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November 11, 2009
The healthcare IT marketplace is growing by 11% annually, which will likely continue through 2013, says a study from Scientia Advisors.
By Mitch Wagner, InformationWeek
Health information technology (HIT) is the fastest growing segment of the $1 trillion global health care marketplace, and is poised to continue its impressive growth through 2013, according to a study released Tuesday.
The health IT marketplace is showing 11% combined annual growth rate, which is likely to continue over the next four years, according to a study from Scientia Advisors, a management consulting firm.
To remain competitive, vendors must take into account government incentives, requirements for clinical decision-making and electronic health record systems, and emerging competitors in Asia and elsewhere in the developing world, the study said.
Health information technology will grow from 4% of the worldwide health care products market to 5% — a 25% increase in HIT market share, Scientia said.
HIT spending in the US will focus on inpatient and outpatient electronic health records systems, at the expense of specialty and departmental information systems and other capital investments, Scientia said.
“Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia said.
Some small hospitals may choose lower risk, lower cost approaches such as remote hosting. Given the economic slowdown, vendors will lend hospitals capital to finance HIT investments.
“Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” Scientia said.
Also, “over the long term, disruptive innovations such as open source software and ’software as a service’ could lead to dramatically lower pricing,” the company said.
Above article published on http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=221601057&subSection=News
September 24, 2009
By Neil Versel
Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records. To date, most of the research has focused on health IT in specific environments, such as a single hospital, physician office or integrated delivery network, but the stimulus will help put EHRs in new settings that haven’t been studied.
“We are going to be hungry for how to implement health information technology the most efficiently to gain the greatest value for the health IT investment,” Blumenthal told a gathering convened by the Agency for Healthcare Research and Quality last week. “We’re at that transition that we see every time a new technology is moved out from the laboratory.”
Blumenthal advocated clinical decision support technology that encourages continuous quality improvement by delivering research data and new treatment information to the point of care, easily accessible by clinicians. “One thing we haven’t done is apply the scientific method in the practice of healthcare and medicine,” he said.
But he and other health IT experts at the same AHRQ conference cautioned that the road to achieving “meaningful use” of EHRs will be long and fraught with all sorts of danger.
Above article published on
September 21, 2009
Advisory panel considers privacy proposals
By Alice Lipowicz A federal advisory panel today heard several proposals about how to best protect patient privacy while creating and sharing electronic health records (EHRs).
The Health Information Technology Policy Committee convened to prepare recommendations to the Health and Human Services Department on distributing $19 billion in economic stimulus funding for incentive payments for EHRs and health information exchanges. The bulk of the money will go to doctors and hospitals that buy certified record systems and participate in the exchanges. HHS is expected to issue a rule by year’s end.
Dr. Deborah Peel, founder of the Coalition for Patient Privacy, said the core of privacy is patient control of the information in EHRs.
“The right to privacy and control is the national consensus,” Peel said, “It reflects centuries of medical ethics. We are asking you to set a high bar for privacy to meet with patients’ expectations.”
She suggested patients should be allowed to consent, or not consent, to each disclosure of the information, and for the information to be segmented to maintain different levels of disclosure for different pieces of information. Industry does not want to change its practices, so it is best if regulations are created to enforce patient consent management rules, she added.
However, patient consent, by itself, has not proven to be effective tool, asserted Deven McGraw, a member of the advisory panel and director of the health privacy project at the Center for Democracy and Technology.
“Although the concept of patient control is very appealing, consent does not work the way we want it to,” McGraw said. “Consent does not provide protection.”
That is because health insurers often require blanket consent forms in which patients authorize a very broad variety of uses and disclosures that are not well understood by patient, she said. Patients don’t really have a choice, because if they don’t sign the consent form, the insurer will deny coverage, McGraw said.
The solution is to include patient consent in a comprehensive framework of technical and legal standards for IT systems, networks, practices and training, along with other features, she said.
The committee also heard discussions about the use, disclosure, secondary use and stewardship of the personal health data. It also is considering audits and accountability for the EHR systems and models for data exchange, data storage, data de-identification and re-identification.
In July, a separate advisory committee to HHS, the Health IT Standards Committee, considered specific recommendations for patient privacy that included encryption, strong access controls and audits.
Above article published on
September 09, 2009
ScienceDaily — A new framework of recommendations created by health informatics researchers may help doctors and hospitals prepare for a federal initiative to expand the use of electronic health records (EHRs).
