By Chip Means

Relaxing the meaningful use standards, as some physician organizations and members of Congress are urging HHS to do, would be a boon to the EMR industry, according to market research firm Kalorama Information, which completed its market research report “EMR 2010 (Market Analysis, ARRA Incentives, Key Players, and Important Trends)” earlier this year. The report predicts a $13.8 billion market that if properly driven by incentives and encouragement of health systems, could grow in double digits.

“Requiring physicians to undergo 25 mandates by next year may not be effective given the kind of real-world usage among physicians we see today,” said Bruce Carlson, publisher of Kalorama Information. “Getting physicians used to these systems is the challenge to a totally paperless healthcare system in the United States and we think gradual, achievable goals would be preferable.”

Kalorama notes that the objectives of the HSS meaningful use requirements, in order for physicians to receive incentives in 2011, include some that would be expected, such as a requirement that physicians must submit a percentage of claims electronically, use an established diagnostic list such as ICD-9, and have common medications entered for each patient. The firm notes that some sort of requirement for computerized physician order entry (CPOE) on a percentage of orders should also be expected to increase EMR use. But Kalorama believes that requiring 80% of orders via CPOE by 2011, or that half of patients get auto-reminders through an EMR system, is a possible limiter to sales of EMR systems.

Thirty-seven U.S. Senators, led by Senate Finance Committee Chairman Max Baucus, D-Montana, and Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, wrote a letter requesting improvements in a proposed rule for distributing stimulus funds for health IT that was published by the Centers for Medicare & Medicaid Services which would increase flexibility and encourage participation among providers. 235 members of the U.S. House of Representatives urged CMS to modify its proposed definition and requirements for hospitals to qualify for the meaningful use of health IT incentive payments.

Kalorama’s market research study was conducted before the release of ‘meaningful use’ standards by HHS, but it did note that the largest barrier to EMR use in the United States is physician compliance. Kalorama has also noted that for EMR to grow in the way the federal government envisions, healthcare systems will have to develop incentives of their own, something that might be in jeopardy if standards are not easier to follow.

“It’s not just about encouraging physicians directly, though that’s part of it,” notes Carlson. “It’s about encouraging healthcare systems to develop ‘matching’ programs to encourage EMR among their affiliated physicians. Unless there’s a clear road to incentive money they won’t do that.”

Above article publish on http://ehr.healthcareitnews.com/story/relaxing-meaningful-use-key-emr-industry-growth-kalorama-notes

By Shawn Riley

Electronic Medical Records (EMR) documents patient’s medical history such as test results, medication and general clinical data in an electronic format and allows easy and rapid access to such information to authorized personnel providing patient care. EMR has brought many benefits to physician’s practice that includes better administrative reforms, reduction in costs and better profits, better coding of procedures, more accurate, legible record processing, reduced medical errors and reduce documentation time. According to the center for disease control estimates, approximately 29.2 percent of physicians reported using full EMR systems in their office-based practices in 2006. With the Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many physicians are expected to adopt EMR. To realize the benefits of EMR, it is essential to pick the right EMR. Few key issues before picking a new EMR include license, technical support, and import of text, image format and printers and transferring of information.

License

Some companies grant “site license” under which the user pays for the use of the software at his site with no restriction on the number of users. However, most vendors grant license for their software per user. It is essential to understand the terms and conditions because it can be more complicated than it appears. Information regarding the number of license required and the amount of time it might take for a license to become available (in simple terms, how soon another user can log on after a user logs out or after the system crashes) should be collected from the vendor.

Technical support

All vendors offer technical support, understanding how these technical supports is defined and how much it costs is essential. A cost-benefit analysis will help in deciding the technical support to opt for.

Text import into the system

Before picking an EMR, know how text other than notes can be imported and whether additional hardware and software is required. Confirm the utility of EMR in terms of importing text such as X-ray reports, notes from consultants and operative reports into the EMR. For example, scanner and an optical character recognition program convert the text on X-ray reports to text in the EMRs that saves a lot of physical storage space, and allows for easy access to information. One should be aware and be comfortable in handling these processes.

