Bernie Monegain, Editor

An EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later, according to a new study.

The Kaiser Permanente program in Denver linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record to help keep the patients healthy two years after they left the program by keeping them in touch with their caregivers electronically, according to a randomized study.

The study, which was funded by the American College of Clinical Pharmacy, is published in The American Journal of Managed Care this month. It is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, researchers said.

The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente’s HealthConnect EHR with patient outreach, education, lifestyle adjustments and medication management.

The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.

“Because lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the healthcare system through our electronic health record,” said the study’s lead author, Kari L. Olson, a clinical pharmacy specialist with Kaiser Permanente Colorado’s Cardiac Risk Reduction program. “The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.”

In the study, the patients in the Clinical Pharmacy Cardiac Risk Service with well-controlled blood pressure and cholesterol levels were randomized so that 214 continued to receive intensive direct counseling from the care team. The other 207 patients were discharged from the program back to their primary care physician.

The mean age of the trial participants was 72 years old, and 74 percent were male. Patients who were discharged from the program had electronic reminders in their chart to ensure their lipid panels were ordered annually, with the results sent directly to their primary care physician. The discharged patients also received reminders generated by KP HealthConnect indicating they were due for a lab test.

The study found that patients discharged from the program maintained control of their risk factors with the help of electronic reminders. The EHR intervention was as effective at keeping cholesterol and blood pressure in check, compared to the more intensive counseling approach offered to those patients who stayed enrolled in the program.

The Clinical Pharmacy Cardiac Risk Service cares for 13,000 cardiac patients with integrated nursing and pharmacy teams that work collaboratively with patients and their doctors using technology tools and activities such as lifestyle modification, medication management, patient education, laboratory results monitoring and management of adverse events.

The program also achieved these results:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and;
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

Above article published on

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HUDSON, IA – Full-practice automation seems to pay off for many small physician offices, but others who choose only select areas to convert are feeling the positive financial effects as well.

Kurt Kastendieck, MD, a family practitioner in Sante Fe, N.M., is in the process of automating his practice and finds his e-prescribing tool to be particularly useful.

“It works well,” he said. “Things like refill communications are automatically sent back. It saves an amazing amount of time.”

The e-prescribing program came with Kastendieck’s EHR, which he installed two years ago. He also bills through the system.

Larger pharmacies are better equipped for e-prescribing, but not many smaller pharmacies are, Kastendieck said. Some still take prescriptions by phone or fax.

The e-prescribing tool calculates and produces a 24-hour turnaround bill through the clearinghouse and on to the insurance company. Kastendieck said reimbursement now averages two weeks from a patient’s visit.

Automation, such as e-prescribing, helps improve a doctor’s quality of life, said Kastendieck. one doesn’t need a complete EHR, only Internet access.

Theresa Dickson, who manages her husband’s solo general surgery practice in Dennison, Texas, says electronic billing technology brings the money in quicker, even without an EHR.

“The few practices I know of out there that paper bill their claims simply budget the practice to allow for the 45 day delay in payment as opposed to 20-30 days that we experience,” she said.

Dickson said many IT companies say an EHR will save money because physicians will need less room to store charts. However, Dickson says the monthly fees for the use of an EHR often outweighs the cost of hard copy storage.

“I have seen monthly fees of $500 to $1,500 a month for one doctor,” she said. “We are not being reimbursed by our major carriers enough to offset that cost. In our particular community, real estate is relatively inexpensive, so for me personally it would cost me less to store charts.”

James Selenke, a family practitioner based in Hudson and Reinbeck, Iowa, fully automated his practice with an EHR and e-prescribing system.

He said that he is amazed at where people get numbers for cost of EHRS – to many it seems to be a tremendous amount of money, but other than hardware, which cost him $16,000 in 2004, he is only paying $870 per month to service two physicians on the EHR.

“Cost was a major factor,” said Selenke. “The fees are good for my size practice.”

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http://www.healthcarefinancenews.com/news/docs-see-money-faster-automation

The plan will rely on federal grants and build on previous state efforts to expand health IT adoption in underserved rural areas.

By Pamela Lewis Dolan, AMNews staff.

Louisiana Gov. Bobby Jindal signed into law a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system.

The Electronic Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of Health and Hospitals the authority to apply for $25 million in federal stimulus funds in order to administer loans for EHR purchases. The measure also included $5 million in matching funds from the state, a requirement under the American Recovery and Reinvestment Act. The state will learn later this year if it will get the federal grant.

