HUDSON, IA – Full-practice automation seems to pay off for many small physician offices, but others who choose only select areas to convert are feeling the positive financial effects as well.

Kurt Kastendieck, MD, a family practitioner in Sante Fe, N.M., is in the process of automating his practice and finds his e-prescribing tool to be particularly useful.

“It works well,” he said. “Things like refill communications are automatically sent back. It saves an amazing amount of time.”

The e-prescribing program came with Kastendieck’s EHR, which he installed two years ago. He also bills through the system.

Larger pharmacies are better equipped for e-prescribing, but not many smaller pharmacies are, Kastendieck said. Some still take prescriptions by phone or fax.

The e-prescribing tool calculates and produces a 24-hour turnaround bill through the clearinghouse and on to the insurance company. Kastendieck said reimbursement now averages two weeks from a patient’s visit.

Automation, such as e-prescribing, helps improve a doctor’s quality of life, said Kastendieck. one doesn’t need a complete EHR, only Internet access.

Theresa Dickson, who manages her husband’s solo general surgery practice in Dennison, Texas, says electronic billing technology brings the money in quicker, even without an EHR.

“The few practices I know of out there that paper bill their claims simply budget the practice to allow for the 45 day delay in payment as opposed to 20-30 days that we experience,” she said.

Dickson said many IT companies say an EHR will save money because physicians will need less room to store charts. However, Dickson says the monthly fees for the use of an EHR often outweighs the cost of hard copy storage.

“I have seen monthly fees of $500 to $1,500 a month for one doctor,” she said. “We are not being reimbursed by our major carriers enough to offset that cost. In our particular community, real estate is relatively inexpensive, so for me personally it would cost me less to store charts.”

James Selenke, a family practitioner based in Hudson and Reinbeck, Iowa, fully automated his practice with an EHR and e-prescribing system.

He said that he is amazed at where people get numbers for cost of EHRS – to many it seems to be a tremendous amount of money, but other than hardware, which cost him $16,000 in 2004, he is only paying $870 per month to service two physicians on the EHR.

“Cost was a major factor,” said Selenke. “The fees are good for my size practice.”

Above article published on

http://www.healthcarefinancenews.com/news/docs-see-money-faster-automation

Implementing electronic medical records has become the top priority for senior healthcare information professionals; a major US survey has shown.

The survey revealed that although recession is being felt in the US, healthcare and healthcare IT are still expected to grow over the coming year.

The 20th Health Information and Management Systems Society (HIMSS) annual survey of chief information officers found that 31% of the 304 participants said their number one priority is to ensure their organization has a full EMR.

Within the clinical environment, 31% of participants said that at least one of their facilities already had a fully functioning EMR, which is a 9% increase on last year.

A further 17% said that their primary focus would be implementing a computerized provider order entry system.

Most respondents completed the research before the American Reinvestment and Recovery Act - President Obama’s economic stimulus bill - was signed in February, which aims for widespread adoption of healthcare IT and electronic medical records.

Survey respondents also confirmed that the weakened economy meant that although healthcare budgets and staff continue to grow, it is now at a much slower pace. Around half said that their IT budgets would increase, compared to 78% last year. Some 42% said that their staffing levels would increase compared to 68% last year.

Charles Christian, chair of the HIMSS board said of the 2009 survey: “The economy is affecting all sectors, healthcare IT included, but the good news is healthcare IT still continues to grow.”

CIOs said financial support continues to be a barrier for healthcare IT professionals with 28% noting that lack of adequate resources raises significant issues in decision-making plans and implementing IT.

The survey also highlighted some key issues that have been at the forefront of healthcare IT in recent years, including the importance of IT in reducing medical errors.

However, although reducing medical errors was the key priority for US healthcare industry CIOs in 2007, now only 38% of respondents suggested that IT would reduce medical errors.

But security remained a key concern with 84% of respondents said their organization actively assesses security risks. Despite this, one in four said that they had had a security breach within the past six months, an increase on previous years.

Respondents identified single-sign on as the technology that will be most widely adopted at their organisations in the next two years.

The HIMSS survey covers 250 unique healthcare organizations, almost 700 hospitals throughout the US It aims to track the shifts in healthcare implementation and attitudes and documents steady progress in healthcare IT.

Above article published on http://www.ehealtheurope.net/news/4751/emrs_named_top_priority_in_himss_survey

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

By Dennis R. Horrigan

An electronically connected health care system promises better access, improved reliability and lower costs. A portion of President Obama’s stimulus plan is aimed at having an electronic health record in every exam room. This investment in health information technology has the great potential to improve the functioning of our health care system.

Supporters and critics are facing-off on the pros and cons of this initiative. Supporters cite the potential savings that will be achieved through increased efficiency and patient self-directed care, while critics point out that cost savings is exaggerated and implementation will be slow.

Technology alone will not improve our health care system, and simply having a computer in every exam room will not be sufficient. Physicians and nurses will need continuous training on how to improve care. Equally important is engaging patients. Patients who take responsibility for their health care will have better outcomes. Make no mistake, the transition from paper to an electronic system will be disruptive, but it is important work that must be done.

