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

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.”

Dr. Scott Ransom is president and professor in obstetrics, gynecology, health management and policy at the University of North Texas Health Science Center at Fort Worth.

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

By Dr. Raj Bhandari and Terry L. Austen

Special to the Mercury News

Patients in the Kaiser Permanente San Jose Hospital are seeing something new when a physician or nurse visits their rooms. The doctors and nurses themselves aren’t different; they continue to provide their patients with superior care and service.

But a piece of equipment they bring with them — a wheeled cart with a computer screen on top — is a significant difference, and it’s an example of what will help dramatically improve health care in America.

The cart-borne computer is wirelessly connected to a huge database containing the medical history of our members, as well as the latest recommended treatments for a wide range of medical conditions. The database contains all outpatient and inpatient visit information, diagnostic images such as X-rays and mammograms, allergies, specialists’ notes, lab tests and prescriptions. And it is all part of KP HealthConnect, the largest nongovernmental electronic medical record (EMR) system in the United States.

Electronic medical records are a cornerstone of President Barack Obama’s health reform effort, and as part of his effort to stimulate the economy, he has dedicated some $19 billion to make EMRs a national reality.

Why? Electronic medical records improve the quality of care. A fully functional EMR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether it’s in the doctor’s office, the emergency room or in a skilled nursing facility. It is also remotely accessible for specialists and others who are on call, allowing them to make informed decisions that expedite patient care.

EMRs have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety, and they do this by harnessing the incredible power of computers — their ability to calculate, to network, to automatically check facts and to provide targeted research results — and applying that power to medical care.

In health care systems with fully implemented electronic medical records, physicians and nurses no longer need to spend valuable time looking through several files for paper records that are often incomplete.

Now, for example, emergency department physicians with a fully functional EMR system can see a patient’s previous hospitalizations, medications and diagnoses when that patient shows up complaining of chest pains. That means treatment can begin more quickly and success is more likely.

Medication is safer, too: Prescriptions written by physicians using the EMR system are spell-checked and legible, and the computer automatically combs the patient’s history for potentially dangerous drug interactions and alerts the doctor.

In the hospital, medications are bar-coded and scanned at bedside to help ensure the right patient is getting the right drug in the right dose at the right time.

Of course, EMRs should not be a one-way street. In integrated health care systems, patients can use their home computers to increase convenience by making appointments online, ordering prescription refills that are delivered to their home, viewing their lab results through secure Web pages, and e-mailing their physicians — all at no additional cost.

Last year, thanks to these online tools tied to EMRs, Kaiser Permanente members had 6 million e-visits without using a gallon of gas.

Notes jotted on paper and placed in multiple files where doctors rarely see them are a remnant of a fragmented, inefficient model of medical care. In the 21st century, Americans expect — and deserve — more.

Dr. Raj Bhandari is physician-in-chief and Terry L. Austen is senior vice president and area manager for Kaiser Permanente San Jose Medical Center. They wrote this article for the Mercury News

Above article published on http://www.mercurynews.com/opinion/ci_13534802

While few practices and hospitals currently use aggregated patient data, the number is expected to increase, and a new study touts the information’s benefits.

By Pamela Lewis Dolan, amednews staff.

One of the biggest untapped benefits of electronic medical record adoption is the secondary uses of the data that are being collected, concludes a study by PricewaterhouseCoopers.

The study, “Transforming Healthcare through Secondary Use of Health Data,” found that practices and hospitals have seen aggregated data from their electronic medical records identify patterns that have allowed them to improve outcomes, reduce errors and increase revenue opportunities.

But the number of institutions using the aggregated, or secondary, data in this way is very small, though it is expected to grow in the next two years.

“Almost every constituent in the [health care] industry that has to make a decision around what type of health care to deliver and when could use this kind of data and the information that aggregating it can produce,” said Dan Garrett, health IT practice leader at PricewaterhouseCoopers.

The report found that among those organizations already using some form of secondary data, 59% have seen quality improvements, 42% have achieved cost savings, 36% have seen patient/member satisfaction improve, and 29% have increased revenue. The biggest users of secondary data are hospitals and physicians, while health plans are the farthest behind.

The survey found that although 95% of physicians are not opposed to using secondary data, many are sensitive to how it should be used. Patients also are concerned.

“We all know we need to use this data, but they also know we can’t risk security,” Garrett said.

The PricewaterhouseCoopers report came from an e-mail survey conducted in June of 732 health care executives, 482 physicians, 136 payers and 114 pharmacy/life sciences organizations.

