By Dr. Raj Bhandari and Terry L. Austen

Special to the Mercury News

Patients in the Kaiser Permanente San Jose Hospital are seeing something new when a physician or nurse visits their rooms. The doctors and nurses themselves aren’t different; they continue to provide their patients with superior care and service.

But a piece of equipment they bring with them — a wheeled cart with a computer screen on top — is a significant difference, and it’s an example of what will help dramatically improve health care in America.

The cart-borne computer is wirelessly connected to a huge database containing the medical history of our members, as well as the latest recommended treatments for a wide range of medical conditions. The database contains all outpatient and inpatient visit information, diagnostic images such as X-rays and mammograms, allergies, specialists’ notes, lab tests and prescriptions. And it is all part of KP HealthConnect, the largest nongovernmental electronic medical record (EMR) system in the United States.

Electronic medical records are a cornerstone of President Barack Obama’s health reform effort, and as part of his effort to stimulate the economy, he has dedicated some $19 billion to make EMRs a national reality.

Why? Electronic medical records improve the quality of care. A fully functional EMR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether it’s in the doctor’s office, the emergency room or in a skilled nursing facility. It is also remotely accessible for specialists and others who are on call, allowing them to make informed decisions that expedite patient care.

EMRs have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety, and they do this by harnessing the incredible power of computers — their ability to calculate, to network, to automatically check facts and to provide targeted research results — and applying that power to medical care.

In health care systems with fully implemented electronic medical records, physicians and nurses no longer need to spend valuable time looking through several files for paper records that are often incomplete.

Now, for example, emergency department physicians with a fully functional EMR system can see a patient’s previous hospitalizations, medications and diagnoses when that patient shows up complaining of chest pains. That means treatment can begin more quickly and success is more likely.

Medication is safer, too: Prescriptions written by physicians using the EMR system are spell-checked and legible, and the computer automatically combs the patient’s history for potentially dangerous drug interactions and alerts the doctor.

In the hospital, medications are bar-coded and scanned at bedside to help ensure the right patient is getting the right drug in the right dose at the right time.

Of course, EMRs should not be a one-way street. In integrated health care systems, patients can use their home computers to increase convenience by making appointments online, ordering prescription refills that are delivered to their home, viewing their lab results through secure Web pages, and e-mailing their physicians — all at no additional cost.

Last year, thanks to these online tools tied to EMRs, Kaiser Permanente members had 6 million e-visits without using a gallon of gas.

Notes jotted on paper and placed in multiple files where doctors rarely see them are a remnant of a fragmented, inefficient model of medical care. In the 21st century, Americans expect — and deserve — more.

Dr. Raj Bhandari is physician-in-chief and Terry L. Austen is senior vice president and area manager for Kaiser Permanente San Jose Medical Center. They wrote this article for the Mercury News

Above article published on http://www.mercurynews.com/opinion/ci_13534802

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

By Ken Congdon, Healthcare Technology Online

In my coverage of the healthcare technology industry, I’ve noticed that many software and hardware vendors, clinicians, and even some analysts tend to use the terms EMR (electronic medical record) and EHR (electronic health record) interchangeably. However, according to the National Alliance for Health Information Technology (NAHIT), there is a distinct difference between the two.

The NAHIT defines EMR and EHR as follows:

EMR — The electronic record of health-related information of an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR — The aggregate electronic record of health-related information of an individual that is created and gathered cumulatively across more than one healthcare organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

In other words, an EMR is a somewhat siloed record of a single diagnosis or treatment, most likely used by a single practice or specialist. Meanwhile, an EHR is a more comprehensive record that is interoperable with and compiles information from multiple medical providers’ systems.

Don’t Judge A Software Package Based On Name Alone

Despite the NAHIT definitions, it’s obvious that the industry is still unclear on how to delineate EMRs from EHRs. For example, some software vendors brand their technologies as EHR platforms when, in reality, they don’t provide interoperability capabilities and would therefore be more accurately marketed as EMRs. At the same time, other vendors brand their products as EMR packages when they actually provide more comprehensive EHR frameworks. In fact, analysis of software packages currently on the market indicates that the latter is more likely to be the case, as most clinical records software vendors tend to brand their products as EMRs as opposed to EHRs. However, the term EHR does seem to be gaining popularity as it is the phrase used by President Obama in his healthcare stimulus talks and is the prominent terminology used in the American Recovery and Reinvestment Act of 2009 (ARRA).

