So, soon providers will get incentives for putting EMRs into place–but as is usually the case, there’s a catch. To get Medicare incentive payments, it’s not enough to simply roll out the technology; hospitals and physicians will have to prove that they’ve made “meaningful use of certified EHR technology.”

This “meaningful use” includes using the technology to exchange electronic health data to improve care quality and submitting care quality measures to HHS. Not only that, hospitals and doctors will need to meet these requirements within a specified time frame.

So, what’s a group of providers to do if they want to get the incentive payments? HIMSS has a few suggestions:

• Rely on CCHIT as the certifying body for EMRs.
• Adopt metrics that can demonstrate meaningful use, and make them increasingly more stringent over two years or so.
• Work with HITSP and IHE to make sure systems are interoperable.
• Close the existing gap between “certified EHR technologies,” “best of breed,” and “open source” technologies. (now there’s a tall order

Any way you look at it, providers have their hands full in meeting the stimulus deadlines, which include October 1, 2010 for hospitals and January 1, 2011. Interoperability, in particular, is likely to be something of a nightmare.

Above article published on

http://www.fiercehealthit.com/story/himss-defines-meaningful-use-emrs-medicare-incentives/2009-05-02?utm_medium=rss&utm_source=rss&cmp-id=OTC-RSS-FHI0

by Julekha Dash Contributing Writer

Maryland Gov. Martin O’Malley will sign legislation Tuesday that provides incentives for health care organizations to implement electronic health records.

House Bill 706 allows the state to make use of federal stimulus dollars available for electronic health records and coordinate those efforts with the state’s own plan to create a state wide health information exchange.

The federal stimulus money provided $19 billion toward electronic health records. State health officials do not know how much of that money will flow to Maryland.

State and federal health officials are pushing electronic health records because they believe they will reduce medical errors and lower costs by eliminating the need for running multiple tests.

The stimulus package enables physicians to receive incentives between $44,000 and $64,000 over the next five years through Medicare and Medicaid.

It costs, on average, $50,000 for a physician practice to implement electronic health records. The incentive payments begin in 2011, and physicians who do not adopt an electronic health records will be penalized through lower Medicaid and Medicare payments starting in 2015.

In the past, the biggest obstacle in getting physicians to install an electronic health record was cost. The federal stimulus money and the state’s health information exchange overcomes that obstacle by providing incentives to adopt health records.

“It’s trying to create a business model to make [health IT] work,” Department of Health and Mental Hygiene Secretary John Colmers said.

While the federal money provides payments to physician practices, the state is taking its own steps to ensure that hospitals can share electronic information. The legislation requires the Maryland Health Care Commission and the Health Services Cost Review Commission to designate a state health information exchange by Oct. 1. State health insurers will provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records.

Erickson Retirement Communities, Johns Hopkins Medicine, University of Maryland Medical System and more than a dozen companies and health care institutions have submitted their own plan to the state’s health care commission to create a health information exchange, known as the Chesapeake Regional Information System for our Patients.

Above article published on

http://www.bizjournals.com/washington/stories/2009/05/18/daily1.html

Privacy becomes an issue with electronic health records

The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.

The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.

For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.

“If you don’t catch the errors at the registration desk, you will see dramatic effects downstream,” Contino said. “If you are going to spend money on health IT, you need the right identification standards.” Without strong ID management, care records are likely to have errors because of false identities, misspelled names, duplicative names and other problems. Even a single error, such as a wrong blood type listed on a patient’s record due to a mix-up with another person’s identity, can lead to catastrophic consequences for a patient, he said.

Congress approved spending $17 billion in incentives for doctors and hospitals that install and use health IT systems as part of the economic stimulus law. The Health and Human Services Department is drawing up standards and policies to distribute payments to providers who can show meaningful use of health IT. HHS also is setting up a framework for secure exchange of the health data and the department’s national coordinator for health IT on May 15 released a road map for creating the standards and policies under the stimulus law.

One standards will involve controls on access to patient records. The leakage of private medical information can affect a patient’s employment, housing and insurance status, and because of that extreme sensitivity, medical information requires more than a password for secure handling, said Michael Magrath, director of business development for North America for Gemalto Inc.