The recommendations from faculty at The University of Texas Health Science Center at Houston, the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine appear in a commentary in the Sept. 9 edition of JAMA, the Journal of the American Medical Association.
“With high-quality, well-designed, and carefully implemented systems, highly-reliable, safe health care will be achieved,” said Dean Sittig, Ph.D., commentary author, associate professor at The University of Texas School of Health Information Sciences at Houston and member of The University of Texas - Memorial Hermann Center for Healthcare Quality and Safety.
The American Recovery and Reinvestment Act of 2009 created approximately $20 billion in incentives for individuals and organizations to “meaningfully” use electronic health records beginning next year. Previous studies report that 4 percent of physicians in the outpatient setting and 1.5 percent of U.S. hospitals have a comprehensive electronic health record system.
“This framework can help make sure that electronic health records are used safely and effectively as doctors continue to adopt them,” said Hardeep Singh, M.D., M.P.H. co-author and assistant professor of medicine and health services research at the VA Health Services Research and Development Center of Excellence and Baylor in Houston.
This framework of recommendations proposed by Sittig and Singh provides guidance for key stakeholders who are either currently involved or who will soon be involved with electronic health records.
“While using electronic health records, we not only have to consider issues related to technology, but also issues related to people who use them, how they interact with technology and how the electronic health record fits with the work flow of the clinic or organization that adopts it,” said Singh, who noted that if the Computerized Patient Record System developed by the Department of Veterans Affairs was included in the EHR-use study, the percentage of U.S. hospitals with a comprehensive electronic health record system would nearly double to 2.9 percent.
VA’s electronic health record system covers many aspects of patient care, including reminders for preventive health care, electronic entry of orders, display of laboratory test results, consultation requests, and pathology and imaging studies.
“The American Recovery and Reinvestment Act stipulates that clinicians and healthcare organizations can receive incentive payments for ‘meaningful use’ of EHRs. Depending on the definition and timeline for ‘meaningful use,’ this legislation could result in a rush to implement sub-optimal systems,” said Sittig, co-author of a new book that addresses EHR issues and is titled “Clinical Information Systems: Overcoming Adverse Consequences.”
For Americans to realize the full potential of electronic health records, which include reduced cost, less duplication and greater quality, Sittig and Singh believe all eight essentials, which are based on a systems engineering model for patient safety, should be followed.
“These issues are essential to maximize patient care benefits and minimize unintended errors from technology,” Singh said.
The commentary is titled “Eight rights of safe electronic health record use.” The authors received support from the National Library of Medicine, the VA National Center of Patient Safety, the Houston VA Health Services Research and Development Center of Excellence and the Agency for Health Care Research and Quality.
Above article published on http://www.sciencedaily.com/releases/2009/09/090908193440.htm
September 04, 2009
If the state’s governor gets his way, Kentucky will soon be home to a statewide electronic health records system. To foster that goal, State Gov. Steve Beshear (D) has created the Governor’s Office of Electronic Health Information.
The state is creating the office to make sure it gets its share of the Obama administration’s stimulus funding package for EHRs, which goes to states who adopt them by 2014.
To get those funds, states are required to create a department that oversees its EMR project. These state offices serve as single points-of-contact for federal and state agencies helping to get the EMR ball rolling. In this case, the office will also work with the state’s three regional health information organizations, healthcare providers, consumers, insurers and the whole kit and kaboodle involved in sharing health data.
It will be interesting to see if any of this comes to fruition. Despite some big talk, RHIOs aren’t going great guns, and getting a state’s worth of EMRs in place by 2014 sounds a tad optimistic at best. But hey, press releases wouldn’t exist if people weren’t optimistic!
Above article published on
September 01, 2009
By Ken Terry While the debate over “meaningful use” of electronic health records rages on, it has been easy to forget the other half of the requirement for getting government health IT subsidies: Physicians and hospitals must use “qualified” EHRs.
Since the passage of the HITECH Act, part of last spring’s stimulus package, there has been speculation that a qualified EHR would have to be certified by the Certification Commission for Health Information Technology (CCHIT), which so far has been the only game in town. But the Health IT Advisory Committee, which advises the Department of Health and Human Services on information technology matters, has decided that there should be multiple certification bodies. All of them would have to certify EHRs under criteria developed by HHS.