Above article published on http://www.ama-assn.org/amednews/2009/10/19/bise1023.htm

By Neil Versel,

More than three-quarters of healthcare executives surveyed by PricewaterhouseCoopers say that information contained in EMRs could become their most valuable asset over the next five years as “secondary use” of EMR data takes off. But this won’t happen until technology improves, more standards get harmonized and, most importantly, the healthcare industry resolves lingering privacy concerns, according to a PwC survey released early this morning.

With billions of dollars in federal health IT stimulus funds set to flow into healthcare in the next few years, secondary use of electronic health data will “grow exponentially,” PwC says, citing a finding that 65 percent of healthcare executives expect their data-mining activity to spike within two years. About 90 percent of respondents believe that secondary use of EMR data will help their organizations make significant improvement to the quality of care.

There may be some legal barriers to overcome, however, before healthcare organizations can unleash the full power of patient-specific healthcare data. Also of concern to healthcare executives are privacy implications of data mining and the bad PR that could result from unauthorized use. This study literally just hit the wires, but we can’t wait to hear Dr. Deborah Peel’s thoughts on this last point.

Above article published on http://www.fierceemr.com/story/healthcare-execs-see-emr-data-their-most-valuable-asset/2009-10-01#ixzz0VEq13Kan

While few practices and hospitals currently use aggregated patient data, the number is expected to increase, and a new study touts the information’s benefits.

By Pamela Lewis Dolan, amednews staff,

One of the biggest untapped benefits of electronic medical record adoption is the secondary uses of the data that are being collected, concludes a study by PricewaterhouseCoopers.

The study, “Transforming Healthcare through Secondary Use of Health Data,” found that practices and hospitals have seen aggregated data from their electronic medical records identify patterns that have allowed them to improve outcomes, reduce errors and increase revenue opportunities.

But the number of institutions using the aggregated, or secondary, data in this way is very small, though it is expected to grow in the next two years.

“Almost every constituent in the [health care] industry that has to make a decision around what type of health care to deliver and when could use this kind of data and the information that aggregating it can produce,” said Dan Garrett, health IT practice leader at PricewaterhouseCoopers.

The report found that among those organizations already using some form of secondary data, 59% have seen quality improvements, 42% have achieved cost savings, 36% have seen patient/member satisfaction improve, and 29% have increased revenue. The biggest users of secondary data are hospitals and physicians, while health plans are the farthest behind.

The survey found that although 95% of physicians are not opposed to using secondary data, many are sensitive to how it should be used. Patients also are concerned.

“We all know we need to use this data, but they also know we can’t risk security,” Garrett said.

The PricewaterhouseCoopers report came from an e-mail survey conducted in June of 732 health care executives, 482 physicians, 136 payers and 114 pharmacy/life sciences organizations.

Above article published on http://www.ama-assn.org/amednews/2009/10/19/bise1023.htm

A new electronic tool that will put family medical history at doctors’ fingertips – alerting them to a patient’s increased risk for birth defects or pregnancy complications - will be developed through a three-year cooperative agreement with a $1.2 million grant from the Health Resources and Services Administration, Genetic Services Branch.

The National Coalition for Health Professional Education in Genetics (NCHPEG) will lead the project and will work with the March of Dimes, the Genetic Alliance, and the Newton Wellesley Hospital of Partners Healthcare to adapt or create a new tool doctors can use to gather a woman’s consistent family history information and analyze it immediately to improve patient care.

“Taking a patient’s family health history is an important way for doctors and other health care providers to evaluate the risk of common conditions such as heart disease or premature birth,” said Joseph McInerney, executive director of NCHPEG. “With this grant, we can improve how prenatal providers gather and use family health history to improve the health of their patients.”

“This project allows us to use state-of-the-art technology and apply a sophisticated understanding of genomics and family history to give more Americans a healthy start in life,” said Alan R. Fleischman, MD, senior vice president and medical director of the March of Dimes. “We hope doctors will use this new family health history tool to identify women at risk for having preterm labor or an infant with a birth defect. It will give women the information they need to improve their health and that of their babies.”

Patients in doctors’ offices will fill out a standardized family history questionnaire using a computerized tablet, instead of paper and Open. The information will be analyzed electronically, and the tool will provide red flags and recommendations for health care providers based on current professional guidelines. Providers may be prompted to ask more questions or to send a woman to a genetic specialist.

The tool also will encourage health care providers to update and use family history data throughout the lifespan of any female patient. The long-term goal is for the family history information to be combined with the patient’s other medical information into an electronic health record (EHR). The proposed health history tool will focus on existing prenatal and women’s health topics, including newborn screening, and will be compatible

with the U.S. Surgeon General’s family history tool, the “My Family Health Portrait” Web-enabled program.

