AHM-540 history - AHM Medical Management Updated: 2023

Choosing the best EHR system for your practice can help increase patient outcomes and practice efficiencies, such as trimming down documentation time, saving money and staying up to date on the most current and efficient processes.

Every practice is unique and will have slightly different requirements of the EHR they select. When you begin your EHR search, know what you want and need from an EHR. Some key points to consider when choosing the best EHR system for your practice include available features and types of EHR software.

Here are the key features to evaluate when choosing the best EHR software:

• Billing: Streamlines billing and claims processing, resulting in faster payment and increased revenue.
• Electronic Prescriptions: Providers electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care.
• Patient Portal: An efficient and practical means for patients to communicate with their clinician and become more involved in their healthcare by accessing outpatient laboratory and radiology results.
• Scheduling: Keeps your practice fully booked and operational by allowing the patient to easily schedule an appointment online or through their patient portal while sending out appointment reminders.
• Telehealth: Secure, HIPAA-compliant and user-friendly solution to connect providers with patients when time, distance or other circumstances make an in-office visit difficult.

Types of EHR Systems

Physician-hosted systems

EHR data is stored on the physician’s servers. The physician is responsible for maintenance, security and data backup on purchased hardware and software. While the data remains under the physician’s control, vendors can include a disabling code in their software. In a dispute, the vendor can hold the data hostage.

Remote systems

EHR data is stored on another entity’s servers. This other entity is responsible for keeping the data and would also be responsible for maintenance, security and data backup. The data is under the control of the third party rather than under the control of the physician.

There are three types of remotely hosted EHR systems:

Subsidized system

Under this system, an entity with whom the physician has a relationship, such as a hospital, subsidizes the financing for the EHR. Typically the subsidizing entity’s servers are utilized rather than the physician’s, so the physician does not have control over the data.

Dedicated hosted system

Under this system, the physician does not store the EHR data on their servers. Instead, the data is stored on the vendor’s dedicated servers. While the physician cannot control data storage, the data is stored on servers in specific, known physical locations.

Cloud-based system

Under this system, the physician does not store the EHR data on their servers, but rather the vendor keeps the data on the internet (in the cloud). The physician’s computers do not have the EHR software; the software is accessed through the vendor’s website.

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Mark Deutchman, MD, Professor, Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora. Email: mark.deutchman@uchsc.edu

Meghan Wulster-Radcliffe, PhD, Senior Scientific Communications Associate, Eli Lilly and Company, Indianopolis, Indiana

Disclosure: Mark Deutchman, MD, has disclosed that he has received honoraria from Pri-Med for lectures on stress urinary incontinence and serves on the Eli Lilly Scientific Advisory Board studying duloxetine.

Disclosure: Meghan Wulster-Radcliffe, PhD is a full-time employee of Eli Lilly and Company.

Initial Therapy

A recent Cochrane review on interventions for the treatment of IIH found insufficient information to create an evidence-based strategy for the condition.^[8] However, there are several widely accepted treatments for IIH available, with varying degrees of supportive evidence and with variable success in the management of IIH-related headache.^[9]

Medical Management

Acetazolamide. Acetazolamide is a carbonic anhydrase inhibitor, which decreases CSF production and thereby decreases ICP and presumably the associated headache. Although the mainstay of treatment for IIH for both headache and vision loss, there has never been a randomized controlled trial to show its effectiveness over placebo. A recent randomized study of acetazolamide versus placebo attempted to do so, but was unfortunately not adequately powered to show a treatment effect.^[10] Currently the Idiopathic Intracranial Hypertension Treatment Trial is evaluating the efficacy of acetazolamide plus weight loss versus weight loss alone in mild to moderate IIH.^[11] The recommended dose of acetazolamide is between 1 and 4 g, titrated to improvement in symptoms and intolerance of side effects, including tingling of the hands and feet, alteration in taste (especially with carbonated beverages), and anorexia. Lower doses may help headache symptoms but probably do not affect ICP. Rare complications can include aplastic anemia and kidney stones. The extended release form of the medication is generally better tolerated. Acetazolamide is contraindicated in patients with liver failure or a significant history of kidney stones. Acetazolamide is listed as a category C medicine in pregnancy; however, Lee et al^[12] have suggested the drug is safe in the second and third trimesters, and a recent retrospective review of patients taking acetazolamide in even the first trimester showed no increase in birth defects or other complications.^[13]

Topiramate. Topiramate was initially marketed as an antiepileptic medication but is also FDA approved for the treatment of primary headache disorders such as migraine. Topiramate is a weak carbonic anhydrase inhibitor and therefore can be used to help reduce ICP. In addition, topiramate suppresses appetite, which can facilitate weight loss. Topiramate is thought to be most efficacious in the treatment of IIH with a prominent headache component. In a small open-label study comparing the relative efficacy of acetazolamide and topiramate in the treatment of IIH, topiramate was as effective as acetazolamide in relieving headache (mean time to resolution, 3.75 vs. 3.3 mo). In addition, patients taking topiramate lost statistically significantly more weight than patients taking acetazolamide, with a mean of 9.76 kg over 12 months.^[14] The topiramate dose ranged between 100 and 150 mg per day, whereas acetazolamide doses were between 1000 and 1500 mg daily—a notably lower dose than many treatment regimens.

