text:
Car 54
I wanted it to look like this car from the Museum of Transportation could still be in service, so I re-built quite a bit of the above.
If you're curious… unedited photo here (click thumbnail for full-size)… and more info below:
Mass. Bay Area Trans. Authority No. 54
Coach (Model RDC-1)
Budd; 1954
Self-Propelled, diesel-powered, built for Canadian Pacific Ry.
About this image: digital photograph; moderately modified
This entry was posted in Digital Media, Photography and tagged Digital Media, Digital Photography, Railroad, Robert Matejcek, Transportation by spilledinkguy. Bookmark the permalink.
84 thoughts on "Car 54"
Annabelle on September 21, 2011 at 12:05 am said:
It's awesome! I love this one!
spilledinkguy on September 21, 2011 at 10:00 am said:
Thank you, Annabelle!
I appreciate that very much!
Bearman on September 21, 2011 at 6:51 pm said:
I wish my wife was so supportive beyond just TELLING me in person..haha
I'm pretty spoiled, aren't I?!
(Don't tell Annabelle that, though)!
FS Photography on September 21, 2011 at 1:57 am said:
You sure did some pretty intense building up there SIG.. Very impressive indeed, and I'd certainly not have realised… Maybe you could get some work rebuilding for the rail companies, as I'm sure your methods would save them a fortune… 😉
That is very kind of you, F.S, thank you!
Hahaha… absolutely!
'I've been airbrushing for the railroads… all the live-long day…'
Syncopated Eyeball on September 21, 2011 at 2:56 am said:
I like what you did with the colours.
I was hoping the boosted yellows/reds would help create a bit of a vintage feel…
that is very nice to hear, S,E… thank you!
nursemyra on September 21, 2011 at 3:27 am said:
Car 54, where are you? 🙂
'Krushchev's due at Idlewild!'
frigginloon on September 21, 2011 at 7:47 pm said:
Damn NM, I was going to say that. Serves me right for being so friggin tardy!!!
spilledinkguy on September 21, 2011 at 7:58 pm said:
I can't believe that didn't occur to me when I titled this one…
maybe I should just pretend it's what I had in mind the whole time…
yeah… yeah, that's the ticket…
Binky on September 21, 2011 at 8:04 pm said:
Yeah, me too! You people should stop thinking like me!
frigginloon on September 22, 2011 at 4:53 am said:
and showing our age 😦
spilledinkguy on September 22, 2011 at 8:46 am said:
I'm in denial about that, so I heard nothing.
Great minds, Binky!
nrhatch on September 21, 2011 at 10:29 am said:
Hey . . . nursemyra "stole" my thought! 😀
That sort of thing happens to me ALL the time!
Laura on September 21, 2011 at 3:39 am said:
Really nice. Thanks for showing us the original — what a difference!
You are very kind, Laura, thank you!
I've had a few requests for a before/after, so I've been meaning to do this for a while now…
Debbie Adams on September 21, 2011 at 6:21 am said:
I like your over the original.
Deb xx
With so many choices it's sometimes difficult to know what direction take these things,
so I really appreciate that, Ms. A!
ceceliafutch on September 21, 2011 at 6:44 am said:
Reminds me of my young childhood MANY years ago. On two different occasions Mom dressed my brother and me up in our Sunday best, and we took the train from Doyline, LA, to Louisville, KY, to visit my grandparents. Wonderful memories. Great shot.
Those really do sound like wonderful memories!
I've never ridden on a train (other than a very sort trip around a yard once), but I imagine that would have been quite a lot of fun! I think there's just something inherently fascinating about trains…
nigel on September 21, 2011 at 7:39 am said:
I find it interesting that you included the 'post' that partially blocks the train…
The rehearsed answer would be something like,
'I wanted this to be about the experience of waiting on a platform'…
the real answer is more along the lines of,
'Not enough distance between the edge of said platform and the train to get much into the shot (with the lens I have, anyway)'… (not a very glamorous answer, is it?)…
Syncopated Eyeball on September 21, 2011 at 6:26 pm said:
Haha! You are a real treat, SIG!
I'm 'something', aren't I!
Lenore Diane on September 21, 2011 at 7:56 am said:
NurseMyra beat me to it….
"Car 54, where aaaare yooou?"
I like this picture. Love the rust/orange colors.
'Brooklyn's broken out in fights'
You know, I don't think I've ever seen an episode of that show… I recognized the reference right away, though!
Thank you very much, Ms. D… that is very kind!
You both beat me to it, Lenore!
The early bird gets the worm . . . I just get another cup of coffee.
I'd happily settle for some caffeine… I think I'm out at the moment! Yikes!
Nice job on the editing, too. Your unedited shot was a good shot (obviously, because you need a foundation from which to edit), but your edits certainly improved the train.
I am very happy to hear that, because I tend to get carried away with these things, you know!
And with so many choices… the possibilities are nearly limitless.
Thank you very much, Ms. D.!
Tori Nelson on September 21, 2011 at 8:41 am said:
I suppose I'm just weird (no surprise there) but I LOVE the look of rust. Things get better with age, right?
I guess we're both weird, then, Ms. N…
Oxidation does some pretty fascinating things, I think!
Plus there's that whole history / decline thing going on…
so… totally!
youngamericanwisdom.com on September 21, 2011 at 10:56 am said:
Wow! I love the rusty quality. Great job!
Thank you so much, Y.A.W…
I 'loves me' some rust, you know!
frizztext on September 21, 2011 at 12:05 pm said:
I love your stylish retro / sepia compositions!
spilledinkguy on September 21, 2011 at 12:22 pm said:
That is very kind of you to say, sir!
Redneckprincess on September 21, 2011 at 12:19 pm said:
Sweet!!!
I really appreciate that, RNP!
Megan (Best of Fates) on September 21, 2011 at 1:52 pm said:
I totally bought it – at first I thought it looked just like photos I take of the metro!
That's awesome, Megan – just what I was hoping for!
elmediat on September 21, 2011 at 2:54 pm said:
Excellent processing.
Waldo : "Car 54 I found you !"
Blast! I thought my hiding spot would last me at least through a nap!
Unapologetically Mundane on September 21, 2011 at 3:31 pm said:
Wow, seeing the unedited one just makes this one all the better. I love the colors, and making the angle upright just . . . I don't know . . . makes it an entirely different picture!
I kind of wanted to write "boo" or something on the Facebook one as joke but figured I should keep my comments neutral to supportive . . . for now.
That is wonderful to hear, U.M… thank you!
The colors and distortion were the quick part… airbrushing out the rope and re-building the boarded-over window took a while though.
HAHAHA… well, as soon as FB puts in a 'Boo this post' button please feel free to use it!
Tony McGurk on September 21, 2011 at 3:59 pm said:
One thing I miss since moving back to Tasmania is going for train rides. We only have freight trains here. Comparing the unedited photo you sure do a great job of them
I've never actually been on a real train ride before, but I love all things train.
Thank you so much, Mr. M. – you are very kind!
wordsfallfrommyeyes on September 21, 2011 at 4:07 pm said:
You're really clever – this is great. A really old time feel.
That is wonderful to hear, thank you!
And thank you very much for stopping by as well – I really do appreciate your kind comment!
jacquelincangro on September 21, 2011 at 6:46 pm said:
I liked seeing the difference between the original photo and the retouched photo. Really cool edits!
I'm very happy to hear that!
I haven't been doing much of the before and after stuff, but I've had a few requests so I thought it would be fun to give it a try!
thedailydish on September 21, 2011 at 6:50 pm said:
So interesting to be able to see the before and after shots. Both quality images, but you've made the 2nd POP! Too cool.
That is very kind of you (as always), Dishy – thank you!
As you can tell I have way too much fun with Photoshop… it's almost wrong!
Would have been cool seeing a person screaming in the window 🙂
I decided to take that out…
(I'm not as photogenic as I'd hoped…)
milkayphoto on September 21, 2011 at 8:05 pm said:
I like what you've done here. The aged tones work so well!
Thank you very much, M.P…
as you know I'm a sucker for anything vintage / retro (which explains this… attempt)!
Nice to see the original; I'd believe the picture was taken at the station. Car 54, going to. . .
I'm very happy to hear that, sir! Thank you!
Hahaha… I might make a stop at the bakery first, though…
jb on September 21, 2011 at 9:19 pm said:
Not what i was expecting.I was expecting to say where are you. but you did a fine job on this one.
Hahaha… I've got to keep everyone on their toes, you know!
Thank you very much, sir!
conspiracyofravens on September 22, 2011 at 5:20 am said:
what a makeover, really like the vintage feel! i reckon you didn't use any editing software, you've simply put the original through a time machine. 🙂
BLAST! You are onto me, COR! Now everyone is going to want to 'borrow' my time machine!
Journey Photographic on September 22, 2011 at 9:12 am said:
Your edit works wonders on this shot – very nice indeed!
That is very kind of you to say, J.P…
Scholar Mel on September 22, 2011 at 1:04 pm said:
Your edited version looks much better.
PS: I hope you are now able to access my site without a redirection.
Thanks very much, Mel!
I'll check it out!
Chris Watkins on September 22, 2011 at 1:11 pm said:
I've been trying for AGES to figure out how to leave comments on your posts, Robert. Maybe I just didn't scroll down far enough. In any event, I just wanted to say that I absolutely love your photographs. You have such a wonderful eye. Now that I know how to comment, I should be doing so more often. 🙂
Very understandable – it sure doesn't help matters the comment link is uber tiny, gets lost in tags and is a bit vague to begin with!
That is very, very kind of you, Mr. W! I sincerely appreciate it, sir!
MC/Curtis on September 23, 2011 at 1:31 pm said:
It's Car 54! Ha…
It looks cool. To me it looks like it's sitting out in a junk yard but I like that.
I'm glad it's in a museum though. I wish they'd do something with ALL the old ones but at least this one found a second use.
I think they should park the old ones on an abandoned track and convert them into apartments and call it Train Town.
Hahaha… Train Town has a very nice ring to it!
Other than the living accommodations, this museum is very much like that…
long sections of track just filled with parked locomotives, cars and railroad stuff… it's a very cool place!
jakesprinter on September 24, 2011 at 3:43 pm said:
I like the way how you create this picture excellent sir.:)
Thank you so much for your kind comments – I appreciate that very much!
Androgoth on September 25, 2011 at 6:46 pm said:
It is truly a wicked photograph my friend 🙂
Androgoth
I'm very happy to hear you liked this one, A.G…
I had a lot of fun working on it!
Hjortur Hjartarson on September 26, 2011 at 8:41 am said:
This one would make a fine poster at a cafe place
That is very kind of you!
Thanks so much, Mr. H… now I'd better go find some coffee!
Juana on October 1, 2011 at 9:34 pm said:
It's amazing how you alter photos! I am ready to go on board that #54!
spilledinkguy on October 1, 2011 at 10:10 pm said:
I'm happy to hear that you like this one, Juana (I was afraid I was posting too many train images for everyone's liking lately)!
Juana on October 2, 2011 at 10:01 pm said:
Your work is always very original- even if you repeat the subject. So don't worry- keep on trucking… I mean, training! 😉
spilledinkguy on October 4, 2011 at 9:22 am said:
You are so kind, Juana!
Thank you! I like trains quite a bit, but I was hoping I wasn't relying on them too much recently!


