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Cover Story: Roundup Quality, meaningful use and EHRs

Tom Darr, M.D., CMO, physician solutions, Ingenix

Physicians have two fundamental goals: to provide excellent, constantly improving patient care; and to help drive the transformation of the healthcare delivery system. The ability to measure the quality of patient care accurately and efficiently is central to each of these goals. An obvious starting place for these capabilities

is the electronic health record, which is an under- utilized technology.

The U.S. federal government is encouraging adoption of EHRs with special Medicare and Medicaid incentive reimbursements to eligible providers who demonstrate meaningful use of the technology. Nearly one year after regulators defined meaningful

use, scores of physician practices are implementing systems they hope will help them improve patient care, manage their workflow more efficiently and control costs.

A focused look shows meaningful-use criteria –

core and menu requirements, each with specific metrics focused on clinical care – are rooted in basic tenets of constant quality improvement. They provide careful, specific direction that adds value now and sets up provider practices for even bigger gains in the future. The goal of the criteria is to help physicians use health IT in a way that meaningfully changes how they engage patients and provide care. Obtaining health intelligence that enables doctors

to improve quality is what meaningful use is all about. It supports the critical goal of transforming what currently is a reactive disease management system to an efficient, proactive health system focused on patient health and well-being, including early detection and even prevention of diseases.

Access control and audit: managing generic accounts

Mac McMillan, CEO, CynergisTek

All certified EHR technologies, in order to meet and demonstrate meaningful use, must have functionality to control access and uniquely identify users to enable effective auditing. When conducting the required risk analysis, many are discovering that generic accounts can create

an unacceptable risk. Generic accounts can include service, training, testing, student and vendor administrator accounts and, in some environments, number into the hundreds. While there is a legitimate purpose for these types of accounts, they should be strictly limited, tightly controlled and audited regularly.

Your access control policy should require, for each account of this type, a validated business need. The ability to create/enable these accounts should be strictly limited to a few individuals. All requests for such access should be reviewed, include a time period required and the identity of the requester/user. A maximum time should be established for the account requested being active, and automated controls should be used to enforce time limits/deactivation. Lastly, the policy, process, controls and actual access should be audited regularly to include those administrator users authorized to create/enable such access. Whether regular user or generic account, all access should be managed to the point that access can be tied back to a specifi c individual. The fi rst step to accomplishing this is conducting a critical review of all accounts and eliminating those that aren’t specifi cally required. Generally, this eliminates many of these accounts and reduces risk. The rest will need to be managed.

Continued on page 16 14 April 2011 HEALTH MANAGEMENT TECHNOLOGY

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