By Tom Philpott: PNT columnist

President Obama’s ambitious plan to establish a lifetime electronic record for service members and veterans will improve delivery of benefits, speed processing of claims and, over time, open VA health care to any veteran, regardless of their medical condition or income level.

VA Secretary Eric Shinseki first raised the idea of a more sophisticated electronic record system, and linked it to automatic enrollment by all veterans in the VA health system, during a House hearing in February.

Last week, through a press spokeswoman, Shinseki confirmed universal access to VA health care is integral to the administration’s plan to develop as quickly as possible a 21st Century electronic record system.

“Secretary Shinseki and the whole (VA) team believe that ‘uniform registration’ ” in the VA health system “is an essential part of the lifetime virtual record,” said Katie Roberts, his press secretary, in an e-mail.

Shinseki and Defense Secretary Robert Gates were with the president April 9 in the Old Executive Office Building when Obama announced to an audience of veterans a “huge step toward modernizing the way VA health care is delivered and (VA) benefits are administered.”

Obama described a comprehensive electronic record system, to be developed and used jointly by the Department of Defense and VA, which would hold all service-related documents, administrative and medical, on individuals from the time they enter service until “they are laid to rest.”

Members leaving service no longer would have to “hand carry” medical records to VA health facilities. And VA health providers, like military counterparts, would have full electronic medical files on any member or veteran. VA claim processes likewise would have access to military administrative files, thereby reducing delays and mistakes for applicants.

“And it would do all this,” the president said, “with the strictest and most rigorous standards of privacy and security so our veterans can have confidence that their medical records can only be shared at their direction.”

Shinseki, a retired four-star general and former Army chief of staff, told the House Veterans Affairs Committee on Feb. 4 that he already was discussing with Gates a joint electronic record system.

“An individual enters the ranks as a youngster and stays for several years, or stays for 20, and comes to us as a veteran. Those records ought to be transferable … accurate and complete. Not just medical records but personal records as well, because the personnel records are also part of the disability adjudication process. If we can get to this agreement on what an electronic medical record looks like, we will solve the challenges we’re wrestling with today where we have two different records,” Shinseki said.

With regard to medical records, Shinseki said features of the VA Vista system were preferred, even by military doctors, to the more cumbersome AHLTA system used by the Defense Department.

At the same hearing, Shinseki said mandatory enrollment in the VA health care system should be part of any move to a joint electronic record.

Above article published on http://www.pntonline.com/opinion/veterans_17270___article.html/care_obama.html

By Jacob Goldstein

Remember that survey last year that found only 17% percent of U.S. doctors have electronic health records? Turns out, the figure’s even lower for hospitals.

In all, about 9% of hospitals have EHRs, according to a survey published in the New England Journal of Medicine. Only 1.5% of U.S. hospitals have adopted “comprehensive” EHRs — those with a complete set of bells and whistles, installed throughout the hospital. Another 7.6% have basic systems installed in at least part of the hospital.

For both docs and hospitals, the main barrier to adoption was the same: Cost. That augurs well for the great big pile of cash the feds will be handing out in a few years to encourage everybody to get with the EHR program.

The federal money should be worth about $6 million over several years for a midsized hospital, according to an expert cited by the WSJ. That will cover a decent chunk of the cost of getting an electronic records system, which runs about $10 million, the WSJ says. But the stimulus incentives should

The survey, funded by the feds and the Robert Wood Johnson Foundation, is brought to you by the same researchers who did the EHR docs survey. One of the authors — Harvard Prof. David Blumenthal — was recently named as the feds’ health IT chief.

Above article published on http://blogs.wsj.com/health/2009/03/26/docs-hospitals-skip-electronic-records-for-the-same-reason/

Federal stimulus incentives for hospitals and physicians to implement interoperable electronic health records (EHRs) will not nearly compensate them for the overall costs they will incur, but future penalties from reduced Medicare reimbursement could be a bigger motivator, according to “Rock and a Hard Place: An Analysis of the $36 Billion Impact from Health IT Stimulus Funding,” a paper published by the PricewaterhouseCoopers LLP (PwC) Health Research Institute.

To help drive adoption of electronic health records by 2015, the federal government is investing $33 billion in incentives to providers. An analysis by PwC’s Health Research Institute shows that a 500-bed hospital could receive an average of $6.1 million in incentives to purchase, deploy, and maintain a government-certified, interoperable electronic health record system. By comparison, the average 500-bed hospital that fails to implement a system by 2015 could see a reduction in Medicare funding by $3.2 million or more, depending on their Medicare volume.

