By Ken Terry

The Health IT Policy Committee, which advises the U.S. Department of Health and Human Services, has adopted the revised recommendations of its workgroup on the “meaningful use” of electronic health records. Physicians will have to show meaningful use to qualify for government financial incentives that are scheduled to start flowing in 2011.

The revised definition is apparently more lenient to physicians than the one presented to the committee about a month ago. Among the requirements for 2011:

• Implement one clinical decision support rule relevant to a specialty or a high clinical priority
• Submit claims electronically to payers
• Check insurance eligibility electronically when possible
• Provide patients with timely electronic access to their health information
• Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge
• Exchange health information where possible

Physicians will be expected to participate in the National Health Information Network by 2015, and will have to give patients access to personal health records to qualify for incentives in 2013. The PHR deadline is two years earlier than the one that was originally proposed.

Another big change from the earlier version is that physicians who apply for government subsidies for the first time after 2011 will only have to meet the 2011 criteria for meaningful use in the year when they apply. That will make it much easier for physicians who are just learning how to use their EHRs.

The government will use the recommendations in shaping its requirements for EHR incentives. HHS is expected to publish a final rule by the end of the year.

On another front, the HIT Policy Committee is also considering how EHRs should be certified for functionality. Earlier this week, it heard testimony concerning whether the Certification Commission for Health Information Technology (CCHIT) should continue to the be sole body that certifies EHRs. This is an important question, since only “qualified” EHRs—which many have interpreted as “certified”—will be eligible for government subsidies.

The committee members listened to hospital executives and others complain about the lack of interoperability among EHRs from different vendors. CCHIT chair Mark Leavitt, MD, noted that CCHIT is requiring that certified products be able to import and export the Continuity of Care Document (CCD), which includes key medical data. But he added, “There are not standardized HIEs [health information exchanges] and almost none of them is using the standardized format that the government approved.”

Meanwhile, in a letter to the HIT Policy Committee’s certification/adoption workgroup, an important organization of health IT professionals said that the CCHIT approach to certification should not continue. The American Medical Informatics Association stated, “We believe that highly prescriptive and detailed, one-size-fits-all requirements will ultimately be counterproductive.”

CCHIT has drawn a great deal of fire of late, mainly from those who fear that continuing to raise the bar on certification criteria will cull down the health IT business to a handful of vendors that can bear the expense of continuing software development and certification fees. But I would ask CCHIT’s critics a question that paraphrases Voltaire: If CCHIT did not exist, would it not have to be invented? How are EHRs going to meet the rising requirements for “meaningful use” unless someone sets standards that apply to all?

Above article published on

http://industry.bnet.com/healthcare/1000927/round-2-of-meaningful-use-lets-up-a-bit-on-physicians/

CHARLOTTESVILLE, VA – Hospitals have seen a decrease in EMR adoption in states where privacy laws restrict their ability to disclose patient information, according to a study published in the journal Management Science.

The study shows that states that have enacted medical privacy laws restricting the ability of hospitals to disclose patient information have seen a reduction in EMR adoption by 11 percent over a three-year period or 24 percent overall. States with no such regulations, on the other hand, experienced a 21 percent gain in hospital EMR adoption.

According to the study, the drop is most evident in the reduced adoption of EMRs through networks of hospitals and medical providers. In states without such laws, adoption of EMRs by one hospital spurs adoption by others, with one hospital’s adoption increasing the likelihood of other hospitals in the local area adopting by 7 percent.

The study’s authors, from the Massachusetts Institute of Technology and the University of Virginia, say privacy protection may benefit the diffusion of information-sharing technologies if it reassures consumers, but may inhibit the diffusion of information-sharing technologies if it imposes costs on firms who adopt the technology.

Above article published on http://www.healthcareitnews.com/news/study-privacy-laws-deter-hospitals-emr-adoption

Ready or not, electronic medical records (EMRs) are coming. President Barack Obama has devoted $20 billion to healthcare IT in the American Recovery and Reinvestment Act, and in February 2009, he announced his aspirations to have an electronic health record for each person in the U.S. by 2014. Dr. James Pierce, chair of the Bioinformatics and Computer Science Department at University of the Sciences in Philadelphia, notes that a nation-wide implementation of EMRs comes with considerable challenges, as well as tremendous advantages.

“Digitization of the healthcare system will be much more efficient and cost-effective, and will enable easier communication among different parts of the system, simpler manageability, and less storage compared to paper records,” explained Dr. Pierce. “EMRs allow healthcare providers to send queries electronically, which is expected to decrease the errors that are made on paper and ultimately, save lives.”

