By Rich Silverman

We talk a lot in this blog about the financial aspects of Electronic Medical Records (EMRs), and with good reason – they can entail a substantial investment in time and money. But it’s sometimes easy to lose sight of the purpose of all that investment – to save lives.

There has been a great deal of research conducted into how much it will cost to implement an EMR, yet there has not been a lot of research into their impact on patient outcomes. A recent study shows that the adoption of Electronic Medical Records and Radiology Information Systems (RISs) in hospitals in the U.S. actually lowers infant mortality in this country. Research conducted by Amalia Miller of the University of Virginia and Catherine Ticker of MIT’s Sloan School of Business showed that when hospitals adopt EMRs and RISs, their infant mortality rates drop.

Using data on births and infant mortality already collected by the U.S. Government, and statistics on health care information technology adoption provided by the Health Information Management Systems Society (HIMSS), the researchers compared infant mortality in selected areas of the country where data was available (privacy laws limited that data pool) with the adoption of EMRs and RISs in those same areas.

After correcting for a wide range of variables, the researchers came to the following conclusions:

The adoption of EMRs by one additional hospital in a county reduces infant mortality by 13%.

The average cost of the HIT used to save that baby is about $450,000.

The reduction of infant mortality is twice as great for African-Americans than non-African-Americans.

The median cost to implement EMR in a hospital, according to a 2007 America Hospital Association study was $5,556 in capital costs per bed and $12,060 per bed per year in maintenance costs.

The authors studied “bare-bones” HIT implementations of EMRs, and only looked at the impact on neonatal and infant health outcomes. They suggest that more robust implementations of HIT, including decision-support and computerized physician order entry, as examples, will extend the beneficial effects of HIT to other classes of patients.

This research serves as a gentle reminder that the HITECH Act was intended to provide incentives for physicians and hospitals to implement and use Electronic Medical Records because EMRs will improve patient outcomes and save lives. This research shows that they do.

Above article publish on http://blog.pchealthstop.com/?p=985

Between 75-85 percent of physicians with EHRs are already using functions that meet some of the proposed criteria for demonstrating meaningful use, according to analysis from Seth O. Hogan, survey director, and Stephanie M. Kissam, health services research associate, at RTI International in Chicago.

The authors of the survey, published in the April edition of Health Affairs, said their analysis contributes new information about the rates at which primary care physicians, medical specialists and surgical specialists who had a basic EHR system used specific functions before the passage of the stimulus law, compared to the level of expected meaningful use of EHRs set forth in the proposed federal regulations.

“Among physicians who had key functions available to them, 75-85 percent reported using functions in the patient record category. These functions included organizing patient information such as sex and date of birth, lists of medications taken by the patient, problem lists or the current diagnoses of patients and clinical notes,” wrote the authors.

A stratified random sample of 5,000 U.S. office-based physicians was drawn from the American Medical Association’s Physicians Masterfile where, after 516 were determined as ineligible, 2,758 of the 4,484 eligible physicians completed the surveys during a data collection period from August 2007 to February 2008, yielding a 62 percent response rate.

The authors sorted completed interviews by whether physicians reported having a basic EHR system, meaning that it offers practitioners, at minimum, the following functions: the ability to record patient demographics, including name, address and sex, inclusion of patient problem lists, clinical notes, patient medication lists, and orders for prescriptions and electronic viewing of laboratory and imaging results. “Applying these criteria resulted in a sample of 485 physicians eligible for analysis,” the authors noted.

Fewer than one in five physicians reported having at least a basic EHR system, the survey found. Of those who did, primary care physicians were the most likely to report having a basic EHR system (19.4 percent). Medical specialists were the next group most likely to have a basic EHR system (17.1 percent) followed by surgeons (16.7 percent). “Availability of additional EHR functions, beyond those defined in a basic system, varied across all physician groups,” the authors wrote.

The use of these basic functions did not differ significantly by broad medical specialty yet the authors reported these data to provide baselines for tracking changes by specialty groups over time.

According to the survey, 79 percent of 306 responding physicians whose EHR systems had warnings for drug-to-drug interactions used this function. For information exchange functions, the authors also reported on the use of sending prescriptions electronically (79 percent of 265 respondents whose records had this function) and submitting laboratory orders electronically (used by 64 percent of 256 respondents whose records had this function).

“Public health reporting functions were less commonly used among the small number of physicians who had those functions available to them,” the authors wrote. In addition, only 27.6 percent of the 128 responding physicians said they could provide at least 10 percent of unique patients with timely electronic access to their health information, the authors found.

“To qualify for new federal funds intended to promote the widespread adoption and use of EHRs, U.S. physician practices must meet the government’s meaningful use benchmarks,” concluded the authors. “Tracking the use of EHRs across different types of providers will be a critical component in evaluating how their use affects healthcare costs, quality and safety and overall population health measures.”

