Bernie Monegain, Editor

CHICAGO – The American Medical Association has adopted new guiding principles for physicians in the event a patient’s electronic medical record is breached. AMA members approved the guidelines at the group’s annual policy-making meeting earlier this week in Chicago.

“Protecting the privacy and safety of patient information, whether in a paper record or an electronic medical record, is a top priority for physicians,” said AMA board member William A. Dolan, MD. “Physicians need a standard protocol to follow to maintain patient security in the event of a breach of personal information.”

Medical information housed in an EMR travels from patient to healthcare provider to health insurance industry with limited regulation and oversight, Dolan noted. Security breaches can happen and physicians need guidance about their responsibilities if health information has been compromised.

The new AMA guidelines ask physicians to:

• Ensure patients are properly informed of the breach,
• Follow ethically appropriate procedures for disclosure,
• Support responses to security breaches that place the interests of patients above those of physician, medical practice or institution, and
• To the extent possible, provide information to patients to enable them to diminish potential adverse consequences of the breach of personal health information.

“EMRs are the wave of the future, so it is important for both patients and physicians to feel secure” Dolan said. “These new guidelines prepare physicians to help patients in the unfortunate situation of an information breach.”

Above article published on

http://www.healthcareitnews.com/news/ama-weighs-emr-security-breaches

Molly Merrill, Associate Editor

CHICAGO – The Healthcare Information and Management Systems Society has published two definitions of “meaningful use” as it applies to certified electronic health record technologies and hospital’s use.

HIMSS officials announced the definitions Tuesday as the National Committee on Vital and Health Statistics Executive Subcommittee began hearings to define “meaningful use.”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures - and other measures - as selected by the Secretary of Health and Human Services.

Officials say physicians must meet the definition within a specified time frame, which as described in the American Recovery and Reinvestment Act of 2009.

In order for hospitals to have a reasonable chance of achieving the definition, HIMSS officials say the requirements must be introduced in incremental stages. In order for hospitals to meet each stage, milestones must be achieved in phases of not less than two years each, commencing in FY11. In the final phase, which must commence in FY15, HIMSS officials believe the mature definition of “meaningful use of certified EHR technology” includes at least four attributes:

1. A functional EHR certified by the Certification Commission for Healthcare Information Technology (CCHIT);
2. Electronic exchange of standardized patient data with clinical and administrative stakeholders using the Healthcare Information Technology Standards Panel’s (HITSP) interoperability specifications and Integrating the Healthcare Enterprise’s (IHE) frameworks;
3. Clinical decision support providing clinicians with clinical knowledge and intelligently-filtered patient information to enhance patient care; and
4. Capabilities to support process and care measurement that drive improvements in patient safety, quality outcomes and cost reductions.

HIMSS officials have urged that CCHIT be named as the certifying body for EHR technology.

HIMSS developed its recommendation by drawing up an initial draft of meaningful users of certified EHR technologies in March. The draft was publicly posted with a discussion forum for a three-week period commencing April 1, 2009. The draft was then reviewed by the HIMSS membership community, which consists of more than 3,000 volunteers organized into nearly 80 groups

Above article published on http://www.healthcareitnews.com/news/himss-publishes-meaningful-use-definitions

President Obama is counting on electronic health records to help modernize the nation’s dysfunctional health care system, improve the quality of care and reduce its cost. His stimulus package will provide $19 billion over the next two years to promote the adoption and use of health information technology, and he has pledged to spend some $50 billion in all over five years.

There is a long way to go. A new study reveals that American hospitals have been appallingly slow to adopt electronic records, just as previous studies have shown that American physicians have been very slow to computerize their operations. By contrast, a vast majority of doctors in four other industrialized nations have adopted electronic records, although hospitals are thought to be lagging.

The study was published in The New England Journal of Medicine and led by Harvard researchers, including Dr. David Blumenthal, who has been chosen by Mr. Obama to be national coordinator of health information technology.

The researchers surveyed some 3,000 acute-care hospitals last year. Only 1.5 percent had a comprehensive electronic-records system in all major clinical units that performed all 24 functions deemed important by a panel of experts. Such systems incorporated physicians’ and nurses’ notes, the ability to order laboratory and radiological tests, clinical guidelines on how to treat various conditions and alerts to avoid dangerous drug interactions, among other capabilities. Only 11 percent of the hospitals had even a basic system in at least one major clinical unit that performed eight functions.

The main impediment is money. Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, a lack of staff with adequate technical expertise and resistance from doctors.

The president’s stimulus plan should help ease the financial obstacles. It will provide $17 billion in financial incentives (higher payments through Medicare or Medicaid) to get hospitals and doctors to adopt electronic health records and will impose financial penalties on those that do not. Another $2 billion will help hospitals and doctors keep their systems working and up-to-date.

The ultimate goal is an “interoperable” system that would allow easy exchange of clinical data between hospitals and doctors. The modernization effort will have limited value if a mélange of different computer systems can’t talk to one another.

