Archive for August, 2009
August 27, 2009
By Brian Smith / Register News Writer The days of a white-coated doctor taking a pen from his pocket and making notations in a file are long gone.
With computers becoming smaller, cheaper and more portable, health care professionals are replacing paper records with electronic records that can be instantly accessed.
The Madison County Health Department’s home health division, MEPCO Home Health, is in the process of implementing an electronic medical records (EMR) system, department spokesperson Christie Green said, and will begin using the system on Sept. 1.
“EMRs will make things faster, more efficient and will provide a huge space savings,” Green said. “For example, MEPCO will be moving from nearly 200 square feet of filing space to electronic records housed in a server room of less than 40 feet.”
Federal health care reform efforts have focused on transitioning health care providers to EMR systems to increase efficiency and reduce spending.
Local public health director Jim Rousey said that an EMR system frees personnel to spend more time treating patients instead of making records.
“Every year, our home health nurses were spending more and more time fulfilling documentation requirements for patient care,” Rousey said.
“This interfered with what nurses really wanted to be doing, which was taking care of patients.
“Employing an electronic medical record system should reduce the amount of time it takes to document the care and ultimately provide more time with the patients,” he said.
Rousey said that using an EMR can take some adjustment for practitioners experienced in maintaining paper records.
“At the beginning, there is a steep learning curve for everyone. Sometimes it actually takes longer to use the EMR in the beginning, but the efficiency becomes apparent as everyone gets accustomed to the system,” Rousey said.
At Pattie A. Clay Regional Medical Center, which switched to an EMR system in 2004, the system has paid large benefits, said Joy Barnes, information technology director.
“The nurse at the bedside may need to spend more time to initially gather and document patient information, but the administration and reporting side of nursing has seen efficiency improvements in both time and accuracy of the patient chart,” Barnes said.
Cost is still a concern when transitioning to an EMR system, Green said, despite the decrease in equipment costs over the past few years.
“Less than a tenth of our total outlay for an electronic medical records system in MEPCO was for the hardware,” Green said. “The cost of installing, licensing, and maintaining a quality system is still extremely high — in the 100s of thousands of dollars, even for a small family practice.”
Security can be another concern, said Martin Hensley, information technology specialist for the health department.
“Controlling access and ensuring security is a problem that exists on a bigger scale than it did in the past,” Hensley said. “In the past, we could just lock a file room and the charts would be secure. Now, everyone in the agency must be more conscious of security. Each computer terminal or laptop can be a doorway to confidential medical information.”
Barnes and Green also both pointed to making wise choices about the systems that are implemented as a key component of implementing an EMR system.
“In the past, we used carts with laptop computers that were wheeled into each patient room,” Barnes said. “The carts were cumbersome and not the best option, especially in a semi-private room with two patients.
“With the new renovations in place, the nursing staff are testing hand-held computers developed specifically for the health care environment,” Barnes said.
“We have to be aware of the potential for the computer to come between the provider and the patient,” Green said. “For example, large screens may block a patient’s view, or a computer’s location in the room may cause the provider to turn her back to the patient.”
Despite the costs and concerns, Green said EMRs and other health technology have a benefit to patients.
“In the long run, electronic records will increase the speed and accuracy of the flow of information between providers,” Green said.
“This translates into improved quality of care for patients, as various providers can communicate about an individual’s health needs.”
Above article published on http://www.richmondregister.com/localnews/local_story_236085613.html?keyword=secondarystory
August 26, 2009
The Certification Commission for Health Information Technology is moving forward with plans to launch a new, less comprehensive electronic health records software certification program in light of the federal economic stimulus package.
In October, the commission plans to launch a more limited, modular inspection program for EHR software, focusing only on compliance with standards required for “meaningful use” of EHRs under the American Recovery and Reinvestment Act.
Rather than wait for the federal government’s final rule defining “meaningful use” of EHRs next spring, CCHIT is moving forward with its new certification efforts based on preliminary definition recommendations from federal HIT advisory committees, says Mark Leavitt, M.D., the commission’s chair. That’s because providers will have limited time to select and implement EHRs by 2011 to qualify for maximum Medicare and Medicaid incentive payments under ARRA.
CCHIT also will continue to update and enhance its existing, more comprehensive, EHR certification system for ambulatory, inpatient and emergency department settings, Leavitt said.
The Chicago-based commission will hold an online “town hall” meeting at noon September 3, when electronic health records vendors can learn about and discuss the two CCHIT certification efforts.
