Show me the technology! That is the conclusion of a study from the Beth Israel Deaconess Medical Center (BIDMC) to be released in the Journal of General Internal Medicine (JGIM) in June. The study reveals that consumers who are defined as “internet-savvy” are ready to take a chance on electronic health records (EHR) despite warnings of potential privacy risks.

The study, supported by the Robert Wood Johnson Foundation (RWJF), investigated whether or not patients were comfortable making the leap with their health care providers to the digital age through the adoption of EHRs. In the tech-savvy cities where they held focus groups, the answer was a resounding ‘yes.’ Not a terrible surprise given that they investigated consumers in Boston, Portland, Tampa and Denver—some of the more tech-educated spots in the country. However, investigators did attempt to include a diverse group of people, drawn from both urban and rural areas. Additionally, they included health professionals in their study to compare their perspectives about health technology relative to consumers.

The findings should not come as a major surprise since an estimated 60 percent of households across all states have a home internet connection. Citizens are increasingly interested in managing their lives via computer—EHRs seems a natural progression in this evolution.

Yet, the study findings echo a sense of surprise at the willingness of consumers to give up some of their privacy in order to obtain greater transparency with respect to their health information. In actuality, it may be more of a reflection of the distrust and frustration with the current patient-physician/health care provider relationship where one may deem transparency of much greater importance than whether or not someone uncovers that they have kidney stones…

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/05/28/edit-me-patients-cheer-on-ehr-technology.aspx

HDM Breaking News,

The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association.

The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology.

“Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.”

Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.”

The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises.

The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets.

Above article published on

http://www.healthdatamanagement.com/news/meaningful_use-38560-1.html

by Julekha Dash Contributing Writer

Maryland Gov. Martin O’Malley will sign legislation Tuesday that provides incentives for health care organizations to implement electronic health records.

House Bill 706 allows the state to make use of federal stimulus dollars available for electronic health records and coordinate those efforts with the state’s own plan to create a state wide health information exchange.

The federal stimulus money provided $19 billion toward electronic health records. State health officials do not know how much of that money will flow to Maryland.

State and federal health officials are pushing electronic health records because they believe they will reduce medical errors and lower costs by eliminating the need for running multiple tests.

The stimulus package enables physicians to receive incentives between $44,000 and $64,000 over the next five years through Medicare and Medicaid.

It costs, on average, $50,000 for a physician practice to implement electronic health records. The incentive payments begin in 2011, and physicians who do not adopt an electronic health records will be penalized through lower Medicaid and Medicare payments starting in 2015.

In the past, the biggest obstacle in getting physicians to install an electronic health record was cost. The federal stimulus money and the state’s health information exchange overcomes that obstacle by providing incentives to adopt health records.

“It’s trying to create a business model to make [health IT] work,” Department of Health and Mental Hygiene Secretary John Colmers said.

While the federal money provides payments to physician practices, the state is taking its own steps to ensure that hospitals can share electronic information. The legislation requires the Maryland Health Care Commission and the Health Services Cost Review Commission to designate a state health information exchange by Oct. 1. State health insurers will provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records.

Erickson Retirement Communities, Johns Hopkins Medicine, University of Maryland Medical System and more than a dozen companies and health care institutions have submitted their own plan to the state’s health care commission to create a health information exchange, known as the Chesapeake Regional Information System for our Patients.

Above article published on

http://www.bizjournals.com/washington/stories/2009/05/18/daily1.html

By JACOB GOLDSTEIN

Only 9% of U.S. hospitals have electronic health records, according to a new survey that reveals the gap between the present state of American health care and a high-tech future envisioned by policy makers.

“We are at a very early stage in adoption, a very low stage compared to other countries,” said David Blumenthal, a Harvard professor and an author of the survey. Last week, the Obama administration named Dr. Blumenthal National Coordinator for Health Information Technology.

The survey, sent to hospitals in March 2008 and published online Wednesday by the New England Journal of Medicine, found that most institutions have some basic electronic systems, such as those for reporting patients’ lab results.

The electronic-record systems advocated by President Barack Obama and former President George W. Bush go further, however, often replacing paper records and including doctors’ notes, treatment orders and automatic safety alerts.

Cost was the most commonly mentioned barrier to adoption of such systems, cited in the survey by 74% of hospitals without electronic records. That suggests many facilities are likely to tap into federal incentives aimed at increasing the use of electronic records.

The economic-stimulus package that Congress passed in February is likely to generate more than $20 billion in federal outlays for health-information technology, mostly between 2011 and 2015, according to the Congressional Budget Office.

Costs for installing electronic records systems vary widely, but a midsize hospital might spend about $10 million over several years, said Erica Drazen, who runs the research group for the health-care division at Computer Sciences Corp. The stimulus incentives are likely to cover much, but not all, of the cost — $6 million to $7 million for a midsize hospital, Ms. Drazen said.