Image formats and printers that support the system

Choosing a system that allows multiple image formats allows you to select the file type that best balances efficiency with visual quality for a given kind of image. Having a system that allows multiple file formats also gives you more choice about the sources from which you can accept images. Unfortunately, not every printer will work with every EMR system. Consider the issue of printing before picking a new EMR. Make sure your printers are compatible with the EMR system.

Transferring of data

Before you buy a system, be sure that you will be able to access your data if you decide to replace it with another. Ensure that the data can easily be transferred to another system.

Above article publish on http://www.healthtechnica.com/blogsphere/2010/04/09/5-easy-things-you-should-look-for-when-picking-an-emr/

A new study reveals an exciting potential benefit of the rapidly accumulating databases of health care information, the ability to make unprecedented links between genomic data and clinical medicine. The research, published by Cell Press in the April issue of the American Journal of Human Genetics, supports the idea that large scale DNA databanks linked to electronic medical record (EMR) systems provide a valuable platform for discovering, assessing and validating associations between genes and diseases.

“The deployment of EMRs offers the hope of improving routine care, not only by enhancing individual practitioner access to patient information but also by aggregating information for clinical research,” explains senior study author Dr. Dan M. Roden from Vanderbilt University School of Medicine in Nashville Tennessee. “EMRs contain large populations with diverse diseases and have the potential to act as platforms for rapid and inexpensive creation of large inclusive patient sets.”

Dr. Roden and colleagues in informatics and in genome science were interested in examining whether large biorepositories containing DNA samples linked to EMRs might be useful for discovering and incorporating new genotype-phenotype associations. “Implementing such a vision requires that major obstacles be overcome, including technological, computational, ethical, and financial issues and determining whether genomic information will meaningfully inform clinical decision making and health care outcomes,” says Dr. Roden.

The researchers used BioVU, the Vanderbilt DNA databank, to detect known common genetic variants associated with five diseases: atrial fibrillation, Crohn’s disease, multiple sclerosis, rheumatoid arthritis and type 2 diabetes. It took only four months to generate a set of nearly 10,000 records from which the cases and controls were identified. Although the process of accessing and defining the samples was technically complex, for each of the five phenotypes, at least one previously reported genetic association was replicated.

These results support the use DNA resources coupled to EMR systems as a valuable tool for clinical research. “Our data demonstrate that phenotypes representing clinical diagnoses can be extracted from EMR systems, and support the use of DNA resources coupled to EMR systems as tools for rapid generation of large datasets required for replication of associations found in research and for discovery in genome science,” concludes Dr. Roden.

Above article publish on http://emrdailynews.com/2010/04/01/electronic-medical-records-may-accelerate-genome-driven-diagnoses-and-treatments/

By Patrick Lukacs

With the advent of the American Recovery and Reinvestment Act (ARRA)/HITECH Act and the promise of stimulus funds, physicians are mulling ways to add electronic medical records (EMRs) to their practices.

Even providers skeptical of the reimbursement process can’t afford not to consider, starting in 2011, an attempt to secure up to $44,000 per physician over five years. Some physicians even propose that those who don’t implement an EMR are diminishing the profession and may be breaking the Hippocratic Oath by not using technology to improve the care of patients, particularly those with chronic conditions.

Group practices pondering stepping up to the EMR plate know they have several routes to implementation, including working directly with EMR vendors and their resellers or leveraging hospital-owned systems. For many reasons, savvy physicians and administrators are starting to rely on third-party billing companies to provide the quickest route to success in adding and supporting an EMR.

Many physician practices and billing companies have invested time and energy in a long-term working relationship, with physicians and administrators coming to depend on the biller’s business acumen and broad technical expertise in helping run the practice. Years of working hand-in-hand with medical office staff give billing personnel a solid grasp of how the particular practice functions and how best practices can help improve effectiveness. Billing staff is attuned to how work flows most efficiently in the practice, the peculiarities of its data and patient population and the peccadilloes of particular providers.

