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

Patty Enrado, Contributing Editor

Long before ARRA, more than five years ago, the University of California San Francisco (UCSF) Medical Center began a $50 million electronic medical record initiative. This past summer, UCSF reportedly wrote off a third of that cost and scrapped its contract with the EMR vendor. The EMR system reportedly had technical difficulties that never enabled it to be fully functional. Undeterred, UCSF is forging ahead with its goal of digitizing its patient records, which says a lot about its faith in EMRs.

UCSF Medical Center isn’t the first healthcare system to have a costly, disastrous experience, and it won’t be the last. Industry stakeholders, however, need to work together to ensure that the number of failures dwindle significantly.

The most important thing that the EHR/EMR market can do for itself is to be transparent. If there is no transparency, how can healthcare systems perform accurate due diligence? There’s a business reason for non-disclosure clauses in sales contracts, which prevent purchasers from reporting problems with the health IT vendor or their products, and “hold harmless” clauses, which exempt vendors from any liability. It may guarantee a risk-free business environment for the health IT vendor, but it hurts the EMR market and eventually hurts the health IT vendor’s reputation. Clinicians and healthcare organization executives may be obligated to remain silent about the product and/or the vendor’s problems, but they will talk informally to their counterparts in other healthcare organizations. You’ve heard the complaints. You know which health IT companies did what to whom.

Transparency need not be the enemy of health IT companies if they have solid products and customer support. For those that have had problems - and I’m not saying they have bad products or customer support - it’s a business imperative to fix those problems. There are less-expensive, more flexible EMR solutions that have come into the market in the last year. There will be other UCSF Medical Centers that cut off their legacy vendor and start anew.

There are some in the industry who say so long as the federal stimulus incentives help subsidize the purchase of legacy systems the problems will continue. University of Pennsylvania sociologist Ross Koppel believes the federal government should have put that money to use by developing “more usable and more responsible software.” I think that route would have been successful as a first step, though I still believe in the incentives. There are some who believe the federal government should regulate the EMR industry. If that sounds odious, then perhaps the EMR industry ought to regulate itself.

As for healthcare providers, they need to understand the enormity of the task. What I mean is that they need to not only put up the cash for the initiative but dedicate human resources to the initiative. Dedicate a team, if that is what is required.

I’d be remiss not to mention that for every UCSF there is a UPMC (University of Pittsburgh Medical Center) - large healthcare systems that have successfully implemented big-budget EMRs and are reaping administrative and clinical benefits. The problem is there aren’t enough of them. And that’s why there is hesitation among healthcare systems. As an industry, let’s try to increase those success stories.

Above article published on http://www.healthcareitnews.com/blog/how-healthcare-industry-can-increase-number-successful-ehremr-initiatives

We’re in an unprecedented boom in health IT, thanks mostly to growth in the EMR/EHR sector.

A new report from Scientia Advisors says health IT is the fastest-growing segment of what the Cambridge, Mass., management advisory company calls a $1 trillion global healthcare products marketplace. Health IT currently is growing at an 11 percent annual rate, and solid growth should continue at least through 2013, which would be the third year of the federal EMR stimulus program here in the States, the Scientia report forecasts. In that time frame, health IT will increase its market share by a quarter, to 5 percent of global healthcare products sales from the current 4 percent.

In the U.S., according to Scientia, the bulk of the spending will come from inpatient and outpatient EMRs, thanks to the American Recovery and Reinvestment Act. “Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” the report says, according to InformationWeek. Some of the growth likely will be at the expense of specialty and departmental systems, however.

Established EMR vendors should benefit most from the increased spending. “Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia says. However, the research firm says “disruptive innovations” like open-source software and new applications of software-as-a-service could drive down prices, as might new competition from emerging markets in Asia and elsewhere.