The federal initiative comes at a time when capital-constrained healthcare organizations are struggling to find the necessary funding to purchase EHR systems. In a March 2009 survey of 100 hospital chief information officers, one-half of CIOs in hospitals with more than 500 beds said that federal funding is “crucial” to their ability to implement EHRs. “The stick, even more than the carrot, makes a fiscally compelling argument for adopting electronic health records,” said Daniel Garrett, managing director of PwC’s health industries technology (HIT) practice. “If an organization wants to have an enterprise-wide EHR up and running by 2011, they’ve got to start now. The incentives eventually go away and the stick will only get bigger.”

http://www.hfma.org/hfmanews/PermaLink,guid,c9ac9559-927d-416a-bd7b-5d66d07c4fb4.aspx

By J.E. Robertson

Electronic medical records (EMR), like health insurance, benefit from being spread over the widest pool possible. A system that aggregates and cross-references data from hundreds of millions of patients can find statistical evidence far more efficiently than today’s statistical modeling for health problems and solution improvement.

Allowing for non-identified EMR sharing across the system creates a universal pool of data in which drug side-effects, treatment failure or success rates, disease history, specific organ damage or healing, and all sorts of incidence of drug interactions and health specifics can be cross-referenced, spurring a massive amount of data-rooted research and improving quality of care and treatment success rates.

Pres. Obama has consistently touted the potential for a widespread or even national standard of EMR to help spur innovation and bring down healthcare costs, but the issue has been very little explored by mainstream media and has been consistently opposed by some critics who fear “nationalized healthcare”. The first thing we must understand in exploring EMR and its potential is that it does not mean a nationalization of healthcare.

Unbelievably, a provision in economic recovery legislation signed into law by Pres. Obama was vehemently opposed by some in the opposition on the grounds that EMR would bring about a situation in which the government “punishes” doctors who don’t comply with federal mandates. No such punitive measures were in the bill and no specific mandates for doctors either.

But it’s worth considering the degree to which the private insurance industry, so committed to its right to deny treatment, does actually take punitive measures against doctors who don’t comply with its demands. EMR can be a great efficiency booster for healthcare in general, and could actually be part of the all-important process of reducing the urge of insurers to spend money denying treatment.

But the burden to practitioners is a serious concern, so an effective EMR standard should require as little work as possible for doctors and nurses, ideally zero additional clerical work. Medical professionals should not be able to notice the “labor” involved in EMR upkeep. The best way to achieve this is to make sure the best possible tools are used universally to make EMR upkeep equivalent to or simpler than paper-record upkeep.

A letter-sized e-paper tablet touch screen device would be ideal for fluid management of medical records in a new EMR universal standard. A flexible full-size letter-format touch screen could be easily folded into a doctor’s pocket, taken out at any time for on-screen chart updates, and linked to an onsite or remote server that synchronizes with a universal EMR database in which all personal patient information is filtered out but medical data is stored.

Individual patient records could be accessed through the system as well, in order to maximize the delivery of relevant patient history to any doctor across the system, when needed. This would optimize the quality and precision of patient care choices, preventing unnecessary complications, reducing the incidence of human error and addressing health problems with the optimal course of treatment, ideally also reducing the number of interventions required and the long-term costs over time.

Privacy protection and the banning of data sale or resale are absolute essentials. The system must be informational and function-centered, free and open to the public as well. The benefits to be derived from opening non-identifiable pooled medical data to independent analysis are vast: speeding innovation, judging quality of care, and creating fact-based statistical analyses, not best-guess synthetic limited-pool studies (using either perfectly healthy, one-malady-only or terminally ill patients, to the exclusion of anyone reflecting a more common complex of health issues).

The EMR research database would be open and never, under any circumstances, searchable by individual patient or specific treatment centers. Personal medical records would be part of a sealed atomized patient-specific database accessible only by doctors or medical professionals authorized by virtue of providing actual treatment to that patient, in the moment or in consultation with other physicians.

Separately, an evolutionary quality of care effect could be achieved, if success rates for certain types of treatment were available in relation to specific treatment facilities. This database might need to be less wide-open, perhaps with peer-review and a kind of official rating system, so doctors are not pressured to withhold information or buck or trick the system.

If this 3rd function of EMR could be implemented with optimum effectiveness and benefit to all involved, then the best centers would be elevated for their successes and others would be forced to learn from them and improve their care or else change specialty or close. Ideally, this would eliminate substandard care, and therefore medical errors, excessive complications and other costly inefficiencies.

