While few practices and hospitals currently use aggregated patient data, the number is expected to increase, and a new study touts the information’s benefits.

By Pamela Lewis Dolan, amednews staff,

One of the biggest untapped benefits of electronic medical record adoption is the secondary uses of the data that are being collected, concludes a study by PricewaterhouseCoopers.

The study, “Transforming Healthcare through Secondary Use of Health Data,” found that practices and hospitals have seen aggregated data from their electronic medical records identify patterns that have allowed them to improve outcomes, reduce errors and increase revenue opportunities.

But the number of institutions using the aggregated, or secondary, data in this way is very small, though it is expected to grow in the next two years.

“Almost every constituent in the [health care] industry that has to make a decision around what type of health care to deliver and when could use this kind of data and the information that aggregating it can produce,” said Dan Garrett, health IT practice leader at PricewaterhouseCoopers.

The report found that among those organizations already using some form of secondary data, 59% have seen quality improvements, 42% have achieved cost savings, 36% have seen patient/member satisfaction improve, and 29% have increased revenue. The biggest users of secondary data are hospitals and physicians, while health plans are the farthest behind.

The survey found that although 95% of physicians are not opposed to using secondary data, many are sensitive to how it should be used. Patients also are concerned.

“We all know we need to use this data, but they also know we can’t risk security,” Garrett said.

The PricewaterhouseCoopers report came from an e-mail survey conducted in June of 732 health care executives, 482 physicians, 136 payers and 114 pharmacy/life sciences organizations.

Above article published on http://www.ama-assn.org/amednews/2009/10/19/bise1023.htm

By Neil Versel

Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records. To date, most of the research has focused on health IT in specific environments, such as a single hospital, physician office or integrated delivery network, but the stimulus will help put EHRs in new settings that haven’t been studied.

“We are going to be hungry for how to implement health information technology the most efficiently to gain the greatest value for the health IT investment,” Blumenthal told a gathering convened by the Agency for Healthcare Research and Quality last week. “We’re at that transition that we see every time a new technology is moved out from the laboratory.”

Blumenthal advocated clinical decision support technology that encourages continuous quality improvement by delivering research data and new treatment information to the point of care, easily accessible by clinicians. “One thing we haven’t done is apply the scientific method in the practice of healthcare and medicine,” he said.

But he and other health IT experts at the same AHRQ conference cautioned that the road to achieving “meaningful use” of EHRs will be long and fraught with all sorts of danger.

Above article published on

http://www.fiercehealthit.com/story/blumenthal-more-research-needed-health-it-effectiveness/2009-09-21#ixzz0S12KjFSn

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

http://fcw.com/Articles/2009/09/18/HHS-panel-considers-patient-consent-for-privacy-in-EHRs.aspx?Page=1

By Don A. Solberg, MD, Kathryn L Houck and Jim Roberts

Successful electronic health record (EHR) adoption not only improves quality of care by making patient information easily accessible, it also provides valuable clinical decision support. In addition, organizations benefit from streamlined operations — enabling physicians to spend less time on charting and documentation, and more time engaging in face-to-face interactions with patients.

Despite these obvious advantages, however, many physicians are resistant to adopting EHR systems.

A number of factors account for this resistance. First and foremost, organizations are leery of the cost and disruption that can sometimes accompany the conversion from manual to automated processes. Second, a portion of older physicians — who often serve as the leaders in an organization — are typically less comfortable with new technologies than their younger counterparts. And finally, some physicians believe that taking the time to electronically document patient visits will negatively impact patient interaction because it means spending time in front of a computer screen rather than with the patient.

Kittitas Valley Community Health Information Network is an electronic information-sharing partnership linking 30 providers — about 90 percent of all primary care providers in the county — from seven locations. When we implemented our EHR system in 2007, we utilized several strategies that proved instrumental in overcoming anticipated obstacles and ensuring successful adoption:

1) Locate a physician champion. When identifying champions, we looked for those physicians who had a track record of adopting new technologies, were able to maintain positive attitudes despite occasional setbacks and, most importantly, were well-respected by their peers. These champions could clearly articulate the goals and enthusiastically promote the benefits of a fully functioning EHR system to other physicians — helping to encourage even initially skeptical providers to get onboard.

2) Set honest, realistic expectations for physicians and their staffs. The more complex and sophisticated an EHR system, the more challenges a practice might experience in the early stages of implementation. However, we found the potential productivity gains and cost savings ultimately outweighed any inconveniences. By ensuring that everyone understands that there will be a learning curve and that they will experience some growing pains on the front end, you can alleviate frustration and set a positive tone post-implementation.

