and one of the best places to start is to establish roles and expectations for all parties involved to ensure smooth implementation and effective training. It's important to remember that internal management is just as important as vendor support, and below are just some of the important in-house roles to assign before beginning training.
For any project, either through a small business, large corporation, healthcare organization, or anything in between, the executive sponsor must be an individual who understands the organization's needs and goals thoroughly. Often involved with management, the executive sponsor must have a big picture perspective, and for " For this role, knowledge of how the EHR system will interface with the organization is more important than technical know-how.
Unlike the executive sponsor, the project coordinator manages day-to-day issues with groups and individuals. The project coordinator should be a leader who understands the technical side of implementation sufficiently to serve as a knowledge source for the rest of the organization. Ownership of EHR training and its outcomes is critical for this role, and the assigned individual must be able to take accountability for this crucial stage of implementation.
EMR training roles do not end at the management level. For providers, billing staff, nursing, technicians, QA specialists, and others, key training roles exist that can complement an EMR training program – only if managed properly. Physician super users as trainers or guides during an EMR training program, for example, have demonstrated mixed results. One significant benefit of assigning physician super users is having an in-house expert who understands not only technicalities in the EHR system and how they relate to the individual clinic or practice, but who are available as a resource for providers and staff. Clinician super users should not, however, become a primary resource for information, as this can quickly lead to frustration and significant training gaps.
Always Consider Your Training Strategy
The Office of the National Coordinator for Health Information Technology (ONC) reviews three training strategies commonly employed by healthcare organizations during EMR implementation: super user training, role-based training, and process-based training.
Naturally, the selected training strategy will affect the structure and roles of your training team and roadmap. In all of these strategies, however, a common underlying theme is assigning training roles to individuals who can serve as an information resource for others who perform similar tasks.
Leverage Expert EMR Training from Your Vendor
In many cases, the EHR vendor itself provides expert trainers. Leveraging an EHR vendor is important throughout the implementation process, and this certainly applies to the training period. From classroom-style sessions to one-on-one instruction, different EHR vendors may provide various types of training to help you and your staff achieve fluency in your records system.
At ZH Healthcare, we understand training to use EMR isn't complete until a healthcare organization feels confident in its utility. Our HITaaS (Health IT as a Service) system BlueEHS includes training to fit your unique needs and customization choices.
Technical Dr. Inc.'s insight:
Electronic health records shouldn't be frustrating. However, many providers are finding themselves disappointed or aggravated by EHR systems that don't provide the tools they need to support the very best care for their patients.
In fact, the American Academy of Family Physicians has noted a 30 percent decrease .in physician satisfaction with EHRs within the past five years. Reasons for this dissatisfaction include inefficient systems, deluges of tools that don't apply to their practice or even generic modules that lead to inaccurate documentation.
Fortunately, customisation presents a key solution to these issues and much more.
Your Practice, Your EHR
Every practice is unique, and this should be reflected in each health records system. An EHR system for a small practice will need to operate differently than that of a large practice. Layouts, prescriptions, scheduling, patient education, and countless other EHR tools should reflect the needs of providers and their patients. Customised EHR systems impact not only the efficiency of providers and their staff but also the experiences and health outcomes of patients.
The Impact of EHR Customisation
Tailoring electronic health records to the unique needs of an individual medical practice impacts all parties involved, from the physicians and their staff, to administrators, to patients. For physicians, customisation can result in improved specificity and accuracy of data, whether with a patient or reviewing records outside the exam room.
EHR customisation examples can include setting dosage parameters, accommodating in-house test results, or even modifications to make the system mimic familiar and intuitive paper charts.
A system that is carefully tuned to the needs of a specific practice is far more efficient for users, and saves time for both providers and patients alike. And those specific needs are naturally different across-varying specialities. An ophthalmology practice, for example, would likely benefit from a very different EHR layout than a physical therapy practice or an urgent care clinic.
Not only can the speed and ease of utility improve with the adoption of a customised EHR, but also the quality of that data and accuracy of the information. A 2006 study illustrated that after customising EHRs, more than 50%of surveyed practices reported improved accuracy and quality of records. More accurate records and data means better patient care and ultimately better health outcomes.
Configuring the Best EHR
Determining the configuration of a system to maximise its usefulness and alignment with best practices requires careful planning. Resources who can help a medical practice ideally customise their systems include EHR vendors and third-party consulting firms, and of course, in-house experts such as providers and administrators who understand the practice's needs and challenges best.
Customisation of a EHR system is an effective method of improving practice efficiency, accuracy, and communication for a medical practice.
What could make an EHR built for your practice? The Impact of EHR Customisation and How it works in configuring the best EHR for the Doctors.
Technical Dr. Inc.'s insight:
Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.
Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital's inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians' needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.
To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is "not well." In fact, EHRs are creating as much frustration as benefit. Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It's no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians' professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there's an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians' use of EHRs.
Today's EHRs have done little more than "pave the cow paths." We've gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it's optimized for and native to the technology that enables it.
Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it's only going to increase. As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, "Getting access to personal health information is the start of engaging patients to be full partners in their care."
Patients of the (near) future are going to choose alternate care if they experience poor administrative practices, or if they don't feel a connection with their doctor. And patients will know when technology inefficiency negatively impacts their quality of care, whether it's due to admin issues or diagnosis.
In the coming decade we will begin to realize the benefits of computing and genomics in determining patient care. For example, modern medicine delivers anesthesia based on a number of factors, such as height, weight and age. But people metabolize it very differently, and you can't know how an individual will react unless you look at the genome. For the 20 percent of people for whom drugs do not work, it's usually because of their specific DNA. But since this is something we're currently not tracking, physicians are left to trial and error. Doctors should know what works for each type of person—perhaps based on what has worked for similar people in similar situations in the real world in the past.