Above article publish on http://www.healthimaging.com/index.php?option=com_articles&view=article&id=21577:healthaffairs-about-80-of-emr-users-meet-some-meaningful-use-criteria

By Chip Means

Relaxing the meaningful use standards, as some physician organizations and members of Congress are urging HHS to do, would be a boon to the EMR industry, according to market research firm Kalorama Information, which completed its market research report “EMR 2010 (Market Analysis, ARRA Incentives, Key Players, and Important Trends)” earlier this year. The report predicts a $13.8 billion market that if properly driven by incentives and encouragement of health systems, could grow in double digits.

“Requiring physicians to undergo 25 mandates by next year may not be effective given the kind of real-world usage among physicians we see today,” said Bruce Carlson, publisher of Kalorama Information. “Getting physicians used to these systems is the challenge to a totally paperless healthcare system in the United States and we think gradual, achievable goals would be preferable.”

Kalorama notes that the objectives of the HSS meaningful use requirements, in order for physicians to receive incentives in 2011, include some that would be expected, such as a requirement that physicians must submit a percentage of claims electronically, use an established diagnostic list such as ICD-9, and have common medications entered for each patient. The firm notes that some sort of requirement for computerized physician order entry (CPOE) on a percentage of orders should also be expected to increase EMR use. But Kalorama believes that requiring 80% of orders via CPOE by 2011, or that half of patients get auto-reminders through an EMR system, is a possible limiter to sales of EMR systems.

Thirty-seven U.S. Senators, led by Senate Finance Committee Chairman Max Baucus, D-Montana, and Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, wrote a letter requesting improvements in a proposed rule for distributing stimulus funds for health IT that was published by the Centers for Medicare & Medicaid Services which would increase flexibility and encourage participation among providers. 235 members of the U.S. House of Representatives urged CMS to modify its proposed definition and requirements for hospitals to qualify for the meaningful use of health IT incentive payments.

Kalorama’s market research study was conducted before the release of ‘meaningful use’ standards by HHS, but it did note that the largest barrier to EMR use in the United States is physician compliance. Kalorama has also noted that for EMR to grow in the way the federal government envisions, healthcare systems will have to develop incentives of their own, something that might be in jeopardy if standards are not easier to follow.

“It’s not just about encouraging physicians directly, though that’s part of it,” notes Carlson. “It’s about encouraging healthcare systems to develop ‘matching’ programs to encourage EMR among their affiliated physicians. Unless there’s a clear road to incentive money they won’t do that.”

Above article publish on http://ehr.healthcareitnews.com/story/relaxing-meaningful-use-key-emr-industry-growth-kalorama-notes

By Shawn Riley

Electronic Medical Records (EMR) documents patient’s medical history such as test results, medication and general clinical data in an electronic format and allows easy and rapid access to such information to authorized personnel providing patient care. EMR has brought many benefits to physician’s practice that includes better administrative reforms, reduction in costs and better profits, better coding of procedures, more accurate, legible record processing, reduced medical errors and reduce documentation time. According to the center for disease control estimates, approximately 29.2 percent of physicians reported using full EMR systems in their office-based practices in 2006. With the Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many physicians are expected to adopt EMR. To realize the benefits of EMR, it is essential to pick the right EMR. Few key issues before picking a new EMR include license, technical support, and import of text, image format and printers and transferring of information.

License

Some companies grant “site license” under which the user pays for the use of the software at his site with no restriction on the number of users. However, most vendors grant license for their software per user. It is essential to understand the terms and conditions because it can be more complicated than it appears. Information regarding the number of license required and the amount of time it might take for a license to become available (in simple terms, how soon another user can log on after a user logs out or after the system crashes) should be collected from the vendor.

Technical support

All vendors offer technical support, understanding how these technical supports is defined and how much it costs is essential. A cost-benefit analysis will help in deciding the technical support to opt for.

Text import into the system

Before picking an EMR, know how text other than notes can be imported and whether additional hardware and software is required. Confirm the utility of EMR in terms of importing text such as X-ray reports, notes from consultants and operative reports into the EMR. For example, scanner and an optical character recognition program convert the text on X-ray reports to text in the EMRs that saves a lot of physical storage space, and allows for easy access to information. One should be aware and be comfortable in handling these processes.

Image formats and printers that support the system

Choosing a system that allows multiple image formats allows you to select the file type that best balances efficiency with visual quality for a given kind of image. Having a system that allows multiple file formats also gives you more choice about the sources from which you can accept images. Unfortunately, not every printer will work with every EMR system. Consider the issue of printing before picking a new EMR. Make sure your printers are compatible with the EMR system.

Transferring of data

Before you buy a system, be sure that you will be able to access your data if you decide to replace it with another. Ensure that the data can easily be transferred to another system.