Topiramate is typically started at 25 mg daily and can be titrated up to 100 mg twice daily. It is frequently given in addition to acetazolamide in the treatment of headaches not controlled with acetazolamide monotherapy. However, patients should be counseled on the increased risk of kidney stones with dual therapy. The main side effects of topiramate include paresthesias, difficulties with concentration, drowsiness, and decreased appetite. Patients should be made aware of the increased risk of acute angle closure glaucoma secondary to topiramate therapy.

Topiramate is contraindicated in patients with liver failure and has a relative contraindication in patients with a history of kidney stones. It is a category D medication in pregnancy, and female patients should be counseled that the medication may reduce the effectiveness of estrogen-containing oral contraceptives.

Weight Loss. IIH is a disease most commonly seen in obese individuals and weight loss is regarded as an important element of any treatment regimen. Newborg^[15] first reported on a series of 9 patients with IIH treated with a low-calorie, low sodium diet, leading to weight loss and resolution of papilledema. Johnson et al^[16] showed that approximately 6% weight loss is associated with resolution of papilledema. This was independent of treatment with acetazolamide. Kupersmith et al^[17] reported significant improvement in papilledema and visual field defects in patients with modest weight loss of <10 kg. However, change in headache severity was not a measured endpoint in any of the aforementioned studies. More recently, Sinclair et al^[18] followed up women with IIH given a low-calorie diet. Patients placed on a 425 kcal/d liquid diet for 3 months lost an average of 15.7 kg and were shown to have lowered ICP and reduced papilledema. In addition, subjects reported improved headache severity, frequency, and reduced need for analgesics. Moderate weight loss has therefore been shown to be effective in the treatment of IIH, including symptomatic relief from headache, and thus should be a key component of every treatment plan, potentially reducing the need for both medical and surgical intervention.

When diet and exercise alone are not successful in achieving weight loss, bariatric surgery can be considered, particularly in the morbidly obese with other complications of obesity. Case reports and small cases series have demonstrated efficacy both for weight loss and headache relief.^[19,20] A recent meta-analysis included 62 patients initially presented in 11 publications who underwent bariatric procedures for weight loss in the setting of IIH.^[21] Although headache improvement was not a specific endpoint, 74% reported headache as a presenting symptom, and 92% of patients had resolution of their presenting symptoms after bariatric surgery.^[22]

Surgical Management

Surgical management for IIH is typically reserved for those patients who fail medical management either due to progressive symptoms or intolerance to medical treatment. The surgical options include optic nerve sheath fenestration (ONSF) and CSF diversion procedures.

ONSF. ONSF is often the surgical treatment of choice in patients with vision loss and uncontrolled IIH. The retrobulbar optic nerve is identified through an orbital approach and the nerve sheath is fenestrated by several slits or a window defect, thereby rapidly reducing pressure locally on the optic nerve head. Complications can include diplopia, a tonic pupil, and rarely vision loss secondary to trauma to the optic nerve or central retinal artery.

ONSF does not have a significant effect on ICP or outflow resistance.^[23,24] Despite the local effect of ONSF, patients can have improvement in headache after the procedure. Corbett and Thompson^[25] reported approximately two thirds of patients with headache experience relief after ONSF. In a series of 17 patients with IIH and severe vision loss who underwent ONSF, 9 of 10 patients with preoperative headache symptoms had persistent relief after surgery.^[26] However, in a separate series of 86 patients who underwent ONSF for IIH, only 8/61 (13%) of patients with headache as a presenting symptom expressed subjective improvement during follow-up.^[27] In conclusion, some patients may have an improvement in their headache after ONSF; however, the likelihood of persistent improvement is somewhat variable, perhaps due to differing surgical techniques.

CSF Diversion Surgery. Shunting procedures divert CSF to another part of the body, thereby reducing ICP. The 2 most commonly performed procedures are lumboperitoneal and ventriculoperitoneal shunts; both are discussed in detail elsewhere in this issue. McGirt et al^[28] reviewed patients over 30 years who underwent shunt placement for intractable headache due to IIH. Of note, 42 patients required 115 shunt placement procedures, an average of 2.74 surgeries per patient, with 12% of patients requiring >=6 procedures. Ninety-five percent of patients experienced significant improvement in headache symptoms at 1 month after shunt placement. Severe headaches recurred in 19% of patients at 12 months and 48% at 36 months, despite a properly functioning shunt. Patients with symptoms >2 years before shunt placement had a 2.5-fold risk of experiencing recurrent headache.

