A recent report published by San Jose, CA-based Global Industry Analysts, Inc., providing off-the-shelf market research publications, predicts the global hospital information systems (HIS) market to reach more than $35 billion by 2015.

The HIS helps manage and consolidate clinical, financial and operational data, supporting interoperability and connectivity across the continuum of care. In attempts to reduce medical errors, minimize expenditure and enhance care delivery services, the healthcare industry has witnessed a great demand for healthcare information technology, with many hospitals and healthcare organizations investing in robust HIS and other information systems like electronic health records (EHR), picture archiving and communication systems (PACS), revenue cycle management solutions, etc. With efforts to improve care delivery and patient safety HIS adoption is also being increasingly promoted by the Governments worldwide, through various initiatives and incentives as seen by the US Centers for Medicare and Medicaid Services (CMS), and the recent $787 billion American Recovery and Reinvestment Act signed into law by President Barack Obama, which earmarks $19 billion for health IT.

According to Global Industry Analysts’ current report, some of the worldwide HIS market and adoption trends include:

HIS trends in the healthcare IT global market

• From an international standpoint, the United States was found to have the biggest market for hospital information systems. The healthcare industry has witnessed a surge in the adoption of custom-made radiology information systems (RIS) and laboratory information systems (LIS), with potential market for the electronic medical record (EMR) solutions.

• Considered next in line, is Asia-Pacific, which in spite of having a smaller market with regard to revenue, holds wider opportunities for HIS. With an estimated 11.5% compounded annual rate of growth (CAGR) over the coming years, Asia-Pacific (apart from Japan) has become one of the fastest growing markets for HIS solutions, and also forebodes well for the prospective HIS market, worldwide.

• Additionally, the analysts predict increased growth in the emerging Health Informatics market in China, Australia, India, Malaysia, Thailand, and the Philippines.

Growth in various HIS segments

• Although Non-Clinical Information Systems, pertaining to the financial and administrative departments of a hospital, initially set the ball rolling for HIS adoption, according to the report, clinical information systems (CIS) have taken over in terms of adoption and revenues in the healthcare market.

• Among the various HIS offerings, clinical information systems hold the largest share in the product segment. The US represents the largest market for CIS solutions, which is estimated to increase by about 7.2% CAGR over the coming few years.

• The primary driving force for the CIS segment could be attributed to the healthcare industry’s growing demand for CIS as a decision-making tool to help reduce costs, optimize on workflow and enhance quality of care delivery.

Above article published on

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By Cody Kraatz

Sunnyvale Sun

Health care is going digital in Santa Clara County, which is rolling out electronic medical records at each of its Valley Health Center sites — including the one at 660 S. Fair Oaks Ave. in Sunnyvale. The goal is to make medicine safer and more efficient.

The switch from paper to digital records — something that President Barack Obama touted since he was campaigning — will take some time, and the county expects the Sunnyvale clinic to go live in June. The clinics provide outpatient services such as internal medicine, pediatrics and obstetrics.

“Patients have had untoward consequences and even deaths related to medication problems, inaccurate diagnosing or interactions between medications, or sometimes people didn’t completely know the information about a patient,” said Dr. Robert Horowitz, associate chief of primary care at Valley Health Center Moorpark in San Jose.

He was one of the first to try the electronic medical records system, starting in April 2008, and he said that despite some challenges it stands to help with several problems.

The county has numerous clinics in addition to the Valley Medical Center hospital, and a patient could have different charts at each location. “It’s really difficult to get a sense of one record that everybody sees and contributes to,” said Horowitz.

“The practice of medicine is really a collaboration, and many people participate in that,” including physicians, managed care coordinators, chronic disease specialists, pharmacists and dietitians, he said.

Doctors can also manipulate data from many visits or the course of a disease to tease out patterns in a patient’s history. “Those of us who have been using [electronic records] the longest are seeing the benefits of having the information at your fingertips,” said Horowitz.

The county is also hoping to secure funding from the American Recover and Reinvestment Act, or stimulus, for inpatient electronic medical records at the county hospital. But the county won’t decide how much stimulus money to seek until after May, when it expects the federal government to release criteria for how applicants must show a “meaningful” usage for the funds.

Besides the Moorpark clinic, the outpatient system was rolled out at the Valley Health Center Silver Creek in January and at the Valley Health Center East Valley in early April.

The county hopes that the cost of the system — which was one of eight elements of a $43.6 million information technology contract signed in 2006 — will be recouped through the efficiency that the system allows.

Take prescriptions, for example. The system allows a doctor to write a prescription directly into the computer and send it to the pharmacy electronically, saving the patient time.

