Both the House and Senate stimulus bills include incentives for physicians to incorporate electronic health records into their practices, but for pathologists, qualifying for the different incentive programs will depend on your practice.

Independent pathologists, as part of H.R. 1 and S. 1, the American Recovery and Reinvestment Act of 2009, would be eligible for a $15,000 incentive payment for adopting electronic health records starting 2011, with a declining incentive scale each subsequent year until 2015.

Hospital-based pathologists are ineligible for this particular incentive payment due to concerns over double payment. Legislators have allocated HIT incentive payments directly to the hospital, and have assumed it would negate the need to provide HIT incentives directly to hospital-based pathologists. CAP is monitoring the effect of this provision.

Additional HIT grants may also be made available for physicians through low-interest loans provided by the Federal government to the states.

The Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using electronic health records within the next decade as a result of the American Recovery and Reinvestment Act of 2009.

The College anticipates tremendous advantages from the adoption of the electronic health record system, and will continue to advocate for incorporation of health information technology provisions within the stimulus package and in the healthcare agenda.

Above article published on www.cap.org

20th Annual HIMSS Leadership Survey Findings Show Commitment to Healthcare IT, Cite EMR, CPOE, Security, Financial Concerns as Top Issues

CHICAGO — Implementing clinical systems – including an electronic medical record (EMR) and computerized provider order entry systems (CPOE) – was cited as the top priority for healthcare information technology (IT) professionals who responded to the 20th Annual Healthcare Information and Management Systems Society (HIMSS) Leadership Survey.

Of the 304 respondents, 31 percent said the primary focus would be ensuring their organization has a full EMR. Another 17 percent said the primary focus would be the installation of a CPOE. Complete results of the Leadership Survey will be presented today at the 2009 Annual HIMSS Conference & Exhibition, one of the largest conferences in the IT industry.

Survey respondents’ answers also suggested the weakened economy has slowed the breakneck pace of growth but also that they and their organizations remain committed to healthcare IT. More than half of respondents (55 percent) said their IT budgets would increase, compared to 78 percent last year, and 42 percent said their staffing levels would increase, compared to 68 percent last year.

Many respondents completed the research prior to the Feb. 17 signing of the American Reinvestment and Recovery Act (ARRA), which aims to prompt the widespread adoption of healthcare IT and enable electronic exchange of health information through financial incentives. To assess the impact that the ARRA will have on IT spending, HIMSS is gathering additional information from survey respondents.

“The economy is affecting all sectors, healthcare IT included, but the good news is healthcare IT still continues to grow,” said Charles E. Christian, HIMSS board chair. “With the passage of the ARRA, the resulting billions of dollars intended to stimulate healthcare IT should certainly impact how respondents view their budget options.”

As in past years, security issues remain a top concern and 84 percent of respondents said their organization actively assesses security risks. One in four (25 percent) said they’d had a security breach in the past year. To address the risks, nearly half (49 percent) said they plan to purchase single sign-on technology in the next year. Currently, 31 percent said they have single sign-on technology. Other security technologies a third or more respondents said they plan to purchase include e-mail encryption; biometric technologies, intrusion prevention/detection service and data encryption. Currently, 62 percent use e-mail encryption, 18 percent use biometric technologies, 75 percent use intrusion prevention/detection service and 56 percent use data encryption.

Other findings of the 20th Leadership Survey include:

• Respondents were most likely to indicate that IT can have an impact by reducing medical errors (38 percent) and improving quality outcomes (24 percent).
• While 29 percent said sustaining financial viability was the key business objective at their organization, 24 percent identified patient safety and quality of care as the single key business objective.
• More than half (54 percent) said financial considerations was the business issue that would most impact on healthcare.
• Lack of adequate financial resources was identified by 28 percent of respondents as the top barrier to successful implementation of IT. Although this has been named as the top barrier for nine years straight, the percentage continues to climb – last year it was cited by 26 percent of respondents and the year before by 20 percent.
• An overwhelming majority (84 percent) said there is a strong level of integration between IT strategies and overall organizational strategy: 37 percent said their IT strategic plan is a component of the organization’s strategic plan and 47 percent said the plans were separate, but integrated.

