Obama administration rolled out a program to make $1.2 billion grants available to help the nation’s health care system transition to electronic medical records. The grants are part of a $48.8 billion chunk of the economic stimulus bill devoted to health information technology, including grants for individual doctors to help cover the costs of converting from paper records.

These grants were approved by Congress under the economic stimulus bill, but they’re also a part of the administration’s ambitious health-care agenda. And advocates of the transition say the investment will not only upgrade the quality of care, it will also save the country money in the long run.

However, estimates of the potential savings from a transition to electronic medical records vary widely. The Obama administration says that increasing the adoption of health information technology will save the federal government more than $12 billion over the next 10 years. The left-leaning Center for American Progress estimates that investments in health information technology could lead to federal savings of $196 billion during roughly the same period. The RAND Corporation projects savings of about $80 billion a year for the entire health-care sector.

The variance among these estimates is caused in part by different assumptions about what a transition to electronic medical records really means. A 2008 report by the Congressional Budget Office noted that some optimistic estimates rely on a best-case scenario of “potential” savings if health IT systems are widely adopted – and other changes are made to the health-care system as well.

“The way to think about it is that alone, if all we do is electronic records, then we’re just going to do the wrong stuff faster,” says Len Nichols, the director of the Health Policy Program at the New America Foundation. “You’ve got to think about electronic records as a piece of a re-engineered delivery system.”

Part of the promise of electronic medical records systems is the idea that every time a doctor or nurse sees a patient, a whole database of information is instantly available: that individual’s medical history including any allergies, underlying conditions like diabetes, or tests that other specialists have already run, as well as public health data on what treatments have been proven to be most effective for patients with this person’s history and symptoms. Nichols describes a scenario in which a migraine sufferer, frustrated after years of ineffective treatment, asks his doctor for an MRI; the doctor has instant access to data that proves that an MRI isn’t the best option for this particular patient. She doesn’t order the test, and the system saves money on an unnecessary and expensive test.

The current health-care system, in which doctors are typically paid on a fee-for-service basis for every treatment they provide, offers no financial incentive for making that cheaper choice. The CBO report concludes that, without a change in the way providers are paid, electronic medical records could improve the quality of care, “but it is relatively rare for providers to be compensated for such improvements.” So a move to electronic medical records alone won’t save as much money as an electronic transition combined with a new system that rewards doctors based on the quality of care they provide.

The move to electronic medical records also raises privacy concerns because data could be shared widely among health-care providers – and used to create public health databases that could help identify the most effective treatments. The stimulus-bill grants include protections for patient privacy that could serve as a good first step to keeping health information secure, says Christopher Calabrese, a lawyer for the American Civil Liberties Union.

“Now the devil’s really in the details,” Calabrese says. “The central question is, what privacy is going to mean? Is privacy going to mean just confidentiality?” He says privacy protections should include patient control over which providers can see what information. “Your podiatrist does not need to know whether you’ve had an abortion,” he says.

Some electronic records advocates say the switch is so valuable that it should trump privacy concerns. Ellen-Marie Whelan, the associate director of health policy at the Center for American Progress, says privacy needs to be addressed, but it shouldn’t hold up the move to a more efficient system that could produce better outcomes for patients.“ I don’t know that we’ll ever get a 100% guarantee [of privacy],” Whelan says. “And it’s so important that I don’t think we can afford to wait until we have a 100% guarantee before we move forward.”

With health-care costs continually growing, policy makers are looking for any way to cut costs – even though the debate over coverage has left a cloud of uncertainty around the final bill.

“We may or may not decide as a nation that we care enough about our fellow human beings to expand coverage,” Nichols says. “We have no choice but to try to get our system to become more efficient.”

Above article published on

http://www.smartmoney.com/Personal-Finance/Health-Care/Can-Electronic-Medical-Records-Save-You-Money/

One part of President Obama’s healthcare agenda that has been nudged out of the spotlight is the push to create a nationwide network of electronic health records (EHR) by 2014. McKnight’s will hold a webcast on this issue later this month.