Furthermore, billing companies understand the legislative landscape and ways to clear technical hurdles and pave the way to stimulus funds. Comprised of more than 600-member organizations, the Healthcare Billing & Management Association (HBMA) is helping physicians access necessary information from EMRs to facilitate reimbursement and meet medical and business needs. The California-based organization is dedicated to helping members monitor relevant trends and learn how best to implement EMRs into group practices through a task force, white papers, annual conferences and a series of educational summits.

In-depth knowledge of the EMR space helps third-party billing companies downsize the daunting plethora of EMR vendors in the marketplace to a short list of only those systems which best suite a practice’s financial, functional and specialty needs. Billing companies are counseling clients on whether it is best to consider an EMR with broad capabilities that can be tailored to and grow with the practice’s needs or an EMR that is designed particularly for a specialty.

The staffs at third-party billing companies are well versed in coding and compliance, including those of clinical backgrounds to ensure the best marriage of administrative and clinical functions.

Billing companies offer fast, but carefully phased-in implementations. While EMR vendors start implementation at the absolute beginning, billing services can add an EMR to a practice in weeks rather than months because there is already a data center supporting the IT infrastructure, software configurations and policies and procedures developed to support recommended business processes, modified to client requirements.

Last, but not least, because billing companies have an ongoing relationship with medical offices, their staff can be available long after go-live to troubleshoot problems, resolve them quickly and help physicians and their staff gain confidence and wring the most out of their EMR.

Above article publish on http://www.healthcareitnews.com/blog/billing-companies-are-key-adopting-emrs

Fifty-eight percent of U.S. physicians who don’t use electronic medical records (EMRs) intend to purchase an EMR system within the next two years, according to a new report from Accenture (NYSE: ACN).

“If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

Today, just six percent of U.S. office-based physicians use a fully functioning system.

Accenture’s Innovation Center for Health and Institute for Health & Public Service Value worked with Harris Interactive to survey 1,000 U.S. physicians from practices of fewer than 10 practitioners to measure their views of EMRs. Approximately 15 percent of respondents were users of EMRS and 85 percent were non-users.

The survey’s primary objective was to determine concerns and perceptions of EMRs and gauge motivating factors at a time when U.S. federal legislation includes incentives for physicians who implement and use EMRs and penalties for those who do not adopt EMRs by 2015. The New York Academy of Medicine assisted with the qualitative survey and analysis.

Among the key findings:

• 58 percent of non-users intend to purchase an EMR system within the next two years;
• About 80 percent of physicians under the age of 55 plan to implement an EMR system within the next two years;
• Three-quarters of non-users are intrigued by the idea of purchasing an EMR system from a local hospital - if the purchase is at least partially subsidized by the hospital;
• On average, non-users would expect a hospital/health network to subsidize about half the cost of an EMR system;
• The key driver of EMR adoption is federal legislation - 61 percent cited federal penalties for non-adoption and 51 percent cited federal incentives;
• Non-users underestimate the cost and time requirements to implement an EMR system, but also have an exaggerated perception of difficulties in using EMR systems, compared to the actual experiences of EMR users; and
• The vast majority of current EMR users – 90 percent – believe that their EMR system has brought value to their practice, in particular “changing the way their practice works for the better.”

The 90 percent of users who feel their EMR system has been beneficial to their practice cited the following reasons:

• Their EMR system provides an effective overview of patients’ relevant history, records and information; and,
• Their EMR system allows quick and accurate data entry.

“Our research indicates that, as intended, federal legislation is an important driver of EMR adoption among U.S. physicians,” said Dr. Kip Webb, who leads Accenture’s clinical transformation practice. “If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

Above article publish on http://asociagroup.com/blog/?p=1288

By, Rich Silverman

The two most important aspects of any electronic medical records system have been meaningful use and certification. Meaningful use, as we discussed in an earlier post, has finally been defined. Now the certification process is being clarified.

The Office of the National Coordinator (ONC) has announced the release of the National Proposed Rulemaking (NPRM) related to how certification will work. The NPRM, published in the Federal Register on March 9th, came through at a mind-boggling 186 pages.

When you read between the lines, what seems to be happening is this: The Office of the National Coordinator is setting up a temporary certification process. This will enable providers to finally be sure they are getting certified systems, and begin establishing meaningful use so they can qualify for the incentive payments. The ONC is also asking for organizations that want to be approved to perform the certifying and testing of EMR products to send in applications.