text:
tag 'ehr adoption'
Current selected tag: 'ehr adoption'. Clear.
How to Choose the Right EHR Vendor for your Practice
From www.talkehr.com -	March 26, 12:30 AM
Electronic Health Records (EHR) Software has gained considerable attention from practices worldwide due to its innumerable advantages. EHR's are built to provide an organized, accurate, and cost-effective documentation process. Using one saves time and reduces paper work drastically, thereby enhancing productivity. But, finding the EHR system that best suits your practice and also installing it correctly are two major challenges that you are likely to face before reaping the real benefits of an EHR. So, before you go further with your EHR planning, let's first have a look at some important pointers to keep in mind while looking for the best EHR vendor.
There are so many EHR vendors waiting for a chance to gain your business. They all offer attractive service packages and discounts to make their product seem the most attractive. But, they can't all be the best in actuality, so it's important that you consider some critical questions. These questions will equip you with sufficient information about the vendor and will help you make an informed decision. Below are the primary items we'd recommend you think through before going forward:
Tips for Choosing the Right EHR Vendors for your Practice
Compatibility and Reliability
If you are used to evaluating vendors on a regular basis, then you would be aware of the requisites of the vendor selection process. But for those not accustomed to this, the first step is to determine that the EHR system in question is compatible with your company's infrastructure. For that, a trusted and reliable vendor should be chosen who has a solid history, including an impeccable service record. Customer reviews say a lot about a product or a service and are worth looking into.
Meaningful Use (MU) Criteria
There are certain criteria that'll help you shortlist a vendor. The EHR incentive program has set the meaningful use criteria specifically for the EHR systems, so look to this as a priority. It is a common feature found in EHR systems, but the latest one is the MU3 category. We would recommend that you make sure your new one has this.
Aligned Core Values
You want an EHR system made specifically for the management of healthcare-related information and organized for proper documentation. But, it should also align with the needs and values of your practice (a.k.a. customization options). The vendor should be willing to design a unique service package that suits your core operations, too.
Impressive User Experience
Although this is not the number one priority list, it's still important to keep in mind when picking the right EHR system. A system with a confusing workflow that isn't intuitive won't work. Ignoring this would be a mistake. Make sure you and some team members of your practice try it first to confirm whether it's the right fit from a usability perspective.
These are some of the key characteristics to think through. Before stepping into the market, do some homework and shortlist all the potential EHR vendors that seem to carry potential. Then, conduct some research on each one of them to narrow down your list. These steps will save you time while guaranteeing, to a great extent, the trustworthiness of your vendor and effectiveness of your decision.
Technical Dr. Inc.'s insight:
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com
Physician viewpoint on How to remove 'stupid stuff' from EHRs
From www.beckershospitalreview.com -	January 21, 11:30 PM
It's time to cut unnecessary work from the EHR, according to a perspective in The New England Journal of Medicine by Melinda Ashton, MD, a physician with Hawaii Pacific Health in Honolulu.
In the article, Dr. Ashton describes a program she and her colleagues launched in October 2017, called "Getting Rid of Stupid Stuff." In an effort to engage clinicians and reduce burnout, the program team asked all employees at the healthcare network to review their daily documentation practices and nominate aspects of the EHR they thought were "poorly designed, unnecessary or just plain stupid."
Along with fielding nominations from physicians and nurses, the team also conducted its own review of documentation practices, and removed 10 of the 12 most frequently ignored alerts the EHR pushed to physicians. The team also removed order sets that had not been used recently.
Dr. Ashton acknowledged the specific changes likely aren't relevant for other hospitals, but she advocated for the shift in mentality the "Getting Rid of Stupid Stuff" program initiated. "It appears that there is stupid stuff all around us, and although many of the nominations we receive aren't for big changes, the small wins that come from acknowledging and improving our daily work do matter," she wrote.
Here are four of the categories Dr. Ashton and her colleagues deleted from the EHR as part of the program:
1. One nurse who worked with adolescent patients asked to remove a physical assessment row labeled "cord," meant to reflect care of the umbilical cord remnant in newborns. The row, which was supposed to be suppressed for those older than 30 days of age, had still been present for other ages.
2. A nurse who cared for newborns said she had to click three times whenever she changed a diaper, as a result of EHR documentation for incontinence requiring the clinician to indicate whether the patient is incontinent of urine, stool or both. The team created a single-click option for children in diapers.
3. Multiple nurses highlighted the frequency of "head-to-toe" nursing assessments, which they are expected to complete upon assuming care of each patient. However, in some units, the EHR prompted nurses to document several of these assessments during a 12-hour shift.
"We sought to identify standards in the literature and found that some of our practices were in keeping with those standards," Dr. Ashton wrote. "In other units, we reduced the frequency of required evaluation and documentation."
4. An emergency medicine physician questioned why the EHR prompts employees to print an after-visit summary before scanning it back into the system. He hadn't noticed the patient was expected to sign the summary, which was stored in the record.
"His question led us to query other health systems and our legal team about the value of the signature, and we were able to remove this requirement," Dr. Ashton wrote. "The physician was delighted that he had been able to influence a practice that he believed was a waste of support-staff time."
Pediatric EHRs Must be Treated Differently
From www.optimumhit.com -	October 25, 2018 3:30 PM
When it comes to healthcare, there are many different types of facilities and settings. There are acute care hospitals, specialty care hospitals, nursing homes, long-term care facilities, ambulatory care centers, surgical centers, outpatient clients, physicians' offices, rehabilitation centers, pediatric care hospitals, and many more. What all of these different care settings have in common is that they most certainly benefit from some form of electronic health record (EHR) software, each with their own specific needs. What they do not have in common, is the type of patients or type of care they provide. Pediatric patients and healthcare facilities require the right approach to install their Pediatric EHR.
An acute care hospital's primary task is to provide short-term care for people with varying degrees of health issues. These usually stem from injury, disease, or genetics. They are open 24/7/365 and bring together physicians from varied specialties, a skilled nursing staff, technicians, and specialized equipment. Most hospitals offer a wide range of services including emergency room, labor and birth, scheduled surgeries, and lab work. Acute care hospitals utilize standard EHR software where each department has a specific module with tailored functionality to meet their needs.
The difference between the standard acute care hospital and pediatric care hospitals is, of course, the patients. Though it may seem obvious, teams in pediatric facilities must recognize that infants, children and those with special needs are not merely small adults and they cannot be treated as such. Caregivers must pay additional attention to how they interact with pediatric patients and their families. Bedside manner, psycho-social considerations, and family dynamics have to be considered during the course of care. In many respects, the Pediatric EHR must be treated the same.
Pediatric facilities have unique requirements that dictate many aspects of their EHR software adoption. Hardware and device placement have unique needs to facilitate documentation where the patient is – many times patients aren't located in their bed or assigned room. Specific attention and adherence to isolation requirements are vital. Also, close attention should be given to screen visibility to include parents or other approved family members engaged in care planning, patient teaching, and patient education. Consideration is also given to the multi-disciplinary care team engaged with a pediatric patient – case management, social work, therapies, child life services, etc.
Hospitalizations are essential for both adults and children. How a healthcare organization chooses to treat them is even more critical. Pediatric organizations require special machines, special tests, special nurses, special doctors, and more importantly SPECIALIZED Pediatric EHR software systems. While the primary objective for healthcare organizations is to provide high-quality patient care, they must also make money. Reimbursement rates continue to decrease which calls for consistent best practices for both hospitalized adults and child to ultimately reduce the length of stays. Effective and efficient use of the EHR coupled with the power of the data it provides is crucial to patient satisfaction and improved care. Additionally, healthcare organizations can save money and improve patient care by partnering with healthcare IT consulting companies who have the knowledge and methodologies to ensure that when an EHR is implemented, no matter the setting or patient type, it will be done correctly.
Whether it is a standard acute care hospital or a specialized pediatric hospital, Optimum's expert resources recognize these needs and facilitate incorporation of the "triangle of care" – meaning patient, family and caregiver/device. In the majority of our activations, we have provided expert support for pediatric inpatient settings, PICU settings, Leve 2, 3 and 4 NICU's, Pediatric Trauma and Emergency Room settings while implementing their Pediatric EHR.
