By Dr. Raj Bhandari and Terry L. Austen

Special to the Mercury News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.