Only 1.5% of hospitals have adopted what the survey’s authors define as a comprehensive, hospital-wide system. Another 7.6% of hospitals have adopted basic systems in at least one unit of the hospital, according to a less-rigorous definition that includes electronic physician notes, but not certain other features.

Proponents of electronic records say they will improve patient safety, reduce unnecessary testing and create useful data to measure quality of care. But the push is controversial, as skeptics point to the cost and complexity of installing the systems and building data networks required to share information electronically between doctors’ offices and hospitals. Some doctors argue that the systems are a distraction that takes away from patient care; more than a third of the hospitals that hadn’t adopted electronic records cited resistance from physicians as one reason.

The survey, based on responses from more than 2,900 U.S. hospitals, was funded by the federal government and the Robert Wood Johnson Foundation. The study excluded federal hospitals, such as those for veterans.

Above article published on

http://online.wsj.com/article/SB123802378615142099.html?mod=dist_smartbrief

Electronic Health Records Emerging as Important Care, Research Tool

With the American Recovery and Reinvestment Act set to spur their development and implementation, electronic health records (EHRs) are getting a lot of attention.

The widespread adoption of EHRs, however, involves “huge challenges,” acknowledged Dr. David Blumenthal, the National Coordinator for Health Information Technology. As a recent study he led documented, less than 2 percent of U.S. hospitals have a comprehensive EHR system in place. Cost, the study found, was the biggest obstacle to adoption.

Despite some of the problems reported to date with EHRs, evidence is emerging that they can improve the quality and efficiency of medical care. For example, the relatively new EHR system at the University of Arkansas for Medical Sciences (UAMS) has made many aspects of delivering care “so much better,” said Dr. Laura Hutchins, director of Hematology/Oncology at the UAMS Winthrop P. Rockefeller Cancer Institute. While the system is not perfect, she continued, “I don’t know of anybody here who wants to go back to a paper record. In addition to saving money, she explained, the system has generally made patient visits more efficient—for example, streamlining the search for information that can influence diagnosis or treatment.

Whereas the UAMS system is still in its early days, the EHR system at the University of Pittsburgh Medical Center (UPMC) dates back to 1991. The center recently completed the first phase of an “interoperability initiative” intended to eventually provide staff at 20 hospitals and more than 400 physician offices and outpatient sites access to what Dr. Daniel Martich, UPMC’s chief medical information officer, calls a “full-fidelity” EHR system, an integrated network of patient records with data on everything from admissions to allergies to recent imaging studies. While access to a number of EHR-related tools, such as electronic prescribing, still varies, he explained, the goal is a widely accessible EHR system that “provides a unified view of what’s going on with the patient.”

Importantly, EHR systems are beginning to demonstrate their utility in research. At UPMC, for example, they have conducted studies showing that, with the addition of clinical prompts, the EHR system reduced the risk of patients receiving an overdose of acetaminophen and improved by fivefold the number of patients notified by their primary care physicians that they may be candidates for clinical trials. Dr. Hutchins and colleagues at UAMS, meanwhile, used their EHR system to evaluate vitamin D levels in women with metastatic breast cancer who received bisphosphonates to treat bone pain and osteoporosis, finding that vitamin D supplements were being underprescribed, which can affect patient outcomes.

The success of EHRs, Dr. Martich believes, will be measured by the extent to which they can be effectively integrated into clinical care and research systems. “The real issue [with EHRs] isn’t a technological one,” he said. “The question is: How do they function within the workflow of a health care system?”

Above article published on http://www.cancer.gov/ncicancerbulletin/050509/page6

By Jacob Goldstein

Remember that survey last year that found only 17% percent of U.S. doctors have electronic health records? Turns out, the figure’s even lower for hospitals.

In all, about 9% of hospitals have EHRs, according to a survey published in the New England Journal of Medicine. Only 1.5% of U.S. hospitals have adopted “comprehensive” EHRs — those with a complete set of bells and whistles, installed throughout the hospital. Another 7.6% have basic systems installed in at least part of the hospital.

For both docs and hospitals, the main barrier to adoption was the same: Cost. That augurs well for the great big pile of cash the feds will be handing out in a few years to encourage everybody to get with the EHR program.

The federal money should be worth about $6 million over several years for a midsized hospital, according to an expert cited by the WSJ. That will cover a decent chunk of the cost of getting an electronic records system, which runs about $10 million, the WSJ says. But the stimulus incentives should

The survey, funded by the feds and the Robert Wood Johnson Foundation, is brought to you by the same researchers who did the EHR docs survey. One of the authors — Harvard Prof. David Blumenthal — was recently named as the feds’ health IT chief.