3) Ask each location to designate a physician, nurse and administrative user to participate in several days of training with the EHR vendor. These “super users” were then available to help others navigate the EHR system, reducing the need for support while building staff camaraderie.

4) Prepare for the transition. In our case, each location went to an abbreviated schedule for two weeks — scaling back patient volume so that physicians and administrative staff would have adequate time to train on the new system. In hindsight, we would recommend that organizations allow a full month for staff to get comfortable and then gradually add back patient visits each week. For example, a practice might take four patient slots out of both the morning and afternoon schedules during the first week, three slots during the second week, two during the third week, and so on. Providing staff members with the opportunity to use the system while performing their daily routines enables them to learn at a comfortable pace.

5) Use a staged rollout. We did not do this during our initial implementation, but have used it several times with processes and changes adopted since. Within each location, two to three physicians, who were committed to the EHR system and willing to work through any stumbling blocks, were selected for initial implementation. Working with fewer physicians at the onset enabled the implementation staff to provide a strong support system, and helped ensure that any issues or concerns were resolved early in the deployment process. Once the first few physicians went live in each location, other providers were added two at a time. That way, each successive group of physicians could seek guidance from colleagues who were already using the system and could witness firsthand the successful utilization of an EHR system.

As an increasing number of health care organizations take advantage of the dollars offered by the American Recovery and Reinvestment Act to deploy EHR systems, it will become even more important to ensure timely and successful adoption of these systems. By setting realistic expectations among key stakeholders, identifying hurdles early and putting plans in place to proactively deal with any challenges that may occur, the likelihood of a smooth transition is significantly increased.

Above article published on

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=202207&CP=2

Diana Manos, Senior Editor

The Certification Commission for Health Information Technology is expected to release more details on its “modular” certification on Sept. 24, and it is also tentatively planning training sessions in Chicago on Sept. 29 and Oct. 1, to orient vendors and developers to new programs, including updated application processes, certification criteria and test scripts.

The modular approach to certification would tell providers that a healthcare IT product is capable of performing to provide meaningful use, a requirement under the federal stimulus law under which providers could receive bonus payments beginning in 2011.

The certification would be provided in advance of the definition of meaningful use, which is expected out by the end of the year.

Federal officials have said providers would have to make “a business decision” as to whether to go forward in faith with the modular certification ahead of the final rulemaking.

The Certification Commission for Health Information Technology held a “town call” Web conference Thursday to gather input from the vendor and developer communities on the commission’s planned new paths to certification for electronic health record technologies.

CCHIT Chairman Mark Leavitt, MD, said the goal is to achieve more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).

“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until spring 2010 - the expected date of (the Department of Health and Human Services’)’ final approval of requirements - to begin adopting this technology,” said Leavitt, “CCHIT has analyzed the recommendations of the federal HIT advisory committees and is preparing to offer new paths to certification beginning this October.”

Besides updating and enhancing its certification program for comprehensive EHRs in ambulatory, inpatient and emergency department settings, the commission plans to launch a more limited, modular inspection program for EHR technology, focusing solely on compliance with ARRA-required standards.

In an Aug. 14 meeting, the federal government’s Health IT Policy Committee adopted additional recommendations on meaningful use and proposed expansion of EHR certification to include 10 to 12 certification panels in addition to the existing Certification Commission for Health Information Technology. Physicians, activists, vendors and others warned the committee at a meeting that it was moving too fast.

Above article published on

http://www.healthcareitnews.com/news/cchit-maps-out-path-certification-meaningful-use-focus

By Joseph Conn

Only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system, according to HHS-funded researchers in a report released by the New England Journal of Medicine and mirroring preliminary survey results released by the same researchers this past November.

Lead author Ashish Jha, an associate professor at the Harvard School of Public Health and a staff physician at staff physician at Veterans Affairs and Brigham and Women’s hospitals in Boston, said in a news conference that just 7.6% of hospitals had a “basic” EHR that included the capability to record and store physician and nursing notes. The survey found that 10.9% of hospitals had a basic system without those clinical note-keeping functions.

“Very few hospitals in America have a comprehensive electronic health record,” Jha said. In addition, Jha said, “We didn’t get into effective use of these technologies. And we don’t have information right now with the notion of sharing data with other providers. Just because they have these systems doesn’t mean they are sharing that information with other doctors or hospitals down the street.”

