The health care industry is trying to catch up when it comes to technology.

“Other businesses have been able to figure out how to make it work, such as the finance business. You can get money wherever you go. Health care is really behind,” said Helen Connors, executive director for Kansas University Center for Health Informatics.

Connors said it is unreasonable to ask patients to recall their medications and past history every time they see a doctor.

“Why are we asking the patient for that information? We can’t rely on the patients or providers to remember everything, so it’s got to change,” she said. “I think eventually consumers are going to drive it because they are not going to put up with it.”

The federal government has earmarked $34 billion in stimulus funds to address the issue.

“That’s a lot of money,” said Dave Garets, CEO and president of HIMSS Analytics, which collects and analyzes health care data related to information technology. “The federal government has never allocated much of any money to provide incentives to hospitals and doctors to get in gear. But boy, they did this time.”

The goal is to offer incentives for health care providers to move from paper charts to computers during the next five years, and after 2015 penalize those who don’t by, for example, providing lower reimbursements for Medicare patients.

Congress is working on the details with some preliminary regulations expected by year’s end, Garets said.

High-tech advantages

The ultimate goal is for doctors, hospitals and pharmacies to be able to access any patient’s information in a more efficient and timely manner by using electronic medical records, commonly called EMRs.

For example, if an out-of-town patient is taken to an emergency room and has allergies, an EMR would immediately alert the physician. EMRs also allow doctors to order and see lab results at the click of a button. Research has shown that EMRs significantly reduce medical errors.

For example, they can alert a doctor if he or she prescribes a medication that would not interact well with a current medication. EMR prescriptions also are more legible than their hand-written counterparts. Dr. Jon White, health information technology director of the Agency for Healthcare Research and Quality, said EMRs can help doctors manage more information better and more quickly. An EMR can contain patients’ medical information, lab work, the latest research in health, insurance information, pharmaceutical data and messages from other office workers, to name a few applications. “You can still practice without those tools, and in fact, people do every day. It just becomes more challenging to do it as time goes by,” he said.

High-cost process

White said doctors and hospitals have been dragging their heels on changing over to EMRs primarily because of costs. “They are expensive. But, we think that they will get back the money that they put into it,” he said. “Ultimately, everyone who successfully implements electronic medical records say they would never go back, but that’s a big hurdle to get over.”

The agency estimates that it costs about $30,000 for a provider that isn’t in a hospital setting.

Lawrence Memorial Hospital and Kansas University both started moving to an electronic system several years ago. LMH has spent more than $12 million just for software. KU Hospital has budgeted $52 million for the entire process.

“It’s probably one of the largest single activities that any hospital will pursue,” said Chris Hansen, chief information officer at KU Hospital. “It’s monumental, which is why there haven’t been a lot of hospitals that have gotten there.”

According to a 2008 survey in the New England Journal of Medicine, only 4 percent of physicians reported having an extensive, fully functional electronic records system and 13 percent had a basic system.

Hospitals are doing better.

Garets, of HIMSS Analytics, said 83 percent of hospitals nationwide have a basic system, but in Kansas, only 62 percent of the 132 hospitals do. More startling, he said, is that 29 percent — or 38 — of the state’s hospitals have no basic system and have no plans to purchase one, compared with 12 percent nationally.

“That is craziness,” Garets said, laughing. “It’s like what, ‘Are you living under a rock?’”

Connors, of KU’s Center for Health Informatics, is chairwoman of the state’s new e-Health Advisory Council, which is working to recommend a health information exchange plan for the state. She said some states already have a plan and are applying for federal money to begin implementing those plans. However, Kansas is applying for funding to develop a plan.

“Right now, we are fact-finding, looking at what other states have done, what do we need and what is going to be best for Kansas,” she said.

The first mission is to help health professionals get electronic systems and then figure out how they can exchange that information. Ultimately, the state’s systems will plug into a national one.

Learning curve

But, change isn’t easy.