There is significant risk of complication related to the placement of shunts for IIH, including shunt failure, and intracranial hypotension and infection, requiring revision, explantation, and potentially multiple procedures. Rosenberg et al^[29] reviewed the efficacy of shunts for the treatment of IIH in 37 patients who underwent 82 shunt placement surgeries, including 73 lumboperitoneal and 9 ventriculoperitoneal shunts. Fewer than half of patients had only a single procedure, with 9 months as the average time before shunt replacement and 64% lasting <6 months.

Although shunts can be effective for immediate improvement of headache related to IIH, there is significant risk of recurrence and need for repeated revisions in long-term follow-up.

© Provided by KXAN Austin Ascension confirms layoffs in Texas

AUSTIN (KXAN) — A union that represents 900 registered nurses at Ascension Seton Medical Center said Thursday that 98% of its members authorized a one-day strike at the health system.

A strike at Ascension Seton would be the first nurses strike in an acute care setting, as well as the largest nurses strike in Texas history, according to the release from The National Nurses Organizing Committee/National Nurses United.

The release said the nurses voted Wednesday and Thursday to authorize the strike.

The union said if nurses do strike they would provide notice at least 10 days in advance.

According to the Thursday’s release, the union called the hospital management’s responses to its contract proposals “unacceptable and delayed”.

NNU said the proposals would ensure “the highest level of patient care in Austin, by improving nurse recruitment and retention so that every unit has safe staffing levels.”

In January, KXAN obtained official union complaint forms that cite instances of “inadequate training, delayed response to hospital alarms, and delayed response to crying babies.”

KXAN contacted Ascension Seton Medical Center and Nurses United for comment on this story and will update when we hear back.

For the latest news, weather, sports, and streaming video, head to KXAN Austin.

Clinical asset management in the healthcare industry now extends far beyond logging inventory. Next-generation technologies track, manage, and maintain clinical equipment in real-time to provide a comprehensive, ongoing assessment. These sophisticated software tools provide a holistic approach to clinical asset management: the quantity of medical equipment a healthcare facility has, how much it’s used, its current condition, and what risks it presents—whether because of an FDA recall or as a network vulnerability for cybercriminals to exploit.

Dozens of data points, such as manufacturing date, service history, cybersecurity information, OEM support, and downtime, do much more than provide benchmarks in the present. They can provide valuable insight if collected and evaluated in the right way. The resulting assessments can forecast critical needs, particularly during a pandemic, and guide financial decisions on procurement and reallocation. They also can help Improve clinician satisfaction and patient care.

Clinical Asset Management Can Help Overcome Supply Shortages

The ventilator shortage during the outbreak of the COVID-19 pandemic underscored just how critical the management of clinical assets is to healthcare. It also provided beneficial lessons going forward.

An accurate and detailed equipment inventory updated frequently is key to overcoming supply shortages, according to an April 2020 article in Harvard Business Review. Getting ahead of supply shortages requires forecasting the next bottleneck in the system, said the business administration and health professionals who wrote the article, and forecasting requires detailed information about available inventory. Clinical asset management (CAM) software provides those details.

Pooling to make equipment such as ventilators available to other hospitals in the network also requires details on what equipment is available and where it is. “Good information cannot magically make shortages of physical materials go away, but bad information can certainly make shortages worse,” the authors wrote. “Lack of information creates uncertainty, and uncertainty can lead to ‘just-in-case’ hoarding.”

Amid a public health crisis, CAM solutions afford the flexibility to meet the challenge head-on. During the pandemic, each piece of equipment used in the treatment of COVID-19 can be flagged with a critical response indicator to help prioritize needs for that equipment over others. COVID-19 case trends can be tracked geographically against repairs and inventories to aid planning and preparation. Parts needed for repairs can more quickly be identified, and that knowledge can expedite the search for alternative sources for parts during a shortage.

Smarter, predictive inventory management through CAM tools can help alleviate the troubles caused by supply shortages during a health crisis, which helps patients and aids staff. CAM software can help solve these and other challenges hospitals face—even challenges of a more devious nature.

How Healthcare Providers Can Improve Cybersecurity

The risk to hospitals from cybercrime cannot be overstated. Nearly seven out of 10 medical devices are projected to be connected to an online network in the next few years, according to a 2018 report by Deloitte Centre for Health Solutions.