EMR can also allow for better-targeted monitoring of individual health, even in cases requiring constant targeted screening. One of the main reasons for prolonged hospital care is continuous monitoring, doctor-assessed dosing and crisis response times. EMR can allow for far more effective at-home monitoring, reducing hospital stays, optimizing IC-use and helping to limit the overburdening of skilled healthcare professionals, thus bringing down costs.

The question now about EMR is how to make a viable national system of electronic medical records function for the benefit of everyone. First would be getting everyone covered. Second would be incentivizing the relevant technologies. Third would be showing doctors a real benefit to their own workflow and quality of care.

Then comes the big task of making sure the system works as intended: allowing patients’ medical records to arrive as they do or before, with no effort required of patients or patients’ prior doctors in the moment of record retrieval… protecting patient privacy to 100% effectiveness… allowing the pooling of non-identifying medical data across the system… and using EMR to improve quality of care and treatment options, and in the process, save and prolong lives.

• As part of our Intellectual Property Preserve, this article contains some ideas that are more proposals than reporting. If you would like to collaborate with the author or seek further information for a potential partnership regarding the implementation of some of these ideas, please contact The Hot Spring at: think.media@casavaria.com

Above article published on http://www.casavaria.com/hotspring/2009/04/387/electronic-medical-records-could-help-find-cures-speed-progress-cut-costs/

WPI team launches international study to glean insights and best practices for realizing the benefits of electronic medical records and health care IT systems

WORCESTER, Mass. – The push is on to bring the U. S. health care system into the digital age by replacing paper-based systems now used at many medical facilities with electronic medical records systems and other information technology (IT) tools. To understand how best to realize the benefits these systems can provide, a team of experts at Worcester Polytechnic Institute (WPI) has launched a three-year study of health information technology (HIT) systems now in various stages of implementation at four medical organizations—two in the United States and one each in Canada and Israel.

Funded by a $750,000 grant from the National Science Foundation, the study will focus on the primary care setting to examine and analyze how implementing HIT systems impacts medical providers, their patients, and the operations of the health care delivery system. The goal of the study is to develop new insights and best practices to help guide future HIT implementations at other medical facilities. “Adapting to computer systems will be a learning process for primary care organizations, for physicians, and even for patients,” said Diane Strong, Ph.D., professor of management at WPI. “From what we observe, we will develop new ideas and new concepts for health care delivery, such as better ways of organizing work flow and decision making to take advantage of the new opportunities enabled by these IT systems.”

Strong and colleagues Sharon Johnson, Ph.D., associate professor of industrial engineering, and Isa Bar-On, Ph.D., professor of mechanical engineering, are the principal investigators leading the study. The team has extensive experience analyzing the impact of IT systems in other large organizations, such as global manufacturing companies, which have been using enterprise-wide computer systems for decades, with varying degrees of success. “As we’ve seen in many other complex organizations, just installing an IT system alone typically doesn’t achieve efficiencies,” Johnson said. “What has to happen is that an organization and its processes need to adapt to realize the efficiencies and quality improvements that are enabled by IT—and that’s tough to do. If processes don’t adapt, then just imposing at IT system alone can be counter-productive.”

In the United States, the study will focus on two organizations in Massachusetts: Fallon Clinic, a large group medical practice located throughout Central Massachusetts, and UMass Memorial Heath Care, an integrated medical system with 700 primary care physicians, several community hospitals, and an academic medical center serving Central New England. In Canada, which has universal coverage and a single-payer funding system, the study will include primary care offices of the Vancouver Coastal Health District. In Israel, which has a hybrid health care delivery model with four health funds that provide medical care to the entire population, the study will examine primary care practices in two of the health funds.

These four sites were chosen because of their diversity of operating models, management structures, financial systems and cultural differences. The sites are all at different points on the continuum of migrating from paper-based systems to fully digital systems, giving the researchers a broader range of perspectives and data for analysis. Israel, for example, has the most extensive experience with HIT, with more than 90-percent of physicians there already using the technology. “Looking at the experience in Israel will give us a reality check,” Professor Bar-On said. “We’ll see what works, and what doesn’t, and learn from people who have been using these systems for more than 10 years. And we will examine how the organization changes in response to the implementation of these systems. We want to see how people live with the systems.”

Over the course of the three-year study, the research team, working closely with the leadership at each of the primary care sites, will conduct an extended series of interviews and observational sessions with physicians, management and support staff. The researchers will observe the planning for HIT implementations and the roll-out of the systems in various locations, and examine how management and staff adapt to the new systems and tools.