According to the work group that made the recommendations approved by the whole committee, CCHIT’s criteria for certification are too detailed and the organization is too close to the industry to be the only certifying entity. Other observers have pointed out that CCHIT is very close to the Healthcare Information and Management Systems Society (HIMSS), a trade association for health IT professionals that include many software vendors among its members. In addition, Mark Leavitt, MD, chair of CCHIT, used to be a HIMSS executive and, before that, led an EHR company. However, there is no evidence that CCHIT’s ties with HIMSS have influenced its approach to certification, which has been implemented by workgroups that include a wide range of industry professionals.
In any case, CCHIT plans to certify EHRs under the criteria that will be established by HHS. Meanwhile, the advisory committee has asked CCHIT to submit a proposal for developing a “Preliminary HHS Certification” process that would allow it to provide preliminary certification to EHR vendors so that providers can begin purchasing qualified products, perhaps as early as October. In addition, the committee approved a plan to grandfather in vendors that have 2008 CCHIT certification, with the proviso that they upgrade their products later.
In a signifier of what this debate is really about, the committee has approved the certification of “open-source” EHRs, which contain non-proprietary code that is available to anyone who wants to use it. The best-known example in the healthcare arena is the VA system’s Vista EHR, which has been available to software developers for a number of years. In addition, the comment about CCHIT’s criteria being too detailed suggests that the committee wants to use looser criteria under which less advanced (and less expensive) EHRs could qualify for government aid.
I applaud this decision on a couple of grounds: First, continuing to tighten criteria for “qualified” EHRs would help a dozen or so vendors consolidate their hold on the market as providers sought EHRs that could garner government aid. Second, physicians don’t need all of the bells and whistles in current EHRs to improve health care. Relaxing the criteria in certain respects would help the development of nontraditional community EHRs, including those linked to disease registries, that might serve the purpose better. But as HHS develops its criteria, it should bear in mind that the EHRs that are qualified for government subsidies must also help doctors demonstrate meaningful use.
Above article published on http://industry.bnet.com/healthcare/10001008/hhs-will-choose-criteria-for-ehr-certification/
September 01, 2009
By Neil Versel
Lest the health IT industry be stuck with competing standards yet again, National Coordinator for Health IT Dr. David Blumenthal says he intends to harmonize standards for “meaningful use” of electronic health records within the framework of the planned Nationwide Health Information Network. Speaking at a users group for NHIN-Connect, the open-source software that supports NHIN development, Blumenthal said that federal standards for “meaningful use” of EHR software must be compatible with the national network. Meaningful use is the benchmark by which healthcare organizations will qualify for federal health IT subsidies beginning in 2011.
“NHIN can provide a path for meaningful use,” Blumenthal said, according to Federal Computer Week. The stimulus law requires meaningful use to include the ability to exchange patient-specific data. “Given the federal investment in health IT, and the definition of meaningful use, it is clear there is a vibrant future for the NHIN,” Blumenthal said. “Our hope is that it will support health information exchange and meaningful use at the federal, state and local levels.”
Above article published on http://www.fierceemr.com/story/blumenthal-wants-meaningful-use-standards-work-nhin/2009-07-02
September 01, 2009
By Pamela Lewis Dolan, AMNews staff.
When it comes to electronic health records, functionality has had its time in the spotlight. Now, the buzz term is usability. What’s the difference? Functionality is what a system does. Usability is how easily you and your staff can operate the system.
Usability is coming into the spotlight as vendors and consultants are learning that a lack of it has been a major reason many implementations have failed. The push is now on for practices (and vendors and consultants) to pay less attention to the bells and whistles and more to whether physicians and support staff can figure out how to make them work.
Determining what usability means to you will require a hard look at not only the system but also your practice — how it works now, how you want it to work, and how ready and able employees are to adapt to technology.
Ron McNamara, PhD, a certified usability analyst who runs the EMR Usability Group, a consulting firm, said that despite the seemingly relative nature of usability, there is some science to it. But at its most basic level, usability means everyone will be able to use the records system to electronically complete tasks in the same or less time as it takes on paper.
McNamara has developed a nine-point assessment that practices can use to help determine a system’s usability:
Dictation: A good system will accommodate doctors accustomed to dictating their notes as well as those who are comfortable typing.
Prescriptions: Sending a prescription electronically should be just as fast as writing it on paper.
Ability to receive faxes: Allowing faxes to be imported directly into the EHR should not negatively impact work flow.