While preparation is undoubtedly a key ingredient for success, all the planning in the world can yield minimal results if you don't have the right people in place to execute the plan. In addition to the years of experience Optimum brings to the table, we also specialize in allocating the right resources – the right people – for your project at the right time. Optimum Healthcare IT uses its SkillMarket portal to not only manage your go-live resources, but to optimize resources based on your needs, their skillset, and geo-location.
Our commitment to your needs ensures that your implementation will be successful throughout your planning, go-live, stabilization, and optimization. And once you make it through the arduous task of implementing an electronic health record, the challenge then becomes sustaining it and meaningfully using it. Optimum Healthcare IT has the best team in the business.
The Changing Healthcare IT Consulting Landscape
From www.dc-associates.com -	August 21, 2017 6:10 AM
The last several years of healthcare IT consulting, specifically around EHR implementations, has been busy and fruitful. For a period of time there, it seemed that anyone who could both breathe and type would be hired on, trained, and thrown into the fire, working at a feverous pace to digitize our Nation's medical records. Largely, this onslaught was driven by the financial incentives of Meaningful Use – get up on an approved medical record system, hit specific targets, by specific dates, and reap large financial rewards. The incentives were highly effective and as a result the vast majority of US hospitals are now utilizing some form of electronic health record solution. But there is a murmur out there: "what's next?"
To begin, two significant dates come to mind. The first date was May 25, 1961, when President Kennedy committed to having a man on the moon by end of the decade. To many it was an impossible goal. Something that seemed so absurd considering we had only just witnessed the first American to orbit the Earth some 20 days prior. The next 8 years were filled with collaboration, heavy investments, long hours, and much ingenuity, which all culminated to the first human to walk on the moon on July 20, 1969.
The second date was January 20, 2004, when President Bush, during his State of the Union address, announced his vision for the majority of American enjoying the benefits of computerized medical records within 10 years. Here we are, 10 years later, and the majority of Americans are provided care at a facility that utilizes an Electronic Health Record. The parallels between the two announcements and efforts are apparent – unbelievable amounts of money were invested and an innumerable number of people were involved in realizing the vision, similar amounts of time were allotted, and both meant accomplishing something that seemed impossible. In both cases we were successful. We successfully landed on the moon by the end of the 60's and today the majority of Americans are provided care at a facility that utilizes an EHR.
We've accomplished what we've set out to do. Sure, not all facilities are utilizing an EHR yet, and not all that are using an EHR are yet meeting "meaningful use guidelines", but for the most part, the big push is complete. The big question that looms is: what's next? And this question is one that riles many who were involved in this great undertaking. It's alarming and concerning to know that what you've become accustomed to will be changing – demands of great effort and great ingenuity working tirelessly to discuss, plan, build, configure, test, train, implement, and support, and then repeat and repeat again – this will be changing. But this is the nature of IT. Without successfully completing our mission, would be akin to Neil Armstrong not taking the first step onto the Moon. But as with NASA, that first step wasn't the last one either, but the beginning of what would become its greatest era with the likes of the Hubble Space Telescope, Space Shuttle, and Rover programs.
I believe that this is just the beginning of a more exciting time for healthcare IT. That the real bread and butter, the real pleasure from the work we do, and the real benefit to patients is just beginning. Now that the majority are utilizing an EHR, we can now leverage the efforts and investments through optimization, integration, and interoperability. Through optimization, we can make the experience more effective for both the clinician and the patient. Through integration with other health software, we can extend the capabilities of the EHR further using the EHR as the jumping off point. And through interoperability it's easier to share patient information when it's needed the most; no more burning CDs with images or faxing results.
About the only tangible benefit of utilizing an EHR over a paper based documentation system is legibility; it's not having an EHR that matters, rather it's how the digital bits of information are used and leveraged that makes the difference. Walking on the moon did very little for us, it's what it took to get there, what it represented, and its ability to make us realize our potential that mattered most.
It's important that we never stop progressing, that we never settle down and accept status quo. We must continue to innovate.
Moving to an EHR from a paper based documentation system should never be the end goal but rather the means to getting there. As a healthcare IT professional, your continued success will be in driving this progress forward. Continuing to look for opportunities – by recognizing issues when they present themselves and developing solutions, continuing to develop yourself through continuing education and certifications, and networking with other professionals. The possibilities are endless really, and now is the time when we get to see the real benefit of this investment. Now is the time for leverage.
Can True EHR Customization Help Physician Practices Survive?
From ehrintelligence.com -	February 3, 2015 5:39 PM
In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.
It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.
Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today's world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.
This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from "corporatized" healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.
Capable and cost-effective?
So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government's evolving mandates that regulate healthcare record-keeping.
In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.
And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way, and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence 'Rusty' Hofmann in The Huffington Post, describes it, "EHRs are like Model T Ford: Any Color You Want As Long As It's Black." The majority of these solutions hitting the market today just don't cut the mustard when it comes to really addressing the needs of our country's doctors and healthcare practices.
Furthermore, while the creators of many of these packaged EHR solutions claim to be "customizable," they are actually merely "configurable." Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.
These solutions also require heavy reliance on a computer screen, which often hinders a doctor's ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.
Diversity and true EHR customization rule
So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.
In short, it is crucial that developers of these software tools accommodate doctors' needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.
This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.
Functional Limitation Reporting in Your EMR
From www.emrnews.com -	January 27, 2015 12:02 PM
There are a lot of myths, misconceptions and fears about functional limitation reporting. The bottom line is that clinicians who see Medicare patients after July 1, 2015 must use functional limitation codes on their documentation for the initial evaluation, at least once every 10 visits, and at the time of discharge or they won't get paid.
All practitioners need is an EMR system that prompts them to select one of the functional limitation measures and the goal codes at the appropriate time. It's then a simple matter of sending the claim to the clearinghouse and on to Medicare for approval and payment. Functional limitation reporting is essentially a goal-oriented process.
The judgment of the physical therapist is critical in meeting functional limitation reporting requirements. Therapists will need to document the patient's condition at the initial visit, the selected treatment plan, severity of the client's limitation and the expected outcome when therapy is completed.
In Touch EMR™ provides clinicians with prompts for all the information, G-codes and modifiers needed and at the appropriate times to remain within compliance. The data automatically goes into the patient file for transmission.
Supporting Evidence
Documentation to support every decision, measure taken and treatment is critical. Therapists must maintain a record of the patient's level of function upon their initial visit using their best clinical judgment, combined with the information obtained from the patient.
Listen closely to what the client says and observe their range of movement to accurately select the level of severity under which they're functioning. Meticulous records are necessary to document the condition of the patient at each treatment session and when the patient is discharged from further therapy. The process begins again if further treatment is required.
The EMR clinicians choose should have the ability to prompt them at the three major checkpoints of functional limitation reporting – initial evaluation, the 10th visit, and at discharge. In Touch EMR™ provides practitioners with that functionality, making it easy to remain in compliance and get paid.
Direct Reimbursement Solutions's curator insight,	June 29, 2015 1:22 PM
Make sure your biller knows the ins and outs of FLR!
Docs urge big changes to health records program
From thehill.com -	January 26, 2015 10:49 AM
A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.
Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.
"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.
"Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers' needs, patient safety, and product innovation," the letter stated.
The coalition called on regulators to decouple the certification of electronic health records from Meaningful Use, which imposes a timetable for EHR adoption and a series of penalties and incentives based on doctors' compliance.
The groups also asked the Office of the National Coordinator to reconsider alternative software testing methods and to incorporate stakeholder feedback on a variety of technical matters related to Meaningful Use.
The healthcare world has been struggling with the migration to digital records, arguing that the Meaningful Use standards are hampering their ability to deliver good care.