The commission’s action comes after the federal HIT Policy Committee’s certification/adoption workgroup recently recommended that multiple organizations offer “HHS Certification” testing of EHRs for the incentive program. The workgroup, in making its recommendation, said that CCHIT’s existing, comprehensive certification of EHRs should not be a requirement for incentive payments. Instead, software should be certified solely for achieving the minimum set of criteria to meet ARRA’s “meaningful use” standard, according to the workgroup.
But federal regulators have yet to make a final decision on a certification approach, much less designate whether CCHIT, or other organizations, will be the government’s recognized certification bodies.
Above article published on http://www.healthdatamanagement.com/news/CCHIT-38877-1.html
August 25, 2009
Obama administration rolled out a program to make $1.2 billion grants available to help the nation’s health care system transition to electronic medical records. The grants are part of a $48.8 billion chunk of the economic stimulus bill devoted to health information technology, including grants for individual doctors to help cover the costs of converting from paper records.
These grants were approved by Congress under the economic stimulus bill, but they’re also a part of the administration’s ambitious health-care agenda. And advocates of the transition say the investment will not only upgrade the quality of care, it will also save the country money in the long run.
However, estimates of the potential savings from a transition to electronic medical records vary widely. The Obama administration says that increasing the adoption of health information technology will save the federal government more than $12 billion over the next 10 years. The left-leaning Center for American Progress estimates that investments in health information technology could lead to federal savings of $196 billion during roughly the same period. The RAND Corporation projects savings of about $80 billion a year for the entire health-care sector.
The variance among these estimates is caused in part by different assumptions about what a transition to electronic medical records really means. A 2008 report by the Congressional Budget Office noted that some optimistic estimates rely on a best-case scenario of “potential” savings if health IT systems are widely adopted – and other changes are made to the health-care system as well.
“The way to think about it is that alone, if all we do is electronic records, then we’re just going to do the wrong stuff faster,” says Len Nichols, the director of the Health Policy Program at the New America Foundation. “You’ve got to think about electronic records as a piece of a re-engineered delivery system.”
Part of the promise of electronic medical records systems is the idea that every time a doctor or nurse sees a patient, a whole database of information is instantly available: that individual’s medical history including any allergies, underlying conditions like diabetes, or tests that other specialists have already run, as well as public health data on what treatments have been proven to be most effective for patients with this person’s history and symptoms. Nichols describes a scenario in which a migraine sufferer, frustrated after years of ineffective treatment, asks his doctor for an MRI; the doctor has instant access to data that proves that an MRI isn’t the best option for this particular patient. She doesn’t order the test, and the system saves money on an unnecessary and expensive test.
The current health-care system, in which doctors are typically paid on a fee-for-service basis for every treatment they provide, offers no financial incentive for making that cheaper choice. The CBO report concludes that, without a change in the way providers are paid, electronic medical records could improve the quality of care, “but it is relatively rare for providers to be compensated for such improvements.” So a move to electronic medical records alone won’t save as much money as an electronic transition combined with a new system that rewards doctors based on the quality of care they provide.
The move to electronic medical records also raises privacy concerns because data could be shared widely among health-care providers – and used to create public health databases that could help identify the most effective treatments. The stimulus-bill grants include protections for patient privacy that could serve as a good first step to keeping health information secure, says Christopher Calabrese, a lawyer for the American Civil Liberties Union.
“Now the devil’s really in the details,” Calabrese says. “The central question is, what privacy is going to mean? Is privacy going to mean just confidentiality?” He says privacy protections should include patient control over which providers can see what information. “Your podiatrist does not need to know whether you’ve had an abortion,” he says.
Some electronic records advocates say the switch is so valuable that it should trump privacy concerns. Ellen-Marie Whelan, the associate director of health policy at the Center for American Progress, says privacy needs to be addressed, but it shouldn’t hold up the move to a more efficient system that could produce better outcomes for patients.“ I don’t know that we’ll ever get a 100% guarantee [of privacy],” Whelan says. “And it’s so important that I don’t think we can afford to wait until we have a 100% guarantee before we move forward.”
With health-care costs continually growing, policy makers are looking for any way to cut costs – even though the debate over coverage has left a cloud of uncertainty around the final bill.
“We may or may not decide as a nation that we care enough about our fellow human beings to expand coverage,” Nichols says. “We have no choice but to try to get our system to become more efficient.”