That said, not all was gloom and doom. For one thing, if data from the VA hospitals, which were gathered but excluded from the final survey totals, were added back in, the comprehensive EHR adoption numbers would nearly double to 2.9% and the national numbers for the basic adoption rates would be driven up as well.

“All VA hospitals now have adoption of comprehensive medical records,” said Jha, who is serving as VA advisor. “There are as many VA hospitals with comprehensive medical records as there are non-VA hospitals (with those systems) if you look at it numerically.”

Also, he said, “There is no suggestion here that 90% of hospitals don’t have a computer in the hospital,” Jha said. In fact, some component parts of an EHR are in widespread use. For example, the survey found that 75% of hospitals surveyed reported having electronic lab and radiology systems.

What hospitals don’t have is “a constellation of functionalities” that help doctors and nurses provide the best care possible, Jha said, but the relatively high levels of adoption of some components “suggests we have a good place to start.”

Information about the study was under embargo until Wednesday, but its authors and other healthcare luminaries were available to reporters via a telephone conference Tuesday. One of those was David Blumenthal, the physician founder of the Institute for Health Policy, who spoke briefly about the research report and an article he had written for the New England Journal of Medicine on the federal role for health IT promotion.

Last week, Blumenthal was named as President Barack Obama’s choice to be the national coordinator for health information technology. Blumenthal said he will take over the post in mid-May.

Speaking of the impact the American Recovery and Reinvestment Act of 2009 would have on healthcare information technology, Blumenthal said that for physicians, “This whole project was conceived by the Congress as a building block as a pillar of healthcare reform.”

“One of the key elements is to support behavior change,” he said. “IT is one important and ultimately critical way to do that. I think it would be wrong to see it as a technology that can be adopted on its own, but as a technology to support that.”

The study and Blumenthal’s article are scheduled to appear Thursday in the journal’s online edition.

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090325/REG/303259966&AssignSessionID=373357728181706

e-Patient Dave (right) while on a panel at Health 2.0

As is well known by now, part of the federal stimulus package included $19 billion for electronic medical records (EMR) implementation — and part of those billions include incentives for physicians and hospital groups that implement EMRs by various deadlines. Of course, the implementation also has to meet a criteria referred to as “meaningful use,” however, the legislation purposefully left out just what “meaningful use” meant.

In the past few weeks, health IT thought leaders have sketched out their own takes on what meaningful use should mean, but only the most recent opinion piece includes an analysis that suggests connected devices and smartphones may have a place in that definition.

Dave deBronkart, also known as ePatientDave, has written an eloquent post on the ongoing debate as to what “meaningful use” should mean for EMR implementation. One of deBronkart’s central points is: “The systems we design today will be in use a long time from now, so I suggest we look at the world as it will be in 2020, and how we’ll be using these systems then.”

deBronkart goes on to emphasize that everything and everyone will be ten years older — you, your parents, your children — and even the Internet will have ten more years of innovation behind it. Our oldest doctors today will be retired or deceased by then, and doctors like Fast Company’s “Doctor of the Future” Jay Parkinson (of Hello Health) will be middle-aged, he writes.

“Handheld computers (smartphones) will be ten years more advanced,” deBronkart writes. “(More advanced? Heck, the iPhone was only introduced 28 months ago.) Connected e-health devices will be out of their infancy: WiFi blood pressure monitors, bathroom scales, glucose monitors, you name it. It’s fairly certain that by then we’ll be able to use cheap devices that send routine data to some central storage place, where smart software (your choice of smart software) can send out alarms or reminders, your care team can view it … and you should be able to view it, too. And make notes on it.”

Predicting the future is no easy task, and deBronkart does a nice job of only hinting at the vision of a more connected health environment in 2020, but decisions makers at ARRA need to decide now whether and (then how) technologies like connected devices should be included as part of the definition for meaningful use.

Above article published on

http://mobihealthnews.com/2164/should-meaningful-use-include-connected-devices/

You’re keen to buy an EMR. But how do you know which one is right for your practice?
By Shirley Grace

http://www.physicianspractice.com/index/fuseaction/articles.details&articleID=1335.htm

The federal government is establishing a new system for updating medical records of servicemen and women during and after their military careers, President Obama announced Thursday.

The joint virtual lifetime electronic record will, among other things, help ensure a streamlined transition of health care records between the Pentagon and the Veterans Administration.