“Health information exchanges and regional information exchanges will be targeted by hackers,” Magrath said. “I have strong concerns about the prospect of minimum standards,” such as passwords alone. Identity authentication standards for receiving medical care and handling medical data should require a password and also use of some type of identity token or certificate issued by a third party, he said.

Ideally, patients would be in charge of — and would have complete access to — all of their health records, said William Yasnoff, managing partner of the National Health Information Infrastructure Advisors consulting firm.

“Who has your complete medical records? For most people, it’s no one,” Yasnoff said.

Above article published on

http://fcw.com/articles/2009/05/19/obama-health-it-initiative-needs-strong-id-management-vendors-say.aspx

Rep. Bryan Cutler Proposes Using $25M In Stimulus

LANCASTER, Pa. — The use of electronic medical records could become more widespread in Pennsylvania if new legislation passes.

Rep. Bryan Cutler, R-100th district, is introducing a bill that would create a grant program for health care providers to implement the health information technology.

The systems used in parts of Lancaster General Hospital and some of its doctors offices put a patient’s medical records in one electronic chart.

Cutler wants to use $25 million in stimulus money to fund the program.

“This technology needs to be adopted for patient safety and for decreasing costs,” said Cutler.

Sixty percent of the doctors in its health system will have computerized medical records by July and all of them will have the system by 2010, Lancaster General officials said.

The medical record system will be shared with physicians outside its health system, Lancaster General officials said.

Above article published on

http://www.wgal.com/wgalhealth/19396405/detail.html

Former Gov. Mark Warner said sharing medical records among providers will improve care and reduce costs.

By Sarah Bruyn Jones
With nearly $20 billion in federal funds about to hit the world of health care information technology, Virginia’s health sector and political leadership are trying to prepare to capture their share of the money.

The money is part of the federal stimulus bill signed by President Obama in February and is intended as a financial incentive to get the health care industry to embrace using electronic medical records. Still, the timeline and details of how the money will be distributed have not been finalized.

“This represents a big leap forward for health technology, so we are excited about it,” said Virginia Secretary of Health and Human Resources Marilyn Tavenner. “We just want to be positioned to take maximum advantage of it.”

Some monies will likely go directly to the states to be distributed, while other funds will be allocated through a competitive grant process.

Tavenner said a significant amount of money coming to Virginia could boost job growth for information technology specialists as more health providers implement electronic record-keeping systems.

To help ready Virginia for coming funding, U.S. Sen. Mark Warner has arranged for a health IT summit Monday in Richmond. The national coordinator for health information technology, recently appointed by Obama, will be at the summit.

“This is going to be one of the areas that is going to drive health care reform,” Warner said.

The state will form an advisory group to help Virginia providers access the federal money and implement effective electronic medical record systems.

Between 15 and 20 people will be named to the group, including four people already named to the newly created Health Information Technology Standards Advisory Committee, which was established by the 2009 General Assembly, Tavenner said.

Warner said establishing electronic medical records in hospitals, nursing homes and physicians’ offices throughout the state will improve care and reduce costs.

“There is no reason why health care can’t get some of the efficiencies that every other field has,” he said, pointing to manufacturing and telecommunications as examples.

While the guidelines for exactly how the money will be distributed are still being worked out, Warner said he believes that cooperation between different health care providers will be the key to attracting government dollars. That includes requirements that different hospital systems and physicians’ offices be able to share information.

Warner, who has a background in telecommunications, said the system should be similar to the way cellphone companies operate: There are different providers, but a call from a Verizon phone can be received by a Sprint phone. Financial incentives will be needed to push a working system into operation, he said.

Questions remain about the security of such a system. And some medical providers don’t want to share all their data with another business due to competition in the industry.

Carilion Clinic’s chief information officer, Daniel Barchi, said it is important for system administrators to talk to each other as electronic records become the standard. Carilion began rolling out its new multi-million-dollar record system last year and has been in discussions with some other hospital systems in the state to share experiences, he said.

“The more that health IT leaders get together, the better off we are going to be,” Barchi said.

He is one of the four people already appointed to the advisory committee.

“By cooperating and choosing a common data record, there is a way we can share — with patient permission — information across all these health systems,” Barchi said. “And I think the government is doing an admirable job of putting incentives out there for the providers to make their systems more interoperable.”