Above article published on
August 24, 2009
Filed Under (EMR, Electronic Medical Records) by admin
By Neil Versel
After months of being the target of critics both legitimate and questionable, the Certification Commission for Healthcare Information Technology is reasserting itself in the EMR marketplace. Last week, the federal Health IT Policy Committee signed off on recommendations from its Workgroup on Certification and Adoption that there should be multiple bodies to certify EMRs for participation in the multibillion-dollar Medicare and Medicaid EMR subsidy program authorized by the economic stimulus legislation. However, given the time it would take to start up a competing certification mechanism, the committee recommended that CCHIT take the lead for now in adapting certification to the “meaningful use” matrix that will determine whether a provider qualifies for stimulus money.
Meanwhile, CCHIT says it will update its certification criteria in October to meet the stimulus requirements for 2011, the first year of the subsidy program. The commission plans to respond to earlier criticism by adding certification options for some individual EMR components such as e-prescribing and clinical decision support. It also asked HHS to determine whether CCHIT’s existing criteria satisfy the 2011 requirements for meaningful use.
Above article published on http://www.fierceemr.com/story/cchit-advances-plans-2011-emr-certification/2009-08-20
August 21, 2009
By Ken Congdon, Healthcare Technology Online
In my coverage of the healthcare technology industry, I’ve noticed that many software and hardware vendors, clinicians, and even some analysts tend to use the terms EMR (electronic medical record) and EHR (electronic health record) interchangeably. However, according to the National Alliance for Health Information Technology (NAHIT), there is a distinct difference between the two.
The NAHIT defines EMR and EHR as follows:
EMR — The electronic record of health-related information of 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 of an individual that is created and gathered cumulatively across more than one healthcare organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.
In other words, an EMR is a somewhat siloed record of a single diagnosis or treatment, most likely used by a single practice or specialist. Meanwhile, an EHR is a more comprehensive record that is interoperable with and compiles information from multiple medical providers’ systems.
Don’t Judge A Software Package Based On Name Alone
Despite the NAHIT definitions, it’s obvious that the industry is still unclear on how to delineate EMRs from EHRs. For example, some software vendors brand their technologies as EHR platforms when, in reality, they don’t provide interoperability capabilities and would therefore be more accurately marketed as EMRs. At the same time, other vendors brand their products as EMR packages when they actually provide more comprehensive EHR frameworks. In fact, analysis of software packages currently on the market indicates that the latter is more likely to be the case, as most clinical records software vendors tend to brand their products as EMRs as opposed to EHRs. However, the term EHR does seem to be gaining popularity as it is the phrase used by President Obama in his healthcare stimulus talks and is the prominent terminology used in the American Recovery and Reinvestment Act of 2009 (ARRA).
Knowing that the terms used to brand clinical records software aren’t always accurate, you must dig deeper to ensure a software platform you’re assessing is equipped to meet the needs of your facility and your patients. Criteria to consider when evaluating EMR/EHR software include:
If you purchase a system that matches your requirements, it should provide a speedy ROI regardless of whether or not it is “technically” branded correctly.
Above article published on http://www.ecmconnection.com/article.mvc/EMR-Or-EHR-Whats-In-A-Name-0001
August 21, 2009
Filed Under (EHR, Electronic Health Records) by admin
By David Blumenthal, National Coordinator for Health Information Technology
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.
Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.
My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.
In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.
But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.
Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.
The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.
We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.
In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.
Above article published on
August 21, 2009
Filed Under (EHR, Electronic Health Records) by admin
Health care providers and health IT vendors should consider legal issues as they begin to transition to electronic health record systems, experts said at the American Health Information Management Association’s third annual Legal EHR Summit, Modern Healthcare reports.
Health Record Ownership
EHR technologies have started to alter discussions on health record ownership, experts said.
In the past, health care providers generally had exclusive ownership of a patient’s paper medical record. However, state and federal regulations are beginning to grant patients greater rights to access and modify their health records.
George Schroeder, director of risk management and medical network services at Cedars-Sinai Health System, said legal constructs for EHR ownership are similar to a trustee model. He explained that health care providers can function as trustees because they act on behalf of themselves and their patients. He said, “You have to have a balance between competing rights and competing responsibilities.”
Legally Defensible EHRs
Experts at the conference also noted that most EHR systems on the market cannot produce a legally defensible health record because they do not track when people access and modify the records.