Appointment/scheduling integration: With good integration staff will not have to toggle between two systems.
Scanning: Your system should allow documents to be scanned directly into a patient file.
Vital signs: Support staff should be able to enter vitals directly into the patient’s file at the time of care, with a touch screen, tablet or laptop in the exam room.
Interface design: Is it customizable to match each physician’s current work flow? Can information that is not needed on a regular basis be hidden? Can it be customized according to user (whether physician, nurse, physician assistant)? Is it intuitive and easy enough that a novice can learn to use it?
Office work flow: Is your vendor willing to define current work flow and match the system to it as closely as possible and/or help identify current work flow problems that can be fixed with technology?
Application performance: Does the system take a long time to load? Does it go from screen to screen quickly? Does it crash often? Hardware, as well as software, will be a factor.
Can your staff adapt? The other important task is assessing your employees’ ability to learn a new system.
Jeffrey Linder, MD, MPH, director of the Brigham and Women’s Primary Care Practice-Based Research Network in Boston, said there is no test to assess an employee’s tech-savviness. So you mostly have to rely on self-reporting.
Allen Wenner, MD, a family physician in Columbia, S.C., said that when he interviews potential employees at his practice, he addresses their tech-savviness with two basic questions.
The first is, “What is your e-mail address?” It must be a personal address, not a current or former work e-mail. The second is, “What operating system do you use?” A response of “Windows” is not adequate. He wants to know what version.
“If a person doesn’t know the answer to those things,” he said, “then you can’t teach the level of technology that is necessary to operate an EMR in a live environment while you are seeing patients.” Dr. Wenner is also the co-founder of the High Performance Physician Institute, an EMR training organization.
But that’s not to say everyone should be able to program the next best thing to Microsoft Windows. A good EHR system will meet people where they are and allow them to learn as they go along, McNamara said.
Dr. Linder said that during the implementation projects in which he has participated, there was an effort to get diversity on the teams charged with picking a system. The strategy was to form a group with the widest spectrum in terms of age, self-reported tech-savviness and job requirements to test-drive potential systems.
Dr. Linder compared a good EHR to Microsoft Word. He said most anyone can figure out how to use the program, but most users don’t use 92% of what’s in it. Likewise, a good EHR system will be easy enough for novices to use, but offer more options for a “power user.”
The caveat is that if all of the EHR’s functionalities aren’t being used by the majority of people in the office, the practice is not realizing the system’s full potential. That’s where incentives come in, Dr. Linder said.
As payment moves from fee-for-service toward pay-for-performance, practices will have the time and motivation to learn and utilize more of the EHR’s functionalities, he said. Incentives built around the patient-centered medical home model, for example, will be practice wide, not physician-specific, which means every employee in the practice will have an incentive to learn — and take their own steps — to increase the system’s usability.
Above article published on
August 21, 2009
Filed Under (EHR, Electronic Health Records) by admin
By David Blumenthal, National Coordinator for Health Information Technology
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.
Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.
My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.
In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.
But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.
Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.
The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.
We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.
In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.
Above article published on
August 07, 2009
By Jean DerGurahian / HITS staff writer
Providers looking to make decisions about technology will find the revised “meaningful use” definition helpful, but the implementation timeline might still be challenging, professionals say.
The federal Health Information Technology Policy Committee approved updated recommendations from its meaningful use work group during a conference. The revised definition for the meaningful use of electronic health records includes changes to computer physician order-entry criteria and speeds up the schedule for granting real-time access to patient information through personal health records. The 2011 measures are being established with a focus on data capture and sharing, according to the work group’s recommendations.
Overall, the revisions “have some nice granularity to them,” said Brian Jacobs, a critical-care physician and chief medical information officer of 230-bed Children’s National Medical Center, Washington. As the medical center finishes components of its EHR, the revised measures will serve as guidelines for what it needs to focus on, he said. The medical center is already available for the full, first-year IT adoption incentive payment under the American Recovery and Reinvestment Act of 2009 because it meets the 2011 criteria now.
The American Hospital Association said that it is reviewing the revisions and the deadline for meeting criteria. “We remain concerned that many hospitals that haven’t already adopted health IT systems may find the proposed timelines unachievable,” said Don May, AHA vice president for policy, in a written statement Above article published on http://www.modernhealthcare.com/article/20090717/REG/307179990/1153 |
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