Once the temporary system is up and running, ONC will work to create a second, separate and permanent certification system for use moving forward. While the processes of certification and testing will require separate approvals from ONC, it looks as though an organization can be authorized by ONC to do both.

The rulemaking sets forth 30- and 60-day periods for public comment, after which ONC will make decisions as to the final form the testing and certifying bodies will ultimately take. The Certification Commission for Health Information Technology (CCHIT), which has been certifying EHRs since 2004, has already announced that it is ready to apply.

Above article publish on http://blog.pchealthstop.com/?p=820#more-820

Emergency Physician’s have relied on electronic medical records, in some form, for decades now. From stat laboratory data and patient locator software to integrated Zoll monitors that streamline the recording of codes, the accuracy and reliability of these data systems are paramount for delivering high quality emergency care. The sophisticated technology is undermined, however, when power failures hit and communication channels are compromised. Fortunately, contingency programs can be integrated into Electronic Medical Records Systems (EMRs).

EMERGENCY MEDICINE-SPECIFIC EMRS

The EMR System you choose needs to interface with the various systems in place throughout the hospital. From the time a patient sees the Triage Nurse and is put into a room, an ideal system would have a single interface that integrates these data with the patient’s medical history, imaging, and patient records from regional hospitals. The dozens of small steps in the process of patient care in your unique Emergency Department should be able to seamlessly integrate into a user-friendly experience. For example, if you do physical exams, x-rays and ultrasounds all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many trauma transfers and referral patients bring CD-ROM’s and documentation from hospitals and physicians that use different machines and software than your hospital. Choosing an EMR based on the myriad of consultant’s and referral hospitals’ equipment is difficult at best. For example, if you use the Siemens AR Star CT Scanner, but an outside hospital transfers a trauma patient with CT images on a CD-ROM from a Toshiba Asteion ER004, you need to make sure that your department’s software will be able to read the disk. The days of needing a double-dose of IV contrast to repeat a CT scan because of incompatibility are nearing an end.

BUILDING TRUST IN YOUR EMR SYSTEM

In addition to software and equipment compatibility, the right EMR for your Emergency Department should make your workflow easier, not harder. Your daily operations and patient flow through the department should not have to adapt to accommodate an antiquated EMR. It should be the other way around.

In the event of a disaster, make sure you have contingency plans for power and communications failures. Investigate the EMR you’re considering thoroughly to determine if it has the ability perform data recovery and system backup. Be sure you have a system in place that you can trust to alert you to critical developments.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

Verify that your EMR will seamlessly integrate triage notes, ER visit history, previous elopements, as well as all past medical history. Automatic visual and/or auditory notification of critical laboratory tests and contraindications for medication administration will improve outcomes. From documenting triage decisions and patient contact times, to tracking which personnel log into the EMR, many repetitive tasks can be integrated into an EMR system that curbs human error and improves department efficiency.

DICOM COMPATIBILITY

Digital Imaging and Communications in Medicine (DICOM) is a standard construct used increasingly by Health Information Systems, but it is not universal. Specifically, DICOM covers handling, storing, printing, and transmitting information in medical imaging.

Typically, different imaging systems and software are used to render different modalities, such as ultrasound, CT, and MRI. The danger of putting all imaging modalities in one viewing system is that it could fail. Therefore, redundancy and parallel backup systems are needed. Because you will view color video of Doppler ultrasounds along side plain x-rays and graphical data, the EMR System you choose will likely need to meet the DICOM standard with PACS compatibility.

Above article publish on http://www.emrconsultant.com/education/emergency-physicians-guide

By Eric Fishman, MD

It is unlikely that you will find the process of implementing an Electronic Medical Record in your office to be an easy one. However, there are a variety of activities that you can do to simplify and streamline the process, and increase the probability of success.

First, please understand that not only do you need to learn a new complicated and sophisticated software program, but you also need to undertake a significant modification of your current workflow.