Linda Kloss, AHIMA CEO, said many vendors have not focused on developing legally defensible EHR systems. In addition, health care providers have not created a demand for such functionality.
Kloss said the annual summit aims to counter vendor inattention to the importance of legal EHRs. She added that AHIMA will pressure policymakers to include auditing requirements in certification criteria for EHRs (Conn, Modern Healthcare, 8/18).
HIPAA Enforcement
Kirk Nahra, an attorney in Washington, D.C., said the federal economic stimulus package imposes stricter enforcement guidelines for the HIPAA privacy and security rules.
Nahra said the stimulus package sets penalties of $25,000 to $1.5 million for violations of patient data restrictions. The stimulus package also grants state attorneys general the authority to enforce HIPAA rules.
Nahra noted that the stimulus law also requires software vendors and other health care business partners to alert consumers about security breaches. He said he expects health care providers to revise vendor contracts to reflect the new provisions (Anderson, Health Data Management, 8/18).
Above article published on
August 21, 2009
Critics have complained that the Certification Commission for Health Information Technology is too closely aligned with large EMR vendors. By Marianne Kolbasuk McGee
The Certification Commission for Health Information Technology, which has been the group providing a seal of approval for electronic medical record products since 2006, will continue to be the certification body for health IT systems at least until December when the U.S. government finalizes its definition of “meaningful use” of e-health products.
After the meaningful use definition is finalized, multiple organizations will be allowed to perform testing and certification of products for meeting the evolving criteria and standards of U.S. and Health and Human Services health IT certification rules. Vendors would need certification from only one certification body.
The continuation of CCHIT as a certification body was among the recommendations endorsed by the HIT Policy Committee certification and adoption workgroup during a meeting on August 14.
The HIT Policy Committee is an advisory board to the Office of Coordinator of National Health IT, which is guiding the U.S. Dept. of Health and Human Services on filling in the details of the $20 billion federal stimulus HIT legislation signed into law in February.
The non-profit CCHIT organization was founded in 2004 and began certifying products in 2006 during the Bush administration’s push for most Americans to have e-health records by 2014.
To date, CCHIT has certified more than 200 e-health products. However, with the passage of the American Recovery and Reinvestment Act ’s health IT legislation earlier this year, the future role of CCHIT was uncertain.
According to provisions in ARRA, in order for healthcare providers to be eligible for federal stimulus rewards starting in 2011, they must use “qualified” health IT products in “meaningful” ways. The details of qualified and certified–as well as “meaningful use” are still being hammered out. However, the HIT Policy Committee meeting last week helped clarify some of those ongoing questions, including the role of CCHIT at least in the short term.
Over the last few months, critics of CCHIT have complained to the HIT Policy Committee that CCHIT is too closely aligned with large EMR vendors selling comprehensive, feature-rich products, making it difficult or impossible, as well as expensive, for smaller vendors, open source developers and in-house development teams, who provide modular products with fewer bells and whistles, to get CCHIT certification.
CCHIT announced recently it will offer additional paths of certification for open source and modular products, such as e-prescribing, as well as in-house developed or assembled e-health systems.
In documents distributed at its Aug. 14 meeting, the HIT Policy Committee said that moving forward, the proposed definition of HHS Certification “means that the system is able to able to achieve the minimum government requirements for the security, privacy and interoperability, and that the system is able to produce the ‘meaningful use’ results the government expects.”
The HIT Policy Committee added that “HHS Certification is not intended to be viewed as a ’seal of approval’ or an indication of the benefits of one system over another.” Other recommendation by the HIT Policy Committee:
Above article published on
August 21, 2009
Filed Under (EHR, Electronic Medical Records) by admin
OREM, UT, August 12, 2009 — Healthcare technology research firm KLAS today announced its annual clinical market share report, which details the wins and losses of acute care electronic medical record (EMR) vendors at large hospitals with more than 200 beds.
The report notes that, in 2008, EMR vendors sold the fewest number of new contracts in the United States and Canada in the seven years since KLAS began tracking clinical market share information. However, despite a tough economy, Epic continued to make gains among large hospitals, capturing nearly 40 percent of the new business. McKesson and Siemens also scored some unusual wins, while Cerner saw no net growth in its clinical market share for the first time.
The KLAS report, “Physicians, Nurses, and EMR Adoption: Which Solutions are CEOs Betting On?”, reflects data collected from more than 1,600 hospitals over 200 beds in the United States and Canada. While acknowledging the seven-year low in EMR sales, the report also notes that the recent past does not appear to be an indication of the future.