Knowing that the terms used to brand clinical records software aren’t always accurate, you must dig deeper to ensure a software platform you’re assessing is equipped to meet the needs of your facility and your patients. Criteria to consider when evaluating EMR/EHR software include:

• Interoperability with current certification standards (CCHIT [Certification Commission for Health Information Technology], HL7 [Health Level 7])
• An ACID (Atomicity, Consistency, Isolation, Durability)-compliant relational database for data protection and the ability to recover fully from failure (not just restore from backup)
• Both thin and fat client support (i.e. remote control and direct control) to accommodate for the lower bandwidth of satellite offices
• Ease-of-use at the point of care
• A workflow that matches your practice and specialty

If you purchase a system that matches your requirements, it should provide a speedy ROI regardless of whether or not it is “technically” branded correctly.

Above article published on

http://www.ecmconnection.com/article.mvc/EMR-Or-EHR-Whats-In-A-Name-0001

The plan will rely on federal grants and build on previous state efforts to expand health IT adoption in underserved rural areas.

By Pamela Lewis Dolan, AMNews staff.

Louisiana Gov. Bobby Jindal signed into law a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system.

The Electronic Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of Health and Hospitals the authority to apply for $25 million in federal stimulus funds in order to administer loans for EHR purchases. The measure also included $5 million in matching funds from the state, a requirement under the American Recovery and Reinvestment Act. The state will learn later this year if it will get the federal grant.

“This is another step in updating and improving Louisiana’s health delivery system for all Louisianians,” Jindal said in a prepared statement.

The measure builds on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health Information Exchange. In 2008, additional funding allowed another seven rural hospitals to become connected.

To qualify for the loans, the purchased EHR system must be certified by the body eventually chosen by the U.S. Dept. of Health and Human Services for such approval. Loans could also apply to fully integrated telemedicine systems.

Acknowledging upfront costs are a barrier that the incentives wouldn’t help alleviate, many EHR vendors also launched financing options for physician practices as a result of the stimulus. General Electric Co., for example, is giving practices the options of deferring payments until incentives start being paid in 2011.

Jenny Smith, health information technology project manager for the Louisiana Health Care Quality Forum, which is the state-designated entity for distributing all grants coming out under the federal stimulus package, said details are still being worked out in terms of the loan agreements. Work groups consisting of several stakeholders in the state are currently working on structuring the loan program, she said.

“The goal is to maximize the amount of support we can give to providers in Louisiana who couldn’t otherwise purchase an electronic health record or upgrade their electronic health record to meet the meaningful-use criteria for the incentives,” Smith said.

Once the state has reached 100% compliance, Smith said, the fund would likely be used for support such as upgrading systems or training.

Above article published on

http://www.ama-assn.org/amednews/2009/08/03/bise0806.htm

In a recent interview with American Medical News, National Coordinator for Health IT David Blumenthal discussed timetables for electronic health record adoption and the generation gap between older and younger users of the technology.

EHR Timetables

Blumenthal said federal officials are promoting EHR adoption in an effort to meet President Obama’s goal of providing all U.S. residents with an EHR by 2014.

He added that the Office of the National Coordinator for Health IT also is working under the time frame of the federal economic stimulus law, which imposes penalties on health care providers who do not adopt health IT tools by 2015.

Blumenthal acknowledged that many physicians have concerns about the pace of the EHR adoption timelines. He said ONC is “very aware that we need to find a balance between our long-term goals of using electronic health records to improve practice and the practical realities of everyday medicine.”

Blumenthal said his office will continue to solicit and consider stakeholder feedback on EHR timetables and other issues.

Health IT Generation Gap

In addition, Blumenthal spoke about generational differences in technology use among health care providers. He said many younger physicians are comfortable with EHRs and expect to use IT systems that connect them with colleagues and comprehensive medical data. However, he said older physicians might have less experience with the technology”

Above article published on

http://www.ihealthbeat.org/Articles/2009/8/4/Blumenthal-Discusses-
Efforts-To-Promote-EHR-Adoption-Nationwide.aspx

By Joseph Conn

There may soon be one more incentive for hospitals and physician offices to buy and install electronic health-record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at today’s meeting of the Health Information Technology Policy Committee.

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year.

Above article published on

http://www.modernhealthcare.com/article/20090616/REG/306169965/-1

Bernie Monegain, Editor

The Healthcare Information Technology Standards Panel has approved new interoperability specifications for electronic health records, data exchange and architecture that align with the federal government’s stimulus package for healthcare IT.