“Almost every single one of us that is out there now grew up writing words on charts, writing notes on charts and using a pen,” White said. “Until not too long ago, we were taught that the pen was the mightiest instrument available to a doctor.”

Dr. Sabrina Prewett, 54, medical director in the LMH Emergency Department, would agree. In January, the emergency room will be one of few nationwide that is paperless.

“It was very challenging,” Prewett said of the five-year process. She worked alongside IT personnel to implement the software and then helped train staff.

“That’s why I became the one that helped develop it because if I can do it — anybody can do it,” she said, laughing.

But, Prewett said it has been worthwhile. It is safer, quicker and the information is legible.

“The impetus is for patient safety,” she said.

Above article published on http://www2.ljworld.com/news/2009/nov/02/health-industry-finally-moving-toward-computerized/?city_local

By Pamela Lewis Dolan, AMNews staff.

When it comes to electronic health records, functionality has had its time in the spotlight. Now, the buzz term is usability. What’s the difference? Functionality is what a system does. Usability is how easily you and your staff can operate the system.

Usability is coming into the spotlight as vendors and consultants are learning that a lack of it has been a major reason many implementations have failed. The push is now on for practices (and vendors and consultants) to pay less attention to the bells and whistles and more to whether physicians and support staff can figure out how to make them work.

Determining what usability means to you will require a hard look at not only the system but also your practice — how it works now, how you want it to work, and how ready and able employees are to adapt to technology.

Ron McNamara, PhD, a certified usability analyst who runs the EMR Usability Group, a consulting firm, said that despite the seemingly relative nature of usability, there is some science to it. But at its most basic level, usability means everyone will be able to use the records system to electronically complete tasks in the same or less time as it takes on paper.

McNamara has developed a nine-point assessment that practices can use to help determine a system’s usability:

Dictation: A good system will accommodate doctors accustomed to dictating their notes as well as those who are comfortable typing.

Prescriptions: Sending a prescription electronically should be just as fast as writing it on paper.

Ability to receive faxes: Allowing faxes to be imported directly into the EHR should not negatively impact work flow.

Appointment/scheduling integration: With good integration staff will not have to toggle between two systems.

Scanning: Your system should allow documents to be scanned directly into a patient file.

Vital signs: Support staff should be able to enter vitals directly into the patient’s file at the time of care, with a touch screen, tablet or laptop in the exam room.

Interface design: Is it customizable to match each physician’s current work flow? Can information that is not needed on a regular basis be hidden? Can it be customized according to user (whether physician, nurse, physician assistant)? Is it intuitive and easy enough that a novice can learn to use it?

Office work flow: Is your vendor willing to define current work flow and match the system to it as closely as possible and/or help identify current work flow problems that can be fixed with technology?

Application performance: Does the system take a long time to load? Does it go from screen to screen quickly? Does it crash often? Hardware, as well as software, will be a factor.

Can your staff adapt?

The other important task is assessing your employees’ ability to learn a new system.

Jeffrey Linder, MD, MPH, director of the Brigham and Women’s Primary Care Practice-Based Research Network in Boston, said there is no test to assess an employee’s tech-savviness. So you mostly have to rely on self-reporting.

Allen Wenner, MD, a family physician in Columbia, S.C., said that when he interviews potential employees at his practice, he addresses their tech-savviness with two basic questions.

The first is, “What is your e-mail address?” It must be a personal address, not a current or former work e-mail. The second is, “What operating system do you use?” A response of “Windows” is not adequate. He wants to know what version.

“If a person doesn’t know the answer to those things,” he said, “then you can’t teach the level of technology that is necessary to operate an EMR in a live environment while you are seeing patients.” Dr. Wenner is also the co-founder of the High Performance Physician Institute, an EMR training organization.

But that’s not to say everyone should be able to program the next best thing to Microsoft Windows. A good EHR system will meet people where they are and allow them to learn as they go along, McNamara said.