Despite the clear benefits of EMRs, there are important issues that need to be addressed before implementing the system, Dr. Pierce cautioned.

• Storage: While EMRs will likely be stored in internal hospital systems or external servers, each patient’s file could generate a colossal amount of data. “In the near future, terabytes of information may be generated during a doctor visit,” said Dr. Pierce. “It’s very difficult to transfer files of that magnitude, and the software must be able to store and send every x-ray, cat scan, genomic analysis data, MRI, prescription, and test that a patient gets.”

• Compatibility: Because most EMR programs are developed and sold by private companies, different hospital systems may not be interoperable with each other, making the transfer of electronic files complicated or impossible. Rapidly changing technology also poses a financial strain. “When a hospital or physician’s office invests millions of dollars into purchasing a system today, it may be outdated in five years, at which point, it can be very expensive to update and get a new program.”

• Privacy and Security: Given the infinite shelf-life of electronic files, EMRs incite debate about serious privacy, security, and ownership concerns, as well as the potential for past medical information to be used against a person. Dr. Pierce hypothetically notes a person who was prescribed antidepressants in college, and years later, the individual may not want this information available to potential employers. However, if the patient’s history is catalogued in an EMR, it will not only live-on forever, it is also highly accessible.

• Training: EMRs are still a relatively new system, and as such, require a form of interdisciplinary training that is not yet widely available. “Traditionally, hospitals staff an IT person who has little or no training in healthcare, and doctors and nurses who aren’t familiar with IT,” said Dr. Pierce. “A nation-wide move to EMRs prompts the need for trained individuals who are well-versed in both IT and medical technology.”

Above article published on

http://www.chiroeco.com/chiropractic/news/7885/675/Challenges-to-the-Presidents-plan-to-digitize-healthcare/

The call for widespread adoption of electronic medical records has prompted some states to pass stringent privacy laws to protect their residents against fraud or identity theft. But a new analysis finds these laws seem to significantly diminish the effectiveness of the new technology.

Many of the new technologies available to healthcare providers depend on information sharing to be effective, study authors note. If one hospital adopts the use of EMRs, they explain, that increases the likelihood of nearby hospitals adopting EMRs by 7%. Conversely, in states where EMR privacy laws restrict the sharing of patient information, record sharing has been reduced by as much as 24%. Recently, the American Association of Homes and Services for the Aging found that nursing homes lead the healthcare field in overall adoption of electronic medical records.

The Bush administration largely endorsed the idea of a national health IT infrastructure, and has set a goal of full implementation by 2014. Ideas for spurring adoption of EMRs have been present in most draft versions of new healthcare reform legislation, but no final plan has emerged. The report, “Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records,” appears in the current issue of Management Science.

Above article published on

http://www.mcknights.com/State-privacy-laws-could-be-slowing-electronic-medical-record-adoption/article/139971/

Rick Weinhaus

Dr. David Blumenthal, the new National Coordinator for Health Information Technology, has stressed that the goal of the ARRA/HITECH initiative is to improve patient care, not to mindlessly adopt health information technology. In this regard, he wrote that many CCHIT-certified EHRs “are neither user-friendly no designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”

It is therefore disconcerting that the Association of Medical Directors of Information Technology (AMDIS) just weighed in on the issue of meaningful use with their letter to Dr. Blumenthal, recommending that the new national HIT Policy Committee use the 2008 CCHIT certification criteria to determine which hospitals and physicians get HITECH incentive dollars.

Even more disturbing is the AMDIS recommendation that meaningful adoption (their newly coined term) substitute for meaningful use until at least 2013.

We see placing the reporting of quality measures in advance of reporting measures of meaningful EHR adoption as akin to putting “the cart before the horse” — the fields that form the basis for automated quality reporting must first be populated on a regular basis . . .

What’s going on here? As I read it, AMDIS is acknowledging that CCHIT-certified EHR technology is so difficult for hospitals and physicians to use that it will take years of training before meaningful use can even be addressed. AMDIS states that process of EHR adoption and use must follow a ‘crawl-walk-jog-run’ progression requiring continuous cycles of training and practice that ‘cannot be skipped or shortened’ [italics mine] without risking failure, introducing errors, and causing the frustrated physicians to give up.

Most disquieting of all is the AMDIS recommendation to exempt hospitals (but note, not office-based physicians) from HITECH’s computerized physician order entry (CPOE) requirement until 2013 or beyond. AMDIS states that even in the hands of its most experienced members, working with EHRs that are already up and running (most inpatient EHRs are CCHIT-certified according to HIMSS) successful implementation of CPOE is a challenging, multi-year undertaking.