Also, “you no longer have the doctor’s traditionally terrible handwriting to sort out,” Horowitz said. Moreover, because the patient’s existing prescriptions are in the electronic record, the system can highlight potentially dangerous drug interactions or allergies.

With paper records, that process would likely be slower. Refills — of which some doctors fill 25 to 100 per day — become more rapid through electronic requests, too.

All this could, in the end, save the county money. But many, including those who are not as technology-savvy, are finding that electronic medical records slow them down.

“That is definitely an issue that we will need to grapple with. I think it does make me a little bit slower,” said Horowitz.

It takes about six months to get comfortable with the program, which includes a mind-boggling number of pages, templates and data entry fields. There have also been technical glitches that the county hopes will be ironed out by the time clinics such as Sunnyvale’s go online.

Meanwhile, doctors who are accustomed to taking notes about patient visits by hand may feel that the many entry fields of the software disrupt their flow.

“It’s a significant learning curve both to learn the product but also to learn to use the [electronic record] and be with a patient at the same time,” Horowitz said. “You’re almost speaking a different language.” There is, however, a space for free text and he makes use of that.

There are also opportunities to make treatment more collaborative and transparent for patients, he said, by showing them what he is entering on the screen and asking them to review their medications with him.

Patients have been mostly enthusiastic about the electronic records, in Horowitz’s experience. “It’s sort of a`What took you so long?’ kind of feeling. This is a modern way to do medicine, and this is the way people expect medicine to be done,” he said.

However, he does know of one patient who refused to have information entered into an electronic record, fearing that it would be insecure. Ultimately, there will be no opting out.

Likening electronic records to e-mail, Horowitz said that within a year he expects doctors to feel the way he does. “I don’t know how I could have lived without it. I couldn’t see going back to the other way.”

http://www.mercurynews.com/valley/ci_12203584

You’re keen to buy an EMR. But how do you know which one is right for your practice?
By Shirley Grace

http://www.physicianspractice.com/index/fuseaction/articles.details&articleID=1335.htm

Electronic Health Records Emerging as Important Care, Research Tool

With the American Recovery and Reinvestment Act set to spur their development and implementation, electronic health records (EHRs) are getting a lot of attention.

The widespread adoption of EHRs, however, involves “huge challenges,” acknowledged Dr. David Blumenthal, the National Coordinator for Health Information Technology. As a recent study he led documented, less than 2 percent of U.S. hospitals have a comprehensive EHR system in place. Cost, the study found, was the biggest obstacle to adoption.

Despite some of the problems reported to date with EHRs, evidence is emerging that they can improve the quality and efficiency of medical care. For example, the relatively new EHR system at the University of Arkansas for Medical Sciences (UAMS) has made many aspects of delivering care “so much better,” said Dr. Laura Hutchins, director of Hematology/Oncology at the UAMS Winthrop P. Rockefeller Cancer Institute. While the system is not perfect, she continued, “I don’t know of anybody here who wants to go back to a paper record. In addition to saving money, she explained, the system has generally made patient visits more efficient—for example, streamlining the search for information that can influence diagnosis or treatment.

Whereas the UAMS system is still in its early days, the EHR system at the University of Pittsburgh Medical Center (UPMC) dates back to 1991. The center recently completed the first phase of an “interoperability initiative” intended to eventually provide staff at 20 hospitals and more than 400 physician offices and outpatient sites access to what Dr. Daniel Martich, UPMC’s chief medical information officer, calls a “full-fidelity” EHR system, an integrated network of patient records with data on everything from admissions to allergies to recent imaging studies. While access to a number of EHR-related tools, such as electronic prescribing, still varies, he explained, the goal is a widely accessible EHR system that “provides a unified view of what’s going on with the patient.”

Importantly, EHR systems are beginning to demonstrate their utility in research. At UPMC, for example, they have conducted studies showing that, with the addition of clinical prompts, the EHR system reduced the risk of patients receiving an overdose of acetaminophen and improved by fivefold the number of patients notified by their primary care physicians that they may be candidates for clinical trials. Dr. Hutchins and colleagues at UAMS, meanwhile, used their EHR system to evaluate vitamin D levels in women with metastatic breast cancer who received bisphosphonates to treat bone pain and osteoporosis, finding that vitamin D supplements were being underprescribed, which can affect patient outcomes.

The success of EHRs, Dr. Martich believes, will be measured by the extent to which they can be effectively integrated into clinical care and research systems. “The real issue [with EHRs] isn’t a technological one,” he said. “The question is: How do they function within the workflow of a health care system?”

Above article published on http://www.cancer.gov/ncicancerbulletin/050509/page6

Implementing electronic medical records has become the top priority for senior healthcare information professionals; a major US survey has shown.