On the technology side, EHR vendors aren't going to get us to the next step. We must look to data, data scientists and innovative start-ups. Medical research and development is poised to move from a traditional molecular "hypothesis/proof" model to a data-centric "observation/analysis" model, in which it's possible to do a trial without a (clinical) trial. Upwards of 90 percent of Americans are willing to share their medical data to benefit care and treatment research. We currently have enough institutions with enough data to build algorithms and apply them to other populations in such a way that we can change—and dramatically improve—healthcare.
It's time to make healthcare work better for both patients and providers. Leveraging the innovative, ground-breaking tools we have at our disposal will propel healthcare quality and efficiency forward. Making EHRs and other healthcare IT as intuitive to use as Uber, Foodler or Google Maps will not only improve the quality of care, it will help to enhance the overall healthcare experience for everyone involved in it.
Technical Dr. Inc.'s insight:
Telemedicine is something that's existed as a concept pretty much since the invention of the phone. Every form of effective long distance communication has been and can be used for medical consultations, whether between professionals, or between a professional and a patient. It was the recent advances of the Internet however, that brought telemedicine to the limelight and made it a hot topic of discussion.
In essence, telemedicine can have many forms – it's used daily by organizations such as Doctors Without Borders to relay different questions regarding troublesome cases from countries across the planet. It's used for providing medical consultations to places and people that simply don't have the physical access to a medical professional. And it's also used to save time for both professionals and patients when it comes to minor problems.
So what are the main ways telemedicine can improve a patient's health and lower the medical costs of their treatment?
· Easier and faster patient–professional contact. In cases of emergencies, speed is often of the essence. Speed, that face-to-face consultation sometimes can't provide, but telemedicine can. The amount of lives that have been saved by the swiftness of telemedicine rises astronomically every consecutive year and is hard proof of its benefits.
· Otherwise impossible or near-impossible contact between patients and doctors is made possible by telemedicine. Today, it connects instantly doctors and patients across the globe, making distances meaningless. This not only gives – quite literally – life to many people, but at the very least saves expenses to both sides.
· Telemedicine also provides easier and faster contact between professionals. Instead of doctors having to make decisions without consulting with colleagues, or wasting time in waiting for said consult, Telemedicine allows for quick and effective dialogue between professionals, ensuring the best decision is made as often as possible.
· Multiple studies have found a drastic decrease in the average length of patient's stay in hospital, as well as in deaths overall due to the usage of Telemedicine. In 2015 a staggering 35% decrease was measured in patients' average length of stay in ICUs, as well as 30% less deaths than predicted. That's a difference of both thousands of lives, and huge reduction of hospital expenses. The US Telemedicine Association found that the amount of Americans that have went through any type of remote medical care during that year is above 15 million, with the numbers being even higher in 2016.
· Telemedicine allows for much faster reaction time in both diagnosis and additional examinations. Something like this saves not only the patient's time (and potentially – live), but also saves the time of the medical professional, helping him or her be more efficient in his/her work. And with time being pretty much the most important resource in the medical field (or at the very least – one of the most important ones), including in First World countries, where hospitals are still frequently overcrowded – this makes telemedicine an invaluable asset.
· Telemedicine is a way for more frequent consultations with professionals. It's a known fact that the vast majority of health problems escalate because they are usually caught too late. And that is so, because most people don't like visiting hospitals and doctors, and don't like spending time for routine examinations. Telemedicine makes prophylactic examinations so easy and quick, that an unthinkable amount of diseases and other health problems that would've otherwise gone unseen, are now caught in their earlier stages, when they are easiest to treat.
· Telemedicine is also a very potent way for doctors to interact with the online community and to improve their status as a skilled medical professional.
While these and other pluses of telemedicine are overwhelmingly positive, it's undeniable that the field still has quite a way to go. Although it's just as good as face-to-face interaction with the patient in many cases, in some – it's just not the same. We can unfortunately witness the opposite side of things as well – wrong diagnoses and mistreatment of problems that could have been correctly done in person. However, those things are both eclipsed by the numerous positives of telemedicine, and are subject of improvement. With the advances done in both the online sphere and in medical technology, as well as the continuous refining of the rules of telemedicine, such problems are dropping at encouragingly high rate. Simply put, it's getting undeniable that telemedicine is going to be a huge part of the future of medicine as a whole.
Technical Dr. Inc.'s insight:
As genetic testing becomes more common, clinicians are trying to determine how best to use the information at the point of care.
"Repeated genetic test results generated over many months or years are impossible to synthesise into a coherent representation of the patient's condition without using a discrete, comprehensive or end-to-end technology workflow to support care," says Penn Medicine's Brian Wells in an article at Healthcare IT News.
RELATED: Stanford, Google Genomics team up on precision medicine
Wells, associate vice president of health technology and academic computing at Penn Medicine, calls for specific features in EHR design to help ensure-genetic testing results are useful.
Among them:
In a recent paper, researchers from the Mayo Clinic cited an increasing number of "fumbles" related to genetic screening due to use of out-of-date databases.
They argued that the healthcare industry must become "wiser users of genetic testing and even wiser interpreters of the genetic test results."
"The medical community and community at large need to get a better grasp on genetic testing and precision medicine rather than just using them as buzzwords," said Michael Ackerman, a genetic cardiologist at Mayo. "When used properly, these tests are incredibly helpful. But we must become wiser users of genetic testing and even wiser interpreters of the genetic test results so that we can make wise conclusions."
Technical Dr. Inc.'s insight:
Technical Dr. Inc.'s insight:
Telemedicine is a means of connecting providers with remote or undeserved patients. Proper telemedicine systems are necessary to be able to conduct clinical examinations on a patient remotely. These telemedicine systems typically include an encounter management platform, specialised medical devices and video conferencing network. Importantly, the best telemedicine systems also pair seamlessly with other IT solutions. In this way, treating patients becomes more efficient and dynamic, rather than a technological silo.