Above article published on

http://www.chiroeco.com/chiropractic/news/8279/1100/HHS-directs-funds-for-integrating-family-history-into-EHRs/

By Neil Versel

Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records. To date, most of the research has focused on health IT in specific environments, such as a single hospital, physician office or integrated delivery network, but the stimulus will help put EHRs in new settings that haven’t been studied.

“We are going to be hungry for how to implement health information technology the most efficiently to gain the greatest value for the health IT investment,” Blumenthal told a gathering convened by the Agency for Healthcare Research and Quality last week. “We’re at that transition that we see every time a new technology is moved out from the laboratory.”

Blumenthal advocated clinical decision support technology that encourages continuous quality improvement by delivering research data and new treatment information to the point of care, easily accessible by clinicians. “One thing we haven’t done is apply the scientific method in the practice of healthcare and medicine,” he said.

But he and other health IT experts at the same AHRQ conference cautioned that the road to achieving “meaningful use” of EHRs will be long and fraught with all sorts of danger.

Above article published on

http://www.fiercehealthit.com/story/blumenthal-more-research-needed-health-it-effectiveness/2009-09-21#ixzz0S12KjFSn

Advisory panel considers privacy proposals

By Alice Lipowicz

A federal advisory panel today heard several proposals about how to best protect patient privacy while creating and sharing electronic health records (EHRs).

The Health Information Technology Policy Committee convened to prepare recommendations to the Health and Human Services Department on distributing $19 billion in economic stimulus funding for incentive payments for EHRs and health information exchanges. The bulk of the money will go to doctors and hospitals that buy certified record systems and participate in the exchanges. HHS is expected to issue a rule by year’s end.

Dr. Deborah Peel, founder of the Coalition for Patient Privacy, said the core of privacy is patient control of the information in EHRs.

“The right to privacy and control is the national consensus,” Peel said, “It reflects centuries of medical ethics. We are asking you to set a high bar for privacy to meet with patients’ expectations.”

She suggested patients should be allowed to consent, or not consent, to each disclosure of the information, and for the information to be segmented to maintain different levels of disclosure for different pieces of information. Industry does not want to change its practices, so it is best if regulations are created to enforce patient consent management rules, she added.

However, patient consent, by itself, has not proven to be effective tool, asserted Deven McGraw, a member of the advisory panel and director of the health privacy project at the Center for Democracy and Technology.

“Although the concept of patient control is very appealing, consent does not work the way we want it to,” McGraw said. “Consent does not provide protection.”

That is because health insurers often require blanket consent forms in which patients authorize a very broad variety of uses and disclosures that are not well understood by patient, she said. Patients don’t really have a choice, because if they don’t sign the consent form, the insurer will deny coverage, McGraw said.

The solution is to include patient consent in a comprehensive framework of technical and legal standards for IT systems, networks, practices and training, along with other features, she said.

The committee also heard discussions about the use, disclosure, secondary use and stewardship of the personal health data. It also is considering audits and accountability for the EHR systems and models for data exchange, data storage, data de-identification and re-identification.

In July, a separate advisory committee to HHS, the Health IT Standards Committee, considered specific recommendations for patient privacy that included encryption, strong access controls and audits.

Above article published on

http://fcw.com/Articles/2009/09/18/HHS-panel-considers-patient-consent-for-privacy-in-EHRs.aspx?Page=1

Diana Manos, Senior Editor

Social Security administrators have set aside $24 million for contracts to provide electronic medical records to improve the efficiency of its disability programs.

Michael Astrue, Commissioner of Social Security, said the agency is looking for healthcare providers, provider networks and health information exchanges to participate in its Medical Evidence Gathering and Analysis through Health Information Technology program.

Astrue said health IT will improve the efficiency of a process which is largely paper-bound. For nearly a year, he said, Social Security has been testing health IT to obtain electronic medical records. Disability applications processed with electronic medical records from test sites in Massachusetts and Virginia have significantly reduced processing times, he said.

“With these competitive contracts, Social Security continues to be a leader in the use of health IT to improve service to the American public,” Astrue said. “This technology will greatly improve the speed and consistency of our disability decisions.”

The contract opportunities announced Friday are funded through the American Recovery and Reinvestment Act. They will require awardees, with a patient’s authorization, to send Social Security electronic medical records through the Nationwide Health Information Network. The NHIN, considered by the federal government to be a safe and secure method for receiving instantaneous access to electronic medical records, is an initiative of the Department of Health and Human Services and is supported by multiple government agencies and private sector entities.

Social Security reports a significant increase in disability applications as a result of the current recession. The agency expects to receive more than 3.3 million applications in fiscal year 2010, a 27 percent increase over FY 2008. To process these applications, the agency sends more than 15 million requests for medical records to healthcare providers.

Above article published on

http://www.healthcareitnews.com/news/social-security-fund-24-million-contracts-emrs