Archive for the ‘EMR Stimulus Package’ Category
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 09, 2009
Experts say success hinges on the outcomes of these decisions
By Alice Lipowicz Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.
The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.
1. Strong standards or wiggle room? Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance between strong rules and flexibility.
“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.
2. Broaden the meaning of “meaningful use?” In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.
3. Take baby steps or giant leaps forward? To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.
Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”
4. Let the states lead the way on data exchange? The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.
For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.
“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.
5. Wait for broader health reforms or forge ahead? Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.
“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.
Above article published on http://fcw.com/Articles/2009/09/07/FEDLIST-5-steps-to-EHR-success.aspx?Page=1
September 09, 2009
ScienceDaily — A new framework of recommendations created by health informatics researchers may help doctors and hospitals prepare for a federal initiative to expand the use of electronic health records (EHRs).
The recommendations from faculty at The University of Texas Health Science Center at Houston, the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine appear in a commentary in the Sept. 9 edition of JAMA, the Journal of the American Medical Association.
“With high-quality, well-designed, and carefully implemented systems, highly-reliable, safe health care will be achieved,” said Dean Sittig, Ph.D., commentary author, associate professor at The University of Texas School of Health Information Sciences at Houston and member of The University of Texas - Memorial Hermann Center for Healthcare Quality and Safety.
The American Recovery and Reinvestment Act of 2009 created approximately $20 billion in incentives for individuals and organizations to “meaningfully” use electronic health records beginning next year. Previous studies report that 4 percent of physicians in the outpatient setting and 1.5 percent of U.S. hospitals have a comprehensive electronic health record system.
“This framework can help make sure that electronic health records are used safely and effectively as doctors continue to adopt them,” said Hardeep Singh, M.D., M.P.H. co-author and assistant professor of medicine and health services research at the VA Health Services Research and Development Center of Excellence and Baylor in Houston.
This framework of recommendations proposed by Sittig and Singh provides guidance for key stakeholders who are either currently involved or who will soon be involved with electronic health records.
“While using electronic health records, we not only have to consider issues related to technology, but also issues related to people who use them, how they interact with technology and how the electronic health record fits with the work flow of the clinic or organization that adopts it,” said Singh, who noted that if the Computerized Patient Record System developed by the Department of Veterans Affairs was included in the EHR-use study, the percentage of U.S. hospitals with a comprehensive electronic health record system would nearly double to 2.9 percent.
VA’s electronic health record system covers many aspects of patient care, including reminders for preventive health care, electronic entry of orders, display of laboratory test results, consultation requests, and pathology and imaging studies.
“The American Recovery and Reinvestment Act stipulates that clinicians and healthcare organizations can receive incentive payments for ‘meaningful use’ of EHRs. Depending on the definition and timeline for ‘meaningful use,’ this legislation could result in a rush to implement sub-optimal systems,” said Sittig, co-author of a new book that addresses EHR issues and is titled “Clinical Information Systems: Overcoming Adverse Consequences.”
For Americans to realize the full potential of electronic health records, which include reduced cost, less duplication and greater quality, Sittig and Singh believe all eight essentials, which are based on a systems engineering model for patient safety, should be followed.
“These issues are essential to maximize patient care benefits and minimize unintended errors from technology,” Singh said.
The commentary is titled “Eight rights of safe electronic health record use.” The authors received support from the National Library of Medicine, the VA National Center of Patient Safety, the Houston VA Health Services Research and Development Center of Excellence and the Agency for Health Care Research and Quality.
Above article published on http://www.sciencedaily.com/releases/2009/09/090908193440.htm
August 27, 2009
By Brian Smith / Register News Writer The days of a white-coated doctor taking a pen from his pocket and making notations in a file are long gone.
With computers becoming smaller, cheaper and more portable, health care professionals are replacing paper records with electronic records that can be instantly accessed.
The Madison County Health Department’s home health division, MEPCO Home Health, is in the process of implementing an electronic medical records (EMR) system, department spokesperson Christie Green said, and will begin using the system on Sept. 1.
“EMRs will make things faster, more efficient and will provide a huge space savings,” Green said. “For example, MEPCO will be moving from nearly 200 square feet of filing space to electronic records housed in a server room of less than 40 feet.”
Federal health care reform efforts have focused on transitioning health care providers to EMR systems to increase efficiency and reduce spending.
Local public health director Jim Rousey said that an EMR system frees personnel to spend more time treating patients instead of making records.
“Every year, our home health nurses were spending more and more time fulfilling documentation requirements for patient care,” Rousey said.
“This interfered with what nurses really wanted to be doing, which was taking care of patients.
“Employing an electronic medical record system should reduce the amount of time it takes to document the care and ultimately provide more time with the patients,” he said.
Rousey said that using an EMR can take some adjustment for practitioners experienced in maintaining paper records.
“At the beginning, there is a steep learning curve for everyone. Sometimes it actually takes longer to use the EMR in the beginning, but the efficiency becomes apparent as everyone gets accustomed to the system,” Rousey said.
At Pattie A. Clay Regional Medical Center, which switched to an EMR system in 2004, the system has paid large benefits, said Joy Barnes, information technology director.
“The nurse at the bedside may need to spend more time to initially gather and document patient information, but the administration and reporting side of nursing has seen efficiency improvements in both time and accuracy of the patient chart,” Barnes said.
Cost is still a concern when transitioning to an EMR system, Green said, despite the decrease in equipment costs over the past few years.
“Less than a tenth of our total outlay for an electronic medical records system in MEPCO was for the hardware,” Green said. “The cost of installing, licensing, and maintaining a quality system is still extremely high — in the 100s of thousands of dollars, even for a small family practice.”
Security can be another concern, said Martin Hensley, information technology specialist for the health department.
“Controlling access and ensuring security is a problem that exists on a bigger scale than it did in the past,” Hensley said. “In the past, we could just lock a file room and the charts would be secure. Now, everyone in the agency must be more conscious of security. Each computer terminal or laptop can be a doorway to confidential medical information.”
Barnes and Green also both pointed to making wise choices about the systems that are implemented as a key component of implementing an EMR system.
“In the past, we used carts with laptop computers that were wheeled into each patient room,” Barnes said. “The carts were cumbersome and not the best option, especially in a semi-private room with two patients.
“With the new renovations in place, the nursing staff are testing hand-held computers developed specifically for the health care environment,” Barnes said.
“We have to be aware of the potential for the computer to come between the provider and the patient,” Green said. “For example, large screens may block a patient’s view, or a computer’s location in the room may cause the provider to turn her back to the patient.”
Despite the costs and concerns, Green said EMRs and other health technology have a benefit to patients.
“In the long run, electronic records will increase the speed and accuracy of the flow of information between providers,” Green said.
“This translates into improved quality of care for patients, as various providers can communicate about an individual’s health needs.”
Above article published on http://www.richmondregister.com/localnews/local_story_236085613.html?keyword=secondarystory
August 25, 2009
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
August 04, 2009
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. Above article published on http://www.mcknights.com/Electronic-health-records-overlooked-in-healthcare-debate/article/141021/
August 03, 2009
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:
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.” Above article published on
July 17, 2009
Filed Under (EMR, EMR Stimulus Package) by admin
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
July 06, 2009
Filed Under (EMR, EMR Stimulus Package) by admin
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 |
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