Working alongside some of the most common EMR platforms, a telemedicine encounter can smoothly integrate data from a check-up or appointment. Images, EKG reports, vital signs data and other information is saved easily and securely, without disrupting existing workflows.
Business as usual
Images from a telemedicine encounter can be easily added to a patient's EMR following an appointment. The same is true of X-rays, CT scans and other images, ECG reports, or vital signs data. By working with existing EMR platforms, telemedicine systems can adapt to a provider's specific workflow. Because saving data and images is so easy, something as simple as an HL7 configuration file can be used to relay information from a telemedicine software platform into and EMR. This is very much like the way a proper HIE system works. In this way, little needs to be changed in integrating a telemedicine system. This reduces lapses in production when implementing telemedicine into a practice.
The most recent technology advancement making a significant impact on the world of integration between telemedicine and EMRs is the availability of robust APIs from the best telemedicine software companies. This means healthcare professionals can work on one platform without having to manage two separate windows or applications, resulting in a much smoother workflow and faster adoption process.
Security and ease of use
The UI during a telemedicine encounter doesn't just make it easy to store patient data, but also works to eliminate misplaced or lost documents during the charting process. That way a doctor can quickly prepare for the next patient without worrying about any mistakes. The best telemedicine platforms come with robust security measures to ensure the patient encounter is private and well-protected from third-parties or sources of compromised privacy. In this way, it is easy to exchange information in real-time and store the data for later reference in an EMR.
An integrated UI also makes it simple for a physician to draw from a patient's EMR during a telemedicine encounter. This makes care more targeted and personal. While a physician is treating a patient using an embedded telemedicine system, an individual's EMR can also be accessed. In this way, an individual's entire health history is available to doctors, even if a patient is dozens or hundreds of miles away. This access to data allows for high-quality care that is more efficient, accessible and coordinated.
Technical Dr. Inc.'s insight:
ONC's increased oversight of EHRs embodied in new regulations doesn't go far enough to protect patient safety, according to a new analysis from the Pew Charitable Trusts.
The new rule, released October 14, clarifies ONC's ability to directly review certified EHR technology and hold EHR vendors accountable for non-conformities.
Both design errors and human factors have contributed to adverse patient safety events, sometimes seen as an unintended consequence of EHRs.
Pew warns that the new rule does not cover gaps in hospitals', doctors' and developers' ability to detect flaws that could put patients at risk because ONC requires only limited testing of EHRs to check for defects before products are installed and there is no comprehensive system to collect information on safety problems.
The analysis recommends two additional steps be taken to improve patient safety:
"These additional steps would help detect and prevent safety problems during the development and implementation of EHRs and reduce patient harm related to these products," The analysis says.
Both design errors and human factors have contributed to adverse patient safety events, sometimes seen as an unintended consequence of EHRs.
However, providers have been hampered in their ability to communicate safety issues attributable to EHRs for fear of repercussion from vendors, who by contract or otherwise seek to suppress such discussion. Even the EHR vendors' code of conduct, updated earlier this year, doesn't promote open discussion of patient safety issues except in certain circumstances.
The rule had received mixed reviews from stakeholders, with some applauding its attempts to improve patient safety and others concerned that ONC is over reaching its authority by delving into safety issues typically the purview of other agencies.
Technical Dr. Inc.'s insight:
Many patients are turning to the web to schedule doctor appointments. This trend is becoming more common as we continue to move forward. Its pervasive reach requires our understanding on why patients are scheduling with online booking systems and how doctors can utilise these to create a more efficient practice.
Status Quo
Understanding and utilising online booking mechanisms is a part cultivating an optimised clinical presence. Patients use these to have control and autonomy with their own schedules, while also saving time and understanding their health on a more personal level. Research the different options and decide which kind of e-booking platform would work best for your clinic.
Technical Dr. Inc.'s insight:
Being able to copy and paste information in the EHR saves time and improves efficiency. But when physicians use the functionality inappropriately, it can also cause significant patient safety issues.
Robert Giannini, NHA, CHTS-IM/CP and Lorraine Possanza, DPM, JD, MBE, of the ECRI Institute, talked about some of these issues and how to mitigate risk during a presentation at the 88th annual American Health Information Management Association's (AHIMA) annual convention held October 16-19 in Baltimore, MD. The ECRI Institute is a nonprofit organization that applies scientific research to improve patient care and safety.
"Electronic health records aren't really the cause [of safety issues]—but they do play a role. It's important to keep that in mind and to be cautiously aware of what's going on," said Possanza.
Much of the problem stems from an over-reliance on EHR automation and shortcuts, said Giannini. He reminded attendees that these shortcuts come in many forms, each of which require user validation. Examples of these shortcuts include the following:
When physicians copy and paste information frequently, they run the risk of jeopardising the integrity of the information, said Possanza. "Is that information timely, accurate, and contemporary? It may not be," she added.
Documentation that is copied and pasted can also lead to an over-abundance of information in the medical record. Physicians may inadvertently overlook important data. Unfortunately, this can lead to diagnostic error, said Giannini.
"The note becomes so big, long, and convoluted that you really can't tell the true picture of what's going on with the patient," he added.
The ECRI Institute's Copy and Paste Toolkit, a free resource, includes several examples of how physicians use copy and paste functionality incorrectly. Following are a few of them:
Copy and paste compliance: 4 tips
Technical Dr. Inc.'s insight:
Stephen Lopez's curator insight, December 14, 2016 7:03 AM
Olathe Health System, one of the largest providers in the Midwest announced it will integrate its existing enterprise-wide EHR with Cerner Revenue Cycle. The relationship expansion will deliver advanced integration between Cerner's clinical and financial solutions enables streamlined coordination of care across inpatient and outpatient facilities, as well as independent physician practices. It also is designed to enhance the patient billing experience by enabling data to flow through the system in near real-time.