AMDIS therefore recommends that inpatient CPOE be deferred for an indefinite time period because “it requires more advanced planning, building, testing, training, experience, data capture, data sharing, and decision support than many practices and hospitals can successfully achieve in the next 2-3 years.” Ironically, CCHIT makes CPOE a cornerstone of its inpatient certification.

AMDIS is warning us about the risk of EHR and CPOE system failures on a national scale. These software system failures have real life consequences. To list just one example, physicians from the Children’s Hospital of Pittsburgh reported a highly statistically significant increase in mortality after implementation of a CCHIT-certified CPOE system.

The first step in fixing a system failure is to acknowledge that there is a problem. Although AMDIS clearly is aware that a problem exists, they continue to promote the flawed CCHIT model. I doubt, however, that their solution (try harder, you can do it!) is what most physicians and patients would choose.

What happens after 2 or more years? Where is the evidence that most physicians will ever be able to ‘jog’ or ‘run’ with EHRs built on the CCHIT model? Where is the evidence that these CCHIT-certified EHRs will be any more usable after causing 2 or more years of inefficiency, error, and potential harm to patients?

As I have written in a previous post, the CCHIT certification model is fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design.

Fortunately, the situation is not nearly as bleak as it seems. EHR technology can begin to improve patient care right away if we adopt the right model. There is no reason that it should take 2 or more years for physicians to train to use EHR technology. With well-designed, user-friendly EHR software, physicians can be up and running with core functions in 2-3 weeks, not 2-3 years.

We need to remember that Congress and the Obama administration have entrusted the national HIT Policy Committee, not CCHIT, with the mandate to shape our new HITECH policies. The national HIT Policy Committee needs to keep EHR certification rules simple and focused on standards for data, interoperability, and privacy. Keeping certification rules simple will allow physicians and hospitals to select well-designed, user-friendly EHR software that can be used meaningfully from the start.

Rick Weinhaus practices clinical ophthalmology outside Boston. He trained at Harvard Medical School, the Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute.

Above article published on

http://www.healthcareitnews.com/blog/meaningful-use-vs-meaningless-adoption-electronic-health-records

PHILADELPHIA, PA — For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease.

In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study appeared online last week in the British Medical Journal.

“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper — this can work.”

In January 2009, President Barack Obama unveiled plans to implement electronic medical records nationwide within five years, arguing that such a plan was crucial in the fight against rising health care costs. Of the nearly $900 billion in Obama’s planned stimulus package currently before the United States Senate, $20 billion is proposed for electronic health records.

Tannen says he and his group recognized that the large EMR databases containing compiled medical information could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials. However, such databases contain observational information, which critics argue do not offer the same level of control as randomized trials.

“Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage

healthcare,” Tannen says.

To address criticisms of observational studies, Tannen’s group had to first determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid.

Beginning six years ago, Tannen’s team selected six previously performed randomized trials with 17 measured outcomes and compared them to study data from an electronic database — the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death.

After using standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes.

In the other eight outcomes, Tannen’s group used an additional new biostatistical approach they discovered that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new biostatistical method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the randomized clinical trials.

Though Tannen warns the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, he says the results of his study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies.

“An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen says. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose an opportunity, an enormous health opportunity.”

Above article published on

http://www.chiroeco.com/chiropractic/news/7359/865/Penn-study:-EHR’s-can-be-used-to-test-efficacy-of-treatments/

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.”

Above article published on

http://www.chiroeco.com/chiropractic/news/7524/1100/Measuring-the-impact-of-electronic-medical-records/

The times we live in demand a lot of speed and efficiency from any service that we pay for, and that includes medical care services. There are many complications involved in the medical care business and no matter what size your practice is, it will always benefit from a more efficient system of data and time management. Plus, when it comes to billing, who wouldn’t like to have minimal errors and the lowest possible processing time per bill or per individual. This is when you know you need to change your old ways of doing thing and bring something new and more sophisticated to make your job a lot easier and more effective.

That is where EMR (Electronic Medical Records) software comes in. You will at how much EMR software can do and it takes so little time to do everything. Be it entering relevant data, recalling appointment schedules or queue management, a good EMR software is exactly what you have been waiting for to give your business a boost. You will love the amount of efficiency it will bring in to the entire system. You will be doing everything faster, with fewer errors and with a much lower processing time.

For instance, when it comes to queue management and alerting the staff at hand, you can do it instantly with EMR software. This is handled by the internal communications system with which, for example, you can alert your nurse that a patient is ready for his appointment. This saves a lot of time in communications

and speeds up the entire process. Bill generation is another area that will amaze you with its capabilities. You can generate bills that contains everything, from the medical treatment details to the different sets of insurance codes that will help you patients claim there medical insurance.