Dr. Linder said that during the implementation projects in which he has participated, there was an effort to get diversity on the teams charged with picking a system. The strategy was to form a group with the widest spectrum in terms of age, self-reported tech-savviness and job requirements to test-drive potential systems.

Dr. Linder compared a good EHR to Microsoft Word. He said most anyone can figure out how to use the program, but most users don’t use 92% of what’s in it. Likewise, a good EHR system will be easy enough for novices to use, but offer more options for a “power user.”

The caveat is that if all of the EHR’s functionalities aren’t being used by the majority of people in the office, the practice is not realizing the system’s full potential. That’s where incentives come in, Dr. Linder said.

As payment moves from fee-for-service toward pay-for-performance, practices will have the time and motivation to learn and utilize more of the EHR’s functionalities, he said. Incentives built around the patient-centered medical home model, for example, will be practice wide, not physician-specific, which means every employee in the practice will have an incentive to learn — and take their own steps — to increase the system’s usability.

Above article published on

http://www.ama-assn.org/amednews/2009/08/31/bica0831.htm

Electronic medical records are the wave of the future, and Chicago area hospitals are already on board.

Hospitals with more advanced record-keeping technology have fewer complications, lower mortality rates, and lower costs, according to a study released last week by Johns Hopkins University. The study looked at more than 40 hospitals with digital record systems and more than 160,000 patients in a six-month period.

“It’s the right thing to do and we’re going to see a lot of studies like this in the next 5-10 years that attempt to measure the benefits of electronic medical records,” said Dr. Mike Kelleher, chief medical information oficer at Children’s Memorial Hospital.

Most of Chicago’s top medical institutions including Northwestern Memorial Hospital, NorthShore University HealthSystem–Evanston Hospital, Glenbrook Hospital, Highland Park Hospital, Skokie Hospital, and 75 doctor’s offices–, University of Illinois Medical Center at Chicago, Rush University Medical Center and Children’s Memorial Hospital have either already made the leap to digital records, or are in the process.

Former President George W. Bush laid out the goal of having electronic records nationwide by 2014, a goal that was quickly adopted by President Barack Obama.

Wired In

The study findings are no surprise to Chicago-area hospitals, well versed in digital technology.

“What we did was transformational–it changed the way we do things and the way we think,” says Mark Neaman, president and chief executive officer of NorthShore University HealthSystem.

“Patients can even have a Blackberry conversation with their physician or order a prescription online,” Neaman said.

NorthShore University HealthSystem, one of the pioneers in digital records, went completely digital in 2004.

Digital records can even prevent mistakes from being made.

“We have seen measurable improvements in the quality of our outcomes, reduced medication errors and become generally more efficient,” Neaman said.

The complete transition at NortthShore $took 15 months from launch to finish in April of 2004 and cost an estimated $42 million, according to Neaman.

“We applied the big bang theory,” Neaman said. “We wanted to have everything up and running quickly.”

Almost all Chicago-area hospitals have some digital record keeping system in place or are in the process of implementing one.

Security, however, becomes a major concern with personal information in digital form.

With electronic records, it is much easier to track who has accessed a file—an important security feature—but making sure the right people have access can be time consuming.

“It’s a big concern,” Kelleher said. “You have to make sure that the people you give access to are properly vetted.”

“Before electronic medical records, files were continually being misplaced,” said Dr. David S. Channin, radiologist at Northwestern Memorial Hospital and chief of imaging informatics at Northwestern University Medical School. “We relied on loose pieces of paper with illegible writing, and human memory.”

Northwestern Memorial has used electronic records for more than a decade now for nearly all of their services.

More Benefits

The benefits of digital records aid in many different aspects of patient care.

One key benefit is allowing doctors to find information on patients more easily.

While it may take physicians or nurses more time to enter information into the system, the ability to find it and search for it with ease is invaluable according to Kelleher.

Patients and doctors can also have their information readily available at the touch of a keyboard without having to dig through extensive files.