Additionally, Olathe Health System will implement a suite of Cerner oncology solutions designed to provide care teams with the necessary tools to manage complex medication orders. Olathe Health System will also implement RxStation®, Cerner's automated medication dispensing device.
"The potential patient benefits and outcomes are truly what drive our business actions, including this decision to expand our health IT system," said Randy Rahman, vice president and CIO of Olathe Health System in a statement. "Our goal is to bring our organization onto one platform to work toward becoming one of the most integrated and progressive health care providers in the region. We understand the value that Cerner's system-wide integration can provide to Olathe as we strive to develop the best patient experience and satisfaction possible."
Technical Dr. Inc.'s insight:
Following the introduction of electronic medical records, patient care portals were developed to improve how patients and healthcare providers interact and to give patients access to their own health information so that they can take active roles in maintaining healthy lives.
These so-dubbed "portals" are simply Web-based tools, and it is possible to have one that exists as a stand-alone site, an integrated service with your medical practice or a part of your EMR system. No matter the type of platform that you choose, your patient portal can provide your patients with secure online access to medical details and increase their engagement with you while affording you several benefits as well.
Rapid Growth
More and more health care providers have introduced their own patient portals since the medical industry shifted focus to patient-centred care, and an increasing number of patients are signing up and actively using the service. Of the 74,368 disadvantaged adult patients monitored during a two-year study conducted between April 2008 and April 2010, 16 percent obtained an access code to their medical providers' portals, Among those patients, 60 percent activated their accounts, and 49 percent used their accounts two or more times. Later studies show that activation and use has increased.
Increased Office Efficiency
Implementing a patient care portal for your medical practice can increase efficiency in your office through direct messaging between you and your patients. As of June 2014, about 35 percent of family practices were using portals to educate patients, and 41 percent were using it for other messaging purposes. This can save time for receptionists and nurses, especially since the messages appear in real time.
Streamlined Workflow
Having a patient portal can also streamline workflows in your office. Rather than your receptionists and nurses dealing with simple, non-urgent questions over the phone, your office staff can move these communications online to reserve the phone lines and their time for answering and dealing with more urgent health care needs.
Promotion of Telemedicine
Patient portals can reduce the number of unnecessary patient visits to your office, allowing you to fit in more patients who really need to see you. This can help facilitate telemedicine, which allows patients to consult with you through the messaging system. For example, instead of a patient scheduling an appointment to see you for a change in medication doses, the patient could ask you about it over the patient portal. Using this feature allows you to keep that appointment open for a patient who has an illness and requires a diagnosis and prescription or immediate medical care. More than 25 percent of family practices were using patient portals for prescription-related purposes as of June 2014.
Fewer Medical Errors
When receptionists or other staff in a medical office take phone calls, they have to relay to you the information that the patients give them. This sometimes leads to misinterpretations of patient needs and medical issues. Being able to receive written messages from patients allows you and your staff to correctly interpret what your patients need so that you are well informed and can make the appropriate decisions.
Other Benefits
In addition to the four benefits above, having a patient portal and patients who actively use it allows you to send them reminders for appointments or to schedule an appointment for a yearly checkup. This reduces the chances of your patients forgetting.
It can also be used to provide your patients with billing information, consent forms, educational materials, and test results to keep them informed. Sending them educational materials and test results can save time from having to explain every detail during the office visit. This will allow you to see more patients every day. If your patients have questions, they can ask for more details via the patient portal or wait until their next visit.
Technical Dr. Inc.'s insight:
EHR Cost
Electronic health records systems can be (and often are) costly. This is true for a variety of reasons. The expenses of implementing an EHR are driven by costs associated with system design to training and everything in between. Even so, health records systems have seen a dynamic history of prices trending from the very expensive to the very affordable. Understanding these market fluctuations requires a quick look at some of the most substantial trends in EHR design and adoption.
Many variable factors influence EHR cost. Watching the environment of the market in the health records industry can help to clarify some of the EHR pricing variations.Three significant trends to follow are open source systems, API usage, and customization in EHR systems.
Despite their initial popularity, particularly with respect to their low cost, open source EHR systems do require a higher degree of technical capacity early on, and some may also lack the functionality delivered by paid, packaged systems. These systems are among some of the most affordable EHR solutions, with little or even no upfront costs in some cases. However, financial investment is typically seen at a later stage in implementation, training, upgrades, and maintenance.
Interfacing software systems through API-driven models has also seen a deceleration, partly due to the complexity of bridging numerous systems. However, a decrease in API-driven models can also serve to drive up costs in health records as a result of adecrease in interoperability and an increase in proprietary systems.
The more adoption of EHR systems in the healthcare industry will lead to more customization. Practices continue to realize that a one-size-fits-all approach to EHRs is detrimental to workflow, revenue cycles, and usability. But with customization comes the increased costs of creating systems tailored by specialty or individual practice.
Technical Dr. Inc.'s insight:
Modern physicians operate in a fast-paced, constantly-changing world.
Between dealing with regulation changes, insurance billing complexities and simple business requirements, the precious time and attention of doctors seems to be stretched thinner than perhaps ever before.
To help them manage such a demanding environment, most physicians everywhere are now turning to advanced technologies such as Electronic Health Record (EHR) software to maximize their practice's efficiency.
Doing research on which is the 'best' option can be mind-numbing.
Currently today there are over 700 EHR options in the marketplace, and that number is growing steadily. Aside from the technical capabilities, and the simple functions that are required, here are 5 important factors to consider before investing in an EHR for your clinic.