Above article published on http://www.medicexchange.com/EMR/emr-likely-to-boom-throughout-2013.html

By Neil Versel

Without EMRs, PHRs and health information exchange, the patient-centered medical home may not be bound to fail, but it certainly is difficult to establish and maintain. “IT is really the key to supporting the doctor/patient relationship and making it more efficient, safer and more effective,” Dr. Paul Grundy, president of the Patient-Centered Primary Care Collaborative, tells Health Data Management. The Washington-based organization advocates the medical home, under which a primary-care physician manages and coordinates care on behalf of patients, with an eye toward prevention and management of chronic diseases.

It may be a challenge to implement the medical-home model under current reimbursement systems, but until payers start rewarding physicians for keeping patients healthy, IT may be the best avenue. EMRs with clinical decision support, PHRs that help patients monitor their own conditions and health information exchange to support care coordination all can help establish a team approach to care and treatment, HDM reports.

“This is simply about restructuring the way healthcare is delivered to catch the efficiency of technology,” adds Grundy, who also is director of heathcare transformation at IBM.

Above article published on http://www.fierceemr.com/story/emrs-phrs-hie-necessary-support-patient-centered-medical-home/2009-11-12

By Kenneth Corbin

Sen. John Kerry is continuing his push to accelerate the adoption of electronic medical records.

The Massachusetts Democrat on Tuesday introduced legislation to spur family doctors and small-scale practitioners to migrate their paper records to digital format, a goal that most everyone agrees would improve care and lower costs, but one that entails a significant initial expense.

“Electronic medical records and prescriptions are the common sense solution to restricting costs, reducing errors and reforming a broken system,” Kerry said in a statement. “Doctors don’t need convincing — they’ve seen the results.”

Kerry’s bill, the Small Business Health Information Technology Financing Act, would make small-scale doctors eligible for grants from the Small Business Administration to move to electronic records.

“This legislation helps small practices acquire the technology that will allow them to be more efficient and to focus on patient care,” Kerry said.

The federal government has already made it clear that digital records are a priority, earmarking $19 billion for the cause in the February stimulus bill.

In 2007, Kerry introduced legislation to push doctors use digital systems when issuing prescriptions. The 2008 Medicare bill passed with provisions establishing a timetable offering bonus payments to early adopters of the technology, and eventually phasing in penalties for the laggards who continue issuing paper prescriptions.

Above article published on http://blog.internetnews.com/kcorbin/2009/11/kerry-backing-bill-to-boost-el.html

The healthcare IT marketplace is growing by 11% annually, which will likely continue through 2013, says a study from Scientia Advisors.

By Mitch Wagner, InformationWeek

Health information technology (HIT) is the fastest growing segment of the $1 trillion global health care marketplace, and is poised to continue its impressive growth through 2013, according to a study released Tuesday.

The health IT marketplace is showing 11% combined annual growth rate, which is likely to continue over the next four years, according to a study from Scientia Advisors, a management consulting firm.

To remain competitive, vendors must take into account government incentives, requirements for clinical decision-making and electronic health record systems, and emerging competitors in Asia and elsewhere in the developing world, the study said.

Health information technology will grow from 4% of the worldwide health care products market to 5% — a 25% increase in HIT market share, Scientia said.

HIT spending in the US will focus on inpatient and outpatient electronic health records systems, at the expense of specialty and departmental information systems and other capital investments, Scientia said.

“Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia said.

Some small hospitals may choose lower risk, lower cost approaches such as remote hosting. Given the economic slowdown, vendors will lend hospitals capital to finance HIT investments.

“Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” Scientia said.

Also, “over the long term, disruptive innovations such as open source software and ’software as a service’ could lead to dramatically lower pricing,” the company said.

Above article published on http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=221601057&subSection=News

BY DR. SCOTT RANSOM

When Dr. Henry Plummer developed the concept of the “unit record” nearly 100 years ago, his idea was to place all of a patient’s records in a single file that traveled with the patient and could be stored in a central repository. His concept of medical care continuity quickly became the standard for medical record keeping worldwide.