Digital Divide

Despite the many advantages there are still countless hospitals that are falling behind with this technology.
After years of recording information manually, some doctors are hesitant to change to a new electronic system.

“The older physicians are more likely to be unwilling or uncertain about using the computer system,” said Kelleher.

“The catch is that there are tradeoffs between quality and efficiency and independent tradeoffs within each one,” says Dr. Channin.

There is also a steep cost of investment as far as equipment and training.

NorthShore University HealthSystem invested an estimated $42 million in the new technology, $5 million of which went to training staff, according to Neaman.

They are foreseeing an estimated return of 17 million dollars per year in savings related to the new system, but the return is very long-term and small in comparison.

Originally Published by Vanessa Handand and Chris Kelly, Northwestern University.

If you’re like the majority of physicians, you don’t prescribe electronically and you don’t see why you should. After all, what’s wrong with the old prescription pad that has served you well over the years? But citing safety, quality, and efficiency, the government, private insurers, and some medical societies want you to change your mind.

This month, a CMS initiative will start adding 2 percent to your Medicare payments if you prescribe electronically. The incentive drops to 1 percent in 2011 and 2012 and to 0.5 percent in 2013. Starting in 2012, CMS will pay you 1 percent less than its fee schedule if you don’t e-prescribe; that penalty will rise to 1.5 percent in 2013 and to 2 percent in 2014 and every year thereafter.

Speaking at a recent conference in Washington, D.C., CMS acting administrator Kerry Weems said he was confident that the incentive “changes the business case enough that we’ll see investments made in e-prescribing. We also think some private payers will come along with us.”

But with standalone e-prescribing systems priced at around $3,000, plus monthly maintenance fees, observers are divided on whether the CMS incentive alone will be sufficient to get doctors to adopt e-prescribing. Bruce Merlin Fried, a Washington, D.C., healthcare attorney and health IT policy expert, is one of those who think that it will: “The incentive will have an enormous impact on doctors moving toward e-prescribing.” The penalty on the back end, he adds, will convince many other physicians to do the same.

Representatives of primary-care medical societies, however, are less optimistic. Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology, which has been promoting e-prescribing for years, says, “I don’t think the 2 percent incentive will be enough for most family physicians. It will accelerate the thinking of people who are close to making the decision for their practice; but for those physicians who don’t think they should be e-prescribing or aren’t ready, this 2 percent — which, for a family physician, is about $1,400 a year — is not enough to change their decision.”

The incentive is prompting some physicians “to take a harder look” at e-prescribing, says Michael Barr, vice president of practice advocacy and improvement for the American College of Physicians. “It’s not something people are taking lightly. Some doctors are wondering, ‘If I’m going to invest in technology, is now the right time for me to go the EMR route, or should I go to e-prescribing?’”

Both the investment and the work flow changes are much greater with an EMR, he admits. “But if your practice has been thinking about an EMR, and hasn’t been able to create a business case for it, and if you’re on the fence, the e-prescribing incentive might push you over.”

Other help

Of course, you’d be more likely to adopt e-prescribing if all of your payers, not just Medicare, were providing incentives. Don’t hold your breath: Waldren says such a widespread move is unlikely, noting that most plans doubt that they’ll see a return on investment. But Blue Cross and Blue Shield of Massachusetts will require physicians to e-prescribe by Jan. 1, 2011 in order to participate in the plan’s incentive programs. Highmark Blue Cross Blue Shield and Blue Cross Blue Shield of Delaware are helping doctors switch to e-prescribing, and several other Blues plans have agreed to support a service offered by Prematics, a Vienna, Va.-based firm that gives e-prescribing technology to practices for free. Insurance companies also fund the PocketScript e-prescribing service of ZixCorp, based in Dallas. And the National ePrescribing Patient Safety Initiative, a coalition that includes technology companies and plans such as Anthem, Aetna, and Horizon Blue Cross Blue Shield of New Jersey, is offering physicians free e-prescribing software.