1) Features and Functions
This may seem an overly obvious factor, yet it can be overlooked. Before you begin to search for an EHR, consider exactly what you want it to do for you. What will it make easier in your clinic? Will it remove some manual tasks from your teams daily routines?
EHRs can streamline the daily activities of a clinic, simplifying functions such as scheduling, billing and reporting, while still meeting the demands of the government, insurance companies and patients alike. (You may like to refer to this comprehensive list of functions as a starting point).
Therefore, writing a list of what you want and need is a great place to start. Choose 5-10 key features or functionalities that are essential for you. Then choose another 5-10 that are nice to have. Taking time to consider your individual needs will help you narrow the field dramatically, and reduce the chance you are being sold on the sizzle, rather than the steak.
3)Design, Flow and Usability
Design is about much more than color schemes and logos. It is about the overall feel, and ease of use of the software. Believe it or not, good design can make an EHR a pleasure to use, or a nightmare.
As Dr Joseph Cramer explains "Color, space, placement, size, shape, and form all guide how one looks at the medical record. Information is not all the same. Monotony is not only boring; it is dangerous for care if everything is hidden in the same dull camouflage."
Consider the way it feels to use the EHR software. Does each screen flow logically? Is it easy on the eye? Can you adjust or change the layout or text sizes? Do the repeated functions you are using daily feel cumbersome or overly complicated?
Think about how much gmail changed the way we use email. Small simple innovations within an EHR can make a huge difference. Having to click through several screens to be able to save records, or source data can become an incredible burden when you do it hundreds of times a day.
According to Jess White from Health Care Business Tech, "Providers who aren't comfortable with entering information in an EHR are more likely to make mistakes that can affect patient care. And an EHR that's too difficult to work with can decrease efficiency."
Keep this sense of flow and usability top of mind when testing an EHR.
The future of all EHRs is going to be determined by who can connect them together. Today the challenge of interoperability is still a huge issue, and whilever the EHR vendors limit access to third-party apps, this will continue.
Even in 2016, this factor may still be a nice to have, but according to D'Arcy Guerin Gue writing for HealthIT Consultant, "The industry's road to interoperability is paved with bumps and ruts. With certified EHRs now in place throughout the country, it's a front and center concern. This is because interoperability is only practical if EHR usage has reached enough critical mass to make the possibilities realistic, including providing the basis for common standards for data sharing."
Seeking out an EHR that has a plan for interoperability, and connection to useful apps is another factor to consider to future-proof your clinic.
Technical Dr. Inc.'s insight:
Customizing an EHR can offer incredible benefits to a medical practice, but it is critical to understand the cost-benefit analysis of customization before implementation for the benefit of the practice and the health of its patients.
To Customize of Not to Customize
One of the first questions to ask before deciding to move towards a customized EHR is about the health or the efficiency of an existing system. Are there currently bottlenecks in flow? Would EHR customization better support "meaningful use" and best practices? Do providers and staff find themselves frustrated on a routine basis with data entry or records management? If so, it may be time to consider a tailored records system.
Despite the benefits of customization,there are associated costs which must also be weighed in the decision-making process. Resource consideration is important when deciding if customization is appropriate, for example. Are the resources (both time and financial) available? Creating a cost-benefit analysis can help to determine whether or not to adopt a customized EHR system.
Pros of Customization
Designing and implementing a customized EHR system has many incredible benefits. Custom modules lead to better capturing of data and improved accuracy of that data. SuchEHR system impact affects not only practice flow, but also health outcomes.
Another important benefit of a customized records system is utilization by providers and staff. With a system carefully tailored to the needs of the practice (and in-turn its staff), practice-wide adoption can become much easier. It is no coincidence that staff will be eager to use an EHR system that's more functional; when appropriate screens and modules appear when and where they are needed, and the system is tailored to the flow providers desire and follow, staff is more invested.
Cons of Customization
Despite its advantages, practices need to be aware of the cost of implementing a customized EHR system, both in terms of time and financial investment. The cost of implementation can by high, which is a common barrierto EHR customization for practices. This cost comes in the form of financial investment, but also the investment of time.
Adaptation and training take commitment on the part of providers, staff, and administrators, and customization management requires thoughtful and careful leadership. Other points of consideration include long-term system changes such as updates, as vendor updates down the line may create rifts with interfacing custom systems. Careful communication with a vendor before customization about future changes is key to best prepare for such events.
Understanding the advantages and costs of implementing a custom EHR system is an important step in deciding if customization is right for your practice.
Technical Dr. Inc.'s insight:
One of the challenges of choosing a new EHR is considering the long-term investment.
Implementing any new system into a medical clinic is a potential short-term disruption, so there needs to be an assurance that your decision to change EHR services will serve you well moving forward.
The rapid pace of technological ensures that most doctors will switch their electronic records system throughout their career.
Some doctors start building a medical practice with a budget, and then become ready to pay more for a full service EHR. Others are simply dissatisfied with their current system and want to move to something more suited to their needs.
Very often the big issues that arises is with data continuity. Changing EHR systems should ideally mean that you retain access to your previous patient records. But this is not always the case. The fear of transferring data and losing vital information is a real threat.
With the recent growth in cloud-based EHRs, your patient data is no longer stored on a local server in-house, rather it is under the care of the EHR vendor.
The good news is that the ease of transferring medical records has been steadily improving over the last several years. The recent wave of federal regulations relating to Meaningful Use includes a set of standards developed to enable electronic referrals and cross-provider communication.
For any two EHR applications, it is unlikely that all data will transfer over seamlessly. You need to check with your new vendor which information is essential.
Start with Structured Data.
This includes ICD9 Diagnosis codes, medication lists, procedure lists, allergies, and immunizations. Detailed chart notes and SOAP-type templates can prove to be difficult because the data is unstructured, and free text format may not transfer easily from one EHR technology to another.