Even though a deadline is in place, EHR faces significant challenges toward implementation. One of the main factors holding back EHR adoption is the sheer cost of the undertaking, according to CNNMoney.com. Depending on the size of the facility, an EHR system can cost tens of millions of dollars to implement, and take years to get off the ground. One Kentucky hospital system will require $80 million and three years to fully implement an effective EHR system, CNN reported. Convincing physicians to change their long-held practices can be a challenge as well, according to the report. Smaller rural facilities face other challenges, including lack of training and resistance to change. The long-term care industry has long been considered ahead of the curve in EHR adoption practices.

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http://www.mcknights.com/Electronic-health-records-overlooked-in-healthcare-debate/article/141021/

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews

The Obama administration’s national health information technology coordinator has approved recommended definitions for what constitutes “meaningful use” of electronic health records, about a month after asking a key working group to revise its initial recommendations.

The green light from David Blumenthal, MD, means that the recommendations now will be sent to the Dept. of Health and Human Services, which by the end of the year must issue a rule with final definitions. Meaningful use is a key term that ultimately will determine which physicians and hospitals are eligible for billions in federal EHR money made available through the economic stimulus package approved earlier this year.

Recommendations from Dr. Blumenthal and the Health IT Policy Committee provide the first look at a policy framework for the development and adoption of a nationwide health information infrastructure. The committee said it received nearly 800 comments after unveiling a first draft of the recommendations June 16, though policy experts say few major changes were made since then.

“To say Dr. Blumenthal sent the working group back to the drawing board really is inaccurate,” said Erica Drazen. a managing partner in the health care group at Computer Sciences Corp., a technology firm in Waltham, Mass. “There weren’t really too many surprises or changes made from the initial draft. If anything, it’s slightly more aggressive.”

Drazen pointed out, for example, how the final recommendations specified that only 10% of all orders entered by an authorizing physician at a hospital must be made via computerized physician order entry. The initial draft did not provide an exact percentage. But the requirement for physician practices remains the same — they must use CPOE for all orders, according to the final version. Doctors also received several additional recommended standards to meet by 2011.

HHS must finalize EHR meaningful use guidelines by year’s end.

Some health care policy experts praised the quick work by Dr. Blumenthal, the committee and the working group.

“They have laid out these big, achievable goals that are central and critical, and the way meaningful use needs to be implemented is with an eye toward achieving these objectives,” said Carol Diamond, MD, managing director of the health program at the Markle Foundation, a health IT policy organization based in New York. Markle teamed up with two other health care policy organizations — the Center for American Progress and the Engelberg Center for Health Care Reform at Brookings — to comment on the working group’s report.

The organizations called the measures ambitious but achievable. Dr. Diamond cautioned, however, that HHS should not try to add new goals or tasks for physicians. “Rather than try to expand these even more and add more requirements, there’s a real opportunity for HHS to define within these goals how each specific provider group can achieve these measures.”

2011 objectives

Despite some revisions, most of the initial recommended requirements for physicians receiving EHR stimulus money remain the same. By 2011, physicians will be considered meaningful EHR users if the practice meets multiple objectives, including:

• Maintaining an active medication list.
• Incorporating lab test results into the EHR as structured data.
• Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach.
• Reporting ambulatory quality measures to the Centers for Medicare & Medicaid Services.
• Sending reminders to patients for preventive and follow-up care.
• Documenting a patient progress note for each encounter.

The Health IT Policy Committee also recommended objectives for 2013 and 2015.

The medical community has tracked the committee’s work and the meaningful-use debate with much interest, as the stimulus package provides approximately $19 billion in net Medicare and Medicaid EHR incentives for physicians, hospitals and others. The incentives begin as bonuses for early adopters but turn into penalties for those who don’t adopt quickly enough.

Meaningful users have been defined generally as physicians who have demonstrated to the government that they are using electronic prescribing and that their systems are connected to other entities in a way that provides for the exchange of health data to improve care quality. But the working group was asked to specify exactly what objectives and measures physicians would need to meet for stimulus incentives.

Health IT and policy experts say the recommendations approved by Dr. Blumenthal are a significant benchmark for physicians.

