Bernie Monegain, Editor

An EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later, according to a new study.

The Kaiser Permanente program in Denver linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record to help keep the patients healthy two years after they left the program by keeping them in touch with their caregivers electronically, according to a randomized study.

The study, which was funded by the American College of Clinical Pharmacy, is published in The American Journal of Managed Care this month. It is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, researchers said.

The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente’s HealthConnect EHR with patient outreach, education, lifestyle adjustments and medication management.

The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.

“Because lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the healthcare system through our electronic health record,” said the study’s lead author, Kari L. Olson, a clinical pharmacy specialist with Kaiser Permanente Colorado’s Cardiac Risk Reduction program. “The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.”

In the study, the patients in the Clinical Pharmacy Cardiac Risk Service with well-controlled blood pressure and cholesterol levels were randomized so that 214 continued to receive intensive direct counseling from the care team. The other 207 patients were discharged from the program back to their primary care physician.

The mean age of the trial participants was 72 years old, and 74 percent were male. Patients who were discharged from the program had electronic reminders in their chart to ensure their lipid panels were ordered annually, with the results sent directly to their primary care physician. The discharged patients also received reminders generated by KP HealthConnect indicating they were due for a lab test.

The study found that patients discharged from the program maintained control of their risk factors with the help of electronic reminders. The EHR intervention was as effective at keeping cholesterol and blood pressure in check, compared to the more intensive counseling approach offered to those patients who stayed enrolled in the program.

The Clinical Pharmacy Cardiac Risk Service cares for 13,000 cardiac patients with integrated nursing and pharmacy teams that work collaboratively with patients and their doctors using technology tools and activities such as lifestyle modification, medication management, patient education, laboratory results monitoring and management of adverse events.

The program also achieved these results:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and;
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

Above article published on

http://www.healthcareitnews.com/news/study-places-ehrs-core-saving-cardiac-patients-lives

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

The times we live in demand a lot of speed and efficiency from any service that we pay for, and that includes medical care services. There are many complications involved in the medical care business and no matter what size your practice is, it will always benefit from a more efficient system of data and time management. Plus, when it comes to billing, who wouldn’t like to have minimal errors and the lowest possible processing time per bill or per individual. This is when you know you need to change your old ways of doing thing and bring something new and more sophisticated to make your job a lot easier and more effective.

That is where EMR (Electronic Medical Records) software comes in. You will at how much EMR software can do and it takes so little time to do everything. Be it entering relevant data, recalling appointment schedules or queue management, a good EMR software is exactly what you have been waiting for to give your business a boost. You will love the amount of efficiency it will bring in to the entire system. You will be doing everything faster, with fewer errors and with a much lower processing time.

For instance, when it comes to queue management and alerting the staff at hand, you can do it instantly with EMR software. This is handled by the internal communications system with which, for example, you can alert your nurse that a patient is ready for his appointment. This saves a lot of time in communications

and speeds up the entire process. Bill generation is another area that will amaze you with its capabilities. You can generate bills that contains everything, from the medical treatment details to the different sets of insurance codes that will help you patients claim there medical insurance.

As you might know, errors in the bills, especially in the codes often stop patients from successfully claiming insurance for treatments availed. While it is quite human to make errors, especially with so many codes to handle, you must also realize that each such mistake hurts your business because it leaves your customer dissatisfied with your service. The EMR software will make sure that the correct code is implemented and printed each time on the bill. So you have a complete bill that does everything for you.

It also has complete tracking and analytical features whereby you can recall your performance from previous working days, weeks, months and even years. You can instantly call up charts and graphs to look at the demographics of your patients. You can look at your accounts, your total revenue and much more. With the data at hand, you can spot trends and spot the performance of each wing, division and department. Through this improved performance tracking you can truly enhance your practice to fine tune to your unique needs. So you absolutely must try EMR software to see how much it can help you

Source: http://www.articlesbase.com/computer-forensics-articles/use-emr-software-to-enhance-your-practice-992322.html

By Jonathan D. Epstein NEWS BUSINESS REPORTER

Western New York’s three health insurers have asked the region’s electronic clinical information exchange to lead an effort at driving more adoption of electronic medical records by area physicians.

Western New York Health Plans, comprised of HealthNow New York, Independent Health Association and Univera Healthcare, hired HEALTHeLINK to implement a program seeking to get 500 more doctors to start using electronic medical records over the next three years.

That’s part of a nationwide effort by the government, insurance industry and providers to increase the use of electronic records to lower costs, streamline operations and reduce medical errors. While use of the electronic records is spreading locally, so far it’s been limited to a few major practices, such as Buffalo Medical Group.

“It’s certainly not at the rate that we wanted, so that’s why this is an exciting opportunity that the health plans are providing to the physicians,” said Daniel E. Porreca, executive director of HEALTHeLINK.

Under the agreement, HEALTHeLINK will help the health plans select the vendor software packages that physicians can choose from, including determining the requirements used to evaluate them. For example, the software must help providers produce better medical outcomes, and also support personal health records and electronic prescribing.