In order to meet Meaningful Use certification, EHR vendors are required to be able to produce this data in a standardized, structured format for any given patient. However, they are NOT required to be able to automatically export all data for all patients.
With some EHR vendors, they may charge a processing fee for creating an export file of all of your patient data. A new EHR vendor may also charge you a fee for importing previous data.
This fee will vary based on the volume and complexity of your previous record set.
Testing the new System
Once the data transfer has been the second step is testing. Anyone familiar with the process will tell you the the transfers are rarely executed perfectly on the first round. So be patient and persistent.
It is necessary to perform careful quality testing to validate that your data in the new environment is accurate, just like in the old environment.
The simplest way to do this is to select a small test group of your patient population and manually verify that everything is exactly correct for those people. Check both systems to see that everything is correct and orderly. Ensure that you check more than contact information, also review medication lists, procedure lists, allergy lists, and immunization lists. Detailed chart notes and SOAP-type templates can also show if the data has transferred effectively.
If you find an error in the record of one individual, chances are that it is a systemic problem that is affecting many other patient records in your population.
If you identify any problems, you will then need to work with both EHR vendors to determine the origin of the issue and correct it. This can be time consuming, but also worth fixing early.
Even with cloud based date, and modern EHR systems, data transfer can still be a challenging process for any provider to undertake.
Technical Dr. Inc.'s insight:
Electronic health record (EHR) systems are an enormous investment. This investment comes in the form of time, labor, and of course, money. Whether a medical practice chooses to host an on-site EHR system or subscribe to a web-based system, these costs demand significant planning and preparation.
Understanding the cost breakdown of an EHR system can help a medical practice not only prepare for the financial investment but also generate implementation focus.
What is the cost of an EHR?
Estimates of EHR costs have ranged anywhere from $15,000 to $70,000 per provider. Many factors drive this expense.
First, the development and design of the system itself is a concrete contributor to the value of electronic medical records. EHR cost is also affected by the degree of interfaces and integrations it offers, particularly with respect to other health records systems.
Implementation decisions also impact the cost. Practices implementing an in-house, locally-hosted system, have higher costs than for those adopting a web-based SaaS (Software as a Service) model.
Regulatory requirements, compliance, and certification, are also a significant source of EHR cost. Testing and certifications to meet Meaningful Use requirements or updates to align with changes such as ICD-10 are examples of how these areas influence EHR cost.
Once selected by a client or practice, user interfaces, customization, implementation, and training also contribute to EHR cost.
Evaluating Cost of EHR
EHR Cost
One of the very best sources for evaluation of EHR pricing is the vendor. During this stage, it is important to scrutinize options with a critical eye to truly evaluate what an electronic records system delivers.
Questions such as "How will data migration or input from paper charts impact pricing?" or "What is the training timeline and volume?" can help your practice to determine value vs. cost for a particular vendor.
This step requires doing appropriate research beforehand on the scope, features, and requirements you're looking for in an EHR.
Understanding Cost and Value of EHR
High costs should equate to high value. This is true of any service, and healthcare HITaaS (Healthcare IT as a Service) is certainly no exception. Experienced vendors should be able to provide clients with a thorough understanding of the value of their systems and services as well as the cost. This value translates into meaningful benefits for your medical practice, both immediately and down the line.
EHR value should be measurable with concrete metrics including documentation accuracy, workflow efficiencies, and more. And while this means that vendors are responsible for exceptional service, it's important to remember that you can't knock cost without knowing the expected value.
Technical Dr. Inc.'s insight:
Here are a few of the guaranteed EHR benefits:
Obviously this is just a small list of the guaranteed benefits. We could create an even longer list of the possible, probable, and future benefits of an EHR as well. I'll just cap it off with one simple example. How are you going to handle pharmacogenomic medicine on paper? It's coming. The simple answer is that you're not doing pharmacogenomics on paper. You're going to need technology, and it will likely be connected to your EHR.
Technical Dr. Inc.'s insight:
Technical Dr. Inc.'s insight:
Healthcare Innovation is the creative adoption and usage of technology that works to improve the quality of healthcare by enabling personalised care models to predict when adverse healthcare conditions may occur and to better manage the health status of a patient real-time. Obviously the adoption and implementation of innovative tools will require significant changes to existing patient care models and organization restructuring to focus on personalised care.
Advancing technologies can enable better patient interaction, wellness management processes, and predictive analytics that focus on keeping patients healthy. As these technologies advance, so will the needs and methods that healthcare facilities have become accustomed to. So, what can your organization do to keep up with the times and use innovation to better their facility?
HCIs Senior Vice President of Innovation and Technology Solutions, John McDaniel, has a framework for how to establish and build an innovation team – from the Chief Innovation Officer to an innovation council, and eventually up to an innovation center.
1) CEO's and the Board
Before getting into the team that will be responsible for directing and managing innovation within your organization, it is important to keep in mind that a healthcare facility must first get their CEO, executive team and Board of Directors to see eye-to-eye with the idea. After all, the agents of change within a healthcare organization are ultimately the CEO and the Board of Directors.
Innovation is a change in the way an organization most likely has done business for a long time, and this change will probably cause some members of your staff to be skeptical. A change in the way an organization has done things may be faced with some resiliency, but the world is changing, technology is changing, and it is the responsibility of the CEO to make the decision for the better of their organization. Creation of an Innovation Strategy is essential and will assist the CEO and the Board with finding the right candidate to be their Chief Innovation Officer.
2) Chief Innovation OfficerWhen using innovation to influence a healthcare facility, one of the first things that must be done is establishing a Chief Innovation Officer. Innovation is a journey, not a destination, and the Chief Innovation Officer will be responsible with creating the roadmap for this journey, as well as being able to think outside the box with relation to how healthcare is traditionally delivered. This individual will be the internal champion at the executive level for innovation and change, and will have an understanding of the process of healthcare today, as well as what it's going to evolve into.