Twenty years of HIMSS Leadership Surveys have tracked the shifts in healthcare IT implementation and mindset. Steady progress has been documented. For instance, the 1995 survey asked respondents about their plans for implementing an EMR – what was then called a computer-based patient record system – and just 26 percent of respondents said they had invested in software and equipment (although not necessarily implemented it), while 74 percent of respondents essentially hadn’t even begun. Perhaps not fully understanding the complexities of the issue, 87 percent of survey respondents thought physicians would be able to share computerized patient information in a nationwide system by 2005. This year 41 percent said they have a fully operational EMR in at least one facility in their organization, up from 32 percent two years ago. Seventeen percent said they have a fully operational EMR throughout their entire organization. More than a third (37 percent) said they’d begun to install EMR in at least one facility.

Above article published on www.himss.org.

President Obama is counting on electronic health records to help modernize the nation’s dysfunctional health care system, improve the quality of care and reduce its cost. His stimulus package will provide $19 billion over the next two years to promote the adoption and use of health information technology, and he has pledged to spend some $50 billion in all over five years.

There is a long way to go. A new study reveals that American hospitals have been appallingly slow to adopt electronic records, just as previous studies have shown that American physicians have been very slow to computerize their operations. By contrast, a vast majority of doctors in four other industrialized nations have adopted electronic records, although hospitals are thought to be lagging.

The study was published in The New England Journal of Medicine and led by Harvard researchers, including Dr. David Blumenthal, who has been chosen by Mr. Obama to be national coordinator of health information technology.

The researchers surveyed some 3,000 acute-care hospitals last year. Only 1.5 percent had a comprehensive electronic-records system in all major clinical units that performed all 24 functions deemed important by a panel of experts. Such systems incorporated physicians’ and nurses’ notes, the ability to order laboratory and radiological tests, clinical guidelines on how to treat various conditions and alerts to avoid dangerous drug interactions, among other capabilities. Only 11 percent of the hospitals had even a basic system in at least one major clinical unit that performed eight functions.

The main impediment is money. Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, a lack of staff with adequate technical expertise and resistance from doctors.

The president’s stimulus plan should help ease the financial obstacles. It will provide $17 billion in financial incentives (higher payments through Medicare or Medicaid) to get hospitals and doctors to adopt electronic health records and will impose financial penalties on those that do not. Another $2 billion will help hospitals and doctors keep their systems working and up-to-date.

The ultimate goal is an “interoperable” system that would allow easy exchange of clinical data between hospitals and doctors. The modernization effort will have limited value if a mélange of different computer systems can’t talk to one another.

Above article published on www.nytimes.com

Director, Business Development
Software Advice

Should you implement an EMR or an EHR? Do you know the difference? Is there a difference? These are only a few, but very important questions that IT implementers at a healthcare organization face while deciding which software to select from all the variety offered in the market.

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded healthcare providers’ understanding of the two software definitions.
Recently, the National Alliance for Health Information Technology (NAHIT), established definitions for electronic medical records (EMR), electronic health records (EHR), and personal health records (PHR). NAHIT is a senior leadership organization dedicated to leveraging the power of health IT to improve the US healthcare system.

EMR and EHR as NAHIT defines it

The NAHIT has produced the following definitions for EMR and EHR:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems).

Who needs which?

Marc Anderson, CEO of the AC Group, says it comes down to the words ‘medical’ and ‘health.’ An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements. It will help providers report and measure quality indicators for pay-for-performance incentives.

Meanwhile, an EMR is the record of a single diagnosis or treatment maintained in silos, most likely used by a specialist. If your responsibility is to take care of one unique problem - such as an orthopedist setting a bone - then a stand-alone EMR may well be sufficient. Certain specialists may not need information about patient history as much as they need specialty-specific workflows and templates.

The market is still figuring it out

Despite the NAHIT definitions, we think the market is still figuring out which definitions to adopt. An analysis of Google Trends data shows that roughly four times more searches are performed for ‘electronic medical record’ than for ‘electronic health record.’ At the same time, ‘electronic health record’ seems to be gaining in search frequency.

One interesting exception to the data was that the searches originating in Washington, D.C. are split evenly between ‘electronic medical record’ and ‘electronic health record!’

Software vendor marketing migrates slowly

The same is true when we look at the usage of terminology by software vendors.

Why such limited adoption of EHR amongst vendors? First, it simply takes time and effort to change over marketing terms. Moreover, from a very practical standpoint, many vendors will want to continue to use the EMR label while it is the most commonly used - and ‘Googled’ - term for clinical records systems.