The electronic health record may aid physicians in documentation, coordination of care, adherence to quality guidelines, ordering tests and prescribing medications. Electronic prompts can alert physicians to adverse drug interactions, when laboratory results are not normal and enable physicians to better monitor the care for patients with chronic health conditions to help avoid emergency room and hospital visits.

These systems are designed to be “interoperable” so that physician-to-physician and physician-to-hospital communication can be timely and reliable. The physician you see on Wednesday will have an electronic report of the services you received the day before at the specialist office.

Patients will be able to access their records, review test results, schedule appointments and request prescription refills. No more waits and delays on the phone trying to reach the office. A connected health care system will enable patients to communicate to their physician using e-mail and to have an electronic visit. Imagine e-mailing your physician for assistance with non-emergent medical issues and receiving medical advice and treatment online or accessing your physician’s Web site to gain valuable information you can use to manage your health care needs.

An electronically connected health care system has the greatest potential to reduce the duplication of services and the poorly coordinated care that is responsible for a large share of rising health costs. All physicians and hospital leaders need to embrace this formula for success by adopting technology, training staff and proactively engaging patients. Now is the perfect time for the health care system to embrace electronic health records and let the patients reap the benefit.

Dennis R. Horrigan is president and CEO of Catholic IPA Western New York, a partnership between Catholic Health and a network of associated physicians.

Above article published on www.buffalonews.com

20th Annual HIMSS Leadership Survey Findings Show Commitment to Healthcare IT, Cite EMR, CPOE, Security, Financial Concerns as Top Issues

CHICAGO — Implementing clinical systems – including an electronic medical record (EMR) and computerized provider order entry systems (CPOE) – was cited as the top priority for healthcare information technology (IT) professionals who responded to the 20th Annual Healthcare Information and Management Systems Society (HIMSS) Leadership Survey.

Of the 304 respondents, 31 percent said the primary focus would be ensuring their organization has a full EMR. Another 17 percent said the primary focus would be the installation of a CPOE. Complete results of the Leadership Survey will be presented today at the 2009 Annual HIMSS Conference & Exhibition, one of the largest conferences in the IT industry.

Survey respondents’ answers also suggested the weakened economy has slowed the breakneck pace of growth but also that they and their organizations remain committed to healthcare IT. More than half of respondents (55 percent) said their IT budgets would increase, compared to 78 percent last year, and 42 percent said their staffing levels would increase, compared to 68 percent last year.

Many respondents completed the research prior to the Feb. 17 signing of the American Reinvestment and Recovery Act (ARRA), which aims to prompt the widespread adoption of healthcare IT and enable electronic exchange of health information through financial incentives. To assess the impact that the ARRA will have on IT spending, HIMSS is gathering additional information from survey respondents.

“The economy is affecting all sectors, healthcare IT included, but the good news is healthcare IT still continues to grow,” said Charles E. Christian, HIMSS board chair. “With the passage of the ARRA, the resulting billions of dollars intended to stimulate healthcare IT should certainly impact how respondents view their budget options.”

As in past years, security issues remain a top concern and 84 percent of respondents said their organization actively assesses security risks. One in four (25 percent) said they’d had a security breach in the past year. To address the risks, nearly half (49 percent) said they plan to purchase single sign-on technology in the next year. Currently, 31 percent said they have single sign-on technology. Other security technologies a third or more respondents said they plan to purchase include e-mail encryption; biometric technologies, intrusion prevention/detection service and data encryption. Currently, 62 percent use e-mail encryption, 18 percent use biometric technologies, 75 percent use intrusion prevention/detection service and 56 percent use data encryption.

Other findings of the 20th Leadership Survey include:

• Respondents were most likely to indicate that IT can have an impact by reducing medical errors (38 percent) and improving quality outcomes (24 percent).
• While 29 percent said sustaining financial viability was the key business objective at their organization, 24 percent identified patient safety and quality of care as the single key business objective.
• More than half (54 percent) said financial considerations was the business issue that would most impact on healthcare.
• Lack of adequate financial resources was identified by 28 percent of respondents as the top barrier to successful implementation of IT. Although this has been named as the top barrier for nine years straight, the percentage continues to climb – last year it was cited by 26 percent of respondents and the year before by 20 percent.
• An overwhelming majority (84 percent) said there is a strong level of integration between IT strategies and overall organizational strategy: 37 percent said their IT strategic plan is a component of the organization’s strategic plan and 47 percent said the plans were separate, but integrated.

Twenty years of HIMSS Leadership Surveys have tracked the shifts in healthcare IT implementation and mindset. Steady progress has been documented. For instance, the 1995 survey asked respondents about their plans for implementing an EMR – what was then called a computer-based patient record system – and just 26 percent of respondents said they had invested in software and equipment (although not necessarily implemented it), while 74 percent of respondents essentially hadn’t even begun. Perhaps not fully understanding the complexities of the issue, 87 percent of survey respondents thought physicians would be able to share computerized patient information in a nationwide system by 2005. This year 41 percent said they have a fully operational EMR in at least one facility in their organization, up from 32 percent two years ago. Seventeen percent said they have a fully operational EMR throughout their entire organization. More than a third (37 percent) said they’d begun to install EMR in at least one facility.

Above article published on www.himss.org.

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