Advocates for Meaningful Use argue it is helping speed the transition to EHRs, which will ultimately boost care and prevent deadly medical errors.
The program has undergone several delays as doctors and hospitals fail to attest to its various stages.
Latest MU Results Offer Something to Ponder
From www.healthcare-informatics.com -	January 19, 2015 11:06 AM
When is a surprise not a surprise? That might be a question to ask some of the Doubting Thomases in healthcare and healthcare IT these days. Because, honestly, when the initial meaningful use Stage 2 attestation numbers came out late last fall, the sense of "I told you so" was fairly strong among many in healthcare. As our Senior Editor, David Raths, reported in November, a number of healthcare association leaders noted that the fact that only 840 hospitals had attested to Stage 2 at that point, and many were ready to declare the entire meaningful use process a failure.
And many had very legitimate concerns, given the level of challenges providers have been facing going into and through Stage 2. But I will say that I, for one, had always trusted the industry observers who had expected most attestations to come at the very last moment. And that is exactly what's happened.
As David Raths reported on Jan. 14, "With one month left in the 2014 reporting period, 77 percent of hospitals eligible to attest to Stage 2 of the meaningful use program have already done so, according to figures presented at the Jan. 13, 2015, HIT Policy Committee meeting." As he further reported, "Concerns about low attestation rates earlier in 2014 may have been mitigated by two factors, explained Elisabeth Myers from the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid. First, most eligible hospitals tend to attest after their fiscal report year closes, and that held true this year… Second is the fact not all hospitals and providers are eligible for Stage 2 in 2014." And as Paul Tang, M.D., the committee's co-chair, noted, the phenomenon of hospitals waiting until the end of the fiscal year is tracking with a pattern from previous years.
So the plain fact is that more than three-quarters of the hospitals eligible to attest in 2014 have now done so. And that's a good thing. Are they facing an uphill battle going into 2015? Absolutely. Will some fail to make it successfully to and through Stage 3? Quite possibly.
But it's important to consider that, in the context of this arduous journey of meaningful use, this 77 percent statistic is significant, and should not be minimized.
Meanwhile, it is interesting to note that only 200 hospitals will see payment adjustments as of this moment, and the number set to get adjustments of more than $5,000 is going to be quite small.
So as challenging as everything looks right now, there is definitely reason for a very cautious flavor of optimism. While this is no time for early victory laps, perhaps things in MU Land are not as dire as some of the Debbie Downers might have led us to believe, either.
And then of course, Stage 3 is now very much on the horizon. As Jeff Smith of CHIME noted earlier this week, "Stage 3 proposed rules are currently under review at the Office of Management and Budget (OMB)—the last step before being released for public comment." And, Smith noted, "The Stage 3 Notice for Proposed Rulemaking (PRM) process is the most likely vehicle CMS and the Office of the national Coordinator for Health IT (ONC) could use to make changes that CHIME and other stakeholders have been advocating. This is the best chance," he added, "to make substantive changes to meaningful use and revive an ailing program."
So we'll see what happens. Doubtless, the next several months will be pivotal for the meaningful use program going forward. So stay tuned. And keep your powder dry.
Amazing Charts Releases 2015 Predictions for Medicine and Technology
From emrdailynews.com -	January 14, 2015 1:49 PM
Amazing Charts, a leading developer of Electronic Health Record (EHR) systems for physician practices, today issued its healthcare predictions for 2015.
1. Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end Concierge Medicine, and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.
2. Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.
3. EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.
4. Wearable Health Devices Empower Patients: Led by FitBit, the market for mobile health monitoring devices saw explosive growth in 2014. Now Apple is entering the scene, and 2015 promises to see even more apps and devices introduced to consumers. How the government regulates these devices may depend on how they are marketed. For example, a glucometer could be unregulated if the intent is for a user to monitor blood sugar levels for better nutrition. If the same glucometer is marketed for monitoring diabetics, however, it may be more strictly regulated as a medical device.
5. EHR Interoperability Still Around the Corner: While all EHRs will not be able to seamlessly communicate in 2015, the core infrastructure for increased data liquidity will largely be in place. The data standards of the CCDA and its predecessor, the CCD, are increasingly used by EHR vendors. In addition, Meaningful Use Stage 2 mandates that patients can receive a digital summary of their own records on demand. These positive steps forward will combine in 2015 to get us closer to the promise of data interoperability.
6. EHR Switching Accelerates: Many practices selected an EHR system lured by the promise of Meaningful Use incentives and now find themselves dissatisfied with their decision, primarily because the solution is not user friendly and slows them down. Despite barriers to switching systems, we will witness a mass conversion of solutions toward EHRs that better meet providers' expectations and requirements.
7. The Doctor Will NOT Be In: In 2015 and beyond we will see reimbursements drive the "virtual" appointment, whereby health plans will reimburse clinicians for online patient visits. Patients and their providers will connect over virtual platforms for scheduling, reviewing test results, writing prescriptions, etc. As they do, more and more insurers will follow suit as technology advances and claims its place in the doctor's office.
What Happens When An EHR Vendor is Acquired?
From www.emrandehr.com -	January 13, 2015 10:38 AM
With meaningful use money running out, and as the EHR industry matures, we're going to see more and more consolidation in the EHR market. Many EHR vendors are going to start running out of money. Other larger EHR vendors are going to want to try and buy up market share. In some ways this has already begun. See Greenway being purchased by Vitera Healthcare Solutions and Cerner acquiring Siemens to name some of the larger ones that have happened recently. Although, anyone that's been a user of Bond EHR (people still miss that EHR software), Allscripts MyWay, Misys, etc etc etc knows the challenges of when your EHR vendor gets acquired.
While your EHR being acquired by another EHR vendor is almost never a good thing for your EHR software's future, L Nelms visited this post on EMR and EHR News and offered an even worse story of an EHR being acquired and the fallout the doctors felt. I've removed the name of the vendors since the principle could apply to many vendors that get acquired.
After completing Stage one of Meaningful Use, I am now dropping out of the whole damn thing. This decision is based entirely on my continued dissatisfaction with the EMR program I chose. I started using EHR Vendor A in 2012. As many know, EHR Vendor A was subsequently bought by ABC corporation who refused to honor the original contract which promised no additional fees. ABC corporation, knowing that they had customers "right where they wanted them" — knowing that switching programs would incur tremendous costs and disruption to the practices' work flow, immediately imposed a $250.00 monthly "support fee", requiring automatic payments from the customers credit card. I do not know what constitutes "support" from this company, as I had problems with the program and attempted to contact them numerous times from Nov 19, 2014 to Dec 9, without a SINGLE reply in any form from them. On Jan 1, 2015, they increased this fee to $300.00.
They continue to inundate us with newsletters telling us how wonderful they are, including an alert urging us to "respond today" to arrange to get the new certified software installed. This was sent on Christmas Eve! They warned us repeatedly that we must be using the new software ON Jan 1,2015, in order to meet MU. What they didn't mention until the day before the install, was that there is a "one-time installation fee of $99.00″ (charged immediately, of course, to you credit card).
I asked if I could do the install myself and was told "yes, but we're not really charging for the install, we're charging for the SQL server update (which actually can be done oneself ). But I was told I had to pay. And now, the new certified software, which is COMPLETELY different from the previous version, is a nightmare. It is agonizingly slow, painstakingly labor intensive, and heaven forbid I should require tech support who, on top of being nowhere to be found, are so disrespectful (the last one one I spoke to actually said — when I expressed my dissatisfaction with not being able to get my data when I terminate my contract — "well we didn't force you to buy our program"
Which doesn't explain why I feel so violated…..
I should clarify that my data from EHR Vendor A is "available": after many cryptic replies from them over several days, I was finally told that I can access the data from the server, but then — and you all know the story– I must take out a second mortgage on my home to have the data converted to some semblance of a usable format. This may not be illegal (only because the the recklessness of the companies has not yet been regulated), but it is certainly of questionable ethicacy
I think this is a fear that many doctors have when selecting and purchasing their EHR software. It's why many of them still choose to go with the big name EHR vendors. Stories like this one scare doctors away from a small EHR vendor with an uncertain future. Although, I've written previously about the uncertain future of large EHR vendors as well.
The EHR industry should do better than this. I hope this story is an aberration, but I'm afraid we're going to see more and more stories like it as the EHR industry consolidates. There will still be many good EHR actors out there that are appalled by these stories like I am. Hopefully, more and more doctors will find those good actors who are sincere in their efforts to provide a quality product with a quality user experience for the doctor. They're out there, but bad actors like what's described above give the good apples a bad name.
EHR Technology Patent Lawsuit Deemed Abstract, Ineligible | EHRintelligence.com