“HITSP has transformed its existing work to be completely aligned with the American Recovery and Reinvestment Act of 2009 (ARRA),” said John Halamka, MD, chairman of the panel. “These approved specifications represent the culmination of some 90 days and 13,000 hours of volunteer effort to meet the requirements of this landmark piece of legislation.”

Approved by the panel at its July 8 meeting are:

• HITSP/IS107 – Electronic Health Record (EHR)-centric Interoperability Specification
• HITSP/TN904 – Exchange Architecture and Harmonization Framework Technical Note
• HITSP/TN903 – Data Architecture Technical Note
• HITSP/SC108-SC116 – Service Collaborations

On April 7, HITSP began to leverage its 13 Interoperability Specifications (IS) and 60 related constructs to consolidate all information exchanges that involve an electronic health record system. The work was organized around ARRA requirements, specifically for the HITECH section.

HITSP formed temporary “tiger” teams to map EHR-related information exchanges to ARRA requirements. These teams identified “capabilities” – specific, implementable business services that use existing HITSP constructs to define and specify interoperable information exchanges. For example, the Communicate Hospital Prescriptions Capability addresses the interoperability requirements needed to support electronic prescribing for inpatient prescription orders.

Twenty-six capabilities have been defined that support the workflow, information content, infrastructure and security and privacy requirements laid out in the ARRA legislation.

HITSP capabilities also address the “meaningful use” of health information technologies. Last week, the Office of the National Coordinator for Health Information Technology (ONC)’s Health IT Policy Committee recommended a definition of meaningful use that names seven electronic exchanges to be required by 2011: e-prescribing, lab results, clinical data summaries (problems, medications, allergies, laboratory reports) from provider to provider, biosurveillance, immunization registries, public health and quality measurement.

“HITSP capabilities provide specific transactions supporting all seven of these required exchanges and others that will be needed in 2011, 2013 and beyond,” said Halamka. “Going forward, the panel will continue to work closely with ONC to respond to ARRA and meaningful use requirements that can be addressed by EHR systems.”

Above article published on

http://www.healthcareitnews.com/news/standards-panel-aligns-interoperability-specs-arra

FISMA is becoming a roadblock for electronic health record implementation, Government Health IT magazine reported this week.

The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification.

A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations.

The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security.

For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities.

In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high.

In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations.

Confusing? You bet. This is government language after, all. Much like statistics, just mold it to your current need.

There is still debate over whether, for example, health information exchanges (HIEs) that “exchange” information but do not “access” federal information systems need to be FISMA compliant. In any event, there is a strong and important need to address information security in the field of healthcare. Will FISMA be the best vehicle for achieving information security with respect to patient information? That remains unresolved, but hopefully, the work to find a middle ground, coaxing the private sector into requiring more robust security standards, will be the outcome.

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/06/30/fisma-a-roadblock-for-ehrs.aspx

SHELBYVILLE, Ind. – Few would question that dramatic change in the U.S. health care arena is well on the way. With billions of dollars on the table to fund systemic change in critical records management and other aspects of service delivery, what will American health care services look like a few years from now?

Health care reform champions have long complained that secure IT systems exist where consumers can pull out cash from an ATM anywhere in the world. That said, patients today often can’t so much as transfer from one clinical floor to the other without filling out multiple duplicate forms about their medical histories. In the past, some medical records have been lost, misplaced or misfiled too often sometimes with devastating results.

Health care reform is expected to speedily address this unfortunate information transfer gap. With large and small hospitals alike embracing high-speed fiber-based broadband, the capacity increasingly exists for instantaneous access to digital X-ray and MRI images, patient histories and even direct physician-to-patient consults.

Such is the basis for emerging telehealth applications where physicians, specialists and other medical professionals can leverage high-speed and secure data platforms to deliver health care services in a more efficient and cost-effective manner. Unfortunately, even in a lightning-fast Internet-fueled world, much of the present state of medical record keeping still represents an anachronistic throwback to a pre-digital age.

While the technology has existed for health care institutions to develop full-spectrum electronic medical records (EMR) and electronic health record (EHR) systems for more than three decades, as of 2006 less than 10 percent of American hospitals had a fully integrated system. This statistic makes many medical experts cry foul as integrated EHR systems can improve patient safety, reduce errors and promote efficient standards of care.