The survey revealed that although recession is being felt in the US, healthcare and healthcare IT are still expected to grow over the coming year.

The 20th Health Information and Management Systems Society (HIMSS) annual survey of chief information officers found that 31% of the 304 participants said their number one priority is to ensure their organization has a full EMR.

Within the clinical environment, 31% of participants said that at least one of their facilities already had a fully functioning EMR, which is a 9% increase on last year.

A further 17% said that their primary focus would be implementing a computerized provider order entry system.

Most respondents completed the research before the American Reinvestment and Recovery Act - President Obama’s economic stimulus bill - was signed in February, which aims for widespread adoption of healthcare IT and electronic medical records.

Survey respondents also confirmed that the weakened economy meant that although healthcare budgets and staff continue to grow, it is now at a much slower pace. Around half said that their IT budgets would increase, compared to 78% last year. Some 42% said that their staffing levels would increase compared to 68% last year.

Charles Christian, chair of the HIMSS board said of the 2009 survey: “The economy is affecting all sectors, healthcare IT included, but the good news is healthcare IT still continues to grow.”

CIOs said financial support continues to be a barrier for healthcare IT professionals with 28% noting that lack of adequate resources raises significant issues in decision-making plans and implementing IT.

The survey also highlighted some key issues that have been at the forefront of healthcare IT in recent years, including the importance of IT in reducing medical errors.

However, although reducing medical errors was the key priority for US healthcare industry CIOs in 2007, now only 38% of respondents suggested that IT would reduce medical errors.

But security remained a key concern with 84% of respondents said their organization actively assesses security risks. Despite this, one in four said that they had had a security breach within the past six months, an increase on previous years.

Respondents identified single-sign on as the technology that will be most widely adopted at their organisations in the next two years.

The HIMSS survey covers 250 unique healthcare organizations, almost 700 hospitals throughout the US It aims to track the shifts in healthcare implementation and attitudes and documents steady progress in healthcare IT.

Above article published on http://www.ehealtheurope.net/news/4751/emrs_named_top_priority_in_himss_survey

By Tammy Worth

Primary care physician Matt Handley believes that information technology enables him to provide better patient care. + So much so that he recently spent an afternoon hooking up a computer and DSL line at the home of a patient so she can contact him more frequently. + Handley is the associate medical director for quality and informatics at Group Health Cooperative in Seattle, a nonprofit health system armed with technology systems that have replaced paper records and enable patients to take part in their healthcare online. + Indeed, health information technology is the new rage for politicians and many healthcare providers who think it will help transform the industry. + Proponents say it will lower healthcare costs and improve quality of care. + Others aren’t so sure. + But computerized record-keeping and communication has the potential to change hospital care and procedures dramatically. + “It gets right to the heart of what we do every day . . . and hospitals have to take pause and think about what this will mean for them,” says Gary Kalkut, senior vice president and chief medical officer of Montefiore Medical Center in the Bronx. + The issues, Page E7.

How is this technology being used?

The systems do a variety of tasks, including replacing paper records with computerized versions and offering capabilities such as bar codes on medications, record management and suggestions for best practices for patient care. With some systems, patients can use the Web to access their medical records and lab results, communicate with physicians, schedule appointments and refill prescriptions.

How does this help patients and doctors?

Private-practice physicians who use comprehensive technology systems reported seeing positive effects on delivery of care and communication with other providers and patients, according to a New England Journal of Medicine survey published last summer. Eighty percent of the physicians polled reported their systems helped them avoid giving drugs to patients with known allergic reactions. More than 65% were alerted to order a critical lab test and recommend preventive care measures.

At Group Health, the integration of electronic records was shown to improve cholesterol and blood pressure in patients with chronic diseases. Montefiore Medical Center’s electronic prescription and dispensing system offers assistance such as a maximum dose alert. The system has helped cut medication errors by about 80%, Kalkut says.

What about costs?

Health technology may reduce healthcare costs. It has been shown to decrease duplicative testing and laboratory use, and can be set up to seek out generics rather than brand-name prescriptions.

“We have been able to improve cost effectiveness of prescribing in a dramatic way,” Handley says. Generics are typically prescribed about 30% of the time elsewhere, but Handley says Group Health physicians recommend the more cost-effective medications about 90% of the time because of the reminder in their system.

How common are these systems?

Although a number of major healthcare providers in Southern California — such as Kaiser Permanente, UCLA Medical and USC University Hospital — are using various forms of information technology, the medical community overall has been slow to embrace electronic records, according to recent studies.