I wonder what Dr. Plummer would make of today’s adoption of electronic medical records (EMR) by U.S. health care providers? After all, the concept is basically the same, just expanded to take advantage of today’s capacious electronic storage and retrieval methods.

Even the federal government has gotten into the act, defining a complete EMR system as containing four basic functions: computerized orders for prescriptions, computerized orders for tests, reporting of test results and physician notes.

In a perfect world, an EMR system tracks a patient’s entire health and medical history in a computerized, electronic format that is accessible wherever the patient is. These records are more easily retrievable than manual systems, and can make a patient’s navigation through the health care system much safer and more efficient.

But it’s hardly a perfect world. Even though the American Recovery and Reinvestment Act of 2009 has made the promotion of a national, interoperable health information system a priority, EMRs have not been adopted nearly as quickly in the U.S. as one might expect. Issues, including the high cost, lack of standardization, security and privacy have stood in the way of implementation.

A recent study from the New England Journal of Medicine points out that hospital EMR adoption rates are still abysmal, concluding that only about 8 percent of the 3,000 hospitals studied by researchers used even a basic EMR in a single unit, which included nurse or physician notes. And only 1.5 percent of non-federal U.S. facilities use a comprehensive EMR.

This seems counter-intuitive, especially when one considers the numerous advantages of EMRs, starting with efficiency. Information stored in an electronic format can be retrieved easily at the touch of a button or the click of a mouse. Search and retrieval times are a fraction of what they would be in manual systems. At the very least, this saves time by eliminating the need to complete the old manual medical history forms at a new physician’s office. This also reduces the chance for error when a patient forgets to list certain prescribed medications or supplements. It’s all there in one easily accessible record.

But efficiency isn’t the only benefit. For patients, access to good care becomes easier and safer when records can easily be shared. Important information — such as blood type, prescribed drugs, medical conditions and other medical history aspects — can be accounted for much more quickly. Doctors and other medical personnel can retrieve these medical records from anywhere using handheld devices like an iPhone, which allows them to continue treatment no matter where they are. And, in case of emergency, information can be shared with emergency room physicians who can then order diagnostic tests and share results online.

Another benefit is safety. It’s estimated that nearly 98,000 patients die annually by preventable medical errors of some type. It’s entirely possible that these numbers could be greatly reduced by a comprehensive medical history information generated through an EMR system.

The Mayo Clinic is setting the standard for EMR implementation. With one of the largest such systems in the world, all medical documentation relating to a patient’s care – physician notes, laboratory reports, surgical dictations, copies of correspondence, appointment schedules, X-rays, ultrasounds, CT and MRI scans, echocardiograms – is instantly available to caregivers via more than 16,000 computer terminals on Mayo’s three campuses. The efficiencies created by simply typing a few identifying keystrokes to retrieve a patient’s record saves a doctor’s practice or a hospital many thousands of dollars. That’s even taking the cost of the electronic system into account.

Even the federal government thinks electronic record keeping is important. Veterans’ hospitals across the country share an electronic system called VistA, which shares records of veterans in its health system. Should a patient find him or herself in a VA hospital, even away from home, the hospital will have the same access to his or her records that the hometown hospital does.

It’s interesting to note that a recent report from PricewaterhouseCoopers’ Health Research Institute contends that Medicaid penalties might do more to boost EMR adoption than incentives, like available funding to physicians to purchase and implement EMRs. According to the report, “Provisions in the stimulus law that call for cuts in Medicare reimbursements, rather than a multibillion-dollar incentive program, will do more to push the adoption of electronic medical records among hospitals and doctor practices by 2015.”

However EMR adoption happens, it’s critical that it happen sooner rather than later. The health care industry’s ability to provide efficient, coordinated, safe and high-quality care is only enhanced by the rapid availability of accurate data. And with the availability of solid data, researchers can also use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings and vastly improving patient care in the future.