MyMedicalRecords has failed in an EHR technology patent lawsuit brought against numerous competitors, according to an Electronic Frontier Foundation report.
The court's ruling applies to a consolidation of cases with MyMedicalRecords as the plaintiff and the following as defendants:
Walgreen Co.
Quest Diagnostics, Inc.
WebMD Health Corp; WebMD Health Services Group Inc.,
Jardogs, LLC; Allscripts Healthcare Solutions, Inc.
United States District Judge Otis D. Wright, II, concludes that the MyMedicalRecords '466 in patent ineligible on the grounds that it pertains to "long-known abstract idea."
Following the application of a test from a related patent case (Mayo Collaborative Servs. v. Prometheus Labs., Inc.), Wright takes particular umbrage with the eighth claim of the MyMedicalRecords complaint because it lacks "inventive concepts":
Claim 8 recites a method for providing a user with the ability to access and collect personal health records in a secure and private manner by: (1) associating access information with the user to access a server storing files; (2) providing a user interface; (3) receiving files at the server from a health care provider; (4) receiving requests through the user interface; (5) sending files; and (6) independently maintaining files on the server. All six of these concepts are routine, conventional functions of a computer and server and therefore broadly and generically claim the use of a computer and Internet to perform the abstract purpose of the asserted claims.
According to Wright, the remaining claims similarly fail in adding anything of significance to the abstract idea of securing and sharing information.
Ultimately, the US District Court of the Central District of California sided with the defendants and their granted their motion judgment "without leave to amend." For its part, MyMedicalRecords is still boasting a large patent portfolio that remains unaffected by the court order.
"MyMedicalRecords, Inc. will continue to pursue opportunities to monetize its 13 U.S. patents with more than 300 existing claims where appropriate in the burgeoning health information technology marketplace," the company said in a public statement following the ruling.
As Adi Kamdar of EFF reports, the litigation being pursued by MyMedicalRecords works against meaningful use requirements that demand eligible providers perform each one of the activities listed by Wright.
"It falls in the category of threats from patent holders who decide to go after companies for abiding by new rules or regulations—doing so, they allege, infringes one or more of their patents," he writes.
Without EHR technology certified to support, these providers would have limited options for selection EHR and health IT systems. For those opposed to "patent trolling," the case of MyMedicalRecords raises questions about the patent application and acceptance process.
What Gets Measured Gets Managed - HITECH AnswersHITECH Answers
From www.hitechanswers.net -	January 12, 2015 10:15 AM
Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I'll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can't deny that data doesn't lie and when we measure data, we can manage it.
Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group's practice manager was new to the organization and tasked with the responsibility of managing the eligible providers' progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.
The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn't sure if they could meet the patient engagement requirements and she didn't know where they stood with the newly introduced objectives.
She asked for support through her network and found me.
Data > Information > Knowledge
I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)
I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).
They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.
We had 90 days to turn this around.
Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.
Meaningful Use is a team sport, after all.
The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.
We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.
With each week's reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.
Getting Creative with the Portal
In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.
Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.
They even told patients what to say:
Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]
This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.
The First Big Win
Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.
Their main focus on closing out the year was to keep up the good work.
Non-Percentage Based Objectives
Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.
1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.
2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.
AMA Lists EHRs, Meaningful Use, ICD-10 as Top 2015 Challenges
From ehrintelligence.com -	January 8, 2015 3:08 PM
The New Year's celebrations may be dying down this week as the healthcare industry gets back to work, but the American Medical Association (AMA) wants providers to keep a watchful eye on ten major challenges that they will face during the year ahead. From ICD-10 to meaningful use to improving population health management and chronic disease care, the AMA list highlights some common complaints.
At the top of the list is a familiar refrain: the ongoing burden of regulatory initiatives such as meaningful use that have frustrated physicians for years. The AMA has long advocated for changes to the program, and plans to "intensify" its efforts to push CMS towards greater flexibility for the program, especially after more than 50% of providers were notified that they will be receiving Medicare payment adjustments in 2015.
The overly-strict requirements of the EHR Incentive Programs "are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden," AMA President Elect Steven J. Stack, MD said in a statement.
Coupled with meaningful use is the AMA's other nemesis – ICD-10. While the organization has tried everything from a Twitter rally to Congressional letters to industry appeals in order to continue delaying the code set indefinitely, the new list of challenges takes a bit of a different tack. Instead of reiterating the AMA's opposition to the codes, the list simply says that the AMA "has advocated for end-to-end testing, which will take place between January and March and should provide insight on potential disruptions from ICD-10 implementation, currently scheduled for Oct. 1."
"Given the potential that policymakers may not approve further delays, ICD-10 resources can help physician practices ensure they are prepared for implementation of the new code set," the section continues, which is some of the mildest language the AMA has used about the ICD-10 transition for some time.
Is there a little hint of resignation to defeat now that Congress itself has backed the 2015 implementation date, or will the AMA continue its lengthy fight until the very end? The degree to which the AMA pushes resistance instead of readiness over the next few months may impact how many providers are prepared for the deadline and how many continue to pin their hopes on a postponement.
Other items on the list that will impact physicians in 2015 include the rampant abuse of prescription medications, the spread of diabetes and heart disease, and the need to adequately modernize medical education and the AMA's Code of Medical Ethics.
The list also highlights the need to continue medical research and the sharing of clinical knowledge, to which end the AMA is launching JAMA Oncology, a new journal in its network of publications. Physician satisfaction and the financial sustainability of medical practices is also on the AMA's mind as it beta tests professional tools to help physicians chart a profitable course for the future.
To round out the top ten issues for the healthcare industry in the coming year, the AMA includes the need for reform to the Medicare physician payment system after the latest temporary Congressional SGR fix in April, the need to ensure adequate provider networks for patient care, and upcoming judicial rulings on healthcare-related issues such as liability, patient privacy, and the regulation of practices by state licensure boards.
Getting the Most Out of Your EHR
From pivotpointconsulting.com -	February 21, 11:30 PM
No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.
8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and trainings can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.
EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.
EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.
Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA's Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.
Pro-Active EHR Optimization is a Necessity
From www.optimumhit.com -	November 25, 2018 11:30 PM
Everyone knows that routine maintenance is required to keep a home, car, or even a person in good shape and performing well. The same is true in regards to our electronic health records (EHR). To meet the requirements and capitalize on the benefits of meaningful use, the US market has seen an unprecedented amount of EHR implementations. However, many organizations aren't seeing the expected benefits. Factors such as rushed, system-focused implementations, lack of standardization or focus on workflows, end-user and physician dissatisfaction, high ticket, and request volumes, and/or sub-optimal training are major drivers for optimization needs. Routine maintenance and pro-active EHR optimization are a constant and ongoing necessity and should be treated that way from a planning, budgeting and prioritization perspective. Here are some key areas to consider in a post-EHR go live world.
Thorough Assessment, Prioritization, and Management of Current Issues and Complaints
Most organizations use a ticketing system to log EHR issues. Following an EHR activation, ticket volumes often increase to the point where an organization cannot manage the volume and cannot differentiate priority issues from common, organizational issues. This is exacerbated by the constant "pull" of resources that are now needed for other organizational objectives and projects.
The truth is, your EHR "project" doesn't go away when the system goes live. Rather, a program management organization, complete with an integrated Governance structure, must remain to manage upgrades, maintenance, and optimization. A great first step is understanding issues and prioritizing ongoing efforts for your teams and your organization. A thorough review, cleanup, validation, and categorization of all issues should be conducted. This requires the establishment and ongoing execution of a ticket intake and review process that identifies the priority and necessity, understands the source of the problem (e.g., user proficiency, workflow inefficiency, build defects) and reconciles that against the objectives of the organization. It is critical to include operational and clinical leaders in this process and often requires time for interviewing and even shadowing clinical and operational users to fully understand and accurately document issues.