The state-led efforts also focus on helping providers who don’t already have electronic medical records systems establish one. That’s because much of the federal funding will be tied to providers who already have an electronic record in use.

Above article published on

http://www.roanoke.com/business/wb/205025

SHELBYVILLE, Ind. – Few would question that dramatic change in the U.S. health care arena is well on the way. With billions of dollars on the table to fund systemic change in critical records management and other aspects of service delivery, what will American health care services look like a few years from now?

Health care reform champions have long complained that secure IT systems exist where consumers can pull out cash from an ATM anywhere in the world. That said, patients today often can’t so much as transfer from one clinical floor to the other without filling out multiple duplicate forms about their medical histories. In the past, some medical records have been lost, misplaced or misfiled too often sometimes with devastating results.

Health care reform is expected to speedily address this unfortunate information transfer gap. With large and small hospitals alike embracing high-speed fiber-based broadband, the capacity increasingly exists for instantaneous access to digital X-ray and MRI images, patient histories and even direct physician-to-patient consults.

Such is the basis for emerging telehealth applications where physicians, specialists and other medical professionals can leverage high-speed and secure data platforms to deliver health care services in a more efficient and cost-effective manner. Unfortunately, even in a lightning-fast Internet-fueled world, much of the present state of medical record keeping still represents an anachronistic throwback to a pre-digital age.

While the technology has existed for health care institutions to develop full-spectrum electronic medical records (EMR) and electronic health record (EHR) systems for more than three decades, as of 2006 less than 10 percent of American hospitals had a fully integrated system. This statistic makes many medical experts cry foul as integrated EHR systems can improve patient safety, reduce errors and promote efficient standards of care.

If that’s not enough, a 2005 RAND Corporation study estimated that efficient exchange of medical records among doctors and hospitals in the U.S. (also known as a health information exchange or HIE) would save $81 billion annually. Other estimates have put that figure as high as $450 billion per year. Throw in better outcomes and a potential higher quality of life and one can only wonder why this hasn’t happened earlier.

Here enters the Obama administration’s American Recovery & Reinvestment Act (ARRA), which includes unprecedented billions of dollars for EHR conversion and development. This access to massive funding has resulted in many hospitals scrambling to update their systems. The ARRA includes both funds for planning and execution as well as cash for physicians to convert their outmoded legacy systems into a 21st century model.

With so few hospitals presently deploying fully integrated systems, where could American hospitals and health care organizations find proven models for EHR and EMR implementation? How about Indiana?

Led by the Indiana Health Information Exchange (IHIE), the Hoosier state is home to not one but four operating health information exchange organizations. This represents a remarkable development as many states in the U.S. today don’t even have a single health information exchange that’s nearing implementation much less operational.

How does it work in the Hoosier state? Created by the Indiana-based Regenstrief Institute, the IHIE securely connects 39 hospitals, 10,000 physicians and more than 6 million patients. It delivers real-time lab results, reports, medication histories and treatment histories that are sent instantly to where they’re needed regardless of the hospital system or location, according to IHIE officials.

Indiana health care leaders haven’t been bashful about touting their early success, openly profiling the IHIE as a proven working model that should be closely reviewed and copied across the United States.

“Indiana has seen how health information exchange drives better health care for our patients, increases efficiencies for our health care professionals and saves health care dollars. Replicating this kind of platform throughout the U.S. would have incredible positive implications on our health care outcomes and cost savings,” IHIE Chairman Vincent C. Caponi (also the CEO of St. Vincent Health said.

The benefits of participating in an HIE or adopting best practices within an EHR system are by no means limited to large hospitals in urban areas as Major Hospital in Shelbyville, Ind. (population 18,000) has eloquently demonstrated.

This 86-bed community hospital was recently named one of America’s top 100 hospitals by Thompson Reuters and its early adoption of state-of-the-art technology is one of the reasons why. Only the St. Vincent Health and St. Francis Hospital systems (which are much larger than Major Hospital) were also included as central Indiana health institutions named in the 2009 benchmark study.

How did this happen? Working in the shadow of much larger hospital systems in nearby Indianapolis, Major Hospital trumped its hefty competitors by instituting the beginnings of a full-scale EMR back in the mid-1990s.