Above article published on http://blogs.wsj.com/health/2009/03/26/docs-hospitals-skip-electronic-records-for-the-same-reason/

Federal stimulus incentives for hospitals and physicians to implement interoperable electronic health records (EHRs) will not nearly compensate them for the overall costs they will incur, but future penalties from reduced Medicare reimbursement could be a bigger motivator, according to “Rock and a Hard Place: An Analysis of the $36 Billion Impact from Health IT Stimulus Funding,” a paper published by the PricewaterhouseCoopers LLP (PwC) Health Research Institute.

To help drive adoption of electronic health records by 2015, the federal government is investing $33 billion in incentives to providers. An analysis by PwC’s Health Research Institute shows that a 500-bed hospital could receive an average of $6.1 million in incentives to purchase, deploy, and maintain a government-certified, interoperable electronic health record system. By comparison, the average 500-bed hospital that fails to implement a system by 2015 could see a reduction in Medicare funding by $3.2 million or more, depending on their Medicare volume.

The federal initiative comes at a time when capital-constrained healthcare organizations are struggling to find the necessary funding to purchase EHR systems. In a March 2009 survey of 100 hospital chief information officers, one-half of CIOs in hospitals with more than 500 beds said that federal funding is “crucial” to their ability to implement EHRs. “The stick, even more than the carrot, makes a fiscally compelling argument for adopting electronic health records,” said Daniel Garrett, managing director of PwC’s health industries technology (HIT) practice. “If an organization wants to have an enterprise-wide EHR up and running by 2011, they’ve got to start now. The incentives eventually go away and the stick will only get bigger.”

http://www.hfma.org/hfmanews/PermaLink,guid,c9ac9559-927d-416a-bd7b-5d66d07c4fb4.aspx

WINSTON-SALEM, NC - The issue around ownership of electronic health information must be addressed before it can be used to improve healthcare, says a recent article in the Journal of the American Medical Association.

“This legal uncertainty presents a major obstacle to integrating and using information about a single patient from various clinicians and hospitals,” say the article’s authors, Mark A. Hall, a professor of law and public health sciences at Wake Forest University and Kevin A. Schulman, MD, a professor of medicine and vice chairman for business affairs in the Department of Medicine in Duke University’s School of Medicine.

Hall and Schulman point out that with paper records the concept of ownership is more straightforward: providers and insurance plans own the paper, so they control the information. “But now that digitizing information frees it from particular storage media, confusion reigns,” they said.

Normal property rights do not apply to patients and their medical records because providers also have a right to the information, the article explains, so patients don’t have sole possession or control. Instead, they have privacy rights to protect and control access to their records.

“Strong privacy laws (favoring the patient) and clinicians’ economic interests in limiting access to health records increase barriers to forming integrated electronic records. This combination of low commercial value with restricted access leaves medical information lying stunted in an undernourished field, ” wrote Schulman and Hall.

The article says the “infomediary” to build the network among different EHRs would need clear authority to bundle and exercise the economic rights of multiple parties.

“An intermediary could compile a bundle of patients’ authorizations to use their information for research or marketing purposes; the compiler could, with patient authorization, then market these databases to permitted users or could transfer the bundled rights to a third party aggregator and marketer,” the article states.

“Some earnings could flow back to patients or compensate participating clinicians. In this way, placing bundled rights to medical information into a stream of commerce could direct them toward their highest and best use,” the authors suggest.

The article maintains that a new system of patient-initiated control of health records could be the key to a successful system. Such a system could “loosen the logjam of competing interests and stimulate market mechanisms to make much larger investments in using and sharing electronic health information.”

Above article published on www.healthcareitnews.com

Both the House and Senate stimulus bills include incentives for physicians to incorporate electronic health records into their practices, but for pathologists, qualifying for the different incentive programs will depend on your practice.

Independent pathologists, as part of H.R. 1 and S. 1, the American Recovery and Reinvestment Act of 2009, would be eligible for a $15,000 incentive payment for adopting electronic health records starting 2011, with a declining incentive scale each subsequent year until 2015.

Hospital-based pathologists are ineligible for this particular incentive payment due to concerns over double payment. Legislators have allocated HIT incentive payments directly to the hospital, and have assumed it would negate the need to provide HIT incentives directly to hospital-based pathologists. CAP is monitoring the effect of this provision.

Additional HIT grants may also be made available for physicians through low-interest loans provided by the Federal government to the states.

The Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using electronic health records within the next decade as a result of the American Recovery and Reinvestment Act of 2009.

The College anticipates tremendous advantages from the adoption of the electronic health record system, and will continue to advocate for incorporation of health information technology provisions within the stimulus package and in the healthcare agenda.

Above article published on www.cap.org

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/