Other research published last September in BMC Medical Informatics and Decision Making noted that many networked medical devices contain critical security vulnerabilities. More devices going online, of course, presents greater risk. “We detected a strong correlation between the degree of connectivity and the likelihood of being attacked,” the authors wrote. The researchers found many networked medical devices contained critical security vulnerabilities. “Due to these vulnerable systems in hospital networks, health care is among the most attacked sectors globally,” according to the BMC research article.

The 2017 WannaCry ransomware attack illuminated how dangerous these vulnerabilities can be. In England, for instance, the cyberattack infected more than 1,200 diagnostic devices, prompted the shutdown of other equipment to prevent it from becoming locked-out, too, and forced five emergency departments to direct patients to other medical facilities, according to an investigative report by the UK National Audit Office. Thousands of medical appointments also had to be canceled. 

The healthcare industry already struggles with cybersecurity. The industry continues to lead all other sectors in expenses tied to data breaches, according to IBM Security’s 2020 “Cost of a Data Breach Report.” For the 10th consecutive year, healthcare incurred the highest average breach costs: over $7 million in 2020.

Medical Device Security Is Key

Today’s CAM and cybersecurity technologies can flag the availability of software patches for medical devices but also monitor for vulnerabilities and detect suspicious activity. A cybersecurity solution can even provide a cyber risk score for each medical device, giving health system administrators another meaningful factor to consider in cost-benefit analyses.

Similarly, CAM solutions today can flag recall notices for each individual piece of medical equipment. Software-related recalls are increasing because of the rising sophistication of medical device technology.

Inventory reports, cybersecurity assessments and recall notifications are all part of a wider, multipoint analysis CAM solutions can provide.   

Proprietary Algorithms, Visual Dashboards, and a Comprehensive Look

With CAM solutions, proprietary algorithms and dashboards help administrators understand, visualize, and assess their equipment needs and troubleshoot problems. Using machine learning, a powerful application of artificial intelligence, the technology can weigh factors such as recalls, cyber risk, OEM support, repair needs, manufacturing date, estimated remaining life, and utilization data to recommend whether a device should be replaced, upgraded, disposed, or reallocated.

Is a device repair prone? Is it even being used? Should it be moved to another hospital? Should it be sold? This continuous monitoring of multiple factors shows not just the status of the equipment now but can predict when a machine will fail before it does so, thus avoiding unplanned and troublesome downtime.

The software provides ongoing inventory management that allows for smarter planning on capital expenditures and reduces operating expenditures. It also can reveal best practices.

Say the infusion pumps on the third floor of a hospital are having fewer issues than the same devices on the fourth floor. Are staff on different floors handling the devices differently? Better monitoring of equipment and mining of best practices can markedly extend the life of existing equipment, freeing up capital to be spent elsewhere or yielding better prices should the equipment be sold.

And yes, CAM tools today can be a godsend for healthcare staff. Nurses no longer have to spend hours out of their busy days hunting down mobile medical equipment. CAM solutions can allow hospitals to establish a process in which equipment is available, sterilized, and stored where nurses know where it is.

Clinical asset management technology today helps avoid supply shortages, lowers the risk of cyberattacks, and allocates valuable dollars where they are needed most. It saves time for healthcare providers and improves patient care.

KEENE, NH – Cheshire Medical Center has selected its new President and Chief Executive Officer.

In a news release on Monday, Cheshire Medical announced that Joseph L. Perras, MD, has been named to the position.

Perras spent the last six years as CEO at Mt. Ascutney Hospital and Health Center (MAHHC), and also served as Chief Medical Officer since 2015. Before joining MAHHC, Perras practiced at Dartmouth Hitchcock Medical Center for 12 years, where he served on the staff of Internal Medicine, and according to the release, was a founding physician within the Hospital Medicine Practice. He held various clinical leadership positions with DHMC, including section chief of Hospital Medicine and Medical Director of Care Management.

As President and CEO of Cheshire Medical Center, Perras will be responsible for “ensuring that the mission and strategic objectives of Cheshire Medical Center are achieved in an efficient, effective, and high-quality manner, consistent with the health needs of the hospital’s service area and the strategic objectives of Dartmouth Health.”

“Dr. Perras joins Cheshire at an important time in their history, and his experience as a trusted and valued Dartmouth Health leader will be instrumental. Outside the academic medical center, Cheshire is our largest healthcare member,” said Dartmouth Health CEO and President Joanne M. Conroy, MD. “Being part of Dartmouth Health enables Cheshire to provide services that far exceed those of a typical rural hospital, including extensive programs in primary care, cancer care, cardiology, orthopaedics, and public health.”

Perras will succeed former President and CEO Dr. Don Caruso, who retired at the end of May after three decades of work at Cheshire Medical Center. Perras will begin work on August 7th.

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