“We are fortunate to have outstanding partners at the four clinical sites to work with on this project,” Professor Strong said. “We are not evaluating any particular software package or software vendor. Our focus is on how organizations must adapt to realize the potentially transformative benefits that can be achieved by the use of these new systems and the data they will collect.”

About Worcester Polytechnic Institute

Founded in 1865 in Worcester, Mass., WPI was one of the nation’s first engineering and technology universities. WPI’s 14 academic departments offer more than 50 undergraduate and graduate degree programs in science, engineering, technology, management, the social sciences, and the humanities and arts, leading to bachelor’s, master’s and PhD degrees. WPI’s world-class faculty work with students in a number of cutting-edge research areas, leading to breakthroughs and innovations in such fields as biotechnology, fuel cells, information security, materials processing, and nanotechnology. Students also have the opportunity to make a difference to communities and organizations around the world through the university’s innovative Global Perspective Program. There are more than 20 WPI project centers throughout North America and Central America, Africa, Australia, Asia, and Europe.

Above article published on http://www.eurekalert.org/pub_releases/2009-03/wpi-mti030509.php

To help transform health care, the state should invest more in electronic infrastructure that supports the automated exchange of electronic medical information, writes Russell Sarbora of Community Health Network of Washington. Increased efficiencies, lower costs and less waste of resources will help improve the health-care system.

By Russell Sarbora Special to The Times

IN Washington, state spending on health care ranks second only to education. The state has consistently asked how we can improve efficiency, reduce costs and focus scarce resources on insuring and caring for more Washingtonians.

The rapid exchange of accurate and timely information is going to transform the delivery of medical care. Infrastructure that supports the automated exchange of electronic medical information is and will continue to be a primary driver for efficient health-care delivery. We need to encourage and realize an efficient infrastructure for interoperability between electronic medical-record systems.

Washington state has at least two key assets already in place that have the potential to support creation of this infrastructure. These are the Washington State Health Care Authority-sponsored Health Information Infrastructure Advisory Board (HIIAB), and the Community Health Network of Washington (CHNW), the nation’s largest system of community health centers.

The 19 community health centers that make up the network are the primary health-care home for more than 600,000 low-income people in Washington state, including one-third of the state’s uninsured adults and one-half of the state’s uninsured children.

At CHNW we are working with HIIAB to achieve its objectives and have already implemented electronic medical-record systems that cover more than 70 percent of our member clinics and more than 85 percent of our patient population.

Business pressures will eventually produce efficient health-data-exchange services for patients served by commercial insurers and providers who rely primarily on commercially insured patients. But who will ensure that similar services are provided to vulnerable populations?

Through continued support for the HIIAB and by strengthening efforts to encourage the interoperability of electronic medical records, Washington state can improve patient health and safety while simultaneously controlling state-funded health-care costs.

Electronic medical records are used in the vast majority of acute-care facilities in Washington state; by all laboratory-service organizations operating in the state; by almost 25 percent of Washington’s primary-care physicians, and by more than 70 percent of CHNW’s member physicians. Yet, there is no statewide or national infrastructure today that supports sharing this information.

This infrastructure needs to be created, and the states that do so will lead the nation in delivery of efficient health care during the next decade. Washington state can and should be a leader in realizing this goal.

To achieve this leadership position, our state must adopt existing data-exchange policies and standards for health-information exchanges between organizations receiving state funding, provide incentives for technology investments required to support health-information exchanges, and financially support pilot programs that enable health-information exchanges.

CHNW is already working with HIIAB to create a Health Record Banking system that supports sharing of health information between patients and their health-care providers. We need to upgrade this existing business process to use current generation technology and thereby overcome existing shortcomings in reliability, efficiency and accuracy.

Interoperability between electronic medical-record systems is the key to achieving widespread sharing of clinical data. Today, these proprietary systems are incented to constrict access to the data they contain and there are numerous unresolved issues regarding access to the data and under what conditions data are shared.

Fortunately, the HIIAB is well-versed in these issues and well-positioned to support their resolution. The HIIAB is already proceeding with the creation of mechanisms to support patient access and control of their health data. However, the single greatest shortfall in the proposed Health Record Bank system is the absence of mechanisms to automatically include physician-created health data in these patient-controlled record systems. Lacking this critical body of data, the value of Health Record Banks will be substantially diminished.