Categorizing, Prioritizing, Integrating and Approving Effort
Most issues can be categorized into four areas:
Break/Fix
Break/fix are issues with the software functionality that need to be fixed by either the IT analysts or vendor.
Enhancement issues pertain to desired functionality that is either not yet developed by the vendor or not yet implemented by the IT department.
Workflow issues arise when a process or procedure is inefficient.
Training issues occur when the system is functioning as designed but the end user is unaware of how to use it properly. Training may also be needed to teach advanced functionality.
After categorization, issues should be prioritized. The prioritization process should be carried out through the Program Management and Governance structure and is typically not simply an "IT" process. Understanding the issues and requests, prioritizing them against the organizational objectives and then including them in the ongoing capital and operating plans allows adequate focus, funding, and validation for the work. This may be simple and quick – break/fix items, refresher training, etc. However, the focus may be more complex and cross multiple areas of the organization – new system functionality, upgrades, workflow redesign, etc. The latter often requires the organization to move back into "project mode" with a detailed timeline, project plan and in some cases, capital funding.
Optimization Implementation and Ongoing Maintenance
Now that a structure is in place, resources are adequately funded and work is prioritized, the organization can move forward knowing that the EHR can be properly maintained, but also leveraged for its true functionality. There will be many moving parts that may involve system configuration, system upgrades, workflow redesign, and end user training. Having a dedicated optimization team and project manager that interacts and coordinates with the key operational and clinical leaders is key to ensuring success, but also aides in optimizing an EHR solution that supports the organization's objectives as well as the patient experience.
Optimum Healthcare IT provides optimization services that are customized to meet our client's needs whether a full assessment and plan are needed or just hands on resources. An example of our streamlined methodology is shown below:
EHRs and the Problem of Efficiency
From 33charts.com -	June 23, 2018 12:30 AM
Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.
And when it comes to doctors and their EHRs, there's a fine line between efficient and lazy.
Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.
Four things I do to fight the downside of efficiency:
Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I've typically crossed the line.
Build narrative. My HPI and impressions represent an identifiable stream of thought. I don't use smart phrases in my HPI or impression.
Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
Stay aware. All of this is a struggle for me. But my discussion and thinking around this make me aware of it. And that's the first step to staying on top of it.
All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don't be fooled. Take any doctor from the analogue age, give him two glasses of wine and he'll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analogue pulldown.
Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.
Updates for Meaningful Use, Interoperability, Health Reform | EHRintelligence.com
Developments during the last week of January will have a serious effect on the progress of meaningful use, interoperability, and health reform in the coming year.
Perhaps the most important development for health IT was a reduction in meaningful use reporting requirements in 2015. After months of feedback criticizing the meaningful use requiring for reporting in 2015, the Centers for Medicare & Medicaid Services (CMS) finally decided to opt for a 90-day reporting period rather than one requiring a full year's worth of EHR data.
In a CMS blog post, Patrick Conway, MD, the Deputy Administrator for Innovation & Quality and CMO, highlighted three meaningful use requirements the federal agency is considering for an upcoming proposed rule.
The first would require eligible hospitals like eligible professionals to report based on the calendar year, which would give these organizations time to implement 2014 Edition certified EHR technology (CEHRT). The second would change "other aspects of the program to match long-term goals, reduce complexity, and lessen providers' reporting burdens." Lastly and most importantly, CMS is considering reducing the meaningful use reporting requirement from 365 days to 90 days.
As Conway noted, this proposed rule is separate from the one for Stage 3 Meaningful Use expected next month. However, the spirit of the two proposals is to reduce burdens on providers while promoting expanded use of CEHRT.
Most recently, the Office of the National Coordinator for Health Information Technology provided its earliest plans for enabling nationwide interoperability. The first draft version of the interoperability is the first iteration of the federal agency's long-term plans for enabling a health IT ecosystem and infrastructure with the ability to exchange patient health data efficiently and securely.
"To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement," National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.
The lengthy draft comprises both long- and near-term goals for promoting standards-based exchange among healthcare organizations and providers. The document is current open to public comment through the beginning of April.
At a higher level, the Department of Health & Human Services (HHS) laid out its plans for shifting healthcare dramatically from volume- to value-based care. Secretary Sylvia M. Burwell has committed Medicare to making half of the program's reimbursements based on value by 2018. Over the next two years, the department is aiming to shift 30 percent of fee-for-service payments into quality-based reimbursement paid through accountable care organizations (ACOs) or bundled payments.
The challenge for the department and the Medicare program is significant considering that accountable care comprises an estimated 20 percent of total Medicare payments. "We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," Burwell said.
While all these changes took place within HHS, President Barack Obama and members of Congress began revealing their plans for supporting personalized medicine. The President's Precision Medicine Initiative is already on the table and offers $215 million to support the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and ONC. Meanwhile, the House Committee on Energy & Commerce is moving forward with the discussion phase of its 21st Century Cures initiative which aims at speeding along patient-centered regulation and supporting medical researchers, clinical data sharing, clinical research, and product regulation.
All in all, the last week of the first month of 2015 may go down in history at a pivotal moment in the real transformation of healthcare in the United States.
Epic Systems Wins Big in "Best of KLAS" EHR Rankings
A number of Epic Systems products have achieved top marks in the annual Best of KLAS health IT and EHR rankings, including best overall physician practice vendor and best overall software suite in addition to other awards for acute care, ambulatory care, health information exchange (HIE) and patient portals. The recognition signals a return to dominance for the health IT giant, which temporarily lost its top title to athenahealth in 2013.
"We are honored to be able to continue to work with talented healthcare providers to create the annual Best in KLAS report. Their feedback is beneficial as vendors strive for excellence," said Adam Gale, CEO and president of KLAS Research in a news release announcing another winner, Phytel, which was named the top population heath management vendor. "We also look forward to expanding our global research initiative to evaluate additional products/services that impact both provider and vendor success."
Other familiar names featured frequently in the latest report, including Impact Advisors, winner of the overall IT services firm category, Cerner Corporation for best small ambulatory EHR, and athenahealth for small and mid-sized practice management. Epic, however, snagged the ribbon for large ambulatory practice management.
Accenture Health may be getting a few more phone calls in the next few months after being named best ICD-10 consulting firm, while Optum's computer assisted coding (CAC) expertise won the category for the in-demand technology. For clinical documentation improvement (CDI), another critical ICD-10 competency, KLAS awarded first prize to Navigant.
Overall, Epic received eleven recognitions from the independent research company, which indicates how deeply and widely the company has been able to integrate itself into the healthcare industry's IT needs. In contrast, Cerner received three nods and athenahealth bagged two, while McKesson and MEDITECH had one apiece. Last year, athenahealth had five honors to its name, with Chairman and CEO Jonathan Bush claiming that his company's victory over Epic for ultimate prize was a triumph of "nimble, innovative models" over the "old guard of HIT leaders."
Putting aside Epic's runaway dominance – and athenahealth's slip from the spotlight this year – Bush may have been correct in saying that new contenders are challenging the big names that seemed so solidified in the early days of the EHR Incentive Programs. The large number and diversity of winners shows that the marketplace continues to be fragmented, giving new companies a chance to offer the intuitive, user-friendly, feature-rich EHRs that healthcare organizations are clambering for.
With EHR replacement still a very strong force in the marketplace, vendors have a strong incentive to claw their way past their competitors onto EHR ranking lists that give them visibility and credibility in an environment of weary mistrust.
"We are all part of a community of care," Gale said of the 2013 winners list. "From the vendors that provide services and advance healthcare technology, to KLAS, who produces insights on vendor performance, to the providers who administer care, our joint efforts can make a difference in the lives of the patients."
"To the healthcare providers, your effort to be heard and counted is critical. It is your voice, amplified by KLAS, that can drive improvements to healthcare technology and services. To the healthcare vendors who diligently seek to align with provider needs, we thank you for your unwavering determination to deliver excellence with passion. We commend your efforts to truly be Best in KLAS."