HEALTHeLINK will also guide physicians in choosing which software to use, and then implement so they can qualify for federal dollars.

Congress set aside $19 billion in the $787 billion stimulus package, called the American Recovery and Reinvestment Act of 2009, to support doctors and hospitals in adopting electronic records. President Obama signed the measure into law on Feb. 17.

“We believe our agreement with HEALTHeLINK, coupled with the recently passed federal stimulus package that will provide physicians reimbursement for adopting electronic medical records, will help ease this technological transition for the physician community,” HealthNow executive vice president Cheryl A. Howe said in a press release.

The new initiative will focus on primary care physicians, Medicaid providers and eventually specialists, including both physicians and mid-level clinicians.

“This initiative by the region’s health plans is another example of the unprecedented collaboration taking place to enhance healthcare for our community,” Porreca said in the release. “We look forward to managing and executing this program on behalf of the health plans and in turn working with the physician community to make the transition to electronic health records as seamlessly as possible.”

Above article published on

http://www.buffalonews.com/145/story/718189.html

Molly Merrill, Associate Editor

CHICAGO – The Healthcare Information and Management Systems Society has published two definitions of “meaningful use” as it applies to certified electronic health record technologies and hospital’s use.

HIMSS officials announced the definitions Tuesday as the National Committee on Vital and Health Statistics Executive Subcommittee began hearings to define “meaningful use.”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures - and other measures - as selected by the Secretary of Health and Human Services.

Officials say physicians must meet the definition within a specified time frame, which as described in the American Recovery and Reinvestment Act of 2009.

In order for hospitals to have a reasonable chance of achieving the definition, HIMSS officials say the requirements must be introduced in incremental stages. In order for hospitals to meet each stage, milestones must be achieved in phases of not less than two years each, commencing in FY11. In the final phase, which must commence in FY15, HIMSS officials believe the mature definition of “meaningful use of certified EHR technology” includes at least four attributes:

1. A functional EHR certified by the Certification Commission for Healthcare Information Technology (CCHIT);
2. Electronic exchange of standardized patient data with clinical and administrative stakeholders using the Healthcare Information Technology Standards Panel’s (HITSP) interoperability specifications and Integrating the Healthcare Enterprise’s (IHE) frameworks;
3. Clinical decision support providing clinicians with clinical knowledge and intelligently-filtered patient information to enhance patient care; and
4. Capabilities to support process and care measurement that drive improvements in patient safety, quality outcomes and cost reductions.

HIMSS officials have urged that CCHIT be named as the certifying body for EHR technology.

HIMSS developed its recommendation by drawing up an initial draft of meaningful users of certified EHR technologies in March. The draft was publicly posted with a discussion forum for a three-week period commencing April 1, 2009. The draft was then reviewed by the HIMSS membership community, which consists of more than 3,000 volunteers organized into nearly 80 groups

Above article published on http://www.healthcareitnews.com/news/himss-publishes-meaningful-use-definitions

For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease. In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study recently appeared online in the British Medical Journal. “Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper - this can work.” In January 2009, President Barack Obama unveiled plans to implement electronic medical records nationwide within five years, arguing that such a plan was crucial in the fight against rising health care costs. Of the nearly $900 billion in Obama’s planned stimulus package currently before the United States Senate, $20 billion is proposed for electronic health records. Tannen says he and his group recognized that the large EMR databases containing compiled medical information could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials. However, such databases contain observational information, which critics argue do not offer the same level of control as randomized trials. “Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage healthcare,” Tannen says. To address criticisms of observational studies, Tannen’s group had to first determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid. Beginning six years ago, Tannen’s team selected six previously performed randomized trials with 17 measured outcomes and compared them to study data from an electronic database — the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death. After using standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes. In the other eight outcomes, Tannen’s group used an additional new biostatistical approach they discovered that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new biostatistical method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the randomized clinical trials. Though Tannen warns the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, he says the results of his study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies. “An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen says. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose an opportunity, an enormous health opportunity.” Mark Wiener and Dawei Xie from Penn are co-authors on this study. This research was funded by a grant from the National Institutes of Health. Above article originally published on www.sciencedaily.com

The medical information age.

With the recent explosion in information and technology over the past twenty years come vast changes throughout every industry worldwide. The medical industry itself has not been exempt from the transition from paper forms of data, to computerized electronic forms. The revolution of converting huge amounts of records, x-rays, names and prescriptions is very time consuming but nevertheless, it must be done. The same thing is taking place in the music business with cd’s being phased out of the market to give rise to mp3’s. Even though it hasn’t happened overnight, it is still a necessary step in the progression of human needs. The difference with the medical field is human lives are what’s at stake opposed to human desires.

Controversy.