Above article published on www.nytimes.com

For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease. In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study recently appeared online in the British Medical Journal. “Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper - this can work.” In January 2009, President Barack Obama unveiled plans to implement electronic medical records nationwide within five years, arguing that such a plan was crucial in the fight against rising health care costs. Of the nearly $900 billion in Obama’s planned stimulus package currently before the United States Senate, $20 billion is proposed for electronic health records. Tannen says he and his group recognized that the large EMR databases containing compiled medical information could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials. However, such databases contain observational information, which critics argue do not offer the same level of control as randomized trials. “Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage healthcare,” Tannen says. To address criticisms of observational studies, Tannen’s group had to first determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid. Beginning six years ago, Tannen’s team selected six previously performed randomized trials with 17 measured outcomes and compared them to study data from an electronic database — the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death. After using standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes. In the other eight outcomes, Tannen’s group used an additional new biostatistical approach they discovered that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new biostatistical method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the randomized clinical trials. Though Tannen warns the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, he says the results of his study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies. “An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen says. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose an opportunity, an enormous health opportunity.” Mark Wiener and Dawei Xie from Penn are co-authors on this study. This research was funded by a grant from the National Institutes of Health. Above article originally published on www.sciencedaily.com

So it looks as if the nation’s taxpayers are going to spend about $20 billion to accelerate the use of computerized medical records. In his press conference Monday night, President Obama went out of his way to explain why that money belonged in the economic stimulus package. It is, he said, a job-creating investment in both the present and the future that will improve the quality of care and save lives.
But in a letter delivered Tuesday to the White House and Congressional offices, 50 of the nation’s leading experts in electronic health records - most of them physicians themselves - warned that “an historic opportunity to achieve quality and efficiency gains through health information technology will be lost,” unless the government channels the spending carefully.
Just throwing money at doctors, they say, is not going to work. “The challenge is going to be all about implementation,” said Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a research arm of Partners Healthcare, a big nonprofit medical group in Boston that includes Massachusetts General Hospital. “Where is the money going to flow and what is the mechanism of implementation?”
Dr. Middleton and others who signed the document say the answer lies in replicating a few standout community projects that have had success in offering installation help, technical support, buying power and training to small physician practices. The small group practices will be where the Obama administration’s push succeeds or fails because 75 percent of the nation’s physicians work in offices of 10 doctors or fewer.
The health information technology provisions in the stimulus bill are a step toward the goal of nearly universal electronic health record adoption over the next 10 years (compared with 17 percent today). The central feature of the plan is incentive payments for using electronic records for improvements in health quality, efficiency, prevention and safety.
But the experts’ letter focuses on the importance of properly financing and assigning a significant role to the “Regional Health IT Extension Centers,” which are called for in the bill. The experts see these centers as a critical bridge to success for a nationwide rollout of electronic health records. In their document, they point to two examples of excellence, the Massachusetts eHealth Collaborative and New York City’s Primary Care Information Project.
The New York project began two years ago with $27 million in funding and a commitment to help small practices, especially in disadvantaged neighborhoods, adopt and use electronic health records. It has worked with software suppliers to tailor a health record suited for its purposes. The project’s leaders insisted that the patient information in the electronic records could be shared across a community health network, linking doctors offices, clinics and hospitals. The project provides centralized technical support, education and know-how for doctors and others. It began rolling out its records about a year ago, and they are now used in two hospital outpatient clinics, 10 community health centers, 150 small group physician practices and one women’s jail, serving a total of one million patients.
I asked Dr. Farzad Mostashari, the assistant commissioner in the New York City Department of Health in charge of the primary care information project, what he’s learned. “There is no way that small practices, especially in underserved areas, can effectively implement electronic health records on their own,” he said. “To get a public benefit, and widespread adoption, just giving cash to doctors is not going to work.”
Above Article originally published on http://bits.blogs.nytimes.com/2009/02/10/electronic-health-records-how-to-spend-the-money-wisely/

The medical information age.

With the recent explosion in information and technology over the past twenty years come vast changes throughout every industry worldwide. The medical industry itself has not been exempt from the transition from paper forms of data, to computerized electronic forms. The revolution of converting huge amounts of records, x-rays, names and prescriptions is very time consuming but nevertheless, it must be done. The same thing is taking place in the music business with cd’s being phased out of the market to give rise to mp3’s. Even though it hasn’t happened overnight, it is still a necessary step in the progression of human needs. The difference with the medical field is human lives are what’s at stake opposed to human desires.

Controversy.

Many patients are choosing to be implanted with radio frequency identification (RFID) transmitter inside of their body that stores their entire medical background. Some states have made it mandatory for aids and Alzheimer patients to get the implant for their own good. In the event of an emergency where a patient may be unable to respond to health care workers questions, the information regarding the patient may still be obtained. This controversial technique to store information has forced the entire medical structure to re-examine its own information storage and retrieval procedures. Are health care facilities equipped to handle the ever growing amount of patients in an accurate and timely manner? The answer is yes, however the medical field at large has been slow to adapt. The benefits far outweigh privacy issues that are often discussed surrounding electronic storage of medical records. All computer systems as well as communication methods may be vulnerable to attacks but it certainly doesn’t stop their increased use.

Electronic Medical Records (EMR)

It is no secret that clinical physician assistants prefer electronic medical records over out-dated paper documents. The biggest complaint amongst them is being forced to serve as not only an assistant but a secretary as well. There is just too much administrative work to take care of!

Practitioners who use electronic forms of record keeping are able to almost instantly engage their patients covering vast amounts of data from the computer. Digging in file cabinets, verifying past treatments etc. are rendered obsolete by simply using inexpensive powerful software designed for medical professionals. The rampant prescription drug abuses are being eliminated with multifunction safeguards that allow doctors to know conclusively who they are dealing with at any given moment. Forgeries and similar crimes are easily detected and the decrease in illegal activities lowers overall health care insurance cost.

Conclusion.

Regardless of how any of us may feel about the rise of medical technology and information, it is here to stay. The quicker we learn to utilize it for our advantage the better off we will be.

Above article published on http://www.articlesbase.com/computer-forensics-articles/using-emr-software-in-the-information-age-763158.html

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.