We believe that we have realized a mechanism to split these two processes, thereby significantly increasing the probability of a successful implementation.

Assuming that you have made a decision that you will be implementing an EMR in the ‘not too distant future’, but are not ready to purchase one immediately, we have found that modifying your workflow to one which will more closely model the workflow that will be imposed upon you by the EMR can be very helpful during the extended implementation process.

Our current recommendations are that, again assuming you have not yet chosen which EMR you will be utilizing, are that you start to modify your workflow by utilizing a Tablet PC, and voice recognition software, so that you can get used to the process of keeping a portable computer by your side, and completing as much of the patient documentation as possible during the actual encounter.

Our current specific recommendations in this regard are that you utilize a Motion Computing LE1600 Tablet PC, with 1 GB of RAM. If you know that you will be utilizing an ASP model EMR eventually, you can save a few dollars by purchasing one with a 30 GB hard drive. If you are unsure, or if you know that you’ll be utilizing a client server model, we would then recommend that you purchase the tablet with a 60 GB hard drive.

It is our opinion that this hardware / software combination will be compatible with the overwhelming majority of EMR software packages that you are likely considering as your final choice.

There are a number of advantages to utilizing this model during the extended implementation procedure. You will have spread out the costs associated with implementing an EMR by months. The above configuration is likely to cost less than $6000.00, and you will start saving money from the onset, as your transcription costs will either be significantly diminished or altogether eliminated, thereby allowing you to save toward what will be the larger expense of the software licenses and implementation fees.

Above article publish on http://www.emrconsultant.com/education/emr-implementation

The medical community has had quite a challenge to convert to entirely medical records and, in many ways, is still in transition. Dermatologists frequently enjoy straightforward practice settings that integrate patient data on surgical procedures, patients’ historical data, and newer technologies that continue to emerge. Any more, the accuracy and reliability of these data systems are improving and high quality dermatology care is being increasingly streamlined. The sophisticated technology is undermined, however, if each piece of the dermatologist’s arsenal isn’t integrated into a comprehensive Electronic Medical Records (EMR) system.

DERMATOLOGY-SPECIFIC WORKFLOW

The term “workflow” refers here to an EMR that adapts to the way you conduct your office activities. Instead of being a cumbersome addition to your workload, the right EMR System for you can and should easily integrate into your unique office setting. For example, if you do physical exams, laser treatments and phlebotomy all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer throughout your office. The days of manually scanning, uploading, and transferring patient data are over. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records. This includes drawings you use to identify the locations of lesions with respect to anatomy. As you will read in a moment, all of this information can be housed within one EMR System.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many dermatologists acquire new patients from a host of community referral locations, with physicians that use different machines and software than they own in their office. You need to be able to verify their previous imaging for the best possible patient care and to avoid repeating any tests, particularly for staging various cancers. The problem is that trying to choose an EMR based on the myriad of consultant’s equipment is difficult at best. For example, if you use the DicomWorks viewer for viewing radiographic images, but a patient brings you a CD-ROM from a consultant that used CT Scanner from Toshiba, the Aquilion 16-Slice, you need to make sure that the EMR you choose to grow your practice will be compatible.

If you consult on patients in the hospital or another setting separate from your primary office, the right EMR can really help increase your efficiency. First, being able to view the patient’s record remotely while your taking the consulting physician’s phone call can be extremely helpful. Second, you can synchronize the data on your laptop or handheld device directly into your EMR. Taking your laptop of portable digital assistant with you on your visit to the away patient can save you time by not having to type notes a second time after the consult is finished.

DRAWING DERMATOLOGIC IMAGES IN YOUR EMR

A growing trend is for physicians to use tablet PC’s at bedside. This lends itself very easily to using EMR’s that allow you to draw on anatomical diagrams directly in the patient’s record. Traditional desktop computers also allow this feature. For example, you can outline a nevus and the EMR software will convert that to an image file that is saved with the patient record. This can be particularly useful when tracking growth. You will need to put specific notes in the text areas of the EMR for it to be searchable later.