“This is another step in updating and improving Louisiana’s health delivery system for all Louisianians,” Jindal said in a prepared statement.

The measure builds on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health Information Exchange. In 2008, additional funding allowed another seven rural hospitals to become connected.

To qualify for the loans, the purchased EHR system must be certified by the body eventually chosen by the U.S. Dept. of Health and Human Services for such approval. Loans could also apply to fully integrated telemedicine systems.

Acknowledging upfront costs are a barrier that the incentives wouldn’t help alleviate, many EHR vendors also launched financing options for physician practices as a result of the stimulus. General Electric Co., for example, is giving practices the options of deferring payments until incentives start being paid in 2011.

Jenny Smith, health information technology project manager for the Louisiana Health Care Quality Forum, which is the state-designated entity for distributing all grants coming out under the federal stimulus package, said details are still being worked out in terms of the loan agreements. Work groups consisting of several stakeholders in the state are currently working on structuring the loan program, she said.

“The goal is to maximize the amount of support we can give to providers in Louisiana who couldn’t otherwise purchase an electronic health record or upgrade their electronic health record to meet the meaningful-use criteria for the incentives,” Smith said.

Once the state has reached 100% compliance, Smith said, the fund would likely be used for support such as upgrading systems or training.

Above article published on

http://www.ama-assn.org/amednews/2009/08/03/bise0806.htm

By Jean DerGurahian / HITS staff writer

Providers looking to make decisions about technology will find the revised “meaningful use” definition helpful, but the implementation timeline might still be challenging, professionals say.

The federal Health Information Technology Policy Committee approved updated recommendations from its meaningful use work group during a conference. The revised definition for the meaningful use of electronic health records includes changes to computer physician order-entry criteria and speeds up the schedule for granting real-time access to patient information through personal health records. The 2011 measures are being established with a focus on data capture and sharing, according to the work group’s recommendations.

Overall, the revisions “have some nice granularity to them,” said Brian Jacobs, a critical-care physician and chief medical information officer of 230-bed Children’s National Medical Center, Washington. As the medical center finishes components of its EHR, the revised measures will serve as guidelines for what it needs to focus on, he said. The medical center is already available for the full, first-year IT adoption incentive payment under the American Recovery and Reinvestment Act of 2009 because it meets the 2011 criteria now.

The American Hospital Association said that it is reviewing the revisions and the deadline for meeting criteria. “We remain concerned that many hospitals that haven’t already adopted health IT systems may find the proposed timelines unachievable,” said Don May, AHA vice president for policy, in a written statement

Above article published on

http://www.modernhealthcare.com/article/20090717/REG/307179990/1153

In a recent interview with American Medical News, National Coordinator for Health IT David Blumenthal discussed timetables for electronic health record adoption and the generation gap between older and younger users of the technology.

EHR Timetables

Blumenthal said federal officials are promoting EHR adoption in an effort to meet President Obama’s goal of providing all U.S. residents with an EHR by 2014.

He added that the Office of the National Coordinator for Health IT also is working under the time frame of the federal economic stimulus law, which imposes penalties on health care providers who do not adopt health IT tools by 2015.

Blumenthal acknowledged that many physicians have concerns about the pace of the EHR adoption timelines. He said ONC is “very aware that we need to find a balance between our long-term goals of using electronic health records to improve practice and the practical realities of everyday medicine.”

Blumenthal said his office will continue to solicit and consider stakeholder feedback on EHR timetables and other issues.

Health IT Generation Gap

In addition, Blumenthal spoke about generational differences in technology use among health care providers. He said many younger physicians are comfortable with EHRs and expect to use IT systems that connect them with colleagues and comprehensive medical data. However, he said older physicians might have less experience with the technology”

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http://www.ihealthbeat.org/Articles/2009/8/4/Blumenthal-Discusses-
Efforts-To-Promote-EHR-Adoption-Nationwide.aspx

One part of President Obama’s healthcare agenda that has been nudged out of the spotlight is the push to create a nationwide network of electronic health records (EHR) by 2014. McKnight’s will hold a webcast on this issue later this month.

Even though a deadline is in place, EHR faces significant challenges toward implementation. One of the main factors holding back EHR adoption is the sheer cost of the undertaking, according to CNNMoney.com. Depending on the size of the facility, an EHR system can cost tens of millions of dollars to implement, and take years to get off the ground. One Kentucky hospital system will require $80 million and three years to fully implement an effective EHR system, CNN reported. Convincing physicians to change their long-held practices can be a challenge as well, according to the report. Smaller rural facilities face other challenges, including lack of training and resistance to change. The long-term care industry has long been considered ahead of the curve in EHR adoption practices.