If that’s not enough, a 2005 RAND Corporation study estimated that efficient exchange of medical records among doctors and hospitals in the U.S. (also known as a health information exchange or HIE) would save $81 billion annually. Other estimates have put that figure as high as $450 billion per year. Throw in better outcomes and a potential higher quality of life and one can only wonder why this hasn’t happened earlier.

Here enters the Obama administration’s American Recovery & Reinvestment Act (ARRA), which includes unprecedented billions of dollars for EHR conversion and development. This access to massive funding has resulted in many hospitals scrambling to update their systems. The ARRA includes both funds for planning and execution as well as cash for physicians to convert their outmoded legacy systems into a 21st century model.

With so few hospitals presently deploying fully integrated systems, where could American hospitals and health care organizations find proven models for EHR and EMR implementation? How about Indiana?

Led by the Indiana Health Information Exchange (IHIE), the Hoosier state is home to not one but four operating health information exchange organizations. This represents a remarkable development as many states in the U.S. today don’t even have a single health information exchange that’s nearing implementation much less operational.

How does it work in the Hoosier state? Created by the Indiana-based Regenstrief Institute, the IHIE securely connects 39 hospitals, 10,000 physicians and more than 6 million patients. It delivers real-time lab results, reports, medication histories and treatment histories that are sent instantly to where they’re needed regardless of the hospital system or location, according to IHIE officials.

Indiana health care leaders haven’t been bashful about touting their early success, openly profiling the IHIE as a proven working model that should be closely reviewed and copied across the United States.

“Indiana has seen how health information exchange drives better health care for our patients, increases efficiencies for our health care professionals and saves health care dollars. Replicating this kind of platform throughout the U.S. would have incredible positive implications on our health care outcomes and cost savings,” IHIE Chairman Vincent C. Caponi (also the CEO of St. Vincent Health said.

The benefits of participating in an HIE or adopting best practices within an EHR system are by no means limited to large hospitals in urban areas as Major Hospital in Shelbyville, Ind. (population 18,000) has eloquently demonstrated.

This 86-bed community hospital was recently named one of America’s top 100 hospitals by Thompson Reuters and its early adoption of state-of-the-art technology is one of the reasons why. Only the St. Vincent Health and St. Francis Hospital systems (which are much larger than Major Hospital) were also included as central Indiana health institutions named in the 2009 benchmark study.

How did this happen? Working in the shadow of much larger hospital systems in nearby Indianapolis, Major Hospital trumped its hefty competitors by instituting the beginnings of a full-scale EMR back in the mid-1990s.

The result, according to Major Hospital CEO Jack Horner, is reflected in both the growth of the hospital and its more than 25 vertical medical practices. They are all linked together by fiber-based broadband connectivity. That coupled with aggressive recruitment and retention of top physicians and hospital staff has led to substantial growth and a high degree of patient satisfaction.

While many other hospitals (large or small) across the nation are just now ditching their legacy systems and working to implement full-scale EHR platforms, Major Hospital is already well into direct physician order and advanced applications all to the benefit of the hospital’s patients.

Major Hospital was one of the first health care institutions outside of Indianapolis to join the Indiana Health Information Exchange. Its success demonstrates that EHR systems can work well in either large or small health care organizations.

As U.S. health care institutions contemplate sweeping change in their IT systems, one could easily argue with merit that – instead of looking to the coasts for proven innovation – this time they would be well-served to look inward to the Midwest and even to Indiana.

Above article published on

http://www.midwestbusiness.com/news/viewnews.asp?newsletterID=19657

Texas State’s Student Health Center (SHC) will begin keeping health records electronically starting May 18 with its new Electronic Health Record (EHR).

The EHR will replace paper medical charts and contain patient information in a readily accessible format. Drug interactions and allergies are automatically checked before prescribing medication. Current diagnostic and therapeutic information will be available to help facilitate patient care. Another benefit to having the system is that an EHR is always legible, unlike hand-written charts.

EHR will also help the SHC by reducing the use of paper and ink. Eventually, off-site storage of medical charts and the costs that go with transporting them can be eliminated, as well.

The EHR program will be implemented in two phases. In May 2009, SHC staff will begin using the electronic records instead of charts. Online forms for students and secured messages with medical providers will be implemented later in the summer or fall.

Above article published on

http://www.newstreamz.com/2009/05/17/texas-state-to-keep-electronic-medical-records/