The result, according to Major Hospital CEO Jack Horner, is reflected in both the growth of the hospital and its more than 25 vertical medical practices. They are all linked together by fiber-based broadband connectivity. That coupled with aggressive recruitment and retention of top physicians and hospital staff has led to substantial growth and a high degree of patient satisfaction.

While many other hospitals (large or small) across the nation are just now ditching their legacy systems and working to implement full-scale EHR platforms, Major Hospital is already well into direct physician order and advanced applications all to the benefit of the hospital’s patients.

Major Hospital was one of the first health care institutions outside of Indianapolis to join the Indiana Health Information Exchange. Its success demonstrates that EHR systems can work well in either large or small health care organizations.

As U.S. health care institutions contemplate sweeping change in their IT systems, one could easily argue with merit that – instead of looking to the coasts for proven innovation – this time they would be well-served to look inward to the Midwest and even to Indiana.

Above article published on

http://www.midwestbusiness.com/news/viewnews.asp?newsletterID=19657

Texas State’s Student Health Center (SHC) will begin keeping health records electronically starting May 18 with its new Electronic Health Record (EHR).

The EHR will replace paper medical charts and contain patient information in a readily accessible format. Drug interactions and allergies are automatically checked before prescribing medication. Current diagnostic and therapeutic information will be available to help facilitate patient care. Another benefit to having the system is that an EHR is always legible, unlike hand-written charts.

EHR will also help the SHC by reducing the use of paper and ink. Eventually, off-site storage of medical charts and the costs that go with transporting them can be eliminated, as well.

The EHR program will be implemented in two phases. In May 2009, SHC staff will begin using the electronic records instead of charts. Online forms for students and secured messages with medical providers will be implemented later in the summer or fall.

Above article published on

http://www.newstreamz.com/2009/05/17/texas-state-to-keep-electronic-medical-records/

Switch is four years ahead of schedule

By CAROL REITER
President Barack Obama has decreed that all medical files be electronic by the year 2013.

Mercy Medical Center Merced is ahead of the game by about four years.

By next week, the local hospital will have all its medical records on computers. Loretta Stuart-Edgerton, director of the health information department, said that with the old handwritten charts, data were input by hand and could only be looked at by one person at a time.

MARCI STENBERG

Merced Sun-Star - Rachel Minor, a tech with the health information management team at Mercy Medical Center Merced, files a paper chart at the hospital on Tuesday afternoon. The hospital is changing over to electronic medical files within the next week.

“We had three different storage areas for the charts,” Stuart-Edgerton said. When the crossover to electronic records is complete, there will only be one offsite, long-term storage site.

Shawn Withrow, who is in Merced helping Mercy with the transition, is an employee of Catholic Healthcare West, Mercy’s parent company. He said the new way of putting records on computers will be cost effective for the hospital.

“There will be quicker retrieval and more than one person at a time can look at a medical record,” Withrow added.

For people worried about many sets of eyes looking at their medical records, Withrow said that is exceptionally hard to do. If anyone is caught, it’s a fine and jail time.

Recently, Farrah Fawcett’s medical records from UCLA were leaked to tabloids. The specialist who leaked Fawcett’s records pleaded guilty to a felony charge of violating federal medical privacy laws. The specialist, Lawanda Jackson, died of cancer in March before she could be sentenced.

“It’s a fireable offense,” said Stuart-Edgerton. “Mercy’s human resources has policies in place about what would happen if a person does look at medical records.”

Carol Caceres, a systems analyst for medical information at Mercy, said putting records on computers will make it easier for physicians. “Now multiple doctors can look at a chart at the same time, and discuss it,” Caceres said.

Although doctors notoriously oppose change, especially when it comes to computers, Caceres said local physicians have been satisfied with the change.

“A lot of our doctors also go to Emanuel Medical Center (in Turlock) and Children’s Hospital Central California,” she said. “Those hospitals already have electronic files. Plus, we are holding classes for doctors to learn the system.”

The staff in medical records has put about 90 percent of the charts online already, and everyone seems to be pleased with the new system.

“Now doctors can log on in their own office,” said Stuart-Edgerton. “Saves them a trip down here.”