A study published this month in the NEJM looked at almost 3,000 hospitals across the country, finding that only 1.5% had adopted comprehensive electronic systems throughout their facilities and only 7.6% had basic systems in at least one clinical unit.

What are the primary barriers?

Technical problems, expense and culture change are among the biggest issues.

Cedars-Sinai Medical Center in Los Angeles spent $34 million creating and implementing a physician order system for medication, labs and procedures in 2002. But physicians said the system took too long to use, limited their ability to make medical judgments and didn’t recognize complex orders or misspelled words. The system was eliminated after three months.

Other technology has had similar problems. Some is too slow or reduces productivity, some is difficult to implement, others require costly training and some physicians are resistant to change. As Cedars-Sinai experienced, health industry IT systems don’t work out about 30% of the time, according to a February article in the Journal of Usability Studies.

The major barrier for health IT systems may be cost. Seventy-three percent of hospital respondents in the NEJM article said they did not have enough capital for the systems, and 44% were concerned about the maintenance costs.

The Obama administration plans to help physicians through reimbursements of up to $60,000 per medical practice and $11 million per hospital. But hospital technology systems can range from $20 million to $200 million. Group Health spent $40 million, and Montefiore has spent about $150 million over 10 years.

What is the outlook for future use of these systems?

Some providers and many in government believe that technology will play a large role in healthcare reform. Through the American Recovery and Reinvestment Act, the Obama administration plans to provide almost $22 billion to help healthcare providers who embrace technology, mostly through Medicare and Medicaid reimbursements.

Nick Papas, spokesman for Health and Human Services, calls health IT “the future of health care.”

Still, the administration’s goal to have a nationwide health IT system by 2014 has been met with skepticism from some because of issues including privacy and funding.

The current healthcare pricing model is based on an in-person visit to a doctor or hospital. This would need to be changed to take into account online interactions, such as e-mail consultations.

Many IT systems already in place are proprietary. And even if the systems were accessible to other physicians, many don’t speak the same language, Kalkut says.

Linda Dimitropoulos, director of health services research for RTI International, an independent, nonprofit research and development organization, says consumers need to be able to “understand where data will be used and shared, with whom, and for what purposes and I don’t think that is very clear right now.”

Above article published on

http://www.latimes.com/features/health/la-he-electronic27-2009apr27,0,1149933.story

By ALAN BAVLEY

The Kansas City Star

Mark Plautz commands his patients’ care with just a few clicks of a computer mouse.

Plautz, a critical-care specialist, can pull up his patients’ complete medical files from computer terminals throughout the Kansas City VA Medical Center, where he works. He can order tests, look at X-rays, make referrals.

All without putting pen to paper. “Instead of my illegible handwriting, I can order a prescription from here,” Plautz said.

Doctors and patients of America, this is your future.

The world of health care, high-tech in so many ways, is one of the last bastions of paperwork — files and orders written by hand, stuffed into folders and stored on shelves.

That’s all about to change. Tucked into the federal stimulus package is $19 billion to computerize the nation’s health care system.

The goal: For every hospital and doctor’s office to do what the Department of Veterans Affairs has been doing successfully for years — put patients’ records into computer files and share them electronically when patients visit other doctors and hospitals.

The White House wants electronic records available for every patient by 2014.

If all goes as planned — which some question — this digital revolution will make patients safer, help doctors practice better medicine, and save money by boosting efficiency. “It’s a historic investment,” said David Blumenthal, the newly appointed national coordinator for health information technology, who will oversee the drive to computerize. “We’re convinced that it’s possible.”

Medicare and Medicaid will use stimulus money to pay doctors and hospitals incentives to make the change.

Doctors who start by 2011 will collect $44,000, enough money to set up a system in the average office. Hospitals will get a one-time, $2 million bonus, plus higher Medicare or Medicaid payments.

By 2015, incentives will turn into penalties for those who lag behind.

Kansas City area doctors and hospitals could receive between $200 million and $300 million in stimulus money.

The federal government is still working out regulations to ensure patients’ privacy and technical standards so that different computer systems can “talk” to each other.

Challenges await

The rules are due by the end of the year. Meeting that deadline won’t be easy.

“It will be a big test of the federal government’s ability to deliver on the charge we have been given by Congress,” Blumenthal said.

Some doctors and conservative critics see electronic systems as an intrusion into medical practices that could take decisions out of doctors’ hands.

And some fret that the records will jeopardize privacy and that computer glitches could put patients at risk.

Potential risks are so great that the computer systems should get the same rigorous testing demanded of new drugs, said Sharona Hoffman, a Case Western Reserve University law professor.

Last year a glitch in the VA system affected nearly a third of its hospitals. Although no patients were harmed, the VA reported nine cases in which patients received incorrect drug doses.