As for hospitals, most have been slow to offer a helping hand, despite a 2006 relaxation of Stark self-referral rules that was supposed to encourage them to subsidize information technology for private practices, according HIMSS Analytics, a healthcare IT research firm. They seem even less inclined to offer assistance with e-prescribing, according to Dave Garets, the firm’s president.

Online only

Further change is coming even for those physicians who have already adopted e-prescribing via their EMR’ s, most of whom are computer-faxing prescriptions to pharmacies. Starting this year, CMS prohibits computer-faxing of electronic prescriptions covered by Part D drug plans. Kevin Hutchinson, president of Prematics and former president of SureScripts, the firm that connects physician offices with pharmacies, says he thinks this will have a big impact on increasing the percentage of online scripts. All that most physicians with EMRs have to do to prescribe that way, he notes, is to get their vendors to upgrade their systems to the latest version.

According to SureScripts, the number of online prescriptions is rising fast. In 2007, 35 million online prescriptions were written, with 6 percent of office-based doctors prescribing online. In 2008, SureScripts expected 100 million prescriptions to be written and sent electronically. They projected the number of physicians e-prescribing online would jump to 85,000, or 15 percent of office-based doctors.

Many physicians will continue to hold off on e-prescribing, partly because of federal and state rules that forbid electronic prescriptions of controlled substances. Nobody wants to have a dual paper and electronic workflow in their office. This is also a problem in areas where only some local pharmacies accept electronic scripts. While nearly all chain pharmacies do, many independent drugstores continue to hold out. At the end of 2007, 70 percent of all community pharmacies accepted electronic scripts, but only 27 percent of independents did.

Still, there’s no doubt that the e-prescribing train is gathering steam. And, while it’s doubtful that there will be a federal mandate to e-prescribe, you should probably start taking a close look at the pros and cons of moving in this direction yourself. When most of your colleagues have made the leap, and your patients expect it, do you want to be the last doctor using an old-fashioned prescription pad?

Ken Terry is a New Jersey-based freelance writer and the author of the book “Rx for Health Care Reform.” He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.

With a host of new incentives, doctors are finally beginning to scrap pen and paper in favor of electronic prescriptions.

Medicare this month began paying doctors a bonus if they switch their patients over to e-prescribing. Some private health plans also have begun offering extra payments along with free equipment, such as digital handheld devices. And a coalition of technology companies is giving doctors free software to encourage them to ditch their paper prescription pads. As a result, the number of physicians prescribing medicines electronically has more than doubled in the past year to about 70,000, or about 12% of all office-based doctors.

E-prescribing allows doctors to transmit prescriptions via a secure Internet network directly to pharmacies using an office or laptop computer or a digital handheld device. The practice has been shown in studies to reduce prescription errors and to cut costs for consumers and health-care providers. It also encourages patients to get more of their prescriptions filled, because it reduces the time spent waiting at drug stores. The Obama administration’s plan to invest $50 billion over five years to encourage broader adoption of health-information technology is expected to include additional incentives for electronic prescribing.

Rx Connection

Where to learn more about electronic prescribing

• Learnabouteprescriptions.com : Sponsored by pharmacies and Sure Scripts-RxHub; lets consumers search for doctors and pharmacies that offer e-prescribing by city or ZIP Code; offers medication-safety advice and benefits of e-prescribing.
• Surescripts.com/Safe-rx : Information from SureScripts-RxHub ranking each state on e-prescribing progress, including growth in doctors and pharmacies using the technology.
• Ehealthinitiative.org : Nonprofit technology advocacy group offers downloadable consumer guide to e-prescribing benefits and questions to ask doctors and pharmacists.

But there are still barriers to full-fledged adoption of e-prescribing. Federal drug laws, which are under review, prohibit electronic prescribing of controlled medications such as narcotics, insomnia drugs and anti-depressants. Safety experts also warn that selecting prescriptions on a computer screen can cause a doctor to inadvertently enter, for instance, a quick-release version of a drug instead of a long-acting formulation because they appear in sequence on an e-prescribing program.

