Archive for the ‘EHR’ Category
October 28, 2009
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
October 27, 2009
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
October 09, 2009
Filed Under (EHR) by admin
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
September 24, 2009
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
September 21, 2009
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
September 18, 2009
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
September 17, 2009
BY MARK WULKAN, M.D. The electronic medical record (EMR) is slowly transforming the way doctors, nurses, and other health care providers deliver patient care. Patients financial records have been electronic for decades; however, clinical data (the information entered by doctors, nurses, and other health care professionals) has been lagging. Processes for capturing lab and radiology results, history and physical details, operative reports, discharge summaries and other critical data have been very basic; paper charts remain the primary means of documentation and communication among the health care team.
Today, some hospitals are creating comprehensive EMRs for their patients that include the documentation and orders entered by all health care professionals. These EMR systems help:
Make it easier to access and share patient information among doctors, nurses, respiratory therapists and other health care professionals, regardless of whether they’re in the same unit, on separate floors or even away from the hospital. For example, if the doctor caring for your child in the hospital gets a call after she’s home, she can access nearly all the information in your child’s medical chart via her home computer (with the appropriate security clearance).
Allow your physician to order medications and procedures with the added benefit of EMR system “guard rails” that generate alerts to prevent errors, such as an overdose, giving a medication your child is allergic to, or prescribing drugs that are incompatible.
EMR systems designed for offices perform many of the same functions, just on a smaller scale.
Most of the top medical centers in metro Atlanta have implemented or are in the process of implementing a comprehensive EMR. Yet, the transition to comprehensive EMRs has been slow. In fact, a study published in the New England Journal of Medicine last year found that only four percent of physicians had a comprehensive EMR and 13 percent had a basic system. The primary barriers have been cost and time. Over the next several years, you should see an increase. The federal government is encouraging hospitals, clinics and doctors’ offices to do so and the American Recovery and Reinvestment Act includes stimulus money to help offset part of the cost.
In the future, as more EMR software manufacturers adopt international standards, your records will be electronically available from nearly any medical facility that you and your family visit. For example, if your child gets sick on vacation in Florida, you will be able to grant access to his pediatrician’s records and any previous hospitalization records to the Emergency Room doctor taking care of him. In addition, your pediatrician will be alerted and have the ability to access information about the ER visit. The details of how this will work are still being discussed, but this is the goal.
Above article published on
September 17, 2009
Filed Under (CCHIT, EHR, EMR, Electronic Health Records, Electronic Medical Records, Health) by admin
By Joseph Conn / HITS staff writer
The Certification Commission for Health Information Technology is adopting a two-tier system of testing and certifying IT systems.
In a conference call with vendors and developers of health IT systems Thursday, CCHIT Chairman Mark Leavitt announced the not-for-profit organization’s new testing program, as the group readies itself for the new realities of the healthcare IT market since passage of the American Recovery and Reinvestment Act of 2009.
One testing and certification program, dubbed Preliminary ARRA 2011 Certification, will specifically test for compliance with what is expected to be—at least initially—a fairly limited set of criteria that HHS and the CMS will use to determine eligibility by hospitals and office-based physicians for an estimated $34 billion in federal subsidy payments for the purchase of EHRs under the stimulus law.
The other, the so-called CCHIT Certified 2011 testing program, will use an elaborate set of about 300 criteria, primarily developed by the organization since its founding, that will closely resemble previous CCHIT testing and certification programs. The core CCHIT criteria will be tweaked to ensure systems that pass muster for its more advanced testing program also will meet ARRA requirements.
When it began testing IT systems in 2006, and on through 2008, CCHIT had offered just one, gold-standard set of criteria for each type of EHR system it tested—ambulatory EHRs or inpatient EHRs, for example.
But by April, CCHIT announced it would halt further testing to adapt its systems to accommodate the stimulus law criteria, development of which remains a work in progress. At the time of the announcement, Leavitt said the organization would keep its full-featured certification program, but would add two new testing and certification regimes scaled down to meet the minimum requirements of the stimulus law.