Survey: Physicians See Benefits, Drawbacks in EHR System Switches
From www.ihealthbeat.org -	January 26, 2015 10:55 AM
Changing electronic health record systems could improve EHR functionality and help physicians meet meaningful use requirements, but physicians might be unhappy with the switch, according to a survey published in the journal Family Practice Management, FierceEMR reports.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Durben Hirsch, FierceEMR, 1/20).
For the survey, researchers polled 305 family physicians who had switched EHR systems in 2010 or later. The survey was conducted between July 2014 and September 2014 (Edsall/Adler, Family Practice Management, January/February 2015).
Survey Findings
The survey found that the most common reasons for changing EHR systems were:
Needing additional functionality;
Wanting to meet meaningful use requirements;
Desire to increase usability; and
Requiring improved training and support.
Researchers also found that 59% of respondents agreed or strongly agreed that their new system had better functionality, and 57% said that the change helped them to meet meaningful use requirements.
However, just 43% of respondents indicated they were happy with the switch to a different EHR system. Respondents who were part of the decision to change EHR systems were happier with the change than those who were not part of the decision-making process.
Overall, 81% said the time investment in changing EHR systems was challenging, with issues such as:
Productivity loss;
Data loss; and
Data migration problems.
Researchers said that physicians need to carry out a careful evaluation of their current EHR system prior to making a change. They also said that making alterations in physician workflow could result in better outcomes.
They noted that switching EHR systems might be necessary to improve functionality or achieve meaningful use but added that "if you just want to change because you don't like using your current EHR or consider it a drag on your productivity, the grass may not be greener on the other side"
The Benefits of Electronic Health Records
From www.nedocs.com -	January 26, 2015 10:17 AM
What are the benefits of electronic health records? Human Resource files? Invoices?
Implementing an electronic records system has the potential to provide extraordinary benefits for clinics, healthcare organizations, and physicians. By facilitating workflows and improving the overall quality of patient care and safety, electronic documents are able to provide a wealth of measurable benefits – including some impressive financial savings.
Financial Benefits of Electronic Health Records (EHRs)
A study, published by The American Journal of Medicine, has shed some light on the financial costs and benefits associated with an electronic health records system. This particular study looked to find quantifiable cost savings directly influenced by electronic records – and what they found was astounding.
The estimated net benefit from implementing an electronic health record system in a primary care setting over a 5 year period? $86,400 per provider.
Researchers even accounted for the inevitable productivity loss during the implementation of an EHR system. In this particular study, researchers found that even if a healthcare organization sustained a prolonged 10% productivity loss for 12 months…there was still a 5 year net benefit of $57,500 per provider.
According to this study, the primary benefits/savings accrued came from:
Savings in drug expenditures
Improved utilization of radiology tests
Better capture of charges
Decreased billing errors
However – this study did not include other cost saving factors, such as:
Decreased malpractice premium costs
Storage costs
Supply costs
Generic drug substitutions
Decreased staff requirements
Increased reimbursement from more accurate patient evaluations
Decreased claims denials from inadequate documentation
Not only does this study illustrate the ROI of electronic records – it illustrates that these financial savings are just the tip of the "benefits" iceberg.
Without a doubt, the implementation of an electronic record system in a healthcare setting can result in a positive return on investment. However, healthcare organizations should also be looking to expand their electronic document systems to include more than just medical records. Consider the financial benefits to be had enhancing other paper-intensive processes, such as the management of HR files or the indexing of invoices.
Electronic documents have proven their value as medical records – so why not share the savings with every department?
HIMSS Analytics Announces eClinicalWorks as Certified Educator of the EMR Adoption Model
EMRAM is an eight-step process that allows healthcare provider organizations to analyze their level of EMR adoption, chart accomplishments, and benchmark progress against other healthcare organizations across the country. Each of the stages is measured by cumulative capabilities and all capabilities within each stage must be reached before progressing.
"We're happy to be able to confirm eClinicalWorks as an EMRAM Certified Educator," said Blain Newton, COO, HIMSS Analytics. "EMRAM allows organizations to align IT initiatives and overall business strategy, which is essential to shaping future direction and moving the industry forward."
Vendors achieving HIMSS Analytics Certified Educator status must pass an annual certification exam and commit to an annual educator program. This ensures they stay current with trends within the model and are equipped with the necessary knowledge to help their clients advance through the various stages.
"A major goal is having our customers utilizing the EMR the most beneficial way possible for both providers and patients," said Girish Navani, CEO and co-founder of eClinicalWorks. "This certification will benefit organizations looking to analyze their adoption of EMR technology. We welcome being part of the program."
Is Physician Fear of ICD-10 Turning Them Off Preparation? | EHRintelligence.com
There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10. More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together. But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process. Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.
"ICD-10 is scary for most people," one physician admitted during one of the interview sessions. The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.
Physicians may be jittery about the unknowns of the future, but they aren't necessarily being proactive about addressing them. Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues. They will address issues as they occur and learn as they go after implementation. They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.
"I have not done anything except read an article or two about how codes are going to increase in ICD-10," a participant said. "I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all."
"Physicians…typically don't want to spend very much time on training for things like this," added another. "It's hard to engage them, so finding a set of materials that they will respond to positively would be valuable." Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.
"Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don't know," remarked a participant.
"For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes," agreed another.
Will EHR vendors and billing partners pick up the slack? Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn't give them adequate education. The groups called ICD-10 a "new language" for them to learn, and put specialty educational materials at the top of their wish lists. One requested "ICD-10 for dummies dumbed down by specialty," while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.
The problem, many of the responses seem to indicate, is that ICD-10 isn't meeting physicians where they are. CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn't enticing. ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed. Many physicians want to view the changes as a positive development, but feel that available resources aren't helping them do so. "Articles on ICD-10 are fear-based," said a participant. "I try not to go there."
So where will they go? To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions. It isn't fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist's particular needs. ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.
Stage 3 Meaningful Use proposals at White House for final review
From www.meaningfulhitnews.com -	January 12, 2015 10:22 AM
Why do these things always seem to happen late on Friday afternoons? At least this time it's not right before a holiday. Actually, with a bit more inspection, I see that it did happen right before a holiday.
HIMSS is reporting today that the White House's Office of Management and Budget is "in its final stages of review" of the proposed rules for Stage 3 of the Meaningful Use EHR incentive program. OMB always goes over proposed and final regulations to measure the fiscal — and, presumably, political — impact before allowing executive-branch agencies to make public releases.
A peek at OMB's reginfo.gov site indicates that the MU Stage 3 proposal from CMS and related ONC plan for certification of EHRs are indeed at OMB for final review.
"We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients. Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements," CMS states in a rule summary on the OMB site.
A placeholder date ("02/00/2015 ") on the same page suggests that the proposal will be published in February. However, a placeholder date on the page for the forthcoming ONC certification standards indicates that the plan was supposed to come out in November.
And the date the two notices appeared on the reginfo.gov? Dec. 31, when pretty much everyone was already checked out for the extended New Year's weekend.
Stage 3 is scheduled to start no earlier than Oct. 1, 2016, for hospitals and Jan. 1, 2017, for individual providers.
IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract | Hospital EMR and EHR
From www.hospitalemrandehr.com -	January 12, 2015 10:11 AM
In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:
On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.
The advisory group's creation was included as part of IBM and Epic's bid package, according to Andy Maner, managing partner for IBM's federal practice.
In a press briefing at IBM's Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.
Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they're taking their bid. Here's a short quote from that report:
Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.
As we noted in our last article, 2015's going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic's chances?