Just as Dr. Plummer saw beyond the information exchange limitations of his era, we can see the benefits of using the latest technologies for the practice of continuity in 21st century medicine. But the goal, just as it was in Dr. Plummer’s time, or even going as far back as Hippocrates and his famous oath, is still nobly laudable: “First, do no harm.”

Above article published on http://www.fwbusinesspress.com/display.php?id=11302

Last week, HHS released an interim final rule updating the HIPAA privacy and security rules to correspond with the stricter penalties imposed under the federal economic stimulus package, Healthcare IT News reports.

The health IT provisions of the stimulus package increased fines for health care organizations that experience a breach of protected health data.

The interim final rule will take effect Nov. 30. HHS said it will consider public comments on the rule until Dec. 29 (Monegain, Healthcare IT News, 11/2).

Rule Details

In its interim rule, HHS described four categories of health data security violations:

• Did not know;
• Reasonable cause;
• Willful neglect that was corrected; and
• Willful neglect that was not corrected.

The rule establishes financial penalties ranging from $100 to $50,000 for each violation. It also sets a maximum yearly penalty of $1.5 million for all violations of an identical provision (Goedert, Health Data Management, 10/30).

Under the new rule, a health care organization can no longer avoid penalties for not knowing about a violation unless it fixes the problem within 30 days of identifying it (Mosquera, Government Health IT, 10/30).

Enforcement Still Unclear

The interim rule does not amend any of the HIPAA enforcement provisions included in the federal stimulus package.

Although the stimulus package calls for “periodic audits” to ensure HIPAA compliance, HHS has yet to release specific details about its audit and enforcement plans (Nicastro, HealthLeaders Media, 10/30).

The interim rule suggests that HHS will release further details about HIPAA enforcement during subsequent rulemaking

Above article published on http://www.ihealthbeat.org/articles/2009/11/2/hhs-releases-interim-final-rule-strengthening-hipaa-penalties.aspx

By Neil Versel

EMRs might be able to give early warning about patients who are at risk for domestic abuse, new research suggests. A study published in BMJ (formerly the British Medical Journal) this week found that data from well-populated EMRs were able to predict future diagnoses of injuries and assaults that could indicate domestic abuse 10 to 30 months in advance.

Researchers from Harvard Medical School analyzed more than half a million de-identified electronic records that contained at least four years of data on adult patients and developed a scoring system based on risk factors for abuse, including alcoholism, ER visits for injuries, depression and psychosis. “Our model predicted abuse two years before it appeared on medical records,” lead author Ben Reis, an informatics specialist, told the Boston Globe.

Reis’ research team will expand their work to other health problems in hopes of creating a screening-support system that could be integrated into EMR systems in the future. “With increasing amounts of data becoming available, this work has the potential to bring closer the vision of predictive medicine, where vast quantities of information are used to predict individuals’ future medical risks in order to improve medical care and diagnosis,” he said, according to Health Imaging & IT.

Above article published on http://www.fierceemr.com/story/emrs-could-be-key-future-predictive-medicine/2009-10-01#ixzz0VybkiMHw

The health care industry is trying to catch up when it comes to technology.

“Other businesses have been able to figure out how to make it work, such as the finance business. You can get money wherever you go. Health care is really behind,” said Helen Connors, executive director for Kansas University Center for Health Informatics.

Connors said it is unreasonable to ask patients to recall their medications and past history every time they see a doctor.

“Why are we asking the patient for that information? We can’t rely on the patients or providers to remember everything, so it’s got to change,” she said. “I think eventually consumers are going to drive it because they are not going to put up with it.”

The federal government has earmarked $34 billion in stimulus funds to address the issue.

“That’s a lot of money,” said Dave Garets, CEO and president of HIMSS Analytics, which collects and analyzes health care data related to information technology. “The federal government has never allocated much of any money to provide incentives to hospitals and doctors to get in gear. But boy, they did this time.”