Above article published on

http://www.mercedsunstar.com/167/story/842570.html

e-Patient Dave (right) while on a panel at Health 2.0

As is well known by now, part of the federal stimulus package included $19 billion for electronic medical records (EMR) implementation — and part of those billions include incentives for physicians and hospital groups that implement EMRs by various deadlines. Of course, the implementation also has to meet a criteria referred to as “meaningful use,” however, the legislation purposefully left out just what “meaningful use” meant.

In the past few weeks, health IT thought leaders have sketched out their own takes on what meaningful use should mean, but only the most recent opinion piece includes an analysis that suggests connected devices and smartphones may have a place in that definition.

Dave deBronkart, also known as ePatientDave, has written an eloquent post on the ongoing debate as to what “meaningful use” should mean for EMR implementation. One of deBronkart’s central points is: “The systems we design today will be in use a long time from now, so I suggest we look at the world as it will be in 2020, and how we’ll be using these systems then.”

deBronkart goes on to emphasize that everything and everyone will be ten years older — you, your parents, your children — and even the Internet will have ten more years of innovation behind it. Our oldest doctors today will be retired or deceased by then, and doctors like Fast Company’s “Doctor of the Future” Jay Parkinson (of Hello Health) will be middle-aged, he writes.

“Handheld computers (smartphones) will be ten years more advanced,” deBronkart writes. “(More advanced? Heck, the iPhone was only introduced 28 months ago.) Connected e-health devices will be out of their infancy: WiFi blood pressure monitors, bathroom scales, glucose monitors, you name it. It’s fairly certain that by then we’ll be able to use cheap devices that send routine data to some central storage place, where smart software (your choice of smart software) can send out alarms or reminders, your care team can view it … and you should be able to view it, too. And make notes on it.”

Predicting the future is no easy task, and deBronkart does a nice job of only hinting at the vision of a more connected health environment in 2020, but decisions makers at ARRA need to decide now whether and (then how) technologies like connected devices should be included as part of the definition for meaningful use.

Above article published on

http://mobihealthnews.com/2164/should-meaningful-use-include-connected-devices/

By JACOB GOLDSTEIN

Only 9% of U.S. hospitals have electronic health records, according to a new survey that reveals the gap between the present state of American health care and a high-tech future envisioned by policy makers.

“We are at a very early stage in adoption, a very low stage compared to other countries,” said David Blumenthal, a Harvard professor and an author of the survey. Last week, the Obama administration named Dr. Blumenthal National Coordinator for Health Information Technology.

The survey, sent to hospitals in March 2008 and published online Wednesday by the New England Journal of Medicine, found that most institutions have some basic electronic systems, such as those for reporting patients’ lab results.

The electronic-record systems advocated by President Barack Obama and former President George W. Bush go further, however, often replacing paper records and including doctors’ notes, treatment orders and automatic safety alerts.

Cost was the most commonly mentioned barrier to adoption of such systems, cited in the survey by 74% of hospitals without electronic records. That suggests many facilities are likely to tap into federal incentives aimed at increasing the use of electronic records.

The economic-stimulus package that Congress passed in February is likely to generate more than $20 billion in federal outlays for health-information technology, mostly between 2011 and 2015, according to the Congressional Budget Office.

Costs for installing electronic records systems vary widely, but a midsize hospital might spend about $10 million over several years, said Erica Drazen, who runs the research group for the health-care division at Computer Sciences Corp. The stimulus incentives are likely to cover much, but not all, of the cost — $6 million to $7 million for a midsize hospital, Ms. Drazen said.

Only 1.5% of hospitals have adopted what the survey’s authors define as a comprehensive, hospital-wide system. Another 7.6% of hospitals have adopted basic systems in at least one unit of the hospital, according to a less-rigorous definition that includes electronic physician notes, but not certain other features.

Proponents of electronic records say they will improve patient safety, reduce unnecessary testing and create useful data to measure quality of care. But the push is controversial, as skeptics point to the cost and complexity of installing the systems and building data networks required to share information electronically between doctors’ offices and hospitals. Some doctors argue that the systems are a distraction that takes away from patient care; more than a third of the hospitals that hadn’t adopted electronic records cited resistance from physicians as one reason.

The survey, based on responses from more than 2,900 U.S. hospitals, was funded by the federal government and the Robert Wood Johnson Foundation. The study excluded federal hospitals, such as those for veterans.

Above article published on

http://online.wsj.com/article/SB123802378615142099.html?mod=dist_smartbrief