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Compare user input with text file in C I need to have a user input a word then compare the word with a text file to see if it is correct. The user has 3 attempts to enter the word before the program terminates. My issue is reading the word from the file I know it's something simple that I have wrong. I should also clarify that the error I'm getting is in the compiler I haven't gotten to the point of being able to compare the strings yet!
#include <stdio.h>
#include <string.h>
#include <stdlib.h>

int main(void)
{
    FILE *fp;
    fp = fopen("secret.txt","r");
    char guess[10];
    const char secret[10];
    int i, c;
    c = getc(fp);
    fgets(secret, sizeof(secret), fp);

    for (i=0; i < 3; i++)
    {
        printf("Please guess the word: \n");
        scanf("%s", guess);

        while (c !=EOF)
        {
            if (strcmp(secret,guess)==0)
            {
                printf("Your guess was correct");
                return 0;
            }
            else
            {
                printf("Your guess was incorrect. Please try again\n");
            }
        }
        fclose (fp);
    }
    return 0;
}

A: Here are some pointers:

*

*c = getc(fp) consumes the first character of the file, so it never becomes part of the secret variable.

*If secret.txt contains a newline, the newline is read into the secret variable.

*The while (c != EOF) loop seems pointless, since c isn't modified inside the loop. Furthermore, the infinite nature of the loop prevents the outer for loop from functioning correctly.

If I were you, I'd fix the while loop and would make sure that secret is read correctly, for example by printing it out or examining it in a debugger.

A: What is
c = getc(fp);

needed for? My "guess" would be that you read the first character of the word into c and then secret misses the first character.
EDIT: Instead of using getc for EOF checking, which as said corrupts the read word (and this while loop is rubbish anyway), just check the return value of fgets:
if(fgets(secret, sizeof(secret), fp) == NULL)
    //file is empty or other error occurred

and remove this infinite while(c != EOF) loop.
So it should rather look something like:
FILE *fp = fopen("secret.txt","r");
char guess[10];
const char secret[10];
int i;
if(fgets(secret, sizeof(secret), fp) == NULL)
{
    printf("Error while reading file\n");
    return -1;
}
fclose(fp);

for (i=0; i < 3; i++)
{
    printf("Please guess the word: \n");
    scanf("%s", guess);
    if (strcmp(secret,guess) == 0)
    {
        printf("Your guess was correct");
        return 0;
    }
    else
        printf("Your guess was incorrect. Please try again\n");
}
return 0;

A: Your code is grossly off: you do not alter 'c' inside a loop, making it spin indefinitely. It's a good idea to sketch your algorithm on a piece of paper before you start coding. In your case, pseudocode should look like this:

*

*Open file

*Read the secret

*Close file

*Repeat three times:

*--- Display the prompt

*--- Read user input

*--- If user input matches the secret, congratulate the user and exit.

*Tell the user his guess was incorrect.

At this point, converting it to C should be more or less mechanical. Good luck!

A: while (c !=EOF)
{
    if (strcmp(secret,guess)==0)
    {
        printf("Your guess was correct");
        return 0;
    }
    else
    {
        printf("Your guess was incorrect. Please try again\n");
    }
}

looks like an infinite loop to me

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A shirred satin gown is not just a work of art. It is also a labor of love and that is how the day started with a million laces and a lot of laughter. Marcia carried a bouquet handmade of satin, pearls and crystal. Joe made their stunning chocolate wedding cake in the days before the wedding. Marcia's family hand assembled the bouquets as she arrived to the mansion. The wedding shawl of Joe's mom became the covering for the gift table. Everything about this day had a loving, very personal touch.
Oxon Hill is a stunning Neo-Georgian mansion overlooking the National Harbor. It is far and away one of the most beautiful settings in DC. The property was first owned by a colonial era family who built their home in 1711. The current home was built in 1929 for Sumner Welles, U.S. Undersecretary of State. Roosevelt and Churchill were both guests. To this day the mansion has a regal feel with sprawling gardens, fountains and statuary.
Marcia and Joe were married in the gardens at sunset. The day was sunny and 70, genuinely perfect in every way.
We would like to express our thanks to Marcia and Tom their family and friends for making this day so joyful, fun and beautiful.
We would like to express our thanks to Kelley, David and their wonderful families for an absolutely amazing day at Thorpewood.
What a joy it was to experience a wedding in the woods under a chuppah made from a prayer shawl — just as simple, inspiring and beautiful as it would have been a century ago.
Thorpewood emanates a sense of majestic calm with hundred year old trees, rolling streams, a stone bridge and a working farm. Kelley and David chose a place of peace where the hubub of daily life stops for a moment, and one can experience nature. Later, Thorpewood rocked with dancing into the wee hours.