The goal is to offer incentives for health care providers to move from paper charts to computers during the next five years, and after 2015 penalize those who don’t by, for example, providing lower reimbursements for Medicare patients.

Congress is working on the details with some preliminary regulations expected by year’s end, Garets said.

High-tech advantages

The ultimate goal is for doctors, hospitals and pharmacies to be able to access any patient’s information in a more efficient and timely manner by using electronic medical records, commonly called EMRs.

For example, if an out-of-town patient is taken to an emergency room and has allergies, an EMR would immediately alert the physician. EMRs also allow doctors to order and see lab results at the click of a button. Research has shown that EMRs significantly reduce medical errors.

For example, they can alert a doctor if he or she prescribes a medication that would not interact well with a current medication. EMR prescriptions also are more legible than their hand-written counterparts. Dr. Jon White, health information technology director of the Agency for Healthcare Research and Quality, said EMRs can help doctors manage more information better and more quickly. An EMR can contain patients’ medical information, lab work, the latest research in health, insurance information, pharmaceutical data and messages from other office workers, to name a few applications. “You can still practice without those tools, and in fact, people do every day. It just becomes more challenging to do it as time goes by,” he said.

High-cost process

White said doctors and hospitals have been dragging their heels on changing over to EMRs primarily because of costs. “They are expensive. But, we think that they will get back the money that they put into it,” he said. “Ultimately, everyone who successfully implements electronic medical records say they would never go back, but that’s a big hurdle to get over.”

The agency estimates that it costs about $30,000 for a provider that isn’t in a hospital setting.

Lawrence Memorial Hospital and Kansas University both started moving to an electronic system several years ago. LMH has spent more than $12 million just for software. KU Hospital has budgeted $52 million for the entire process.

“It’s probably one of the largest single activities that any hospital will pursue,” said Chris Hansen, chief information officer at KU Hospital. “It’s monumental, which is why there haven’t been a lot of hospitals that have gotten there.”

According to a 2008 survey in the New England Journal of Medicine, only 4 percent of physicians reported having an extensive, fully functional electronic records system and 13 percent had a basic system.

Hospitals are doing better.

Garets, of HIMSS Analytics, said 83 percent of hospitals nationwide have a basic system, but in Kansas, only 62 percent of the 132 hospitals do. More startling, he said, is that 29 percent — or 38 — of the state’s hospitals have no basic system and have no plans to purchase one, compared with 12 percent nationally.

“That is craziness,” Garets said, laughing. “It’s like what, ‘Are you living under a rock?’”

Connors, of KU’s Center for Health Informatics, is chairwoman of the state’s new e-Health Advisory Council, which is working to recommend a health information exchange plan for the state. She said some states already have a plan and are applying for federal money to begin implementing those plans. However, Kansas is applying for funding to develop a plan.

“Right now, we are fact-finding, looking at what other states have done, what do we need and what is going to be best for Kansas,” she said.

The first mission is to help health professionals get electronic systems and then figure out how they can exchange that information. Ultimately, the state’s systems will plug into a national one.

Learning curve

But, change isn’t easy.

“Almost every single one of us that is out there now grew up writing words on charts, writing notes on charts and using a pen,” White said. “Until not too long ago, we were taught that the pen was the mightiest instrument available to a doctor.”

Dr. Sabrina Prewett, 54, medical director in the LMH Emergency Department, would agree. In January, the emergency room will be one of few nationwide that is paperless.

“It was very challenging,” Prewett said of the five-year process. She worked alongside IT personnel to implement the software and then helped train staff.

“That’s why I became the one that helped develop it because if I can do it — anybody can do it,” she said, laughing.

But, Prewett said it has been worthwhile. It is safer, quicker and the information is legible.

“The impetus is for patient safety,” she said.

Above article published on http://www2.ljworld.com/news/2009/nov/02/health-industry-finally-moving-toward-computerized/?city_local