We need to extend the HIIAB charter and role to encourage interoperability between electronic medical-record systems employed in Washington State and to achieve automated exchange of clinical data. The technology to do so already exists. Policy and will are the only hurdles to be overcome.

Russell Sarbora is the chief information officer for Community Health Network of Washington.

Copyright © 2009 The Seattle Times Company

Above article published on http://seattletimes.nwsource.com

By Dennis R. Horrigan

An electronically connected health care system promises better access, improved reliability and lower costs. A portion of President Obama’s stimulus plan is aimed at having an electronic health record in every exam room. This investment in health information technology has the great potential to improve the functioning of our health care system.

Supporters and critics are facing-off on the pros and cons of this initiative. Supporters cite the potential savings that will be achieved through increased efficiency and patient self-directed care, while critics point out that cost savings is exaggerated and implementation will be slow.

Technology alone will not improve our health care system, and simply having a computer in every exam room will not be sufficient. Physicians and nurses will need continuous training on how to improve care. Equally important is engaging patients. Patients who take responsibility for their health care will have better outcomes. Make no mistake, the transition from paper to an electronic system will be disruptive, but it is important work that must be done.

The electronic health record may aid physicians in documentation, coordination of care, adherence to quality guidelines, ordering tests and prescribing medications. Electronic prompts can alert physicians to adverse drug interactions, when laboratory results are not normal and enable physicians to better monitor the care for patients with chronic health conditions to help avoid emergency room and hospital visits.

These systems are designed to be “interoperable” so that physician-to-physician and physician-to-hospital communication can be timely and reliable. The physician you see on Wednesday will have an electronic report of the services you received the day before at the specialist office.

Patients will be able to access their records, review test results, schedule appointments and request prescription refills. No more waits and delays on the phone trying to reach the office. A connected health care system will enable patients to communicate to their physician using e-mail and to have an electronic visit. Imagine e-mailing your physician for assistance with non-emergent medical issues and receiving medical advice and treatment online or accessing your physician’s Web site to gain valuable information you can use to manage your health care needs.

An electronically connected health care system has the greatest potential to reduce the duplication of services and the poorly coordinated care that is responsible for a large share of rising health costs. All physicians and hospital leaders need to embrace this formula for success by adopting technology, training staff and proactively engaging patients. Now is the perfect time for the health care system to embrace electronic health records and let the patients reap the benefit.

Dennis R. Horrigan is president and CEO of Catholic IPA Western New York, a partnership between Catholic Health and a network of associated physicians.

Above article published on www.buffalonews.com

WINSTON-SALEM, NC - The issue around ownership of electronic health information must be addressed before it can be used to improve healthcare, says a recent article in the Journal of the American Medical Association.

“This legal uncertainty presents a major obstacle to integrating and using information about a single patient from various clinicians and hospitals,” say the article’s authors, Mark A. Hall, a professor of law and public health sciences at Wake Forest University and Kevin A. Schulman, MD, a professor of medicine and vice chairman for business affairs in the Department of Medicine in Duke University’s School of Medicine.

Hall and Schulman point out that with paper records the concept of ownership is more straightforward: providers and insurance plans own the paper, so they control the information. “But now that digitizing information frees it from particular storage media, confusion reigns,” they said.

Normal property rights do not apply to patients and their medical records because providers also have a right to the information, the article explains, so patients don’t have sole possession or control. Instead, they have privacy rights to protect and control access to their records.

“Strong privacy laws (favoring the patient) and clinicians’ economic interests in limiting access to health records increase barriers to forming integrated electronic records. This combination of low commercial value with restricted access leaves medical information lying stunted in an undernourished field, ” wrote Schulman and Hall.

The article says the “infomediary” to build the network among different EHRs would need clear authority to bundle and exercise the economic rights of multiple parties.

“An intermediary could compile a bundle of patients’ authorizations to use their information for research or marketing purposes; the compiler could, with patient authorization, then market these databases to permitted users or could transfer the bundled rights to a third party aggregator and marketer,” the article states.

“Some earnings could flow back to patients or compensate participating clinicians. In this way, placing bundled rights to medical information into a stream of commerce could direct them toward their highest and best use,” the authors suggest.

The article maintains that a new system of patient-initiated control of health records could be the key to a successful system. Such a system could “loosen the logjam of competing interests and stimulate market mechanisms to make much larger investments in using and sharing electronic health information.”

Above article published on www.healthcareitnews.com

The federal government is establishing a new system for updating medical records of servicemen and women during and after their military careers, President Obama announced Thursday.

