To help transform health care, the state should invest more in electronic infrastructure that supports the automated exchange of electronic medical information, writes Russell Sarbora of Community Health Network of Washington. Increased efficiencies, lower costs and less waste of resources will help improve the health-care system.

By Russell Sarbora Special to The Times

IN Washington, state spending on health care ranks second only to education. The state has consistently asked how we can improve efficiency, reduce costs and focus scarce resources on insuring and caring for more Washingtonians.

The rapid exchange of accurate and timely information is going to transform the delivery of medical care. Infrastructure that supports the automated exchange of electronic medical information is and will continue to be a primary driver for efficient health-care delivery. We need to encourage and realize an efficient infrastructure for interoperability between electronic medical-record systems.

Washington state has at least two key assets already in place that have the potential to support creation of this infrastructure. These are the Washington State Health Care Authority-sponsored Health Information Infrastructure Advisory Board (HIIAB), and the Community Health Network of Washington (CHNW), the nation’s largest system of community health centers.

The 19 community health centers that make up the network are the primary health-care home for more than 600,000 low-income people in Washington state, including one-third of the state’s uninsured adults and one-half of the state’s uninsured children.

At CHNW we are working with HIIAB to achieve its objectives and have already implemented electronic medical-record systems that cover more than 70 percent of our member clinics and more than 85 percent of our patient population.

Business pressures will eventually produce efficient health-data-exchange services for patients served by commercial insurers and providers who rely primarily on commercially insured patients. But who will ensure that similar services are provided to vulnerable populations?

Through continued support for the HIIAB and by strengthening efforts to encourage the interoperability of electronic medical records, Washington state can improve patient health and safety while simultaneously controlling state-funded health-care costs.

Electronic medical records are used in the vast majority of acute-care facilities in Washington state; by all laboratory-service organizations operating in the state; by almost 25 percent of Washington’s primary-care physicians, and by more than 70 percent of CHNW’s member physicians. Yet, there is no statewide or national infrastructure today that supports sharing this information.

This infrastructure needs to be created, and the states that do so will lead the nation in delivery of efficient health care during the next decade. Washington state can and should be a leader in realizing this goal.

To achieve this leadership position, our state must adopt existing data-exchange policies and standards for health-information exchanges between organizations receiving state funding, provide incentives for technology investments required to support health-information exchanges, and financially support pilot programs that enable health-information exchanges.

CHNW is already working with HIIAB to create a Health Record Banking system that supports sharing of health information between patients and their health-care providers. We need to upgrade this existing business process to use current generation technology and thereby overcome existing shortcomings in reliability, efficiency and accuracy.

Interoperability between electronic medical-record systems is the key to achieving widespread sharing of clinical data. Today, these proprietary systems are incented to constrict access to the data they contain and there are numerous unresolved issues regarding access to the data and under what conditions data are shared.

Fortunately, the HIIAB is well-versed in these issues and well-positioned to support their resolution. The HIIAB is already proceeding with the creation of mechanisms to support patient access and control of their health data. However, the single greatest shortfall in the proposed Health Record Bank system is the absence of mechanisms to automatically include physician-created health data in these patient-controlled record systems. Lacking this critical body of data, the value of Health Record Banks will be substantially diminished.

We need to extend the HIIAB charter and role to encourage interoperability between electronic medical-record systems employed in Washington State and to achieve automated exchange of clinical data. The technology to do so already exists. Policy and will are the only hurdles to be overcome.

Russell Sarbora is the chief information officer for Community Health Network of Washington.

Copyright © 2009 The Seattle Times Company

Above article published on http://seattletimes.nwsource.com

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

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/

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor. (Credit: American Well)

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii’s largest insurer, HSMA (which operates the state’s Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday’s launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn’t a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

“That doesn’t necessarily need to be done on a face-to-face basis.” Shimizu said. At the same time, she doesn’t see traditional visits going away.

“I don’t think this situation can completely replace one-on-one doctor’s visits,” she said. “It’s an adjunct to that.”

She’s found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

“The $25 has been received tremendously,” said HMSA marketing Vice President Michael Stollar. “They think the fee is very fair,” he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians’ downtime fills a critical need. “There are not enough primary care physicians,” he said. “It really allows us to capture ‘care opportunities’ out of the same number of physicians that were out there.”

form CNET Health news.

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