Michael Cohen, president of the Institute for Safe Medication Practices, which analyzes medication errors, says the group favors adoption of electronic prescribing. Still, Mr. Cohen advises patients as a backup to leave their doctor’s office with verbal instructions and a printed version of the prescription that includes the name, dose and directions for use.

E-prescribing can catch many dangerous mistakes, studies show. The software automatically checks a patient’s drug history for potential hazards such as improper dosages, medication allergies and adverse interactions with other drugs the patient is taking. More than four billion prescriptions are written in the U.S. annually, and studies show that as many as 4% contain an error with serious patient risks.

“There are more than 1.5 million people hurt every year by preventable medication errors, and the evidence is strong that patients are far better off when we e-prescribe than when we don’t,” says Janet Marchibroda, chief executive of eHealth Initiative, a nonprofit that includes public-health agencies, consumer groups, health plans and technology companies.

Cost Savings

Electronic-prescribing systems also can save patients money by allowing doctors to check, with a patient’s consent, the relative cost of co-payments for generic, formulary and nonformulary drugs in a patient’s health plan. The main software program being offered free to doctors, by Allscripts Inc. and a coalition of technology companies and health plans, displays a green smiley face next to generic and on-formulary drugs, and a red frowning face next to more expensive nonformulary drugs.

In a study published last month in the Archives of Internal Medicine, researchers at Brigham and Women’s Hospital found that e-prescribing systems that allow doctors to select generic or lower-cost medications can reduce annual costs of delivering drugs to consumers by $845,000 for every 100,000 patients.

Linda Green, an allergist in Havertown, Pa., began using electronic-prescribing software two years ago. She says e-prescribing has enabled her to see a list of medications her patients may have neglected to tell her about, “and I’ve had a few surprises that had an impact on the medication I was about to prescribe.” Moreover, she says, “when you are faced with a patient who is complaining of having trouble paying for medication it makes you think, maybe I can prescribe this cheaper one instead, and having their formulary information in real time makes that much easier to do.”

Virtually all chain pharmacies and about 45% of independent pharmacies now accept electronic prescriptions, says Rick Ratliff, co-chief executive of SureScripts-RxHub. The company, which has patient information from pharmacy-benefit managers, operates the main network over which prescriptions are transmitted electronically. The company stores data on more than 200 million insured patients and provides physicians with ready access to information on patients’ medication histories and which medicines are covered by their health plans.

Electronic Records

E-prescribing also is expected to encourage broader use of electronic medical records, which includes such features as storage of full medical histories, lab reports, and programs that let doctors send alerts and reminders to patients. The cost of the technology to maintain full electronic medical records is roughly $25,000 to $45,000 per physician. While free software and hardware programs are being offered to some doctors, generally the cost of a stand-alone e-prescribing system, including software and training, ranges from $500 to $2,500. The system can later be incorporated into a medical-records system.

The Center for Medicare and Medicaid Services, the federal agency that oversees Medicare, this month began paying doctors a bonus to e-prescribe. The bonus amounts to 2% of charges billed to Medicare for 2009 and 2010, and declines to 0.5% by 2013. Current estimates are that the bonus program could yield an additional $1,700 to $3,500 a year for a doctor.

Medicare Penalties

Medicare also plans a penalty for doctors who don’t e-prescribe. These physicians will have their Medicare reimbursements reduced by 1% beginning in 2012, and by 2% in 2014 and beyond.

Consulting firm Gorman Health Group estimates that the federal government could reduce its health-care costs over 10 years by at least $26 billion by offering bonuses and requiring that all prescriptions for drugs covered by Medicare be sent electronically. The program also could prevent 1.9 million adverse drug events, Gorman predicts.

Printed in The Wall Street Journal, page B7