One new program would have tested IT systems by “module” against the new criteria under the recovery act, which requires providers to put “certified” EHR systems to “meaningful use” in order to qualify for federal subsidy payments. The proposed new modular approach was expected to appeal to some physician office practices and, more commonly, to hospitals, that want to piece together a comprehensive IT system from component parts produced by multiple IT vendors.
The other new CCHIT regime would have offered “on-site” testing and certification of EHR systems—again, against the less stringent stimulus law criteria with an eye toward qualifying for federal subsidies. This form of testing would have been conducted on systems installed at physician offices or hospitals. It was an approach targeted to appeal to providers who have developed their own EHRs or planned to assemble an EHR from noncertified sources, and to the open source development community, according to CCHIT.
According to Leavitt Thursday, CCHIT’s testing scheme will be modified again, but only somewhat. While site certification has been dropped as a certification scheme in and of itself, “site certification is still there,” Leavitt said. “In Preliminary ARRA Certification 2011, you can get a product or a site certified.”
Leavitt said it’s unclear whether providers adopting EHRs that have passed the test under the more rigorous CCHIT Certified 2011 program would want on-site certification, but if there is demand for the service, CCHIT will provide it.
Starting in June and running through its latest report in August, the HIT Policy Committee, which was created under the recovery act, has issued three sets of recommended definitions of meaningful use. Some of those recommendations have been controversial. To have market relevance, however, any program of certification of EHR systems that CCHIT develops must take those meaningful use standards into consideration to ensure that certified systems will enable providers to meet meaningful use standards and qualify for federal subsidies. The meaningful use standards, ultimately, will be developed by the CMS, which is tasked with running the bulk of the EHR subsidy program through Medicare and Medicaid.
In addition, CCHIT has to keep an eye on the Office of the National Coordinator for Health Information Technology at HHS, which, on behalf of the HHS secretary, will issue its own certification criteria for EHR systems, since, to qualify for subsidies under the stimulus law, providers also have to use “certified” EHR systems. Leavitt said CCHIT is forecasting ONC will issue its final rule on certification standards by Dec. 31 this year and that they probably will be the same or perhaps even less stringent than the recommendations the HIT Standards Committee made to ONC in August.
“We believe the final requirements will be the same as or less stringent that the current recommendations,” Leavitt said.
Both CCHIT testing and certification programs will open for vendor applications Oct. 7. Duration of certification is expected to run though Dec. 31, 2012, when certification criteria under the ARRA are expected to be ratcheted up, becoming both more numerous and more stringent.
Fees for certifying systems will vary with the certification scheme and the product, according to CCHIT Executive Director Alisa Ray. Under the CCHIT Certified 2011 program, the fee to a vendor to certify an EHR is $37,000 for either an ambulatory-care or an emergency department system, $49,000 for an inpatient system and $18,000 for an electronic prescribing system. Annual renewal costs are $9,000 for each, except e-prescribing, which is $7,000.
For Preliminary ARRA 2011 Certification, costs are pegged to the number of modules being tested, with fees set at $6,000 for one or two modules, $10,000 for three to five, $15,000 for six to 10, $24,000 for 11 to 20 and $33,000 for more than 20. Annual updates range from $1,000 to $5,000.
According to EHR vendor representative Justin Barnes, who listened in on Thursday’s CCHIT call, CCHIT probably has hit on the right strategy by launching its new testing and certification program this fall, based on an educated guess at what the government’s criteria might be, but before the final rules are published. Barnes is the chairman of the Electronic Health Record Association, and a vice president overseeing corporate development, marketing and government affairs for Greenway Medical Technologies, a Carrolton, Ga.-based EHR system developer.
“The detail that we have right now around meaningful use, you really can’t write a product to it,” Barnes said. “The interim final rule will come down at the end of this year. I think that will be a fairly close definition that we could follow. I think it will be plenty to work off of. The certification process, I believe, will be tweaked a little bit as well.”
Barnes said he hopes Leavitt is right when he predicts the ONC and the CMS will not vary too far from the current recommendations in writing the preliminary rules. He also said he hopes they don’t dally in unveiling their preliminary rules so everyone involved, both EHR vendors and users, have time enough to act.