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http://www.mcknights.com/Electronic-health-records-overlooked-in-healthcare-debate/article/141021/

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews

The Obama administration’s national health information technology coordinator has approved recommended definitions for what constitutes “meaningful use” of electronic health records, about a month after asking a key working group to revise its initial recommendations.

The green light from David Blumenthal, MD, means that the recommendations now will be sent to the Dept. of Health and Human Services, which by the end of the year must issue a rule with final definitions. Meaningful use is a key term that ultimately will determine which physicians and hospitals are eligible for billions in federal EHR money made available through the economic stimulus package approved earlier this year.

Recommendations from Dr. Blumenthal and the Health IT Policy Committee provide the first look at a policy framework for the development and adoption of a nationwide health information infrastructure. The committee said it received nearly 800 comments after unveiling a first draft of the recommendations June 16, though policy experts say few major changes were made since then.

“To say Dr. Blumenthal sent the working group back to the drawing board really is inaccurate,” said Erica Drazen. a managing partner in the health care group at Computer Sciences Corp., a technology firm in Waltham, Mass. “There weren’t really too many surprises or changes made from the initial draft. If anything, it’s slightly more aggressive.”

Drazen pointed out, for example, how the final recommendations specified that only 10% of all orders entered by an authorizing physician at a hospital must be made via computerized physician order entry. The initial draft did not provide an exact percentage. But the requirement for physician practices remains the same — they must use CPOE for all orders, according to the final version. Doctors also received several additional recommended standards to meet by 2011.

HHS must finalize EHR meaningful use guidelines by year’s end.

Some health care policy experts praised the quick work by Dr. Blumenthal, the committee and the working group.

“They have laid out these big, achievable goals that are central and critical, and the way meaningful use needs to be implemented is with an eye toward achieving these objectives,” said Carol Diamond, MD, managing director of the health program at the Markle Foundation, a health IT policy organization based in New York. Markle teamed up with two other health care policy organizations — the Center for American Progress and the Engelberg Center for Health Care Reform at Brookings — to comment on the working group’s report.

The organizations called the measures ambitious but achievable. Dr. Diamond cautioned, however, that HHS should not try to add new goals or tasks for physicians. “Rather than try to expand these even more and add more requirements, there’s a real opportunity for HHS to define within these goals how each specific provider group can achieve these measures.”

2011 objectives

Despite some revisions, most of the initial recommended requirements for physicians receiving EHR stimulus money remain the same. By 2011, physicians will be considered meaningful EHR users if the practice meets multiple objectives, including:

• Maintaining an active medication list.
• Incorporating lab test results into the EHR as structured data.
• Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach.
• Reporting ambulatory quality measures to the Centers for Medicare & Medicaid Services.
• Sending reminders to patients for preventive and follow-up care.
• Documenting a patient progress note for each encounter.

The Health IT Policy Committee also recommended objectives for 2013 and 2015.

The medical community has tracked the committee’s work and the meaningful-use debate with much interest, as the stimulus package provides approximately $19 billion in net Medicare and Medicaid EHR incentives for physicians, hospitals and others. The incentives begin as bonuses for early adopters but turn into penalties for those who don’t adopt quickly enough.

Meaningful users have been defined generally as physicians who have demonstrated to the government that they are using electronic prescribing and that their systems are connected to other entities in a way that provides for the exchange of health data to improve care quality. But the working group was asked to specify exactly what objectives and measures physicians would need to meet for stimulus incentives.

Health IT and policy experts say the recommendations approved by Dr. Blumenthal are a significant benchmark for physicians.

“This is a good time for physicians to check in, because the first wave of the draft was more about moving it out of the political process, and this development certainly moves it toward rule-making,” said Jana Skewes, president and CEO of SharedHealth, a provider of health information products and solutions based in Chattanooga, Tenn. “I would say now there are enough signs and pillars of requirements that physicians would be using their time wisely to determine what the requirements are.”

Skewes advised doctors who already have EHRs to check with their vendors to see if systems are up to date with the most current recommendations.

Now that the medical community has a pretty good idea of what to expect from the government, Drazen said, practices shouldn’t wait to start upgrading or adding EHRs.

“The market has been waiting, and people have been afraid to make investments, because they weren’t sure what was required,” she said. “But big capital investments shouldn’t have to be made to at least get started.”

Above article published on

http://www.ama-assn.org/amednews/2009/08/03/gvsb0803.htm