In addition, the Chief Innovation Officer is going to need to be a great communicator who can work within a team concept. They will need to be able to use their understanding of information technology and the clinical process in order to work with constituents to create the roadmap for their innovation journey. It can be very challenging to find an individual who exhibits all of these qualities – however, there are a number of organisations who have found resources such as these who are doing an outstanding job in helping transform organisations into a new models of care. They cannot do this alone, however, which is why they will look to create an innovation council.
3) Innovation Council
An innovation council should consist of a combination of information technology, operations resources, planning resources, and clinicians. In addition, a good practice when forming an innovation council is to include at least a patient or two, because they will have a first-hand understanding of how they feel patients should be engaged, or how patients would like to be communicated with from a clinician (whether it be something such as TeleHealth or in person). Build a process or methodology around engaging with operational resources, clinical resources, and anyone else who is a constituent of your services.
Once your council has been assembled, you can begin to build a process where ideas are germinated and can be presented electronically. Your innovation council can then look at these ideas and begin to sift through them and decide whether or not they make sense based on your organisations strategic plan, or if they could be a current operational improvement, for example. They will then decide which ideas they will move forward with, and put together a high-level business case of what your organization will need to invest, what the change opportunity is, and how it can affect revenue. This innovation council will ultimately be the oversight for the organization in bridging operations with where the future of healthcare is going.
4) Innovation Center
The ideas that your innovation council has conceived and approved will need to be tested, and that is where the innovation centre comes in. Say, for instance, your innovation council has looked at 25 different projects, and needs to see how they will work. The innovation centre can build or test these new solutions, and can see exactly how they will impact the operations today, and how they will help to transform your organization into the future. The innovation centre is a lab, basically, that allows your organization to engage with partners to either provide a solution to a problem that you will be addressing or work towards the development of something completely new.
There are already some very good innovation centres out there, and they work to develop new products that can create a huge ROI in their organization, and have begun to take those and resell them. In some instances, the revenue that came from these resold technologies and applications was even greater than the annual revenue that was associated with patient care. They work with sophisticated, new concepts such as 3D printing, wearables, biomedical devices and their example is a great indicator of how beneficial innovation can be to a healthcare organization.
Technical Dr. Inc.'s insight:
A few days ago, the Human Health Services' (HHS) Office of Inspector General released a report highlighting the 10 biggest management and performance challenges the healthcare industry is facing, and yet again, EHRs and health IT have made it to the list. Healthcare is complex and the challenges we face today might take years to overcome, in the transition from fee-for-service to value-based care, data analytics has a huge role to play as the building block of the healthcare industry.
Data Analytics has efficiently empowered healthcare organizations to thrive in a value-based world, and is not limited to:
Analysis of data only takes one so far, after this comes the proper management of data, and the insight to make sense of it to make population health management truly successful.
By using health information exchange, a value-focused organization was successful in reducing total office visits by 26.2% and increasing the number of scheduled telephone visits to the hospital by eight times!
As the healthcare industry moves from fee-for-services to fee-for-value, much has been done to gain the momentum, but to sustain it and grow with it demands healthcare members to tap the massive potential of data analytics. It can transform the current landscape of healthcare, and the future is dotted with several possibilities. Data analytics is still at a relatively early stage of development, but the rate at which advancements are going on, a revolution is underway. It could be the best thing since sliced bread.
Technical Dr. Inc.'s insight:
Much of the focus on electronic health records has been about their adoption and the requirements of the Meaningful Use program, but many providers may not realise that EHRs also represent legal records that can impact medical malpractice litigation.
While malpractice involving paper medical records often dealt with illegible clinician notes or confusing abbreviations that lead to errors, EHRs often involve other kinds of mistakes, such as those made by hitting the wrong item on a drop down menu, an article in Healthcare IT News outlines.
Another problem with EHRs in malpractice litigation stems from the inability of providers to prove that they made a clinical decision based on information in front of them in the tool. What's more, according to the article, printouts of an EHR, which can run to thousands of pages, do not look the same as when a clinician actually uses the software.
Jodi Daniel, an attorney at Crowell & Moring in the District of Columbia and former policy director for the Office of the National Coordinator for Health IT, says she's anecdotally heard about physicians settling malpractice lawsuits, not because they were guilty, but because they couldn't use the EHR to prove that a decision they made was based on the information available to them at the time, according to the article.
"They couldn't demonstrate what they did and why they did it," Daniel says. "They were forced to settle to make the problem go away."
The article notes that there are still no clear-cut standards for the use of EHRs in discovery or as evidence in court. Those interviewed suggest that providers have policies regarding the EHR as a legal record.
Technical Dr. Inc.'s insight:
A machine learning algorithm shows promise for identifying, via data in their electronic health records, patients at high risk of developing HIV, according to research presented in New Orleans last week.
The work focuses on identifying patients who might benefit from pre-exposure prophylaxis (PrEP), a treatment to reduce the risk of developing HIV that's been found highly effective, reports MedPage Today.
Failure to have sexual health and risk evaluations performed as part of routine care poses the greatest barrier to getting more people on PrEP, according to Douglas Krakower, M.D., of Beth Israel Deaconess Medical Centre. Though many physicians lack training or are uncomfortable talking about sexual health, EHR data can provide insight, he contends. A record of sexually transmitted infection testing or treatment suggests someone has had unprotected sex, while a prescription for buprenorphine or methadone indicates a substance use disorder, he said at the IDWeek annual meeting.
Researchers began by looking at more than 100 variables including demographics, diagnoses, drug prescriptions, laboratory tests, and procedures for patients at a large medical practice in Boston. They then compared characteristics and risk factors between newly infected HIV patients with control subjects who remained HIV-negative, according to MedPage Today.
