While the sales growth in electronic medical record (EMR) systems has been slower than anticipated due to confusion over vendor qualifications and federal guidelines, the EMR market did grow in 2010 and it should see much better years ahead, according to a report from Kalorama Information.

The value of the market for EMRs was about $15.7 billion in 2010, according to the New York-based healthcare market research company in its latest report, “EMR 2011: The Market for Electronic Medical Record Systems.”

The EMR growth rate in 2010 was 13.6 percent–just above the rate in 2009 (10 percent). These rates were less, though, than predicted by Kalorama researchers (it had predicted about a 15 percent growth for both years). However, the rates may be improving as physician adoption improves and more incentive checks for EMR adoption under meaningful use guidelines are sent out.

Kalorama is predicting that adoption and upgrading activities will be “brisk” in coming years. As new systems are sold, companies will earn revenues from existing clients in servicing and consulting–resulting in a market growth rate of 18 to 20 percent for the next two years.

“We think that while progress was made in physician adoption and in vendor sales, there is still a lot more potential,” said Bruce Carlson, publisher of Kalorama Information, in a statement. “There are still a considerable number of physicians who need to be fully functional and hospitals that have to improve their stage ranking.”

Source     :      http://www.fierceemr.com/story/emr-market-expected-increase-growth/2011-03-03

Patient-centered medical homes have become all the rage in the healthcare industry these days. The big push is coming from payers who want to cut costs and provider organizations who want primary care physicians to have a bigger say in the care of their patients. No matter who is driving the financial and clinical model, the train isn’t leaving the station, so to speak, without health IT to power it.

At a primary-care practice in St. Louis, Mo., both patients and their families are seeing firsthand how an electronic medical record system documents patient treatment and applies clinical decision support and analytics to tailor a patient’s treatment plan.

PCMHs are not all the same, and the Des Peres Internal Medicine office further personalizes treatment by having a nurse practitioner and social worker as part of the PCMH team. One of the Des Peres Internal Medicine physicians said that one of the goals of the PCMH is to increase patient access to care. That could mean access to the social worker via telephone. It also gives patients the extra channel of communicating or completing tasks such as making an appointment, filling a prescription or entering patient vitals via a patient portal.

One of the best benefits of an EMR in a PCMH is the streamlining of care delivery, which includes the elimination of duplicative tests. Most patients in a PCMH likely have multiple chronic conditions that a care team must manage. If patients see multiple specialists on their own, who is coordinating the care? Even if the coordination is done through a primary-care physician, without an EMR to aggregate data and document what happens in every specialist office, the amount of administrative and clinical paperwork would be overwhelming.

Another benefit is empowering patients, which can often translate into taking better care of themselves, especially when they have their up-to-date patient information available to them via the patient portal and clinical decision support and analytics to support their entire care team.

Source     :     http://www.healthcareitnews.com/blog/patient-centered-medical-home-requires-emr-system

Washington — Starting Jan. 3, eligible physicians and hospitals will be able to register for the Medicare electronic medical record incentive program, a prerequisite for obtaining billions in available federal bonuses, the Centers for Medicare & Medicaid Services announced Dec. 22, 2010.

Also starting Jan. 3, registration for the Medicaid EMR incentive program will launch for Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas. In February, registration will open in California, Missouri and North Dakota. The remaining states probably will launch their Medicaid EMR incentive program sign-ups in the spring and summer, CMS said.

Officials with CMS and the National Coordinator for Health Information Technology said they hope for broad registration by doctors and hospitals. To prepare for the process, health professionals are encouraged to visit the CMS website (www.cms.gov/ehrincentiveprograms/).

“With the start of registration, these landmark programs get under way, and patients, providers and the nation can begin to enjoy the benefits of widespread adoption of electronic health records,” said CMS Administrator Donald M. Berwick, MD.

David Blumenthal, MD, the national health IT coordinator, said, “It’s time to get connected.”

He added that his office and CMS have numerous resources to help physicians and hospitals enroll in the program. They include a website that lists more than 130 certified EMR systems (onc-chpl.force.com/ehrcert/).

Another site lists the 62 regional extension centers that can assist physicians in obtaining the bonuses (healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495/).

Physicians who want to participate must register in either the Medicare or Medicaid EMR incentive programs. Participants must choose only one program — they cannot receive payments from both. However, after receiving a bonus for a given year, they may change their program selection once before 2015.

In 2010, CMS finalized standards that doctors and hospitals must meet to demonstrate meaningful use of their EMR systems. Physicians can receive as much as $44,000 over a five-year period through Medicare, and up to $63,750 over six years through Medicaid.

CMS on Dec. 22, 2010, announced several additional key 2011 dates for the EMR physician incentive program:

• January — Some state agencies begin issuing Medicaid EMR incentive payments.
• April — Participants begin to attest eligibility for Medicare bonuses.
• May — CMS begins issuing Medicare bonuses.
• Oct. 3 — Physicians have a final chance to begin their 90-day reporting period to demonstrate meaningful use in 2011.
• Dec. 31 — 2011 bonus payment year ends for eligible professionals.

Source     :     http://www.ama-assn.org/amednews/2011/01/03/gvse0106.htm

Results from a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members indicates that iPad deployments are accelerating in large part due to the mobile device’s compelling point-of-care applications and uses.

Conducted October 26 during an online webinar cosponsored by HIMSS and BoxTone, a mobile service management (MSM) company, the survey’s results were released earlier this month.

Data showed that nearly 70% of the attendees were from hospitals or healthcare organizations with more than 1,500 employees, and 15% of attendees were executive-level staff or physicians.

More than 25% of the HIMSS respondents plan to deploy the iPad and other iOS devices immediately and nearly 70% plan to deploy the devices within the next year.

One-third of respondents identified point-of-care applications — including lab order visualization and results, clinical decision support, and medical image viewing applications — as top priorities, while 18% identified general administration, including billing, coding, and claims applications, as top priorities.

Nearly 75% identified secure configuration and deployment as the number one iPad IT management challenge, and 53% identified mobile application deployment as a key issue.

Lynne Dunbrack, analyst with IDC Health Insights, said security will remain a top concern for healthcare CIOs, especially if clinicians bring in their own devices to access the hospital’s healthcare information systems, such as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems.

“As more patient information is moved into EMRs and made accessible both inside and outside the organization via a range of devices, including mobile devices and tablets, the risk of a privacy breach rises. Organized deployment and virtualized clients will help to mitigate this concern,” Dunbrack said.

Dunbrack also noted that the iPad, which has a sleek design, an intuitive user interface, and a large screen (relative to a smartphone), is becoming increasingly popular among clinicians. As the iPad gains traction among healthcare providers, EMR vendors will develop bidirectional integration between their EMR applications and clinicians’ mobile point-of-care devices such as smartphones and tablets.

Vendors are also developing EMR applications specifically for the iPad, Dunbrack observed. One example is St. Louis-based ClearPractice, a company that develops Web-based ambulatory EMR and revenue cycle management applications. ClearPractice recently launched Nimble, a comprehensive EMR application designed and developed specifically for the iPad.

Alan Snyder, BoxTone’s CEO, said in a statement that the iPad is redefining how organizations leverage mobile technology in the enterprise and the healthcare community is leading this paradigm shift.

“As these devices are used more frequently at the point of care, IT must ensure both data security and privacy, as well as superior remote connectivity,” Snyder said.

Source     :     http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=228800929&queryText=electronic%20medical%20records

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

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

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

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