Above article publish on http://www.healthtechnica.com/blogsphere/2010/04/09/5-easy-things-you-should-look-for-when-picking-an-emr/

A new study reveals an exciting potential benefit of the rapidly accumulating databases of health care information, the ability to make unprecedented links between genomic data and clinical medicine. The research, published by Cell Press in the April issue of the American Journal of Human Genetics, supports the idea that large scale DNA databanks linked to electronic medical record (EMR) systems provide a valuable platform for discovering, assessing and validating associations between genes and diseases.

“The deployment of EMRs offers the hope of improving routine care, not only by enhancing individual practitioner access to patient information but also by aggregating information for clinical research,” explains senior study author Dr. Dan M. Roden from Vanderbilt University School of Medicine in Nashville Tennessee. “EMRs contain large populations with diverse diseases and have the potential to act as platforms for rapid and inexpensive creation of large inclusive patient sets.”

Dr. Roden and colleagues in informatics and in genome science were interested in examining whether large biorepositories containing DNA samples linked to EMRs might be useful for discovering and incorporating new genotype-phenotype associations. “Implementing such a vision requires that major obstacles be overcome, including technological, computational, ethical, and financial issues and determining whether genomic information will meaningfully inform clinical decision making and health care outcomes,” says Dr. Roden.

The researchers used BioVU, the Vanderbilt DNA databank, to detect known common genetic variants associated with five diseases: atrial fibrillation, Crohn’s disease, multiple sclerosis, rheumatoid arthritis and type 2 diabetes. It took only four months to generate a set of nearly 10,000 records from which the cases and controls were identified. Although the process of accessing and defining the samples was technically complex, for each of the five phenotypes, at least one previously reported genetic association was replicated.

These results support the use DNA resources coupled to EMR systems as a valuable tool for clinical research. “Our data demonstrate that phenotypes representing clinical diagnoses can be extracted from EMR systems, and support the use of DNA resources coupled to EMR systems as tools for rapid generation of large datasets required for replication of associations found in research and for discovery in genome science,” concludes Dr. Roden.

Above article publish on http://emrdailynews.com/2010/04/01/electronic-medical-records-may-accelerate-genome-driven-diagnoses-and-treatments/

By Patrick Lukacs

With the advent of the American Recovery and Reinvestment Act (ARRA)/HITECH Act and the promise of stimulus funds, physicians are mulling ways to add electronic medical records (EMRs) to their practices.

Even providers skeptical of the reimbursement process can’t afford not to consider, starting in 2011, an attempt to secure up to $44,000 per physician over five years. Some physicians even propose that those who don’t implement an EMR are diminishing the profession and may be breaking the Hippocratic Oath by not using technology to improve the care of patients, particularly those with chronic conditions.

Group practices pondering stepping up to the EMR plate know they have several routes to implementation, including working directly with EMR vendors and their resellers or leveraging hospital-owned systems. For many reasons, savvy physicians and administrators are starting to rely on third-party billing companies to provide the quickest route to success in adding and supporting an EMR.

Many physician practices and billing companies have invested time and energy in a long-term working relationship, with physicians and administrators coming to depend on the biller’s business acumen and broad technical expertise in helping run the practice. Years of working hand-in-hand with medical office staff give billing personnel a solid grasp of how the particular practice functions and how best practices can help improve effectiveness. Billing staff is attuned to how work flows most efficiently in the practice, the peculiarities of its data and patient population and the peccadilloes of particular providers.

Furthermore, billing companies understand the legislative landscape and ways to clear technical hurdles and pave the way to stimulus funds. Comprised of more than 600-member organizations, the Healthcare Billing & Management Association (HBMA) is helping physicians access necessary information from EMRs to facilitate reimbursement and meet medical and business needs. The California-based organization is dedicated to helping members monitor relevant trends and learn how best to implement EMRs into group practices through a task force, white papers, annual conferences and a series of educational summits.

In-depth knowledge of the EMR space helps third-party billing companies downsize the daunting plethora of EMR vendors in the marketplace to a short list of only those systems which best suite a practice’s financial, functional and specialty needs. Billing companies are counseling clients on whether it is best to consider an EMR with broad capabilities that can be tailored to and grow with the practice’s needs or an EMR that is designed particularly for a specialty.

The staffs at third-party billing companies are well versed in coding and compliance, including those of clinical backgrounds to ensure the best marriage of administrative and clinical functions.

Billing companies offer fast, but carefully phased-in implementations. While EMR vendors start implementation at the absolute beginning, billing services can add an EMR to a practice in weeks rather than months because there is already a data center supporting the IT infrastructure, software configurations and policies and procedures developed to support recommended business processes, modified to client requirements.

Last, but not least, because billing companies have an ongoing relationship with medical offices, their staff can be available long after go-live to troubleshoot problems, resolve them quickly and help physicians and their staff gain confidence and wring the most out of their EMR.

Above article publish on http://www.healthcareitnews.com/blog/billing-companies-are-key-adopting-emrs