“If there are any discrepancies, that could pose an interest to some people if you have to do heavy product development,” Barnes said. “It takes 12-plus months for the product cycle to add functionality on the ambulatory side and 18-plus months on the inpatient side. There is a word of caution here. That’s why we’ve urged ONC to move on this as fast as they can.”
Above article published on http://www.modernhealthcare.com/article/20090904/REG/309049989/0
September 17, 2009
Filed Under (EHR, EMR, Electronic Health Records, Electronic Medical Records, Health, Health IT, Hospital) by admin
By Don A. Solberg, MD, Kathryn L Houck and Jim Roberts
Successful electronic health record (EHR) adoption not only improves quality of care by making patient information easily accessible, it also provides valuable clinical decision support. In addition, organizations benefit from streamlined operations — enabling physicians to spend less time on charting and documentation, and more time engaging in face-to-face interactions with patients.
Despite these obvious advantages, however, many physicians are resistant to adopting EHR systems.
A number of factors account for this resistance. First and foremost, organizations are leery of the cost and disruption that can sometimes accompany the conversion from manual to automated processes. Second, a portion of older physicians — who often serve as the leaders in an organization — are typically less comfortable with new technologies than their younger counterparts. And finally, some physicians believe that taking the time to electronically document patient visits will negatively impact patient interaction because it means spending time in front of a computer screen rather than with the patient.
Kittitas Valley Community Health Information Network is an electronic information-sharing partnership linking 30 providers — about 90 percent of all primary care providers in the county — from seven locations. When we implemented our EHR system in 2007, we utilized several strategies that proved instrumental in overcoming anticipated obstacles and ensuring successful adoption:
1) Locate a physician champion. When identifying champions, we looked for those physicians who had a track record of adopting new technologies, were able to maintain positive attitudes despite occasional setbacks and, most importantly, were well-respected by their peers. These champions could clearly articulate the goals and enthusiastically promote the benefits of a fully functioning EHR system to other physicians — helping to encourage even initially skeptical providers to get onboard.
2) Set honest, realistic expectations for physicians and their staffs. The more complex and sophisticated an EHR system, the more challenges a practice might experience in the early stages of implementation. However, we found the potential productivity gains and cost savings ultimately outweighed any inconveniences. By ensuring that everyone understands that there will be a learning curve and that they will experience some growing pains on the front end, you can alleviate frustration and set a positive tone post-implementation.
3) Ask each location to designate a physician, nurse and administrative user to participate in several days of training with the EHR vendor. These “super users” were then available to help others navigate the EHR system, reducing the need for support while building staff camaraderie.
4) Prepare for the transition. In our case, each location went to an abbreviated schedule for two weeks — scaling back patient volume so that physicians and administrative staff would have adequate time to train on the new system. In hindsight, we would recommend that organizations allow a full month for staff to get comfortable and then gradually add back patient visits each week. For example, a practice might take four patient slots out of both the morning and afternoon schedules during the first week, three slots during the second week, two during the third week, and so on. Providing staff members with the opportunity to use the system while performing their daily routines enables them to learn at a comfortable pace.
5) Use a staged rollout. We did not do this during our initial implementation, but have used it several times with processes and changes adopted since. Within each location, two to three physicians, who were committed to the EHR system and willing to work through any stumbling blocks, were selected for initial implementation. Working with fewer physicians at the onset enabled the implementation staff to provide a strong support system, and helped ensure that any issues or concerns were resolved early in the deployment process. Once the first few physicians went live in each location, other providers were added two at a time. That way, each successive group of physicians could seek guidance from colleagues who were already using the system and could witness firsthand the successful utilization of an EHR system.
As an increasing number of health care organizations take advantage of the dollars offered by the American Recovery and Reinvestment Act to deploy EHR systems, it will become even more important to ensure timely and successful adoption of these systems. By setting realistic expectations among key stakeholders, identifying hurdles early and putting plans in place to proactively deal with any challenges that may occur, the likelihood of a smooth transition is significantly increased.