Marketing aside…

Regardless of who is using which terms, the key decision process for selecting an EMR/EHR is to map out your organisation’s requirements and methodically assess systems against those criteria.

Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and VP of Marketing and Government Affairs at Greenway Medical Technologies, believes ‘the future of healthcare IT is interoperability.’

And while Barnes is an advocate of the EHR terminology, he distills the following three criteria for selecting a medical records system:

• Current-year interoperability certification standards (CCHIT, HL7); A unique workflow that matches your practice and specialty.
• Excellent usability at the point of care.

If you purchase an EMR or EHR with these three requirements, you should receive a significant ROI on your investment, and position yourself to receive incentives from payers.

Well what’s a PHR?

NAHIT has provided the following definition of a PHR:

ePHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.

A PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more

To be most effective, a PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more. Given the nature of the PHR, it’s the individual’s responsibility to decide what information is stored, and who has access to it.

Even with complete definitions in place, it can be difficult to evaluate EMRs/EHRs and determine which system to buy. At the same time, most providers will make their decisions based on their IT budget and their career stage. A young physician will almost certainly want to lay the IT foundation for participating in the future vision for healthcare interoperability. They will likely be supported in this effort by their health system. Meanwhile, a more mature physician that wants to ‘go paperless,’ but is not an aggressive adopter of IT may well opt for a stand-alone EMR system and forgo the costs and challenges of integration.

In the end, these individual decisions underlie what is a deliberate, but very slow adoption of healthcare technologies.

Above article published on www.ehealthonline.org

CHICAGO (Reuters) - Less than 2 percent of U.S. hospitals have adopted fully functional electronic medical records, with most citing cost as the biggest barrier, U.S. researchers said on Wednesday.

“The data collectively show we are at a very early stage in adoption, a very low stage compared to other countries,” said Harvard’s Dr. David Blumenthal, who last week was tapped to lead President Barack Obama’s $19 billion push to increase the use of information technology in healthcare.

Obama has made electronic medical records a central piece of his plan to cut costs out of a U.S. healthcare system that consistently ranks lower in quality measures than other rich countries.

Blumenthal said the study, published in the New England Journal of Medicine, clearly shows the United States has room to improve. He said financial incentives in the economic stimulus bill should help, given that most hospitals reporting that cost as their biggest stumbling block.

The study by Blumenthal, Dr. Ashish Jha of the Harvard School of Public Health, and others, is based on data collected in 2008 from nearly 3,000 hospitals.

It was designed to get a baseline reading on how widely U.S. hospitals have adopted electronic medical records, which promise to reduce medical errors and improve health quality.

“Right now, very few hospitals in America have a comprehensive electronic health record,” Jha told the briefing. “Only about 1 in 10 meet the definition of a basic electronic health record.”

A study by the same group last year found just 17 percent of American doctors have switched from conventional paper records to electronic health records, and only 4 percent had fully-functional systems that help them make decisions about patient care or order tests.

COMPREHENSIVE SYSTEM

The group defined a comprehensive system as one that collects doctor and nurse notes, orders tests, helps doctors make decisions about care and is available in every unit of the hospital. They considered a basic system as one that included doctor or nurse notes and was used in at least one care unit, such as radiology.

They found that larger, urban teaching hospitals are more likely to have electronic health records than other hospitals, in part because they are better funded.

Health information systems cost between $20 million to $100 million, depending on hospital size and complexity of the system. And many hospitals in the survey said they had no way of recouping that investment.

Blumenthal said funding purchases is a barrier the stimulus money can address. “For physicians, the cost of adoption could be more or less completely covered. For hospitals, perhaps they would be covered for modest-sized institutions,” he said.

He said the bill would also offer funding for training and technical support, which many smaller institutions lack.

Interoperability — systems that can easily share information between departments — was another big hurdle, the study found. Many hospitals have a hodgepodge of systems for different departments, but none of the pieces fit together.

“That is one of the reasons hospitals have been slower” to adopt such systems, Blumenthal said, adding that standards requiring electronic medical records to be interoperable was “a widely held core goal.”

He said the push for electronic health records needs to be part of an overall transformation of healthcare in the United States, including how doctors and hospitals are paid.

“It would be wrong to see this as a technology that can be adopted solely on its own. It needs to be adopted in an environment that supports it,” he said.

Above article originally published on www.reuters.com