BUILDING TRUST IN YOUR EMR SYSTEM

Dermatologists are known to conduct rather extensive excisions of carcinomas in the clinic setting. Your EMR should record vital signs in real time and trigger audible and visual notifications in the event of abnormal readings. You shouldn’t have to watch the monitor continually; rather you can control all the parameters and alarms exactly how you want them to behave.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

Appointment reminders and recurring laboratory studies frequently require valuable time from your staff. An EMR System that could integrate automatic emails or phone calls one week prior to an appointment would improve efficiency.

In addition, your EMR should timestamp and track every authorized user’s activities. From ordering special materials prior to nuclear studies, to tracking who logs into the EMR, a lot of repetitive tasks can be integrated into an office system that curbs human error and improves your practice’s measurable outcomes.

Above article publish on http://www.emrconsultant.com/education/dermatologists-guide

In the beginning there was memory. The physician’s memory was the original repository of the patient medical record. Memory was supplemented by handwritten notes on papyri in ancient Egypt and Babylon and on paper from medieval times to the 20th century. With the advent of recording devices in the 20th century, handwritten notes gave way to the infinitely more time effective practice of dictating patient notes into a recorder which were then transcribed into a typewritten or word processed document. Of course, that practice introduced an extraneous third party into the medical record keeping process: the transcriptionist with the attendant additional expense to the physician and loss of privacy for the patient.

At the current time, 21st Century technology offers physicians and health care providers a medical record paradigm that will not only vastly upgrade the process of producing, maintaining and safeguarding medical records but will, in a direct and fundamental way, actually improve the quality of medical care. The technology is Electronic Medical Records (EMRs). EMRs produce the most accurate and complete patient health record possible to date and help physicians practice better medicine as well. EMR technology is available in a plethora of shapes and sizes with a great variety of possible features. The technology can change the way you interact with your patients, from before they make their first appointment to after they’ve left your office, and have questions about their visit in your office.

As a practicing physician you are aware of the repetitive nature of some aspects of your practice, specifically with regard to patient diagnosis. It is very likely that you and/or your staff have asked the same or at least very similar questions to each of the thousands of patients you have treated. Unless you are practicing in a tertiary referral center, and never see the same condition twice, the patient answers likewise tend to be repetitive. Similarly, physical examination findings fit into certain categories that are seen over and over again. For this reason, most of the current high-end Electronic Medical Record products very capably utilize ‘pick lists’ or ‘click and point’ methodology to complete large portions of the patient medical record.

These point and click systems are particularly adept at documenting, for instance, allergies to medications, medications that are currently being taken, past medical history, family history, social history, and major portions of the physical exam. This is the case because of the narrow range of options which are available as patient responses. For instance, your patient either smokes or doesn’t smoke. And if he/she smokes, it is probably 1 ppd, or 2 ppd, or some other value that can reasonably easily be foreseen by the experts who have designed the point and click system for your office.

However, the historical portion of the patient medical record typically has a great deal of information that cannot be easily foreseen by the developers of the point and click templates. For instance, as an Orthopedic Surgeon, my patients frequently find themselves in automobile accidents. It is not likely that the author of whichever EMR may find its way into my office has contemplated the various street names and intersections in my community. Therefore, in a typical point and click system, there will be a scarcity of relevant information concerning the specifics of the accident. And I find that these specifics are important for a wide variety of reasons, not least of which is that they remind me of the particulars regarding this patient when they return to the office. Utilizing templates for the historical portion of the report, while feasible, tends to produce extraordinarily repetitive reports, each of which sounds not only vaguely similar to the previous patients, but in many cases essentially identical to other patients. This certainly makes it difficult to recall the characteristics of this particular patient.

One of the advantages of an EMR is that it allows physicians, hospitals, insurance companies, pharmaceutical companies, medical societies, and other parties entitled to view the patient data for legitimate, permissible purposes, to do so. Legitimate, permissible purposes include coordinating patient treatment, accessing diagnostic procedures and results, preventing adverse drug reactions, and ensuring medical practice within clinical practice guidelines. One particularly high priority purpose from the physician’s standpoint is that the data be accessed by third party payors to streamline reimbursement for services.

Above article publish on http://www.emrconsultant.com/education/voicerecog