It will provide “a framework to ensure that all health care providers have all the information they need to deliver high-quality health care while reducing medical errors,” the White House said in a background statement.

“When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a [Defense Department] duty station to a local VA health center. Their electronic records will transition along with them and remain with them forever,” Obama said in remarks delivered near the White House.

The system will “cut through red tape” and allow new veterans to start receiving their benefits more quickly, he promised.

During the announcement, Obama was joined by Defense Secretary Robert Gates and Veterans Affairs Secretary Eric Shinseki.

“We welcome this news. … This is a huge day for veterans and troops,” Paul Rieckhoff, head of Iraq and Afghanistan Veterans of America, told CNN.

“This is a good way for [Obama] to come back from Iraq and make a powerful statement.”

The White House recently proposed a significant budget increase for the Veterans Administration, including an 11 percent hike in fiscal year 2010.

In March, however, the administration abandoned a controversial plan to charge private insurers for treatment of veterans’ service-connected ailments.

Veterans’ representatives and members of Congress angrily opposed the proposal, which White House spokesman Robert Gibbs said was never finalized.

Above article published online on www.cnn.com

Even in advance of the stimulus package, adoption of electronic records is increasing.

By Pamela Lewis Dolan, AMNews staff. Posted March 16, 2009.

An analysis of hospital health IT systems found that not only are more hospitals implementing electronic medical record systems, compared with a year ago, but the systems are becoming more sophisticated.

HIMSS Analytics, which rates hospital EMR systems on an eight-stage scale, announced in February that 42 hospitals are in the top two tiers of implementation, with 15 hospitals reaching the highest stage for the first time since the group started conducting the quarterly surveys in 2005. Those hospitals will be announced at an April 6 awards ceremony by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

However, those hospitals represented fewer than 1% of the 5,166 hospitals that responded to the survey. More hospitals are somewhere in the middle to lower stages, with functions in place such as clinical documentation, error-detecting clinical decision support and photographic archiving systems outside of radiology.

Michael W. Davis, executive vice president of HIMSS Analytics said he was encouraged by the findings.

“As I look at where the market is moving I think the U.S. has done a pretty good job overall because, remember, all of the stuff they [hospitals] have been doing, they have been funding on their own. There has been no help from the government,” Davis said. “I’m just hoping that when we get the funding, we don’t mess that up.”

42 hospitals are in the top two tiers of EMR implementation.

The society in 2005 began rating hospitals quarterly with an eight-stage rating system called the EMR Adoption Model. Stage 0 represents no or very little installation, while Stage 7 represents hospitals that are fully electronic with medical records.

The data are self-reported by participating hospitals, with validation by HIMSS for Stage 6 or Stage 7.

Since the survey was published in February, Davis said, more hospitals have entered Stage 6, bringing that total number to 32, with 15 hospitals still in Stage 7.

Recent entries into Stage 6 range from the 4,049-bed UPMC system in Pittsburgh to the 55-bed Parkview Adventist Medical Center in Brunswick, Maine.

The stage that saw the largest increase (from 25.1% to 35.7%) since 2007 was Stage 3, which includes clinical documentation systems that mostly affect the nursing environment.

Hospitals with EMRs in the higher stages are the ones impacting physicians who would be expected to do clinical documentation, create continuity of care records within the EMR, and use clinical support tools for everything from error detection to clinical protocols.

Rod Piechowski, senior associate director of policy for the American Hospital Assn., said he found the survey’s findings encouraging, especially when coupled with the AHA’s finding that 68% of hospitals are on the road to full EMR adoption.

Don E. Detmer, MD, president and CEO of the American Medical Informatics Assn., said the findings were a “really clear indication of the work that lies ahead.” Dr. Detmer said he hoped that forthcoming stimulus package money dedicated to advancing health information technology will help further the efforts.

Davis and Piechowski both said they, too, were encouraged at the potential the stimulus money will bring in advancing EMR use. Davis said while government reporting guidelines, which would qualify hospitals for incentive money, would likely be met with a Stage 4 or 5 system, “those with Stage 6 and Stage 7 should be rewarded too. Just because they did this on their own doesn’t mean they shouldn’t be rewarded.”

Dr. Detmer said he hopes the stimulus money will help pay not only for the hardware and software, but also for the “clinical champions,” personnel with the expertise to implement the systems and help train people to use them.

Above article published online on www.ama-assn.org