Many patients are choosing to be implanted with radio frequency identification (RFID) transmitter inside of their body that stores their entire medical background. Some states have made it mandatory for aids and Alzheimer patients to get the implant for their own good. In the event of an emergency where a patient may be unable to respond to health care workers questions, the information regarding the patient may still be obtained. This controversial technique to store information has forced the entire medical structure to re-examine its own information storage and retrieval procedures. Are health care facilities equipped to handle the ever growing amount of patients in an accurate and timely manner? The answer is yes, however the medical field at large has been slow to adapt. The benefits far outweigh privacy issues that are often discussed surrounding electronic storage of medical records. All computer systems as well as communication methods may be vulnerable to attacks but it certainly doesn’t stop their increased use.

Electronic Medical Records (EMR)

It is no secret that clinical physician assistants prefer electronic medical records over out-dated paper documents. The biggest complaint amongst them is being forced to serve as not only an assistant but a secretary as well. There is just too much administrative work to take care of!

Practitioners who use electronic forms of record keeping are able to almost instantly engage their patients covering vast amounts of data from the computer. Digging in file cabinets, verifying past treatments etc. are rendered obsolete by simply using inexpensive powerful software designed for medical professionals. The rampant prescription drug abuses are being eliminated with multifunction safeguards that allow doctors to know conclusively who they are dealing with at any given moment. Forgeries and similar crimes are easily detected and the decrease in illegal activities lowers overall health care insurance cost.

Conclusion.

Regardless of how any of us may feel about the rise of medical technology and information, it is here to stay. The quicker we learn to utilize it for our advantage the better off we will be.

Above article published on http://www.articlesbase.com/computer-forensics-articles/using-emr-software-in-the-information-age-763158.html

Electronic medical records are the wave of the future, and Chicago area hospitals are already on board.

Hospitals with more advanced record-keeping technology have fewer complications, lower mortality rates, and lower costs, according to a study released last week by Johns Hopkins University. The study looked at more than 40 hospitals with digital record systems and more than 160,000 patients in a six-month period.

“It’s the right thing to do and we’re going to see a lot of studies like this in the next 5-10 years that attempt to measure the benefits of electronic medical records,” said Dr. Mike Kelleher, chief medical information oficer at Children’s Memorial Hospital.

Most of Chicago’s top medical institutions including Northwestern Memorial Hospital, NorthShore University HealthSystem–Evanston Hospital, Glenbrook Hospital, Highland Park Hospital, Skokie Hospital, and 75 doctor’s offices–, University of Illinois Medical Center at Chicago, Rush University Medical Center and Children’s Memorial Hospital have either already made the leap to digital records, or are in the process.

Former President George W. Bush laid out the goal of having electronic records nationwide by 2014, a goal that was quickly adopted by President Barack Obama.

Wired In

The study findings are no surprise to Chicago-area hospitals, well versed in digital technology.

“What we did was transformational–it changed the way we do things and the way we think,” says Mark Neaman, president and chief executive officer of NorthShore University HealthSystem.

“Patients can even have a Blackberry conversation with their physician or order a prescription online,” Neaman said.

NorthShore University HealthSystem, one of the pioneers in digital records, went completely digital in 2004.

Digital records can even prevent mistakes from being made.

“We have seen measurable improvements in the quality of our outcomes, reduced medication errors and become generally more efficient,” Neaman said.

The complete transition at NortthShore $took 15 months from launch to finish in April of 2004 and cost an estimated $42 million, according to Neaman.

“We applied the big bang theory,” Neaman said. “We wanted to have everything up and running quickly.”

Almost all Chicago-area hospitals have some digital record keeping system in place or are in the process of implementing one.

Security, however, becomes a major concern with personal information in digital form.

With electronic records, it is much easier to track who has accessed a file—an important security feature—but making sure the right people have access can be time consuming.

“It’s a big concern,” Kelleher said. “You have to make sure that the people you give access to are properly vetted.”

“Before electronic medical records, files were continually being misplaced,” said Dr. David S. Channin, radiologist at Northwestern Memorial Hospital and chief of imaging informatics at Northwestern University Medical School. “We relied on loose pieces of paper with illegible writing, and human memory.”

Northwestern Memorial has used electronic records for more than a decade now for nearly all of their services.

More Benefits

The benefits of digital records aid in many different aspects of patient care.

One key benefit is allowing doctors to find information on patients more easily.

While it may take physicians or nurses more time to enter information into the system, the ability to find it and search for it with ease is invaluable according to Kelleher.

Patients and doctors can also have their information readily available at the touch of a keyboard without having to dig through extensive files.

Digital Divide

Despite the many advantages there are still countless hospitals that are falling behind with this technology.
After years of recording information manually, some doctors are hesitant to change to a new electronic system.

“The older physicians are more likely to be unwilling or uncertain about using the computer system,” said Kelleher.

“The catch is that there are tradeoffs between quality and efficiency and independent tradeoffs within each one,” says Dr. Channin.

There is also a steep cost of investment as far as equipment and training.

NorthShore University HealthSystem invested an estimated $42 million in the new technology, $5 million of which went to training staff, according to Neaman.

They are foreseeing an estimated return of 17 million dollars per year in savings related to the new system, but the return is very long-term and small in comparison.

Originally Published by Vanessa Handand and Chris Kelly, Northwestern University.