The joint virtual lifetime electronic record will, among other things, help ensure a streamlined transition of health care records between the Pentagon and the Veterans Administration.

It will provide “a framework to ensure that all health care providers have all the information they need to deliver high-quality health care while reducing medical errors,” the White House said in a background statement.

“When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a [Defense Department] duty station to a local VA health center. Their electronic records will transition along with them and remain with them forever,” Obama said in remarks delivered near the White House.

The system will “cut through red tape” and allow new veterans to start receiving their benefits more quickly, he promised.

During the announcement, Obama was joined by Defense Secretary Robert Gates and Veterans Affairs Secretary Eric Shinseki.

“We welcome this news. … This is a huge day for veterans and troops,” Paul Rieckhoff, head of Iraq and Afghanistan Veterans of America, told CNN.

“This is a good way for [Obama] to come back from Iraq and make a powerful statement.”

The White House recently proposed a significant budget increase for the Veterans Administration, including an 11 percent hike in fiscal year 2010.

In March, however, the administration abandoned a controversial plan to charge private insurers for treatment of veterans’ service-connected ailments.

Veterans’ representatives and members of Congress angrily opposed the proposal, which White House spokesman Robert Gibbs said was never finalized.

Above article published online on www.cnn.com

Even in advance of the stimulus package, adoption of electronic records is increasing.

By Pamela Lewis Dolan, AMNews staff. Posted March 16, 2009.

An analysis of hospital health IT systems found that not only are more hospitals implementing electronic medical record systems, compared with a year ago, but the systems are becoming more sophisticated.

HIMSS Analytics, which rates hospital EMR systems on an eight-stage scale, announced in February that 42 hospitals are in the top two tiers of implementation, with 15 hospitals reaching the highest stage for the first time since the group started conducting the quarterly surveys in 2005. Those hospitals will be announced at an April 6 awards ceremony by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

However, those hospitals represented fewer than 1% of the 5,166 hospitals that responded to the survey. More hospitals are somewhere in the middle to lower stages, with functions in place such as clinical documentation, error-detecting clinical decision support and photographic archiving systems outside of radiology.

Michael W. Davis, executive vice president of HIMSS Analytics said he was encouraged by the findings.

“As I look at where the market is moving I think the U.S. has done a pretty good job overall because, remember, all of the stuff they [hospitals] have been doing, they have been funding on their own. There has been no help from the government,” Davis said. “I’m just hoping that when we get the funding, we don’t mess that up.”

42 hospitals are in the top two tiers of EMR implementation.

The society in 2005 began rating hospitals quarterly with an eight-stage rating system called the EMR Adoption Model. Stage 0 represents no or very little installation, while Stage 7 represents hospitals that are fully electronic with medical records.

The data are self-reported by participating hospitals, with validation by HIMSS for Stage 6 or Stage 7.

Since the survey was published in February, Davis said, more hospitals have entered Stage 6, bringing that total number to 32, with 15 hospitals still in Stage 7.

Recent entries into Stage 6 range from the 4,049-bed UPMC system in Pittsburgh to the 55-bed Parkview Adventist Medical Center in Brunswick, Maine.

The stage that saw the largest increase (from 25.1% to 35.7%) since 2007 was Stage 3, which includes clinical documentation systems that mostly affect the nursing environment.

Hospitals with EMRs in the higher stages are the ones impacting physicians who would be expected to do clinical documentation, create continuity of care records within the EMR, and use clinical support tools for everything from error detection to clinical protocols.

Rod Piechowski, senior associate director of policy for the American Hospital Assn., said he found the survey’s findings encouraging, especially when coupled with the AHA’s finding that 68% of hospitals are on the road to full EMR adoption.

Don E. Detmer, MD, president and CEO of the American Medical Informatics Assn., said the findings were a “really clear indication of the work that lies ahead.” Dr. Detmer said he hoped that forthcoming stimulus package money dedicated to advancing health information technology will help further the efforts.

Davis and Piechowski both said they, too, were encouraged at the potential the stimulus money will bring in advancing EMR use. Davis said while government reporting guidelines, which would qualify hospitals for incentive money, would likely be met with a Stage 4 or 5 system, “those with Stage 6 and Stage 7 should be rewarded too. Just because they did this on their own doesn’t mean they shouldn’t be rewarded.”

Dr. Detmer said he hopes the stimulus money will help pay not only for the hardware and software, but also for the “clinical champions,” personnel with the expertise to implement the systems and help train people to use them.

Above article published online on www.ama-assn.org