“The advent of new meaningful use requirements, plus the ongoing debate around broader healthcare reform, has many organizations looking for a new clinical information system,” said Jason Hess, KLAS general manager of clinical research and author of the new report. “During this study, KLAS identified more than 400 large hospitals that either have no EMR or are using a legacy system; and we
are already aware of purchasing activity that, if the rate continues, will far exceed 2008 sales.”
Beyond the steady progress of Epic EpicCare Inpatient, Siemens Soarian Clinicals and McKesson Paragon Clinicals found some unusual wins in 2008. Siemens was able to communicate its vision for Soarian to providers outside its client base, as five non-Siemens hospitals (four organizations) bought Soarian in 2008, despite the product’s historically low computerized physician order entry (CPOE) adoption. Further, the company won three hospitals in the over 400-bed space, bucking Epic’s trend of pushing vendors out of that market.
McKesson Paragon also made some surprising inroads with larger hospitals, given its reputation as a smaller community hospital solution. Of the 12 McKesson EMR wins in hospitals over 200 beds, four of the organizations chose Paragon as opposed to Horizon. These wins indicate that Paragon, one of the lowest-rated systems that KLAS followed in 2000, is now gaining significant momentum, not to mention leading performance scoring in the community hospital information system (HIS) market.
For Cerner and Eclipsys, the KLAS report noted that leadership in CPOE adoption did not necessarily translate into EMR wins. As validated by KLAS earlier this year, Cerner has the highest number of hospitals doing CPOE, and Eclipsys has the greatest number of physicians doing CPOE - yet neither vendor was among the top three in new large hospital EMR sales in the United States and Canada in 2008.
Above article published on http://www.chiroeco.com/chiropractic/news/8403/1112/Report:-EHR-adoption-increase-expected-in-2009/
August 13, 2009
The requirements for what health IT users need to do to meet the meaningful use dictates of the stimulus law are now clearer, with the focus apparently swinging to how the IT certification process will handle them.
Healthcare providers finally have some certainty about what they need to do to be meaningful users of health IT, said Dr. Bruce Taffel, chief medical officer of SharedHealth, an healthcare information exchange and application provider.
Dr. David Blumenthal, the national health IT coordinator, and the HIT Policy Committee, a public/private organization, approved July 16 a list of 28 health IT functions and corresponding quality and efficiency improvement measures for 2011 that become progressively more rigorous in 2013 and 2015.
The schedule is aggressive and the criteria will be difficult for some to achieve.
“The recommendations provide more clarity at this stage, although there’s still a lot more work to be done,” Taffel said today.
The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions. Under the American Recovery and Reinvestment Act, providers will be eligible for increased Medicare and Medicaid payments beginning in 2011 if they demonstrate meaningful use of their certified health IT. The payments end after 2015 when health IT should be broadly adopted.
“The committee shaped their recommendations on meaningful use and the progression to achieve that on the basis of what we can do today, what the current condition is and with a fairly reasonable explanation of how you begin phasing in much of this,” Taffel said.
The policy committee also made its first recommendations on the certification process of electronic health records. Currently, the Certification Commission for Health IT (CCHIT) is the sole certifying and testing organization. The HIT Policy Committee wants more competition.
Multiple groups will be needed to perform certifications because so many more providers will seek to have the service conform to the stimulus, said Paul Egerman, retired businessman and chair of the committee’s certification and adoption work group.
The certification process should also accommodate a scaled-down version of certification process for systems or applications that still allows providers to prove they are meaningful users with components of comprehensive electronic health records, EHRs from multiple sources or self-developed applications, he said.
“If comprehensive certification is important, say for vendor marketing, it’s a positive thing that should continue to exist,” Egerman said.
The committee agreed to focus certification on a minimal set of requirements for meaningful use, and not on features and functions. The national coordinator’s office would review CCHIT certification criteria for gaps in assuring meaningful use.
“We could have the meaningful use gap certification process decided by Labor Day,” Blumenthal said.
Those products that are currently CCHIT-certified will be certified for meaningful use under the Health and Human Services Department definition for 2011, “subject to completing a special meaningful use gap certification,” according to the work group’s transition plan.
The work group also urged that the certification process be used to improve progress on security, privacy and interoperability and provide a tighter link with standards. Above article published on |
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