Above article published on http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=202207&CP=2
September 17, 2009
Time to take a look at the costs associated with the 2011 CCHIT Certification programs. If you’re not sure which programs I’m talking about, you need to go read my post about Preliminary ARRA Certified 2011 and CCHIT Certified 2011.
The following are the costs that CCHIT plans to charge for their 2011 EHR certifications: CCHIT Certified 2011 Ambulatory EHR – $37,000 with a $9,000 annual renewal CCHIT Certified 2011 Inpatient EHR – $49,000 with a $9,000 annual renewal CCHIT Certified 2011 Emergency Department – $37,000 with a $9,000 annual renewal CCHIT Certified 2011 ePrescribing – $18,000 with a $9,000 annual renewal
Preliminary ARRA Certified 2011 1-2 modules – $6,000 with a $1,000 annual renewal Preliminary ARRA Certified 2011 3-5 modules – $10,000 with a $2,000 annual renewal Preliminary ARRA Certified 2011 6-10 modules – $15,000 with a $3,000 annual renewal Preliminary ARRA Certified 2011 11-20 modules – $24,000 with a $4,000 annual renewal Preliminary ARRA Certified 2011 >20 modules – $33,000 with a $5,000 annual renewal *These are estimates subject to final approval
Of course, the ones that matter most are the CCHIT Certified 2011 Ambulatory EHR for $37,000 and the Preliminary ARRA Certified 2011 >20 modules for $33,000. Why? These are the two certifications that most people care about. If you’re an EHR vendor, then you’re going to want to do one of these two options (Assuming you’re going to go with CCHIT certification. More on that later.). These are the two options which should eventually be recognized as the certified EHR requirement for the ARRA EHR stimulus money.
Which CCHIT Certification Should I Do? The question an EHR vendor has to make is which of these two certifications make sense. Will having CCHIT Certified 2011 help you to sell more EHR software than just being Preliminary ARRA Certified? I’m guessing that it probably won’t. Most people I’ve seen really just want to make sure they get the ARRA stimulus money to pay for their EHR. Plus, with either certification you’ll be able to honestly tell a clinic that you have a “certified EHR.” Most doctors won’t know or care about the difference in the certification types.
Many might think that it’s only a $4,000 difference between the Preliminary ARRA 2011 certification and the CCHIT Certified 2011 so why not just get the later. It is interesting that the costs are so close to each other. However, remember that this isn’t the only cost associated with becoming certified. One EMR vendor I talked to put the software development costs to become CCHIT Certified in the six figures. We won’t know for sure until CCHIT publishes the final certification criteria, but I project that the CCHIT Certified requirements will number close to 300 while the Preliminary ARRA requirements will be close to 100. That’s a huge difference in development costs to meet 200 more requirements which your customers may or may not find useful.
Some might use the CCHIT Certified 2011 to try and assure potential buyers that they’ll have a more successful EMR implementation because of this certification. Many might actually believe it, but unfortunately there’s no evidence to prove this is actually the case.
EHR vendors should also be aware that CCHIT is looking at doing a site certification as well. This might be a better option for some EHR vendors who work with people who have few people actually interested in the EHR stimulus money.
Other EHR Certification Options Beyond CCHIT It’s still too early to know for sure if other EHR certifying bodies are going to be created to handle the HHS certification requirements for EHR. However, I’m willing to bet that at least a couple will be created.
Basically, CCHIT has set the price for EHR ARRA certification at $33,000 with a $5,000 annual renewal. I could be wrong, but that seems like a lot of money to certify a piece of software. I’m guessing that some entrepreneurial folks will find a way to do it for cheaper. Could you certify 100 EMR vendors for less than $3.3 million? We’ll see what ONC/NIST requires from a certification organization, but seems like a pretty nice business model to me.
For EMR vendors, this is important because competition amongst certifying bodies will most certainly drive the cost of EMR certification down. Then, the PR battle between CCHIT and the new certifying bodies will begin. Basically, this could be really interesting to watch if someone else decides to join the EHR certifying fray.
Above article published on http://www.emrandhipaa.com/emr-and-hipaa/2009/09/14/cost-of-new-cchit-ehr-certifications/ |
|