“This is a good time for physicians to check in, because the first wave of the draft was more about moving it out of the political process, and this development certainly moves it toward rule-making,” said Jana Skewes, president and CEO of SharedHealth, a provider of health information products and solutions based in Chattanooga, Tenn. “I would say now there are enough signs and pillars of requirements that physicians would be using their time wisely to determine what the requirements are.”

Skewes advised doctors who already have EHRs to check with their vendors to see if systems are up to date with the most current recommendations.

Now that the medical community has a pretty good idea of what to expect from the government, Drazen said, practices shouldn’t wait to start upgrading or adding EHRs.

“The market has been waiting, and people have been afraid to make investments, because they weren’t sure what was required,” she said. “But big capital investments shouldn’t have to be made to at least get started.”

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http://www.ama-assn.org/amednews/2009/08/03/gvsb0803.htm

CHARLOTTESVILLE, VA – Hospitals have seen a decrease in EMR adoption in states where privacy laws restrict their ability to disclose patient information, according to a study published in the journal Management Science.

The study shows that states that have enacted medical privacy laws restricting the ability of hospitals to disclose patient information have seen a reduction in EMR adoption by 11 percent over a three-year period or 24 percent overall. States with no such regulations, on the other hand, experienced a 21 percent gain in hospital EMR adoption.

According to the study, the drop is most evident in the reduced adoption of EMRs through networks of hospitals and medical providers. In states without such laws, adoption of EMRs by one hospital spurs adoption by others, with one hospital’s adoption increasing the likelihood of other hospitals in the local area adopting by 7 percent.

The study’s authors, from the Massachusetts Institute of Technology and the University of Virginia, say privacy protection may benefit the diffusion of information-sharing technologies if it reassures consumers, but may inhibit the diffusion of information-sharing technologies if it imposes costs on firms who adopt the technology.

Above article published on http://www.healthcareitnews.com/news/study-privacy-laws-deter-hospitals-emr-adoption

By Jonathan D. Epstein NEWS BUSINESS REPORTER

Western New York’s three health insurers have asked the region’s electronic clinical information exchange to lead an effort at driving more adoption of electronic medical records by area physicians.

Western New York Health Plans, comprised of HealthNow New York, Independent Health Association and Univera Healthcare, hired HEALTHeLINK to implement a program seeking to get 500 more doctors to start using electronic medical records over the next three years.

That’s part of a nationwide effort by the government, insurance industry and providers to increase the use of electronic records to lower costs, streamline operations and reduce medical errors. While use of the electronic records is spreading locally, so far it’s been limited to a few major practices, such as Buffalo Medical Group.

“It’s certainly not at the rate that we wanted, so that’s why this is an exciting opportunity that the health plans are providing to the physicians,” said Daniel E. Porreca, executive director of HEALTHeLINK.

Under the agreement, HEALTHeLINK will help the health plans select the vendor software packages that physicians can choose from, including determining the requirements used to evaluate them. For example, the software must help providers produce better medical outcomes, and also support personal health records and electronic prescribing.

HEALTHeLINK will also guide physicians in choosing which software to use, and then implement so they can qualify for federal dollars.

Congress set aside $19 billion in the $787 billion stimulus package, called the American Recovery and Reinvestment Act of 2009, to support doctors and hospitals in adopting electronic records. President Obama signed the measure into law on Feb. 17.

“We believe our agreement with HEALTHeLINK, coupled with the recently passed federal stimulus package that will provide physicians reimbursement for adopting electronic medical records, will help ease this technological transition for the physician community,” HealthNow executive vice president Cheryl A. Howe said in a press release.

The new initiative will focus on primary care physicians, Medicaid providers and eventually specialists, including both physicians and mid-level clinicians.

“This initiative by the region’s health plans is another example of the unprecedented collaboration taking place to enhance healthcare for our community,” Porreca said in the release. “We look forward to managing and executing this program on behalf of the health plans and in turn working with the physician community to make the transition to electronic health records as seamlessly as possible.”

Above article published on

http://www.buffalonews.com/145/story/718189.html