Next, they used logistic regression modelling and machine learning to predict HIV infections, then compared the models to find the best at predicting HIV.
While this sub-population was only 1.1 percent of the clinic's patients, it represented more than 8,000 patients who might be good candidates for PrEP.
The researchers plan to further fine-tune the algorithm at a community clinic that specialises in care for sexual and gender minorities where PrEP use is more common.
Technical Dr. Inc.'s insight:
The 2009 American Recovery and Reinvestment Act set up established payment adjustments under Medicare for eligible hospitals, who are not users of Certified Electronic Health Record Technology (CEHRT). According the CMS, hospitals that don't demonstrate meaningful use for an EHR reporting "period associated with a payment adjustment year will receive reduced Medicare payments for that year.
October 1st 2014 marked the first payment adjustments for eligible hospitals and now over 4,800 eligible hospitals may participate in the EHR incentive programs.
Straight from CMS
1. What is an eligible hospital?
2. How does a hospital demonstrate meaningful use in order to avoid a payment adjustment?
3. How have hospitals received incentives payments? Are incentive payments still available?
4. What is the FY 2017 EHR Eligible Hospital payment adjustment?
5. How many hospitals successfully demonstrated meaningful use for the 2017 payment adjustment year?
6. Is there an exceptions process for hospitals that did not demonstrate meaningful use?
7. Does a hospital have to achieve meaningful use each year to avoid the payment adjustments or can it avoid the payment adjustments by achieving meaningful use only once?
Technical Dr. Inc.'s insight:
drchrono Inc., an mobile EHR provider of practice management, revenue cycle management (RCM) and medical API platform on iPad, iPhone and web, has upgraded its platform to meet the needs of larger medical practices and provider groups.
The upgrade includes a built an RCM team with its own RCM platform, RCM Pro, optimising the workflow of coders, billers, and billing managers making managing multiple practices more fluid. Almost all RCM companies are service organisations that don't build any software and instead use 10-20 different EHR platforms that their customers were already using along with many spreadsheets exposing practices to a great deal of human error. The RCM Pro platform is solving the medical billing problem with a technology solution instead of using a human workforce. drchrono has been able to build software to streamline and drastically reduce the amount of human labor involved in getting doctors paid from insurance companies and their patients. drchrono has developed a strong software base thanks to the input given by its RCM customers on its iPad EHR solution and have the ability to automate the RCM workflow.
Additionally, drchrono includes these features to meet the needs of larger practices:
Technical Dr. Inc.'s insight:
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Applied Statistics: White: Do the Math! (2nd Revised edition)By: Rebecca M. Warner (author), John K. White (author)
1 - 2 weeks availability
DescriptionRebecca M. Warner: Applied Statistics: From Bivariate Through Multivariate Techniques, Second Edition Applied Statistics: From Bivariate Through Multivariate Techniques, Second Edition, provides a clear introduction to widely used topics in bivariate and multivariate statistics, including multiple regression, discriminant analysis, Manova, factor analysis, and binary logistic regression. Author Rebecca M. Warner uses an applied approach that does not require formal mathematics; equations are accompanied by verbal explanations, and students are asked to think about the meaning of the equations. Each chapter presents a complete empirical research example to illustrate the application of a specific method, along with a glossary and comprehension questions to help students master each concept. SPSS examples are used throughout the book; however, the conceptual material will be helpful for users of different programs. John K. White: Do The Math!: On Growth, Greed, and Strategic Thinking How do pyramid scams work? Are reality television shows fair? Why are sports so uncompetitive? Who really broke the bank in 2009? Our world has become more complicated, and the notion of growth at any cost has led to constant economic uncertainty, a permanently stressed-out workforce, and everyday stories of government and corporate abuse. Author John K. White argues that a better knowledge of basic systems is needed to understand the world we live in, from pyramid scams to government bailouts, from sports leagues to stock markets, from the everyday to the seemingly complex. Do the Math! is a fresh look at the numbers of daily living, providing a thought-provoking guide to better understanding the world around us and enlightening consumers about misleading practice. Numerous creative examples and illustrative figures help to explain the realities of our ever-confusing mathematical world, and modern economic and contemporary social issues link mathematical concepts to real-world examples.
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About AuthorRebecca M. Warner received a B.A. from Carnegie-Mellon University in Social Relations in 1973 and a Ph.D. in Social Psychology from Harvard in 1978. She has taught statistics for more than 25 years: from Introductory and Intermediate Statistics to advanced topics seminars in Multivariate Statistics, Structural Equation Modeling, and Time Series Analysis. She is currently a Full Professor in the Department of Psychology at the University of New Hampshire. She is a Fellow in the Association for Psychological Science and a member of the American Psychological Association, the International Association for Relationships Research, the Society of Experimental Social Psychology, and the Society for Personality and Social Psychology. She has consulted on statistics and data management for the World Health Organization in Geneva and served as a visiting faculty member at Shandong Medical University in China. John K. White (Ph.D.) has a B.Sc. from the University of Waterloo, Canada, and a Ph.D. from University College, Dublin in Applied Physics. Currently, he is a lecturer and Research Fellow at University College, Dublin. However, over the past 25 years, he has also worked as Project Manager and Technical Writer for Sun Microsystems, as a Computational Analysis/Technical Writer for Berminghammer Foundation, Consultant for Interactive Image Technologies for ScotiaBank, and Programmer/Computational analyst for the Ontario Government. He has a wide range of interests and is also active in promoting science and physics in secondary schools. He has published widely in a range of areas in academic journals, has contributed chapters to edited volumes, and has authored a number of technical publications.
Product Details
- publication date: 15/10/2012
- weight: 2631
- edition: 2nd Revised edition
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- 1st Class Delivery: Yes
- Courier Delivery: Yes
- Store Delivery: Yes


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