As you might know, errors in the bills, especially in the codes often stop patients from successfully claiming insurance for treatments availed. While it is quite human to make errors, especially with so many codes to handle, you must also realize that each such mistake hurts your business because it leaves your customer dissatisfied with your service. The EMR software will make sure that the correct code is implemented and printed each time on the bill. So you have a complete bill that does everything for you.

It also has complete tracking and analytical features whereby you can recall your performance from previous working days, weeks, months and even years. You can instantly call up charts and graphs to look at the demographics of your patients. You can look at your accounts, your total revenue and much more. With the data at hand, you can spot trends and spot the performance of each wing, division and department. Through this improved performance tracking you can truly enhance your practice to fine tune to your unique needs. So you absolutely must try EMR software to see how much it can help you

Source: http://www.articlesbase.com/computer-forensics-articles/use-emr-software-to-enhance-your-practice-992322.html

By Jonathan D. Epstein NEWS BUSINESS REPORTER

Western New York’s three health insurers have asked the region’s electronic clinical information exchange to lead an effort at driving more adoption of electronic medical records by area physicians.

Western New York Health Plans, comprised of HealthNow New York, Independent Health Association and Univera Healthcare, hired HEALTHeLINK to implement a program seeking to get 500 more doctors to start using electronic medical records over the next three years.

That’s part of a nationwide effort by the government, insurance industry and providers to increase the use of electronic records to lower costs, streamline operations and reduce medical errors. While use of the electronic records is spreading locally, so far it’s been limited to a few major practices, such as Buffalo Medical Group.

“It’s certainly not at the rate that we wanted, so that’s why this is an exciting opportunity that the health plans are providing to the physicians,” said Daniel E. Porreca, executive director of HEALTHeLINK.

Under the agreement, HEALTHeLINK will help the health plans select the vendor software packages that physicians can choose from, including determining the requirements used to evaluate them. For example, the software must help providers produce better medical outcomes, and also support personal health records and electronic prescribing.

HEALTHeLINK will also guide physicians in choosing which software to use, and then implement so they can qualify for federal dollars.

Congress set aside $19 billion in the $787 billion stimulus package, called the American Recovery and Reinvestment Act of 2009, to support doctors and hospitals in adopting electronic records. President Obama signed the measure into law on Feb. 17.

“We believe our agreement with HEALTHeLINK, coupled with the recently passed federal stimulus package that will provide physicians reimbursement for adopting electronic medical records, will help ease this technological transition for the physician community,” HealthNow executive vice president Cheryl A. Howe said in a press release.

The new initiative will focus on primary care physicians, Medicaid providers and eventually specialists, including both physicians and mid-level clinicians.

“This initiative by the region’s health plans is another example of the unprecedented collaboration taking place to enhance healthcare for our community,” Porreca said in the release. “We look forward to managing and executing this program on behalf of the health plans and in turn working with the physician community to make the transition to electronic health records as seamlessly as possible.”

Above article published on

http://www.buffalonews.com/145/story/718189.html

Kyle Hardy, Community Editor

CHICAGO – The Healthcare Information and Management Systems Society’s EHR Usability Task Force has released a white paper focusing on the level of usability in electronic medical records and their implementation at healthcare organizations.

“Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” identifies usability of software in an EMR as “one of the major factors and possibly the most important factor hindering widespread adoption of EMRs.”

“Through our research, we found that usability as a requirement in the certification process could benefit product development for more usable EMR products and give users or decision-makers more confidence in selecting clinical EMR systems,” said Jeffery L. Belden, MD, associate professor of clinical medicine at the University of Missouri Health Care’s School of Medicine and chairman of the HIMSS EHR Usability Task Force.

Principles and methods are highlighted in the study as processes that offer benefits for organizations that certify technology. These procedures allow certifications organization “to test and rate products for usability.”

The study also looks at:

• a definition of usability relating to an EMR;
• a set of principles pertaining to usability and design; and
• potential methods for assessing and rating usability of an EMR

The HIMSS task force gives suggestions for rating the usability of an EMR through a five-step process, emphasizing that organizations start small with usability ratings, devise measurements and create a five-star rating system base on a standard.

“With the American Recovery and Reinvestment Act as the catalyst for healthcare reform, this white paper provides an insightful review of usability for the EMR and its value in the certification process,” said Edna Boone, HIMSS’ senior director of healthcare information systems. “The task force will continue to study this important topic of usability and its benefits for successful EMR implementation.”

Above article published on

http://www.healthcareitnews.com/news/himss-white-paper-usability-critical-adoption-emrs