But ideally, proponents of electronic medical records say, the system will work with the same seamless security as the networks of ATMs that allow customers of one bank to draw cash from machines operated by other banks.

Electronic medical records offer many opportunities to improve health care:

· Safety: No more medication mix-ups from garbled prescriptions. Alerts about drug interactions and allergies flash on the computer screen.

· Quality: As doctors examine patients, computer prompts recommend appropriate tests or treatments. When patients show up at the emergency room, their records will be available instantly online.

· Savings: No need to reorder tests or scans because the paperwork is missing.

Most researchers who have looked at whether electronic medical records can improve health care generally give automation good marks.

A recent study of urban hospitals in Texas found that the more advanced their computer systems, the lower were their death rates, complications and costs for some conditions.

For example, at hospitals where doctors had the most sophisticated software to help them make decisions about patient care, the average heart bypass cost $1,000 less.

“I can’t imagine not having electronic medical records,” said Plautz of the VA.

When Plautz sees a patient, he logs on to a computer in the exam room and calls up the record. On the screen, he gets a series of pages organized like a binder with tabs at the bottom.

The first page is a “cover sheet” with a list of the patient’s medical problems, allergies and current prescriptions. There are reminders to the doctor — if the patient needs a flu shot, for example, or should be prescribed certain drugs.

From there, Plautz can click tabs to pages for ordering tests, prescribing drugs or entering notes about the exam.

The VA’s decade-old system links all its hospitals and clinics.

Other health systems that have adopted electronic medical records also have been pleased with the results.

Group Health Cooperative, an HMO with 600,000 patients in Washington state and Idaho, maintains electronic records that patients can access from their home computers. They can review their lab results, order prescription refills and e-mail questions to their doctors.

“We’ve had huge usage,” said Gwendolyn O’Keefe, Group Health’s medical director for informatics. “It provides patient satisfaction and patients don’t abuse it. They respect physicians’ time.”

Although it is far from certain that all systems will work that way, Google and Microsoft have launched online services where people can store their medical information.

So far, only about 17 percent of doctors and 9 percent of hospitals have even basic electronic records systems.

“It’s costly, it’s complex, it’s transformational,” said Deborah Gash, chief information officer for the St. Luke’s Health System, which has been investing millions of dollars in the technology to go digital.

“Without an incentive to do it, people may be reluctant to take that step,” she said.

Many are waiting to find out which computer systems will qualify for federal incentive payments, Gash said.

But locally, early adopters are pioneering electronic records.

Two dozen Kansas City area employers and hospital systems sponsor a nonprofit network called CareEntrust that maintains electronic medical records on their employees.

Above article published on http://www.kansascity.com/105/story/1172352.html

Molly Merrill, Associate Editor

CHICAGO – The Healthcare Information and Management Systems Society has published two definitions of “meaningful use” as it applies to certified electronic health record technologies and hospital’s use.

HIMSS officials announced the definitions Tuesday as the National Committee on Vital and Health Statistics Executive Subcommittee began hearings to define “meaningful use.”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures - and other measures - as selected by the Secretary of Health and Human Services.

Officials say physicians must meet the definition within a specified time frame, which as described in the American Recovery and Reinvestment Act of 2009.

In order for hospitals to have a reasonable chance of achieving the definition, HIMSS officials say the requirements must be introduced in incremental stages. In order for hospitals to meet each stage, milestones must be achieved in phases of not less than two years each, commencing in FY11. In the final phase, which must commence in FY15, HIMSS officials believe the mature definition of “meaningful use of certified EHR technology” includes at least four attributes:

1. A functional EHR certified by the Certification Commission for Healthcare Information Technology (CCHIT);
2. Electronic exchange of standardized patient data with clinical and administrative stakeholders using the Healthcare Information Technology Standards Panel’s (HITSP) interoperability specifications and Integrating the Healthcare Enterprise’s (IHE) frameworks;
3. Clinical decision support providing clinicians with clinical knowledge and intelligently-filtered patient information to enhance patient care; and
4. Capabilities to support process and care measurement that drive improvements in patient safety, quality outcomes and cost reductions.

HIMSS officials have urged that CCHIT be named as the certifying body for EHR technology.

HIMSS developed its recommendation by drawing up an initial draft of meaningful users of certified EHR technologies in March. The draft was publicly posted with a discussion forum for a three-week period commencing April 1, 2009. The draft was then reviewed by the HIMSS membership community, which consists of more than 3,000 volunteers organized into nearly 80 groups

Above article published on http://www.healthcareitnews.com/news/himss-publishes-meaningful-use-definitions